Sunday, April 12, 2009

Browsing today’s pet column in the local news paper: Drugs or nutrition to fight disease? Cushing’s Disease & Diabetes

Chipping away on my pile of pet column articles in my daily Palm Beach Post today I would like to address some advice given by Dr. Michael Fox and others I followed in the paper. Today let’s get started with how to fight diseases like Cushing’s disease and, since it came up in this particular incident, diabetes. Let’s dive right into it:
This reader’s dog, a 9 year old Manchester Terrier recently was diagnosed with Cushing’s Syndrome. This woman reports that her vet initially diagnosed the dog with having diabetes. It was only later, when on one day she visited her daughter and went to her daughter’s vet to follow up with the dog’s insulin dosages that another opinion alerted her to the fact that the dog was actually suffering not from diabetes but from Cushing’s. That vet started the dog out on Anipryl and in less than a month all the symptoms such as excessive appetite, potbelly, heavy panting and listlessness disappeared. Apparently following her vets’ advice she continues to give insulin as well as the first vet will not admit that he possibly came up with a wrong diagnosis and insists that the dog has diabetes. The second vet agrees by saying that could be part of the Cushing’s. Further blood tests revealed a significant drop of alkaline phosphatase (from 1183 down to 596). After a few months of treatment that level rose back up to 780. An increased Anipryl dosage to 20 mg finally got it back up to 1100. However now the owner is concerned about overdosing. She also is confused by the vet’s statement , who says one has to go by the disease symptoms and not by the blood chemistry.
This once again is a typical example how some vets make a pet owner’s life difficult by confusing them instead of explaining in simple terms what the problem is and how it will be treated. This poor woman now even has it worst by being caught between 2 vets at the same time. Maybe she should just go, look a third time and hopefully end up finally finding one reliable one. Instead, the woman decided to write to Dr. Michael Fox, D.V.M., let’s see what he has to say:
“Diabetes, hyper- or hypothyroidism and hyper-adrenalism (Cushing’s disease) are all too common endocrine diseases.”
Got that? I have to be honest, I only did because I am dealing with all of this on a more regular basis than Joe, no, not the plumber, but the average pet owner. We just cannot assume everybody knows what diabetes is about. So here we go, a little search on the Internet had me end up at the website of the
American Veterinary Medical Association (AVMA) from where I got directed to “Pet Diabetes Month” website. Kind of providing a quick crash course on the subject matter, according to these guys:
“Diabetes mellitus, the clinical name for “sugar diabetes,” is a disease that affects the level of glucose (a simple sugar that is the major source of energy for many organisms) in your dog’s blood. Diabetes results when the dog’s body makes too little insulin (a hormone secreted by the pancreas that helps cells absorb glucose from the bloodstream) or doesn’t process insulin properly. Insulin affects how your dog’s body uses food. When your dog eats, food is broken down into very small components its body can use. One component, carbohydrate, is converted into several types of simple sugars, including glucose. Glucose is absorbed from the intestines into the blood, then travels to cells throughout the body. Inside cells, insulin helps turn glucose into fuel. If there’s too little insulin available, glucose can’t enter cells and can build up to poisonous levels in the bloodstream. As a result, a diabetic dog may want to eat constantly, but will be malnourished because its cells can’t absorb glucose.
Canine diabetes is quite common, about one dog in 500 develops diabetes and that number is increasing.
Any dog could develop diabetes, but certain breeds are more likely to develop the condition. These breeds appear to be at greater risk for developing canine diabetes: Cocker spaniels, Dachshunds, Doberman pinschers, German shepherds, Golden retrievers, Labrador retrievers, Pomeranians, Terriers and Toy poodles. Diabetes typically occurs when dogs are between 4 to 14 years old. Unspayed female dogs are twice as likely as males to suffer from diabetes.
Explanation of some common terms pet owners are likely to encounter: Polyuria is the production of large amounts of urine in a given period, such as per day. Polydipsia is the medical term for excessive thirst, usually noticed when a pet seems to be drinking excessive amounts of water. Polyphagia refers to eating more food than usual per day or eating more frequently.
Dogs with diabetes mellitus drink more water and urinate more than normal. They usually have good or increased appetites but may nonetheless be losing weight. Other common diseases with these signs include Cushing’s disease (hyperadrenocorticism) and exocrine pancreatic insufficiency (EPI). To diagnose diabetes,the veterinarian will measure your dog’s blood glucose level and test the dog’s urine for glucose and ketones (acids that appear in urine when there is an insulin shortage and the body is using fat instead of glucose for energy. High ketone levels in the blood can lead to diabetic ketoacidosis, which can cause coma and even death. )
Aggressive treatment of diabetes in dogs is relatively new. Not many years ago, diabetic dogs would have gone undiagnosed and would have died at a young age, either from the disease or euthanasia. Consequently, a very short life span for known diabetic dogs is usually quoted in textbooks (two to five years after diagnosis). Also, keep in mind that many dogs are diagnosed with diabetes later in life, so a two- to five-year life expectancy may be near their natural life span. If a diabetic dog has well-managed blood glucose levels and it doesn’t develop other health problems, it should have a normal life expectancy.
Similarities between human and canine diabetese: The two conditions are very similar. In fact, your veterinarian will be using medication, equipment and monitoring systems that are similar to those used for diabetic people.
Diabetes is one of many diseases that can affect your dog and can cause visible changes in behavior and other signs. That’s why it is important that your dog be thoroughly examined by a veterinarian at least once a year or more frequently as your veterinarian advises. “

