Taking Buddy to Vet today - Any Advice?

[Kakesie]

Hi Everyone!

I'm Karen. We live in Nebraska. My 15 yr. old daughter and I have Buddy, who was diagnosed 04-22-09 with Cushing's Disease. Buddy is 8 yrs old, 80 lbs, mixed breed.

He doesn't seem sick, (yet), but he does drink a lot of water. Our veterinarian has explained the various treatment options, but we've decided that as long as he's not suffering yet, to wait before we start giving him medications that could push him into Addison's or cause him to yo-yo. But we just found this out so I'm very open to any and all ideas & suggestions.

Buddy is the sweetest, most loving dog I've ever known and he's my daughter's absolute best friend in the world! We want to do whatever we can to help him.

Our other dog, also 8 yrs old, part cocker, dauchshund, chihuahua mixed breed, 23 lbs. has MegaEsopahgus Disease. We belong to a Mega E support group for her and they have been very helpful.

Vets are wonderful, but owners of a dog with a disease have the passion and drive to do the research on that one disease and try every option and come up with creative solutions, that Vets who have to know about a lot of different diseases simply don't have the time to do. Plus no one understands like one we do, how hard it is when our beloved doggie is sick or passes on.

Bless you for being here and wishing the best for your doggies.
Karen, Saralisa, Buddy & Dolly

[frijole]

Hi Karen! Guess what - I'm from Columbus NE! You sound like you have a house full of critters. How wonderful. I can't wait to learn more about Buddy.

My dog Haley is now over 15 and was diagnosed 3 yrs ago and has been on lysodren the entire time. I understand your hesitancy to use what might seem like harsh drugs. I assure you that unfortuneately there is no herbal cure or I would certainly have gone that route and the drugs are not nearly as nasty as what I read early on.

You came to a fantastic site for information. That's how I landed with this group as well. We are simply cush parents that have been down the same path and want to share our many and varied experiences with others.

As you will learn, cushings is a serious disease if not treated. Do you know if it is pituitary, adrenal or atypical cushings? It might help if you tell us more about the testing that was done to diagnose. Believe it or not there are times we see misdiagnosis so we never assume. ;) Atypical cushings can be treated with flax, lignons and melatonin. Adrenal can sometimes be "cured" with surgery and pituitary requires treatment, typically with either lysodren or trilostane.

While you might just be dealing with abnormal thirst now - at some point that thirst will end up as urine all over your house. :eek: Sorry but thats what happens. And it isn't Buddy's fault... what is happening is that his body is over producing cortisol and it is causing him to be very thirsty - he needs to hydrate his body. Don't limit his water intake as that can hurt him as he needs it.

Probably when you did the tests you found that his liver enzymes (alk phos) were elevated. Most of have this. Liver is the gateway to all major organs and when cushings goes untreated organs can and will eventually fail. It varies but it can be that they go blind, develop diabetes, or have kidney or heart failure. This isn't a decision you have to make immediately and you are wise to read as much as you can about the disease and ask us as many questions as you want.

So tell us about Buddy, his symptoms, the tests that were done. That will help us help you and him. I am so glad you found us.

Hugs from Haley and I
Kim (frijole)

[Kakesie]

Hi Kim & Haley,

Thanks so much for your reply!!! We just talked to our vet yesterday, (Friday) and now I wish I had asked more questions. The first thing we noticed about Buddy is that he is losing his sight.

The vet did a general check-up on him and said his liver, kidneys, heart, lungs, bloodwork, urinalysis, etc. all looked good, but that something was elevated, (cortisol?), and they wanted to test for Cushing's disease. So we had to bring him back after he had fasted and they did a "Low Dose Dex Supp Test" - took blood samples first thing in the morning, at noon and late afternoon.

Our vet didn't say if it was pituitary, adrenal or atypical cushings. She just said in dogs 75% are pituitary & 25% adrenal and that it's exact the opposite in ferrets. So I think she just assumed it was pituitary.

She consulted with vets in Kansas City who said life expectancy once diagnosed is 2-3 years with treatment OR without treatment. She explained that the problems with trying to reduce the cortisol production with lysodren or trilostane is that it needs to be closely monitored and can easily go too far, pushing the dog into Addison's. Her mentor in Kansas City said if they keep yo-yoing, they sometimes purposely destroy the pituitary gland putting them permanently into Addison's and then treat them with steroids. She also said the treatment and the monitoring is extremely expensive.

Although I'm want to do whatever I can to help our baby, I just lost my job and we're having a hard time making ends meet as it is.

I really appreciate SO much your reply and any one else who writes. It really does help to have other dog lovers who care as much as we do and understand what we're going through!

Thank you very much!!!
Blessings to you and Haley, Kim
Karen & Buddy

[Kakesie]

Quick add-on,

In skimming the other posts, I can see there's a lot of additional information I need to get from my Veterinarian! Does this site have a list of "Cushing's-Knowledgable" Veterinarians? I like our veterinarian, but I have learned so much more about our other dog's disease from the Mega-Esophagus support group. I really do think online support groups can help each other out so much and I'm very glad I found this site!

Thank you for being here!
Karen

[BestBuddy]

Hi Karen and Buddy.
A lot of us get the test results and keep them in a file. It's good to have the numbers to compare if you have more tests and also in an emergency if you have to see another vet to have all the info on hand. The most expensive part of cushings is the initial testing and monitoring to get the right treatment and dosage. Welcome and keep us up on how it's going.
Jenny

[frijole]

Karen

I can tell you that there are no internal med vets in our entire state - K State sends some folks to Omaha a few times a month. I would ask friends who love their dogs equally for info on their vets OR call the folks at your local animal shelter (animal lovers) and find out what vets they feel have the most experience and explain your situation. Like I said, mine wasn't a seasoned cushings expert but he was caring enough to learn and wanted to help me save my dog.

Whoever your vet is calling in Kansas City is NOT correct. I suspect your vet did what my first one did (the one I fired) She said she was getting advice but she was just speaking with someone at the lab that she sent the tests to. NOT the same.

Get a copy of the LDDS test that was done. This IS the best first test to have done so that is great. There will be 3 numbers. Those 3 numbers are what your vet (or the lab) should read and use to indicate if its adrenal or pituitary OR if more tests should be done.

That comment about 2 to 3 yrs is untrue. Most of our dogs that seek treatment die of OTHER causes - mostly old age.

Yes you have to monitor when giving the drug but heck, any drug should be monitored and it is the job of the vet to help you do so. They have protocols to follow. (and we can give them to you if you want :p) The key is for the vet to take the initiative to learn about this and help you. Of course we would be here as a reference and answer questions as well.

Don't worry - all will be fine. Lets start by getting the numbers and make sure your dog has cushings. As Jenny stated the expense is the testing at the beginning - it gets better after that. There are organizations that help out with expenses but I don't have the link. Perhaps someone else has it.

So glad you found us. Hang in there - you aren't alone. Give Buddy a big hug ok?

Kim

[lulusmom]

Hi and welcome the forum.

I am so sorry for the reason that brought you here but I'm glad that you found us.

It would help us greatly if you could round up copies of the test that your vet did to diagnose Buddy. It's a very difficult disease to diagnose which makes it the number one disease that is misdiagnosed. As Kim already mentioned, dogs with cushing's usually drink to excess to keep up with the frequent urination. Excess steroids effect the kidneys ability to concentrate the urine so if the dog doesn't drink more fluids that it is getting rid of, it doesn't take long to dehydrate and get very sick. Since your vet said that the urinalysis was fine, I am wondering if he checked the urine specific gravity. This is usually low with cushdogs as the urine is dilute. Increased water intake can be attributable to any number of diseases so I am wondering if Buddy has any other symptoms that are associated with cushing's such as an increased appetite, loss of coat, change of coat, panting, weakness...especially in hindquarters or recurrent infections?

Has Buddy's blindness come on over a long period of time or is this something that you have recently noticed? There is a condition called SARDS (Sudden Acquired Retinal Detachment Syndrome) which comes on quickly and a dog can go blind over night or in a week's time. Researches think there is a connection between Cushing's but they don't know what it is. What they do know is that a lot of SARDS dog are diagnosed with cushing's one to six months of going blind. Those that don't almost always test positive for elevated adrenal hormones within a month to a year after going blind. Excessive thirst and urinations are a symptom of abnormal adrenal hormones/steroids other than cortisol.

Just so you know, a dog can live out their normal life expectancy if the cushing's is controlled with proper treatment. I suspect that a lot of vets tell pet owners that 2 to 3 years after diagnosis is all you can hope for based on the fact that most dogs are pretty senior when diagnosed. One of my cushdogs, however, was only three years old when diagnosed and she is now seven. I have no idea what Buddy's breeding is but 8 years isn't that old for a lot of breeds so I poo-poo that 2 year prognosis bunk.

