? Questions about possible cushings

[Valerie & Fred]

Starting to believe my Fred may have Cushing. I’ve been wondering as he’s had a lot of the symptoms except hair loss and skin tearing/wounds. I emailed his vet today after I finally found a wound on his side today out of nowhere ( about a little bigger than a quarter) to see what she’s thinks.

Fred's had ulcers on this feet that we’ve been dealing with since diagnosis. He also has a BIG pot belly which he’s gotten X-rays for and ruled out tumors etc. vet said he has an enlarged bladder. Still has problems peeing everywhere even when his glucose is low. Everything in my opinion is pointing to crushing. Our vet did mentioned acro a few times as he needs more insulin than usual (never been tested for it though) but she’s never brought up Cushing.

If anyone still on this forum has dealt with Cushing, what made you all first suspect?

also how treatable is this, Is there a good treatment for it?

I appreciate any help!

 

[Wendy&Neko]

I'm afraid there aren't very many current caregivers with Cushings cats who post here, so I'll just be able to give a few ideas and point to some pointers for more reading.

First, acromegaly is more common than Cushings, and both conditions can cause both pot bellies and higher doses. But we've also seen kitties with one or the other condition on around 3-4 units of insulin so dose size is not an indicator. Fred isn't at what I'd call a high dose yet. He has seen some green, but you are holding the doses far too long so I suspect some glucose toxicity is setting in. If you see green, first double check with the One Touch that it really is green (Libre gives lower numbers than a held meter). If he is seeing true green, hold the dose for 5 days but no longer unless he's consistently seeing a lot of green in the 50-80 range all days. He's not, so he needs an increase.

Skin tears tends to be a later indication of Cushings, not something seen first thing. Is he overgrooming at all? Lots of pictures I've seen also include am almost bare belly. We've even seen a cat here that had Cushings, but was not diabetic. If you search the Veterinary Partner website for the word Cushings, you'll find articles on symptoms, diagnosis, and treatment. Other symptoms it mentions are muscle wasting and thin coat. I've seen one member describe their cat as having skin markings like freckles. Some good pictures/description also here: https://www.dvm360.com/view/feline-facets-cushings-disease

There are treatments but it depends on the cause of the Cushings. It's is caused by a tumour on the pituitary, or adrenals, or from steroid over use, with the pituitary tumour being the most common. For the pituitary variation, there is treatment such as trilostane (Vetoryl) being the more common medication, surgery (removal of the pituitary) and radiation therapy. We've had one cat here with the adrenal variety, and it required surgery, but it is a tricky surgery. The steroid variation requires reducing the steroid. If you get to this point, I'd strongly recommend getting a referral to an internal medicine vet. It's not something most general practice vets are familiar with in cats. My own vet said she's seen only one in all her years of practice.

Lastly, an older thread with comments from a couple users who had Cushings kitties. https://felinediabetes.com/FDMB/threads/how-to-diagnose-cushings.207776/#post-2302572

 

[Valerie & Fred]

I'm afraid there aren't very many current caregivers with Cushings cats who post here, so I'll just be able to give a few ideas and point to some pointers for more reading.

First, acromegaly is more common than Cushings, and both conditions can cause both pot bellies and higher doses. But we've also seen kitties with one or the other condition on around 3-4 units of insulin so dose size is not an indicator. Fred isn't at what I'd call a high dose yet. He has seen some green, but you are holding the doses far too long so I suspect some glucose toxicity is setting in. If you see green, first double check with the One Touch that it really is green (Libre gives lower numbers than a held meter). If he is seeing true green, hold the dose for 5 days but no longer unless he's consistently seeing a lot of green in the 50-80 range all days. He's not, so he needs an increase.

Skin tears tends to be a later indication of Cushings, not something seen first thing. Is he overgrooming at all? Lots of pictures I've seen also include am almost bare belly. We've even seen a cat here that had Cushings, but was not diabetic. If you search the Veterinary Partner website for the word Cushings, you'll find articles on symptoms, diagnosis, and treatment. Other symptoms it mentions are muscle wasting and thin coat. I've seen one member describe their cat as having skin markings like freckles. Some good pictures/description also here: https://www.dvm360.com/view/feline-facets-cushings-disease

There are treatments but it depends on the cause of the Cushings. It's is caused by a tumour on the pituitary, or adrenals, or from steroid over use, with the pituitary tumour being the most common. For the pituitary variation, there is treatment such as trilostane (Vetoryl) being the more common medication, surgery (removal of the pituitary) and radiation therapy. We've had one cat here with the adrenal variety, and it required surgery, but it is a tricky surgery. The steroid variation requires reducing the steroid. If you get to this point, I'd strongly recommend getting a referral to an internal medicine vet. It's not something most general practice vets are familiar with in cats. My own vet said she's seen only one in all her years of practice.

Lastly, an older thread with comments from a couple users who had Cushings kitties. https://felinediabetes.com/FDMB/threads/how-to-diagnose-cushings.207776/#post-2302572

Awesome thanks for what info you were able to provide, I know scrolling though there wasn’t many posts about cushings here (not as many as acro at least).

I’m just hoping this one spot on his skin isn’t the start of bigger problems.

We’ll see what the vet says, I don’t think she’s very familiar with any of it either she said she had one cat with acro that went ahead with the surgery but his outcome from it wasn’t great unfortunately. So I’m assuming she probably won’t have much experience with cushings either.

as for insulin dosage I know he was on 4.25 WAY too long as I had to go out of the country but since upping him to 4.5 he did hit 60 two days ago on this OneTouch. So should I wait the five days from there or was that not enough in that range and call for an increase now?

That’s always what gets me, I never know how many low numbers is enough. And then I’ve also got his vet saying don’t go over 4 so the higher I go the more nervous I get lol I feel like I’m sneaking around and doing something wrong

 

[Wendy&Neko]

And then I’ve also got his vet saying don’t go over 4

What is the vet's rationale for that? A cat needs however much insulin they need. Also an indication she's got much familiarity with conditions that can cause a need for higher doses. Mind you, Neko's vet at the time thought she needed to get to 10 units to be tested for acromegaly. She never got that high. But my vet was willing to learn and she was part of team Neko, her first ever acro cat.

You might want to put a comment in the Remarks column for when you left the country and when you came back. That way we won't ask about it. We hold doses that have green nadirs for 10 cycles. Let's see if he gets back to green in the next couple cycles. If not, he needs that increase.

 

[Valerie & Fred]

What is the vet's rationale for that? A cat needs however much insulin they need. Also an indication she's got much familiarity with conditions that can cause a need for higher doses. Mind you, Neko's vet at the time thought she needed to get to 10 units to be tested for acromegaly. She never got that high. But my vet was willing to learn and she was part of team Neko, her first ever acro cat.

You might want to put a comment in the Remarks column for when you left the country and when you came back. That way we won't ask about it. We hold doses that have green nadirs for 10 cycles. Let's see if he gets back to green in the next couple cycles. If not, he needs that increase.

My exact thought. I couldn’t tell you the exact reasoning for that as it was while I was gone and my mom took him to that appointment.

I’m gonna keep him on the increase though, I mean she can obviously see it isn’t bad for him when I tell her, as she has access to his libre numbers. I may just end up having to look for another vet for a second opinion. Not to say she isn’t good I like her a lot actually! Been doing a lot for him she’s just been pretty stumped about Fred so it may be best for everyone honestly.

sounds good though! I’ll hold him a bit more then increase. Thank you!