Now let’s see if we can get the same on the others:
According to, the Dr’s. Foster and Smith Research website: “ Hypothyroidism is a common problem in dogs. The thyroid gland has a number of different functions, but it is most known for its role in regulating metabolism. Hypothyroidism is the condition that occurs when not enough thyroid hormone is produced. Hypothyroidism causes a wide variety of symptoms, but is often suspected in dogs that have trouble with weight gain or obesity and suffer from hair loss and skin problems. Hypothyroidism is easy to diagnose with a blood test that checks the level of various thyroid hormones including T3 and T4. Many dogs suffer from a low thyroid hormone level for years without treatment. If your dog has chronic recurrent skin problems, she may be suffering from hypothyroidism.
Hypothyroidism results from the impaired production and secretion of thyroid hormone. The production of thyroid hormone is influenced by the pituitary gland, the hypothalamus, and the thyroid gland. Although dysfunction anywhere in the complicated hypothalamic-pituitary-thyroid pathway can result in hypothyroidism, more than 95% of all cases occur as a result of destruction of the thyroid gland. About half of the causes of thyroid gland destruction are suspected to be caused by the dog's own immune system killing the cells of the thyroid gland. The other half is caused by atrophy of the thyroid tissue and resultant infiltration of the tissue by fat. The cause for this form of the disease is unknown.
Although the onset of clinical signs is variable, hypothyroidism most commonly develops in middle-aged dogs between the ages of 4 to 10 years. The disorder usually affects mid to large size breeds of dogs, and is rare in toy and miniature breeds of dogs. Breeds that appear to be predisposed to developing the condition include the Golden Retriever, Doberman Pinscher, Irish Setter, Miniature Schnauzer, Dachshund, Cocker Spaniel, and Airedale Terrier. German Shepherds and mixed breeds appear to be at a reduced risk of contracting the disease. There does not appear to be a sex predilection but spayed females appear to develop it more often than intact females.”