Looking forward to hearing lots more about Buddy.

Glynda

[StarDeb55]

Welcome, Karen!

Please disregard these statements about 2 year survival with or without treatment. It's nothing but hogwash!!! My 1st Cushpup, Barkley, was successfully treated with lysodren for just about 8 years, crossing the bridge at 15.

I think you may have misunderstood some of the things your vet has told you, so my responses to clarify are in blue.

The vet did a general check-up on him and said his liver, kidneys, heart, lungs, bloodwork, urinalysis, etc. all looked good, but that something was elevated, (cortisol?)
On general labwork, the first thing that will usually tip off a vet to look for Cushing's disease is an elevated alk phos which is one of several liver enzymes. Most of the liver enzymes are usually elevated in our pups as the liver takes a beating since it has to process the extra cortisol produced by the adrenals.

Our vet didn't say if it was pituitary, adrenal or atypical cushings. She just said in dogs 75% are pituitary & 25% adrenal
Statistically, your vet is correct. You can't just assume that it's pituitary. Sometimes the low dose test will differentiate between the 2 forms, but not always. It is also extremely important to have any positive result on a low dose test confirmed by a second test such as an abdominal ultrasound or the high dose dex. The LDDS is considered to be the "gold standard" for Cushing's diagnostics as the test can yield a false positive result in the presence of non-adrenal illness. This is what makes Cushing's one of the most frustrating diseases to diagnose as there is no single test that is 100% specific or sensitive. An abdominal US would be the better choice to confirm as not only do you get a look at the adrenals, but you get a look at all of Buddy's internal organs, thus getting a better idea of his overall health.

She explained that the problems with trying to reduce the cortisol production with lysodren or trilostane is that it needs to be closely monitored and can easily go too far, pushing the dog into Addison's.
This is possible, but not likely as long as you are working with a vet who is well-experienced in treating Cushpups, following the standard loading/dosing protocols for either med. Vets who lack the knowledge & experience have a tendency to start guessing, "flying by the seat of their pants', etc., & this is where things can get really bad really fast. The other important job of the experienced vet is to work with you, teaching you what you need to know in using either med, including the signs of a possible low cortisol emergency, provide you with prednisone in case this might happen, & answer all of your questions & concerns.

Her mentor in Kansas City said if they keep yo-yoing, they sometimes purposely destroy the pituitary gland putting them permanently into Addison's and then treat them with steroids. She also said the treatment and the monitoring is extremely expensive.
I think you may have misunderstood this, as the pituitary gland is not affected in an Addisonian crisis, it's the adrenal glands. How badly the adrenal glands are affected is strictly determined by how much drug has been administered, how quickly a problem is caught & treated, with quick treatment in an Addisonian crisis, most dogs recover quite nicely without ever going permanently Addisonian. Just to point out, most vets in Europe prefer to totally destroy the adrenal glands when treating Cushing's, then treat the Addison's, feeling that it is the easier problem to treat. I can't deny that the initial treatment phase is expensive. I had to take out CareCredit to help me cover Harley's expenses when he was diagnosed a year ago, & am still paying on his bills. I use lysodren, so really can't speak to the expenses involved with Trilostane. What I will tell you is, with lysodren, once you have the dose stabilized the treatment costs will decrease substantially, with necessary testing either being done only quarterly or maybe even just twice a year. You can shop around for the either med to try to get the best price you can.

Cushing's is a very slowly progressing disease, so you can take a month or two to thoroughly review everything, educate yourself on the disease, possibly get a second opinion from another vet, then make the best informed decision you can on Buddy's behalf.

Debbie

[Kakesie]

Wow, you guys are AWESOME!

Within minutes of posting I had my first reply and now several more! Bless you Kim, Glynda & Jenny.

I have HOPE - maybe two to three years isn't his "death sentence"!

First thing Monday I will contact my vet and get copies of the test results with the numbers.

His breed - Well, you can see photos of him on my profile. The vet we took him to when we first got him thought he might be a Grosser Munsterlander. She showed me a photo in a book and he does look like that. Otherwise I'd say possibly a cross between pointer and black lab.

Thank you all so very much!!!
Karen & Buddy

[Kakesie]

Yes, I probably did misunderstand many of the things my vet said. It hit me all so fast and I went home without any of the test results or anything on paper. I will try to get better information on Monday.

Thanks so ALL of you, (you too, Debbie). I'm over-whelmed by the support and kindness of all who replied!

Bless you all!
Karen

[Carin]

Cushing's is a very slowly progressing disease, so you can take a month or two to thoroughly review everything, educate yourself on the disease, possibly get a second opinion from another vet, then make the best informed decision you can on Buddy's behalf.

Debbie

I just wanted to second what Debbie said. I think a lot of us come to a Cushing's diagnosis with a certain amount of panic, which makes it hard to process all the NUMBERS and other information we're bombarded with. It's very helpful to realize that this is not a disease where you need to make life-or-death decisions in the first day or week or month when you get the diagnosis. You do have time to find an experienced vet and plan an approach to treatment.

Also, I think the idea of keeping a list of vets that we can vouch for as being Cushing's-experienced is great. It would be particularly helpful for new members to have a sticky post they can go to right away without having to search archives to see if anyone has recommended a particular vet. Another forum I'm on for laryngeal paralysis keeps a database of surgeons experience in treating the disease, with contact info for the forum members who've had first-hand experience with that vet.

Carin

[lulusmom]

Posting information received from Buddy's mom, Karen, via PM


Regarding Buddy's symptoms:
Excessive Thirst - YES. Excessive Urination - YES. Panting - YES. Increased Appetite - Not really, although he IS overweight. Weakness...especially in hindquarters - Not really, maybe a little when hopping up to get into the SUV. Changes in Coat - NO. Hair Loss - NO. Recurrent infections - NO.

Blindness - YES. Detatched Retina - I don't think so. Vet looked into his eyes and she should've seen a detatched retina. She said the vessels in the back of his right eye were atrophied, but okay in his left eye. Onset has been over past several months.

Regarding Buddy's breeding:

He is a mixed breed. You can see photos of him under my member name: Kakesie. Someone dumped him in the country when he was about 9 months old and a friend of mine picked him up and that's how we got him.

When we took him to the vet, she thought he looked like a "Grosser Munsterlander". She showed me a photo in a book and he does look like one. She said there were some people who were breeding them south of town, (which is where he was found), but I suspect he isn't a purebred or he wouldn't have been dumped. Either that or someone wanted him as a hunting dog and he's a big 'fraidy cat. He's scared of everything, so I'm sure he'd be spooked by a gun.

I had never heard of a Munsterlander, so my best guess would've been a cross of black lab and pointer maybe. He is black with white speckles and a curled plumy tail. He has a longer, feathery coat, similar to that of a golden retriever.

[Squirt's Mom]

Hi Karen,

Just wanted to add my welcome! :)

You've been given some great info already and I don't have much to add tho I do concur with everything that has been said, especially about the difficulty diagnosing Cushing's and the need for further testing before you start treatment. Lysodren and Trilostane are BOTH powerful drugs and should not be administered until a diagnosis has been confirmed via several tests. At the very least, I would like to see Buddy have an ultrasound (not Xray). The "normal" bloodwork and urinalysis is a bit concerning since you will usually see changes there if the pup is Cushinoid. Once you are able to post the test results, that will help, tho. ;)

I know all this is terribly confusing right now, but I promise in no time you will understand quite a bit. On that understanding your knowledge will grow, and with knowledge comes confidence. Hey, if I can start to grasp a bit of this stuff, any one can! :p And we are here to help you all we can anytime.

Some tricks you can use to help you remember what is said at the vets office are:

* take a notebook and pen, and take notes; if the vet is going too fast, ask them to slow down explaining you are trying to do all you can to learn
* take someone with you to listen and/or take notes with you
* take a recording device (be sure to let the vet know they are being recorded ;) )

I am really glad to see you and Buddy here and hope to learn more about you both in the future!
Hugs,
Leslie and the girls

PS. some links to help you get started on your cush education :eek::D

Kate Connick*
http://www.kateconnick.com/library/cushingsdisease.html
(especially easy to read and understand...written in laymen terms and has good list of signs)

Long Beach Animal Hospital*
http://www.lbah.com/canine/cushings.htm

Drs. Foster and Smith*
http://www.peteducation.com/article.cfm?c=2+2097&aid=416

Newman Veterinary*
http://www.newmanveterinary.com/CushingDiag.html

Cushing’s signs and pics*
http://www.newmanveterinary.com/CushSignFrame.html

BMD Health Library*
http://www.bestbeau.ca/bmd_health_links_4.htm
(scroll down to see Endocrine Diseases)

Mar Vista Animal Medical Center*
http://www.marvistavet.com/html/cushing_s_disease.html

Vetstream*
http://www.vetstreamcanis.com/ACI/February08/VMD2/FactSheet052.asp

[MiniSchnauzerMom]

Hi Karen,

I wanted to offer my belated welcome to you and Buddy. You've been given lots of information to mentally digest right now and at this point I can't think of a thing to add. I'm mainly here right now to offer my support.

Will be watching for your updates.

Louise

[Kakesie]

A HUGE THANK YOU to all of you, (most recently Carin, Leslie and Louise), for all your information, advice and support! And thank you to the many who have read our story but just didn't have anything to add to what these knowledgable people have already said. I can tell you all love your doggies like my daughter and I love ours and so you understand how hard it is when one is diagnosed with a serious illness. I think the kindest people in the world are dog / animal lovers and I've found a wealth of wonderful people here! Thank you to each one of you!

Thank you, Glynda for posting the information I sent to you about Buddy's breed and symptoms. I will be contacting the vet on Monday to get copies of his test results so I will have numbers to refer to.

Thank you, Leslie, for the great list of Cushing's links you gave me!!!

I second what Carin said about having a list of good veterinarians. In fact, I think I'll start a separate thread about that subject.

Bless you all and your doggies!
Karen, Saralisa, Buddy & Dolly

[Kakesie]

WOW! I don't BELIEVE this!!! My vet just "fired" me!

I called my vet on Monday and asked (the receptionist) if I could get Buddy's specific test names and his results. I had also talked to her on Friday about using a nebulizer for our other dog, Dolly, who has Mega Esophagus Disease. (Dogs with that disease often DIE from aspiration pneumonia, which Dolly is suffering from right now). She told me she would find out how I could get a canine mask for a nebulizer and let me know on Monday, or Tuesday at the latest. She asked me if I had enough antibiotics to get Dolly through the weekend and I said yes, but that she was almost out. She ran out Monday morning, so that was another reason I was calling.

I told her from the beginning of Dolly's disease that I was on a support group for Mega E and also had found this one for Cushing's. When Dolly was first diagnosed, I printed out some of the information I found on that site, and showed it to her, such as the names of medications other vets were using on Mega E dogs and other things, (like the nebulizer) that others had found to be helpful. Except for treating the frequent infections that often happen with Mega E disease, she has not tried any of the other suggestions to help Dolly.

Okay, now that you have a bit of the background, back to today:
It's now Wednesday afternoon and she still hadn't called me back. Dolly is still out of antibiotics and her temperatire is 103.8 and she's shivering uncontrollably.

So I called my vet's receptionist and politely asked again. The receptionist said, "Oh, we mailed you some information yesterday." I hadn't checked the mail yet, so I thanked her very much and asked her if I could get more antibiotics for Dolly's fever. she said she'd ask the vet and call me back. So I went out to the maibox to get Buddy's information that they supposedly sent and I found this letter:

Karen,

I think you are extremely fortunate to have time to spend in internet chat rooms all day. Unfortunately I do not. My days are filled with providing the highest quality care for hundreds of patients, all of which I am equally dedicated to, and although a great deal of information available on the internet may be accurate, much more of it is no more than idle dribble. I am confident that the care you have received from this practice has been exceptional, all the while respectfully working hard to remain within your financial constraints.*

I have no idea how other veterinarians respond to clients doing their own internet research. I for one feel extremely insulted every time my research is reviewed and critiqued by on-line, uneducated laypersons, who have absolutely no idea the amount of time and diligence involved with the on-going educational process required to achieve the level of excellence in patient care that veterinarians strive for.

At this time, I feel that perhaps you should consult with your colleagues in the support group regarding another appropriate veterinary care facility to meet your needs. Please let us know where we may forward your records, and to which pharmacy we may forward Dolly's prescriptions.

Sincerely,
(her name)

*(I just paid her over $750 for two check-ups, Bloodwork on Dolly, Buddy's Low Dex test, and antibiotics for Dolly).

I'm just in shock! I am a very polite, un-demanding, cooperative person. I feel like I've just been kicked in the stomach! Any feedback, please???

Thanks,
Karen, Buddy & Dolly

[Wylie's Mom]

:eek:UNBELIEVEABLE!!!!!
I'm gonna read the rest of your thread now...
-Susy

[nikkismom]

That is truly shocking! However, after I talk to my vet tomorrow, she may fire me.I just printed out maintenance protocol on lysodren from Dr. Feldman about dividing doses, and when I show this to her, it may be the end of us too. These vets are so insecure if they are not interested in hearing the opinions of others. It seems like it's usually the younger ones who get so upset. I have run into this with my daughter's many doctors. I hope you have several other options where you live. It shouldn't be hard to find a better vet, that's for sure. Anyway good luck and don't take it personally. Sharon

[Wylie's Mom]

She consulted with vets in Kansas City who said life expectancy once diagnosed is 2-3 years with treatment OR without treatment. She explained that the problems with trying to reduce the cortisol production with lysodren or trilostane is that it needs to be closely monitored and can easily go too far, pushing the dog into Addison's. Her mentor in Kansas City said if they keep yo-yoing, they sometimes purposely destroy the pituitary gland putting them permanently into Addison's and then treat them with steroids.

OMG – with the kind of information she has given you and the letter she wrote you…Good Riddance!


Vets are wonderful, but owners of a dog with a disease have the passion and drive to do the research on that one disease and try every option and come up with creative solutions, that Vets who have to know about a lot of different diseases simply don't have the time to do.

Completely agree with you – I, too, do not expect any vet to be an expert on everything – It’s too bad that you have this understanding, but your vet just sees what you’re doing as offensive. I feel lucky with my GP vet – she immediately sent me to an IMS vet, but I still work with the GP vet for the regular testing. She does not claim or act like she’s an expert in everything that ails my pup – she is upfront with me if she is not familiar with something and is open to learning or trying new things (as long as she doesn’t see anything inherently wrong with it).

If there isn't a Cushing's expert near you, maybe you can at least find a vet who is open to learning new things...and one that truly does research instead of consulting with one particular vet that she assumes is knowledgable and updated on the testing, treatment & monitoring of Cushing's...and one that puts their patients above their own ego!

I hope someone here can give you a referral.

Did you at least get copies of all the test results...THAT YOU PAID FOR?

-Susy

[BestBuddy]

Karen,
I am shocked at your letter and my first response is to write something nasty back but I don't know your situation and what other vet services are available. There is no way a vet who sees hundreds of dogs can know your dog as intimately as you. If you have to mend fences with her then you have to try to get her to understand that you are not "checking up" on her just trying to learn and understand this disease so that you can be part of the treatment. The suggestions given here are just that-suggestions. We all have been through so many different things with this disease that it is so nice to know you are not alone and that any strange problem you see usually has appeared before in someones dog and they can offer those suggestions on what to do.
Jenny

[Squirt's Mom]

Oh Karen!

Honey, this is wrong on so many levels! They didn't even have the decency or courage to tell you in person. The receptionist had to know what was going on the whole time and just led you along! Meanwhile, Dolly suffers needlessly at the hands of one who's "...days are filled with providing the highest quality care for hundreds of patients, all of which I am equally dedicated to...". Leaving Dolly in that shape is "dedication"?

Is she really that insecure? Dr C always cautions me about what I read on the web, but as time has gone by and she sees that I am learning correct info based on studies and hands-on experience, she is less concerned. I guess I just don't understand how educating yourself in order to better help Buddy should be offensive to your vet. But she really is offended, that letter drips with sarcasm, which isn't very professional in itself.

I am so sorry you had to experience something like this when you are simply doing your best to help Buddy. And I certainly hope you have some more choices for vets where you are!

You didn't deserve this at all, Karen, so let it get to you.
Hugs,
Leslie and the girls

[StarDeb55]

Karen, I AM STUNNED, SPEECHLESS, & HORRIFIED! The only thing I can say is you need to find another vet ASAP, I would not let this woman touch any of my pets ever, again.

My GP vet know me very well & knows that I research my boy's medical problems to the moon & back. I don't hesitate to ask questions, bring up my concerns, ask for explanation, or offer information that I have found on cc.net. He has NEVER, EVER acted angry, upset, or anything else by my actions, & if he did, I would be finding another vet.

Debbie

[acushdogsmom]

Unbelievable ... just unbelievable!