College of Veterinary Medicine at the Washington State University explains Cushing’s disease as follows: “The overproduction of the hormone cortisol by the adrenal glands that are located in the belly near the kidneys. Cushing's disease occurs commonly in dogs… Most dogs with Cushing’s disease are about 6 years old or older but sometimes Cushing's disease occurs in younger dogs. Cortisol affects the function of many organs in the body, so the signs of Cushing’s disease may be varied. Some of the more common signs of Cushing’s disease include hair loss, pot-bellied appearance, increased appetite, and increased drinking and urination called polydipsia and polyuria (PU/PD). Hair loss caused by Cushing’s disease occurs primarily on the body, sparing the head and legs. The skin is not usually itchy as it is with other skin diseases. If you pick up a fold of skin on a dog with Cushing’s disease, you may notice that the skin is thinner than normal. The pet may have fragile blood vessels and may bruise easily.
Less common signs of Cushing’s disease are weakness, panting, and an abnormal way of walking (stiff or standing or walking with the paws knuckled over). Some dogs with Cushing’s disease develop a blood clot to the lungs and show a rapid onset of difficulty breathing.
Dogs that are given prednisone or similar drugs can develop signs that look like Cushing’s disease (called iatrogenic Cushing’s).
There are two types of Cushing’s disease that are treated differently. The most common form of Cushing’s disease is caused by the overproduction of a hormone by the pituitary gland in the brain that in turn controls the amount of cortisol produced by the adrenal glands. This is called pituitary-dependent Cushing’s. A small percentage of dogs with Cushing’s disease have a tumor of one of the adrenal glands which is called adrenal-dependent Cushing’s.There is no single test to diagnose Cushing’s disease. The history, physical exam, and results of initial blood and urine tests often provide a strong suspicion for the presence of Cushing’s disease. Laboratory tests that are most commonly altered by Cushing’s disease are an increase in white blood cell count, increase in the liver enzyme ALP (also called SAP or serum alkaline phosphatase), increased blood sugar (although not as high as the blood sugar levels of diabetic patients), increased cholesterol and dilute urine. …..The large amount of cortisol in the body suppresses the immune system and allows the pet with Cushing’s disease to get bacterial infections. The most common location for infection is the bladder. Pets with Cushing’s disease may have a silent bladder infection meaning they don’t show signs of having the infection such as straining to urinate. A culture of the urine may be necessary to diagnose the infection.
X-rays of the belly often show a large liver. Occasionally the x-ray will show calcium in the area of one of the adrenal glands that is suggestive of an adrenal tumor. Ultrasound of the belly may show enlargement of both adrenal glands in pets with pituitary-dependent Cushing’s or enlargement of just one of the adrenal glands in pets with an adrenal tumor. The adrenal glands are NOT always seen during an ultrasound exam in pets with Cushing’s. In some pets with an adrenal tumor, the tumor can be seen growing into large blood vessels close to the adrenal gland or spread from the tumor may be seen in the liver.
….. The treatment of the most common type of Cushing’s disease (pituitary-dependent) is lifelong oral medication. ….. The prognosis for pituitary-dependent Cushing’s disease with treatment is usually good. Some signs will disappear quickly and others gradually. Appetite and water consumption usually return to normal in a few weeks where as full return of the fur may take several months.”

Now, after we got all that straight, I guess these explanations make it little more understandable why the vets in the case of our Terrier came up with confusing diagnostic results, it looks like all the disease have a lot of symptoms in common and one may even be the cause of another one. So let’s get back to Dr. Fox, who, with what he said had it all right. He continues: “There are multiple causes that can be difficult to avoid with the wide spread incidence of endocrine disrupting chemicals in the environment and in food and water.”