And I second everything that the others have said in reply to your Vet firing you. What an uncaring and insecure person she must be, to do this and to leave you without a vet at a time like this! You're probably better off without her though.

I hope you can find another vet in your area quickly, and one who will agree that it's a good thing to be a member of the team when it comes to caring for your own pets. We are the Vet's eyes and ears at home and our input should be taken into consideration, especially when we are bringing them valid ideas that we can back up with references from the veterinary literature which is certainly not "drivel".

My Internal Medicine Specialist actually loves that I am online searching and learning all the time. She has never been intimidated in the least by my choice to become a well informed advocate for my pet. As a matter of fact, I have had occasion to work with several boarded Specialists over the past few years ... in Veterinary Internal Medicine, Veterinary Dentistry, Orthopedic Surgery and also a certified veterinary physiotherapist ... all of whom were absolutely delighted to find that I had "done my homework" online. My current GP Vet also is fine with the fact that I like to be well informed. She's not at all insulted or intimidated and says that it actually keeps her on her toes! ;)

My Internal Med Specialist tells me that I know as much or more about treating canine cushing's than most GP Vets with whom she has worked and she says that she wishes that all of her clients would make the effort to become well informed, so that she and the clients can communicate more effectively with each other and work better together to get the dog well again.

Sheesh!

[k9diabetes]

Hi Karen,

I'm very sorry that you experienced this and I sincerely hope that you have better options for veterinary care so you can move on from this situation and work with a veterinarian who regards you as an important member of the treatment team.

All of our vets and human docs have to accept up front that I will research everything they tell me on the internet - everything.

(I recently started working with a new doctor for myself and that's the first thing I told him. He agreed that gaining as much knowledge as possible was a good thing and encouraged me to research anything we discuss so he passed the first test!)

And that I will ask a lot of questions and require detailed explanations of what we are doing and why we are doing it. Those are standing conditions for me to entrust the health of any creature in this household to a doctor's care.

I am thankful now to have found veterinarians and doctors who treat me as part of the process, not someone to dictate to.

Because treating me as an important member of the treatment team is also a condition.

You are not being unreasonable or demanding. You are being a responsible caring caretaker for your dog and I think many many veterinarians would be thrilled to have a client who invests so much time and energy in their dog's care.

I am fortunate that I live in an area with many many vets to choose from and even then it took me a while to find a vet I am completely happy with. There really does need to be a fit of goals, styles, approaches... our diabetic dog's first vet is a kind, caring, compassionate human being who I greatly respect and who saved his life when Chris was a puppy. But our approaches to diabetes did not match and we found it necessary to find someone who suited us better...

Clearly that's what you need now! :o

So again, my sympathies and I truly hope you have some options.

Natalie

[nikkismom]

These doctors need to realize that all we are concentrating on is cushings. They have a thousand more subjects to worry about and they should be greatful for our research! I have had the same kind of problem with my daughter, who has thyroid disease that started when she was 11. I had to research, diagnose, demand blood tests and demand treatment from doctors who know very little about the disease. She's now 19, and I am still fighting for her treatment. Bless the computer!

[k9diabetes]

Just looked at your photos... Buddy is so very handsome and sweet...

[frijole]

Karen,

I had to calm myself down after reading that letter. I am sooooooooo sorry that this insensitive person that calls herself a vet had the audacity to mail you that letter. I would feel compelled to send it to the newspaper - bet they'd love that story. ;) I nominate her for the cushings Wall of SHAME. That takes the cake.

I am no vet and I am no psychologist but I can tell you that you know more about cushings than she does AND she has some serious issues. She obviously is not compassionate and will not make it as a vet. So you are fortunate to have discovered this before she tried poisoning Buddy without even trying to research protocol on the drugs she prescribes.

Meanwhile to help your dog.... You had discussed finding a new vet already anyway so its just a matter of speeding that up a bit. I made some recommendations in earlier posts, not sure if you've tried them but I'd go there first. There have to be more vets in Kearney than in Columbus so you will find a good one. If you want me to I could contact my vet and see if he recommends anyone.

Give Jesse a big hug for me and don't let that letter get you down. She obviously missed class the day at vet school where they talked about customer service! :D Hugs Kim

[ventilate]

Unbelievable, I am stuned, all day in chat rooms? I am horrified and I would be sure to pass the word around that she is not easy to work with, in fact you cant work "with " her at all she does and you listen. Unfortunately there are some vets like that out there like that. I spoke to my net earlyon with the advice of this uninformed chat room, and told him that If I ask questions it is because I need to understand the why work in the hospital and have learned to never be lead blindly. He said he was the same way and we have to work together as we both have the same goal to keep Nike healthy. He attributes nikes doing so well to my education ( idle dribble) from here, he has not had any dogs do as well as Nike has with her Cushings and she is old. and it is from all the information and assistance and guidance I have recieved from here.
I am so sorry that your poor dog has to suffer the consequences of vet such as this and she calls herself a professional, with that kind of letter she wrote, sounds like a schoolgirl type thing not that professional to me.
Wish I could help spread the word not to use this uncaring selfcentered Its all about me vet but I am glad I am to far away;) to do any good.

Good luck finding a new vet
Hugs to you and yours from me and mine
Sharon

[acushdogsmom]

She consulted with vets in Kansas City who said life expectancy once diagnosed is 2-3 years with treatment OR without treatment.That 2-3 year prognosis statistic is only an "average" and we must remember what data that average is based on.

The statistic includes some dogs who lived only a few months after diagnosis as well as dogs who lived many years after diagnosis.

The data from which that 2 or 3-year prognosis statistic was formulated includes:

... some dogs who were not treated at all for the Cushing's Disease

... some dogs who may have been diagnosed and treated by inexperienced Vets or Vets who were perhaps too conservative in their treatment of the dogs and never really got the dogs' Cushing's well-controlled.

... some owners who quit treatment at the first sign that the dog didn't feel well (when it may have been only a dose adjustment that was needed to get the dog feeling well again and to maintain good control of cortisol production)

... some owners who were not observant or not diligent about giving the prescribed medication and/or were not having the dog monitored as recommended with periodic ACTH stim testing to check cortisol production and to know for certain if or when dose adjustments might be needed etc.

... some dogs who were diagnosed only by the time the Cushing's was quite advanced and by then some irreversible organ damage (liver, kidneys, heart etc) may have already occurred

When you take scenarios like the above-mentioned ones and add that data all together with the available data on the Cushing's dogs who are successfully treated and have successful outcomes, many of whom live 5, 6, 7 years or more after diagnosis with an excellent quality of life, well, you may actually get an average 2-year prognosis, but that does not mean that a dog who is correctly diagnosed and treated for Cushing's will only live 2 or 3 more years from the time of diagnosis.

Also, most Cushing's dogs are already quite "senior" by the time they are diagnosed, and many would not have lived much longer than 2 or 3 more years even if they did not have Cushing's or any other health issues.

My dog was treated with Lysodren for more than 6 years after he was diagnosed with Cushing's and he led a happy and healthy life for all that time.

[gpgscott]

Wow,

I have not posted to you previously.

I feel like you, kicked in the stomach.

I would after finding another Dr. submit this bit of trashing to the BBB, the state licensing board and the local news media.

This Dr. may have some competence as an DVM, but if what you have related is anything close to what actually occured in my 'internet chatroom opinion', she needs to be seeing another type of medical professional.

Scott

[Buffaloe]

Hi Karen,

I'd have to say your vet just did you a big favor. It's good that you found out about her now rather than later. She is obviously very insecure. You have no use for people like her in your life. Good luck finding a really, really good vet for Buddy. They're out there.

Ken

[Roxee's Dad]

All I can say is I am stunned. Sorry your ex-vet refused to take advantage of a free research assistant. What ever you decide to do, don't hesitate to get all your vet records and test results. You paid for them and have a right to them.

Don't be afraid to interview vets and even if you can't find one with experience, ask them if they are willing to work with you as a team to help your Buddy. He deserves the best you can find for him. Be strong for Buddy.

We will be keeping good thoughts and prayers for you and Buddy.
John (Roxee's Dad)

[k9diabetes]

Chris' cardiologist, knowing I was big on researching things myself, asked me to do some research to see if there was a documented starting dose for Plavix in the literature! (There wasn't for dogs) I love her for that, among other things.

What really struck me looking back is that Buddy was diagnosed just a week ago... how could she be so ticked off in a week!

Seriously...

Natalie

[AlisonandMia]

I think the ticked-offness comes from issues with regards Dolly the pup with mega-esophagus and now suffering from aspiration pneumonia. Good thing Karen found out about this vets views now rather than half way into Cushing's treatment! Not that being left in the lurch (and so unpleasantly!) now with Dolly being ill is ok, but still....

Alison

[k9diabetes]

Ah yes, at least there's been more time involved! Still no excuse but makes more "sense".

I don't know anything about mega-esophagus but I do know that you need a vet you can work with for Cushings and all are right that it's better not to even start down this road with this one.

[Kakesie]

God bless each one of you!!! You don't know how MUCH your replies have meant to me! First you all came to my support when I found out about Buddy having Cushing's, which was very upsetting in itself. Then to have my vet send me that letter today. (And for her to dump me right when Dolly is fighting for her life, too!) I just don't know how I would've gotten through today without you all!

Fortunately I had an appointment with my therapist today - yes, you can call me "crazy" if you want - but I'll openly admit I deal with Depression and have all my life. I asked my doctor, "If you diagnosed someone with Depression and she joined an online support group or researched the condition online, would you be offended?" She responded as many of you did. Absolutely not, that she'd see that as a pro-active and healthy thing to do.

I was worried after I fired off my post to this group. Since I've only been on here one week, and I thought you might figure I was demanding, rude or otherwise did something to provoke this vet's response. But believe me, my therapist, (who has known me a long time) says I'm one of the meekest, most UN-demanding, overly-polite people she knows. In fact, she has been working with me to be more assertive. She, (and you) have helped me not take this vet's letter too personally and to realize it's HER problem, not mine. She gave me some good advice, though. She said for me to pick up the dogs' records myself, rather than have HER send them to the new vet, because if she's upset with me, she might "influence" the new vet's opinion of me.

You're all very right, I'm lucky to find out about this vet's attitude NOW before she did further damage to my beloved dogs. I just wish she would've TOLD me she had a problem with this way back when I told her I had found a support group for Dolly's illness. I can handle someone being upset with me, but to take it out on my babies!!! (In fact, this is her THIRD strike with me). I was already considering changing vets because she has done so little to help Dolly.

And Strike One was when I took my (now deceased) dog, Minnie to her for what I thought was a Urinary Tract Infection. Minnie was straining to pee, yet they made her wait 2 weeks before I could bring her in for a urinalysis. We were leaving on vacation, so I left Minnie to be tested and treated. They called me and said they needed to do a "sterile urine test", (withdrawing urine directly from her bladder with a syringe). I said, "Yes, please go ahead and do that." When I got back from vacation a week later and picked Minnie up, the receptionist told me they wanted me to bring her back in another 1 1/2 weeks for the sterile needle urinalysis. I said, "I thought you were going to do that while she was being boarded here." The receptionist said, "But we had to wait to get your permission." (Which I had given over the phone and also signed a paper before I left guaranteeing payment for whatever Minnie needed). I think they just forgot to do it. I said, "Don't I need to take some meds home to be giving her?" She said they hadn't been doing ANYTHING to treat her yet. Then when they finally did the needle test, they decided she needed exploratory surgery and made her wait another 2 + weeks. Her surgery day came and I took her in, but when I went to pick her up they had not done her surgery because they had a cat who was sick and needed their only oxygen tube, so they would have to put Minnie's surgery off for another two weeks! By the time they finally had time to "help" her, she had a cancerous tumor that was too far along to be removed.

Anyway, thank you, thank you, thank you ALL for listening and being here and understanding and being so supportive! I just can't tell you enough how much you helped me out today!

Bless you and your doggie babies!
Karen

[acushdogsmom]

yes, you can call me "crazy" if you want - but I'll openly admit I deal with Depression and have all my life. I asked my doctor, "If you diagnosed someone with Depression and she joined an online support group or researched the condition online, would you be offended?" She responded as many of you did. Absolutely not, that she'd see that as a pro-active and healthy thing to do.I don't think you're crazy, Karen. I think that you are a very bright and a very loving person.

How is Dolly doing? Have you found another Vet yet?

[Kakesie]

Thanks, hon!

I'm not crazy, I just love our doggie babies like crazy! LOL

I called one vet today and left a message on their answering machine but it may have been too late in the day by then. I'll try calling around tomorrow. I've been online all evening searching to see if I can find reviews on vets in our area, but hardly anyone has written any reviews.

I would encourage everyone to please go online and put in a good review for all the excellent vets out there. I know there are many who truly care and are wonderful with animals. (Also, please warn others of any bad experiences you've had, too). I'm going to. The poor animals can't speak in their defense, so we must speak up for them! And it will be so helpful for people who move to your town to know how to find a good veterinarian.

Thanks again to everyone for being there for me today. It was a very upsetting day, but thanks to all of you, I feel much better now.

Karen

[Spiceysmum]

Hi Karen,

Like everyone else I am shocked by the treatment you have received. You are well rid of that patronising and sarcastic vet. We are all trying to do the best for our dogs and even though I am not as knowledgeable as alot on here I have still been able to tell my vet some things they didn't know. I don't expect them to be an expert on every disease and realise that they sometimes have to research things just as we are doing.

Don't take it personally, it is her that has the problem, not you. I would pick the test results up yourself so she doesn't have the opportunity to influence your next vet.

Good Luck in finding a more compassionate and experienced vet.

Linda and Spicey

[Harley PoMMom]

Hi Karen,
So sorry to hear how your vet treated you. I know exactly how you feel. I was with my vet for 20 years when he dx Harley with cushings and when I asked him to run an U/S, he sent me and Harley on our way. He did, at least, give us a recommendation to the Univ. of Penn.
As far as finding a new vet, I pulled out the phone book and started making phone calls and actually interviewing vets. I did find one that I really like, actually I found two. So they are out there and they are willing to work with you and this forum, actually my new vet is happy that I have this forum.
I know it's hard Karen, but keep your chin up and I'll be praying for you.

Take care,
Harley and Lori

[Squirt's Mom]

Hi Karen,

Glad to hear from you this morning and to know that you are dealing with this rudeness quite well! :)

As for crazy, well, if battling depression makes one crazy, count me in! :p That is something I have dealt with all my life, so I know where you are coming from. I actually have many other qualifications for "crazy", too! :D Sanity is so boring! :p And when you're old and crazy, you can get away with lots of stuff! :D;):p:cool:

The best of luck in finding a good vet, your babies sure deserve better than they have gotten and so do you! We're here if you need us!

Hugs,
Leslie and the girls

[Wylie's Mom]

Hi Karen,

I don’t know if you’re still on the look-out for a new vet, but I was thinking the following:

1) As Linda has suggested, “I would pick the test results up yourself so she doesn't have the opportunity to influence your next vet.” – actually, pick-up your pups’ whole files (or copies of them).
2) When you interview the new vets, tell them up front that you do research on-line about whatever ails your pups and find out from the get go how they feel about it. Explain to them why you do this - it's not because you are scrutinizing them, but because:
- you do not expect them to be an expert at everything
- you do not expect them to be abreast of everything new test, techinique, protocol, etc. for everything
- this is a way for you (as the parent) to be more informed and helps you to understand and make informed decisions
- think of me (you, Karen) as someone who will do research for you for free (someone else had posted something to this affect, but I don’t remember who)

Good luck in the search!

BTW – I think everyone has some amount of depression – Just like I think everyone has smoe amoutn of dyselxia – some people realize it, some don’t; some admit to it, some won’t. I wondered when Head & Shoulders came out with the “Dry Scalp” shampoo…was that for people who couldn’t admit that they have dandruff? So they could say, “Oh no, I don’t have dandruff, I just have dry scalp:p”. And I know for a fact, that everyone here is crazy when it comes to our pups;)!

-Susy

[Kwiggles]

Hi Karen,

I just wanted to say hi and echo what many others have said- You and your pups deserve so much better than the shabby and unprofessional treatment you received from that vet! :mad:

What I really don't get is how a vet could possibly discourage someone from any effort to be well-informed when it comes to caring for a Cushings dog. Of all the ailments out there, this is one which requires the owner to be the most attentive & educated about the disease, its diagnosis and treatment. Just about everything our vets know about our dog's symptoms, response to medication, etc comes from what we report to them. I relied so much on the great folks on this forum to help me get through my dog Joe's Lysodren loading last month and they were a tremendous resource.:)

You certainly are due for some good luck and I hope it comes your way in the form of a great, knowledgeable and compassionate vet to care for your furries.

Reading this thread makes me want to send my vet a big box of chocolates- he's the best!:D And would never dream of discouraging me from learning more about this disease. Yay for good vets! :D And poo on the other ones :p

Hang in there, we're all pullin' for ya!

Hugs from Karen & Joe

[maggiebeagle]

Good luck in finding a new vet for your pups. The old one isn't worthy of them :rolleyes:.