Wait a second: Endocrine disrupting chemicals?
The endocrine system is a system of small organs that involve the release of extracellular signaling molecules known as hormones. The endocrine system is instrumental in regulating metabolism, … and tissue function …. Endocrine disruptors (sometimes also referred to as hormonally active agents) are exogenous substances that act like hormones in the endocrine system and disrupt the physiologic function of endogenous hormones. Studies have linked endocrine disruptors to adverse biological effects in animals… … there has been concern that chemicals in the environment might exert profound and deleterious effects on wildlife populations, and that human health is inextricably linked to the health of the environment.
Although researchers had studied the endocrine effects of chemicals in the past, the term endocrine disruptor was coined in 1991 …. stated that environmental chemicals disrupt the development of the endocrine system, and that effects of exposure during development are permanent.
Endocrine disrupting compounds encompass a variety of chemical classes, including hormones, plant constituents, pesticides, compounds used in the plastics industry and in consumer products, and other industrial by-products and pollutants. Some are pervasive and widely dispersed in the environment. Some are persistent organic pollutants (POP's), and can be transported long distances across national boundaries and have been found in virtually all regions of the world. … All communication within the body is facilitated by the either the nervous system or the endocrine system. The nervous system transmits sensory messages to the brain and enables quick responses to sudden environmental events. Typically, these responses involve physical adjustments to avoid something harmful, such as intense heat. The endocrine system regulates adjustments through slower internal processes, using hormones as messengers. The endocrine system secretes hormones in response to environmental stimuli and to orchestrate developmental and reproductive changes. The adjustments brought on by the endocrine system are biochemical, changing the cell's internal and external chemistry to bring about a long term change in the body. These systems work together to maintain the proper functioning of the body through its entire life cycle.
The theory of endocrine disruption posits that low-dose exposure to chemicals that interact with hormone receptors can interfere with reproduction, development, and other hormonally mediated processes. Furthermore, since endogenous hormones are typically present in the body relatively tiny concentrations, the theory holds that exposure to relatively small amounts of exogenous hormonally active substances can disrupt the proper functioning of the body's endocrine system. Thus, an endocrine disruptor might be able to elicit adverse effects at a much lower doses than a toxicant acting through a different mechanism.” (Source:
Wikipedia “Endocrine System”, Wikipedia “Endocrine disruptor” )

Dr. Fox concludes: “Cushing’s disease often develops after dogs have been treated with long term prednisone for allergies. These are usually to food, often with an underlying “leaky gut” syndrome that could be brought on by the harm done to the intestinal wall by such food ingredients as corn, wheat and soy gluten. Non specific changes in organ function (such as liver enzyme readings) indicate that various organ systems are being affected and the heart and digestive system are often affected by endocrine disease.
Discuss changing your dog’s diet with your veterinarian and giving the following beneficial and protective supplements: Probiotics, prebiotics, Vitamin B-complex, COQ10, hemp or flax seed oil, milk thistle, Vitamin E and methionine.”

Here we go: Another incident clearly showing that some of the feeds available to pet owners these days may cause one or another disease. Now let’s see, the Dr. says “discuss with your veterinarian”. What is he going to recommend? Most likely a prescription diet. Which one remains to be seen, I guess it depends on the vet’s preference and with which manufacturer he is set up. As Arnold would have said: “Hear me now, believe me later”, I would say take that kind of vet advice with a large grain of salt, chances are there are not too many changes to be expected (which, after all, I cannot help it to believe, is what they want). Make sure to analyze the prescription food very closely, often pet owners are surprised by the results of an independent food review. To prove my point here, just for fun I picked to prescription diet formulas. No names here, two different products, 2 manufacturers, both formulas supposed to be designed to help with diabetes. Here are the first 10 ingredients for the products I picked:
Product A: Ground Whole Grain Corn, Powdered Cellulose 17.1% (source of fiber), Chicken by-product Meal, Chicken Liver Flavor, Soybean Mill Run, Corn Gluten Meal, Soybean Oil, Dried Beet Pulp, Soybean Meal, Iron Oxide
Product B: Rice, ground corn, chicken meal, powdered cellulose, corn gluten meal, wheat, natural flavors, chicken fat, rice hulls, monocalcium phosphate. What did Dr. Fox just talk about? “…harm done to the intestinal wall by such food ingredients as corn, wheat and soy gluten.”? Do you believe me now? Do you know what I like the most: Dr. Michael Fox is a veterinarian. Awesome, after all some of them still seem to be on the right side of the fence…, that is, where the healthy animals are.

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