Virginia and Maggie

[Kakesie]

I just can't thank all of you enough! Every time I come to this site more people have written in support of me! WOW! I really needed it, too. I took a nose-dive after recieving the Vet's letter. I got pretty depressed and stayed home Thursday & Friday and just spent time with my doggies, caring for them, loving them, and sleeping with them. But Monday I'm gearing up to go out Veterinarian shopping. I appreciate all the wonderful comments on how to look for a new vet.

I do believe in being up front about my struggles with Depression because it's an illness just like any other human illness and I want to do whatever I can to dispell the stigma attached to it. A lot of it is bio-chemically caused and it isn't just a "personal weakness" or something you can tell yourself to get over. So thanks for accepting that aspect of me, as well.

Back to my doggies. I called and asked the receptionist how soon I could pick up the dogs' complete charts and she said she didn't know, they'd have to make copies, probably not before Friday. Friday came and went and no word from them, so Monday I am going to call them again. I'm not a very assertive person, but when it comes to the well-being of my doggies or my child, I can get tough if I need to.

Finding another vet: I'm worried because we live in a small town and the vets work together, taking turns being on emergency call, and such. I'm afraid that this vet may have bad-mouthed me to the other vets in town.

Someone on here said something about "if you have to mend fences with this vet". My first impulse was to write her back as sarcastic and angry a letter as she had written me. But that won't help my doggies and it won't solve anything. I will NOT EVER go back to that vet (except to pick up the dogs' records). But I am thinking my best move would be to bite my tongue, take the high road and write her a nice letter, thanking her for what she has done for my dogs, and apologizing for offending her. Then I'll put her letter to me and my response to her in with my dogs' records for the new vets to see. Hopefully they will be able to see that she was being unreasonable and that I met her rude response with only kindness back.

Her husband was on call last Wednesday when I got the letter and had called about Dolly's high temperature and her being out of anti-biotics. To his credit, he did call in a prescription for Keflex for her to a human pharmacy so I could get her back on antibiotics. So she is a little better now. I was truly afraid she was going to die on Wednesday!

Buddy is still in the early stages of Cushing's, newly diagnosed, so I think I have a few days leeway to find a new vet.

I just wanted to update you on how our dogs are doing and let you know how much you helped me. I am doing better now, thanks to all of your kind words and support!

Bless you and your doggies!!!
Karen, Saralisa, Buddy and Dolly

P.S. I will add photos of Dolly on my album, too.

[rhodesian46]

I am reading this letter and shocked. I can't believe that she wrote this!!!! Sounds to me that she is a jerk. I wonder if you could send the letter to the vet board?I don't think she deserves a written reply. I would do it in person. Be respectful yet firm. It would make you feel better. I am sure. Tell her that you wanted to work as a team and that you don't understand why she doesn't want to include you. She should welcome your questions no matter where you got the info.

[lleigh]

Wow! Does this make my English/Welsh/Polish/Russian blood boil! What really blows my mind is that the vet put it in writing. Can't take back what you put in writing!!!!!

Leaving that practice is a blessing and I hope you quickly find someone you can trust and communicate with regarding the care of your precious babies.

Lyn

[Roxee's Dad]

Hi Karen,

Reading you last post, I believe you are doing it the right way. Take the high road and write a nice response letter.

As far as spreading the word, you might be surprised to learn that if she does, the other vets might actually think less of her and more of you. She would probably do herself more harm than good. Once she recieves you response letter, she will probably and may already be regretting writing that sarcastic letter.

YOU GO GIRL!!!

John (Roxee's Dad)

[4Mikeydog]

Just reading your thread....It's obvious that your former vet is more interested in her own ego than in finding the right treatment for your dog! In a way she did you a favor
by revealing her character flaw early in your cushings "jounney". Now you have a chance to find someone who is compassionate and has your dog's best interest at heart rather than her own ego!
Hang in there!! There are plenty of caring and wonderful practitioners out there!

with best wishes...
Dorothy and Mikey

[k9diabetes]

My guess is that the rest of the vets in town already have her number if she's been around any time at all. Probably you're not the first client she's fired. I agree that her firing you might actually raise their opinion of you! :)

In a smaller town, she's going to run out of clients quickly at this rate...

Good luck... and I say make them cough up those records tomorrow!! After all they have put you through, it's the least they can do to preserve any shred of professionalism!!

Natalie

[forscooter]

OMG...I am just trying to catch up and I think my BP must have gone off the charts!! I would looooove to let her know that not only does my vet listen to me, he also listens to the advice I have received right here, AND he also, when stumps will post on a vet board only to post questions to ask other vets on the INTERNET and he'll talk to the lab techs...anyone who may be able to help. On top of that, he is very educated, much experienced and most of all compassionate. I am sooooo sorry you had to deal with this! It is complete bull!

I am also sorry you must deal with depression on top of all of this. If it helps, I have bouts of it myself, can suffer through panic attacks and ongoing anxiety...and if I got through the past 18 months of my life without falling completely apart, we will get you through this too! This is the best place on earth for support. My friends and family are wonderful, don't get me wrong, but the people here truly understand the ups and downs like no one else can...and stick by you no matter what. I don't know how they have tolerated me this long...:cool:

And yes, "crazy" is just so much better in so many respects any day as Leslie mentioned :D Life would be too boring!

So hang in there and I am sending lots of hugs and warm supportive thoughts to you and the hopes you can find a vet with a heart!!!

Beth, Bailey and always Scooter

[Wylie's Mom]

But I am thinking my best move would be to bite my tongue, take the high road and write her a nice letter, thanking her for what she has done for my dogs, and apologizing for offending her. Then I'll put her letter to me and my response to her in with my dogs' records for the new vets to see. Hopefully they will be able to see that she was being unreasonable and that I met her rude response with only kindness back.

Hi Karen,

I think that's a great idea to write her a letter...but, I would only thank her for what she's done if you truely believe she has done some good. If it were me, and if I could bite my tounge after receiving a letter like this, I would focus on why you did the research...saying something like,

"I'm so sorry you felt insulted by my internet research...I never had any intention of making you feel scrutinized...I believe it is impossible for any vet/human to be an expert on everything, no matter how wonderful of a vet they are (I would gag at this point if I wrote this to her:p) - it's for this reason that I do the research...to focus on the specific issues that ails my pups, because I understand that vets have many patients with a great variety of different ailments and one cannot expect them to keep abreast of every new test, technique, protocol, etc. for every kind of diease...I am trying to do the legwork by finding out if there are any recent developments and weeding out unreliable information before presenting them for discussion with the vet...the research is also for my understanding so that I can better understand what a vet is trying to explain to me and so that I can make better informed decisions for my pups..."

Okay...I was rambling. But I think this could be a good tool to explain where you're coming from to the prospective vets also.

Best of luck!! Keep us posted!

-Susy

[lulusmom]

Hi Karen,

I've been away for a week and am just catching up and wow, was your thread an eye opener. When I read your vet's condescending and very narcissistic letter, I could only shake my head in disdain. Her level of insulting cowardess is unparalleled.

Successful treatment of cushing's is much easier facilitated when an educated pet owner and a cushing's savvy vet work as a team. Your ex vet just did you an incredible favor as Buddy and Daisy deserve a lot better than someone that places her own ego above their welfare. I mean think about it....how incredibly cruel and unethical to abandon two patients with very serious conditions because their owner was trying to understand these diseases and made the mistake of asking questions. Unbelievable!

Your vet took an oath when she became a vet. I'd like to share the last two paragraphs of that oath because you now have written proof that she not only broke her vows, she torched them.


I will practice my profession conscientiously, with dignity, and in keeping with the principles of veterinary medical ethics.

I accept as a lifelong obligation the continual improvement of my professional knowledge and competence.



Karen,

I think you are extremely fortunate to have time to spend in internet chat rooms all day. It's so nice that a professional starts a letter with a glaring inference that you are an idle slug with nothing but time on your hands. Unfortunately I do not. My days are filled with providing the highest quality care for hundreds of patients, all of which I am equally dedicated to, This is almost laughable considering she abandoned the care of two patients that probably have more serious diseases than 95% of her practice and all because their owner cares about educating herself about these diseases. although a great deal of information available on the internet may be accurate, much more of it is no more than idle dribble. The correct word is drivel and well duh, I guess since you do nothing but spend your days in chat rooms, you are too stupid to know the difference between reference material and case studies authored/conducted by experts in their field (endocrinology) and the drivel put out there by laymen. I am confident that the care you have received from this practice has been exceptional, This is highly questionable given the fact that the practice left two patients twisting in the wind, one who went without a refill because they chose to stall until the letter arrived because they were too cowardly to drop the bomb in person. all the while respectfully working hard to remain within your financial constraints.* Respectfully? Now that's rich.

I have no idea how other veterinarians respond to clients doing their own internet research.Both my gp vet and IM think it's great that I took the time to educate myself and I can't imagine either one being so condescending and unprofessional. They are both very learned and experienced in treating cushing’s so perhaps that’s the difference. I for one feel extremely insulted every time my research is reviewed and critiqued by on-line, uneducated laypersons, who have absolutely no idea the amount of time and diligence involved with the on-going educational process required to achieve the level of excellence in patient care that veterinarians strive for. How terribly presumptuous and totally arrogant. If more vets skulked around dedicated forums, they could learn a thing or two not to mention availing themselves of more case studies than they’ll ever see in their lifetime.

At this time, I feel that perhaps you should consult with your colleagues in the support group regarding another appropriate veterinary care facility to meet your needs. It’s ironic that this extremely sarcastic remark is actually excellent advice. Please let us know where we may forward your records, and to which pharmacy we may forward Dolly's prescriptions. You should also let them know where to send the response to the complaint you will be filing. :D

Sincerely,
(her name)



Honestly, Karen, if I received a letter like this, I would file a formal complaint with the state board governing veterinary practices in my state. If you are so inclined and I sincerely hope you are, here’s a link to the Nebraska Board of Veterinary Medicine and Surgery with contact information:

http://www.aavsb.org/DLR/DLRDetails.aspx?id=41

Glynda

[frijole]

Karen,

Was thinking of you last night wondering how you are doing at finding a new vet. Keep us posted as we worry you know!!!

Kim

[jrepac]

Wow...I just read thru the thread and saw the letter from the vet....I think I'd pick up the phone and blast that vet.....but, better yet, find a new vet. And, make sure to put a "review" of your old vet on yahoo, yellow pages, and any other site where people might find a link to her.

That letter is beyond obnoxious and just speaks to the insecurity of the vet...while some of her initial comments on Cushings are not 100% wrong, there are in fact other points of view on treatment. I would not make my dog addisonian and treat w/pred, but I have read that some European vets take this approach.

And, lots of information from vets around the world can be found on the Internet...guess your vet does not turn on her PC. It's not all crackpot stuff.

My view is that your vet (any vet) should be willing to discuss treatment options..particularly in a complex case like Cushings...I wound up going to a new practice as I was not 100% satisfied w/my regular vet (after seeing 3 vets there and getting 3 different opinions)..I'd been going to this vet for 30yrs (albeit different docs over time) and was comfortable with the practice.

While the 2nd practice I visited had the technology to do some more advanced tests (ultrasound, for instance), I found the vets there rather rude and insistent, and unwilling to discuss treatment options (they were a "lysodren" only place, and when I brought up Trilo, among other things, they were taken aback). Needless to say, I did not go back there. I took my new test info, went back to my original practice and had a long talk with my usual vet. He was very open to discussion and treatment options. Happily, my Aussie has been on Anipryl now since Sept'08, plus several supplements and is doing very well. We are going to get an ACTH test in June along w/the Atypical Cushings screen done by U of TN....my vet said "no problem" in sending the samples down there for the test. [I know the ACTH is not all that useful when treating w/Anipryl, but I want to see what the cortisol levels are running AND make sure I'm not dealing w/Atyical as well as "regular" cushings...which I've been suspecting for some time now]

[Squirt's Mom]

Hi Karen,

Just popping in to see how you and Buddy are doing today. Hope things are calmer now.

Hugs,
Leslie and the girls

[frijole]

Hi Karen

Probably life is keeping you busy but I am a worrier and want to hear how you and Buddy are doing. :) Sending my best wishes - hope to hear from you. If you are still in need of a vet please let me know. Who knows, maybe my vet knows someone in your town. Hang in there and keep the faith. We are here for you.

Kim

[Carol G]

Karen,

My cousin lives in Hastings and her daughter lives in Kearney -- both have dogs and cats. I would be happy to ask about their vet recommendations. I know one of their dogs had a serious medical condition so they might have some good input.

You can PM me if you wish.

Carol, Winnie (always), McGill & Atty Cat

[Wylie's Mom]

Hi Karen,

I've been waiting for an update;)...

-Susy

[Kakesie]

Hi Everyone,

I don't know if you remember me. I posted about our dog, Buddy, who was diagnosed with Cushing's Disease a few months ago. (It took me forever to find this group again!) I was the one whose Vet wrote the nasty letter telling me if I was going to listen to people on the internet I'd better just find myself a new vet!

Well, Buddy wasn't exhibiting many symptoms then, but he now NEEDS to get on medication for Cushings. He is panting a lot and clearly showing symptoms now. So I've made an appointment with the Vet Clinic I used to go to before. They are VERY expensive, but I know they are the best in town, so I guess we'll scrape up the money somehow.

They are going to see Buddy TODAY, Friday, October 9th at 4:30 pm Central time. If anyone has any advice about questions I need to ask when I go see the vet, please let me know. In the meantime I'm going to devour this site and try to learn all I can about Cushings.

I hate to admit it, but when Buddy was first diagnosed, and wasn't really showing any symptoms, other than drinking more and occasionally panting I kind of went into "denial". ("No, he's not sick; not my baby, he'll be okay.") Well, I can't deny it any longer and now it's time to get active about treating him.

Any advice you want to share will be most appreciated. You can either post in reply on here.

Thank you so very much!
Karen & Buddy

[Kakesie]

P.S. I did get Buddy's records from the vet who "fired" me.
Karen & Buddy

[AlisonandMia]

Hi Karen!

I'm a bit busy at the moment (dinner time in Australia) but I just wanted to say welcome back and good to see you again.:)

I've merged your "old" thread with this new one so your story is all in one place.

Alison

[Harley PoMMom]

Hi Karen,

I am so happy to see your post, we have been so worried about you and Buddy.

Here is a list that Leslie came up with when she was looking for a new vet for Squirt, it is very good.


Hi ya'll,

Since we are going to have to find a vet in AR to use for a while, I have been working on a questionnaire to send to the vets in the area. Here are the questions I have come up with so far....any input greatly appreciated.

1.) Do you treat canine Cushing’s? (If yes, please continue; if no, thank you for your time.)
2.) How many Cushing’s patients have you successfully treated?
3.) Which Cushing’s treatment(s) are you most experienced with?
4.) Are you familiar with Atypical Cushing’s, the Uni. of TN Knoxville (UTK) full adrenal panel and Dr. Jack Oliver?
5.) Do you stock the stimulation and suppression agents or do you order them as needed?
6.) Which agents do you use?
7.) Which lab do you use and are you under contract to send all samples through them whether they can do the testing or not?
8.) Do you have an endocrinologist and/or IMS to whom you refer patients? If so, who and where are they located?
9.) Where is the nearest, best high resolution ultrasound and someone qualified to interpret them?
10.) In the event of a crisis/emergency after hours/on weekends, what is protocol for your clients?
11.) Do you communicate with your clients directly or through techs and/or staff?
12.) What is your philosophy on yearly vaccinations?
13.) Are you familiar with other conditions associated with Cushing's such as diabetes, hypothyroidsm, etc.?
14.) Do you regularly attend seminars, conferences, and/or continuing education courses?
15.) What is your philosophy on non-pharmaceutical approaches? Which, if any, do you practice?
16.) How do you feel about home prepared diets?
17.) How do you feel about clients being proactive in their pet's care?

I feel like there are some important things I have missed but my brain refuses to go any further. :rolleyes: So let me know what you think I should ask, or not ask...

Thanks,
Leslie and Squirt

Please keep us updated.

Love and hugs.
Lori

[haf549]

Hi Karen:

The best thing your old vet did for you was 'fire' you. If a vet has an attitude like that, you shouldn't be bothered with them. Vets are the ultimate resource for you pets health, but I think it is just as important that you are pro-active in your pet's health care. No one on this website has ever suggested their advise should be taken in place of a vet's, but here you can get ideas as to what questions to ask; what symptoms to look out for; and general all around great support in moments of crisis.

Hoping you new vet works out well for you.

Heidi

[Roxee's Dad]

Hi Karen,
Depending on your location, it may not be easy to find a vet that has experience in treating cushings. You mentioned that you are going to a vet clinic that you really like and respect. That's great. What is also really important as you have already experienced is working with a vet who is willing to work with you as a team and is open to suggestions based on articles written by vet's with real experience. As in our resource section.

IMHO - First would be a proper diagnosis of Cushing's and type of Cushing's.

2nd would be an open discussion of treatment. This would really depend on the type of cushing's that Buddy has. Remember, no one test can confirm cushing's. Except maybe the UTK which is considered the gold standard for diagnosis and covers not only the cortisol but the other intermediate hormones (atypical cushing's)

Finally, make sure before you start treatment you and your vet have a full understanding of the symptoms you should be looking for when treatment starts, and what to do.


I hate to admit it, but when Buddy was first diagnosed, and wasn't really showing any symptoms, other than drinking more and occasionally panting I kind of went into "denial". ("No, he's not sick; not my baby, he'll be okay.")

Don't feel bad. I was exactly the same way when Roxee was first diagnosed.

[Harley PoMMom]

Hi Karen,

I totally agree with what John and Heidi have told you. My boy Harley, when we went to his new vet and asked about the UTK full adenal panel...well Dr. Owings had no idea what we were talking about, BUT she was very willing and eager to learn all about this "UTK full adrenal panel and it's 5 intermediate/sex hormones." She even called and emailed Dr Oliver, who heads the lab who does the UTK full adrenal panel, to find all she could about it. I love Harley's vet.

Best of luck to you and Buddy today. Keep us posted, ok.

Love and hugs.
Lori

[Squirt's Mom]

Hi Karen,

Glad to see you and Buddy again! :)

Sounds like you have been given some great advise as usual already and I would add only a few things. Take a friend, a tape recorder, or notepad and pen to take notes; this way you are more apt to remember what was said once you leave the clinic when you have an extra pair of ears, or recording or notes to go back and reference.

Most importantly, don't panic now that your "delusion" has been shattered. :p;) Cushing's is a scary thing to contemplate, but the more you know the less scary it becomes, and you are in the right place for experience, support and knowledge. We will be with you and Buddy every step of this journey.

Glad you are home again! :D
Keep your chin up!
Hugs,
Leslie and the girls

[Wylie's Mom]

Hi Karen,

I am so very glad to see you here, but sorry that Buddy's symptoms are more evident.

I don’t have much to add to what the others have said, except that if you ask “How do you feel about clients being proactive in their pet's care?”, make sure they know what you mean by this. Tell them that it’s 1) so you can better understand what a vet is saying, 2) so you can make better informed decisions for Buddy and 3) assure them it’s not meant to scrutinized the vet;)… and explain how you do not expect one vet to be an expert on every condition out there.

I hope the appointment goes very well:)!

-Susy

[Kakesie]

Thank you all so much for the warm welcome back and the helpful advice!!!

For simplicity, I'll refer to the two vets as:

"Dr. L" = My vet from 2003 - May, 2009, the less expensive one who "fired" me because she was offended that I was researching my dogs' conditions on the internet. (Incidently Dr. L did her internship under Dr. N).
AND
"Dr. N" = My vet from 1970's - 2003. And the one I've gone back to now. Probably the best in town, but also the most expensive. He is very nice and the dogs like him; he has a lot of experience, the latest equipment, nice facilities, (that I probably helped pay for over the years), but he also caters to the rich in our town, runs every possible test and has been rumored to "pad" the bill.

It's hard for me to go back to Dr. N because I feel guilty for leaving him after being a loyal customer for 25-30 years, to try to find a less expensive vet. I am also worried that Dr. L might have talked to the other vets in town and said bad things about me.

But Buddy needs to start treatment for Cushings Disease and I've already taken Dolly to Dr. N's Clinic twice now. (Dolly saw different vets, but today we're scheduled to see Dr. N. Dr. N now has 3 other vets who work there with him).

Thank you very much for all the helpful suggestions!!!
I will let you know how our appointment goes.
Glad I found my way back here. You are all so awesome! Thanks so much!
Karen & Buddy

[Wylie's Mom]

Here are some ways to save on prescriptions (so you can give the savings to your new vet:p:rolleyes:):

http://stanford.wellsphere.com/pet-health-article/pet-pharmacy-smarts-ten-ways-to-save-big-on-your-pet-s-rx-bill/506032

-Susy

[Kakesie]

I promised I'd let you all know how Buddy's appointment with Dr. N went today.

It went very well! I'm glad we switched back to Dr. N. He really IS a wonderful Vet. (I haven't gotten his bill yet, though.....)

He seemed very knowledgable about Cushings and said he could get the Lycoden (sp?) compounded a nearby (human) Pharmacy to save money. He thinks we can help Buddy a lot by getting him on medication and he totally disagreed with the other vet who advised me not to treat him for Cushings. Dr. N is going to re-check Buddy for diabetes and re-do the bloodwork since it's been several months since the other vet did the testing and also do a urinalysis. He said he should be able to get Buddy started on medication yet this weekend! (My former vet didn't even work on weekends!)

He didn't seem to be bothered by me researching the dogs' conditions on the internet and belonging to support groups. I left feeling very happy and assured that I had made the right decision.

Thanks so much to all of you for being here!
Karen & Buddy

[Harley PoMMom]

Hi Karen,

I am so happy that you and Buddy's visit with Dr. N went so well. I am also glad and relieved that he is rechecking for diabetes and doing another urinalysis.

Now when you say "re-do the bloodwork since it's been several months since the other vet did the testing," is this a bloodwork panel (CBC and Chemistry) or and ACTH stim?

It sounds like Dr. N will work with you as a team, which is so important, and it seems he is being pretty through...all sounds good to me.:)

If you don't mind, when you get the results of any of Buddy's tests could you post them here, the more information we have the better the advice we can give you.

Your doing a wonderful job, Karen, you're such a good mom.

Love and hugs.
Lori

[Kakesie]

Thanks, Lori & Suzy and everyone else!

I'm not sure exactly which tests Dr. N is going to run. He mentioned testing for Diabetes & testing his thyroid. But he just took a blood sample when we came in, so it wasn't a fasting blood sample or a samples drawn at onset, 4 hours and 8 hours.

If it helps, I did get Buddy's records from last April. I'm not positive if I'm posting the right things here, but:

ACTH STIMULATION TEST:

Cortisol Pre (8:10 am) 8.2 ug/dl
Cortisol 2 (12:10 pm) 1.1 ug/dl
Cortisol 3 ( 4:10 pm) 1.8 ug/dl

Interpretation of the dexamethasone suppression tests:
Pituitary Dependent Hyperadrenocorticism

There's also a page with Hematology results with a lot of abbreviations and amounts. Most of those look within the normal range with "RBC", "Hct" and "Hb" slightly elevated. Written in is "MHCT - 51%" Also "HWT = Neg".

Thanks very much!!!
Karen

[acushdogsmom]

ACTH STIMULATION TEST:

Cortisol Pre (8:10 am) 8.2 ug/dl
Cortisol 2 (12:10 pm) 1.1 ug/dl
Cortisol 3 ( 4:10 pm) 1.8 ug/dl

Interpretation of the dexamethasone suppression tests:
Pituitary Dependent Hyperadrenocorticism
Not sure why it says ACTH Stimulation test on your results sheet, but looks to me as if those are probably the Low Dose Dexamethasone Suppression Test numbers and especially because right after the result numbers it says that the interpretation of the results is Pituitary HAC (i.e. Pituitary Cushing's)

And I'd agree that those results are consistent with a diagnosis of Pituitary Cushing's because at the 4-hour mark there is suppression all the way down to 1.1 ug/dl and then at 8 hours, there is the beginning of "escape from suppression" (i.e. the numbers are starting to climb back up instead of staying suppressed)

I'm gonna guess that the blood sample he just took was likely for a chemistry panel and a thyroid panel. If the glucose is high, you may be dealing with Diabetes. And from the same sample he can have the thyroid function checked. A dog can have all three conditions at the same time though, so ruling in diabetes and/or hypothyroidism doesn't rule out Cushing's. Sounds to me as if your Vet just wants to see if you are dealing with only Cushing's or Cushing's plus another condition.

Don't worry though ... all of those three conditions are very manageable! :)

[Kakesie]

Thanks hon! I knew someone on here would know what those numbers meant. I haven't heard back from Dr. N yet, so I may not know any more on Buddy's latest blood tests and urinalysis until Monday. Will keep you all posted.
Thank you to everyone for being here! Without you all I'd be a lot more lost and afraid!
Hugs!
Karen & Buddy

[Squirt's Mom]

Hi Karen,

Hang in there, you're doing just fine!

Hugs,
Leslie and the girls

[Kakesie]

Thanks, Leslie and everyone!

Dr. N called on Sunday and said Buddy's blood tests & urinalysis were consistent with Cushings and he would call the Pharmacy on Monday to get the Lysoden and they would be calling me. It's Monday evening and they haven't called yet, but maybe they were closed today because of Columbus day? Hopefully we can get him started on Lysoden tomorrow.

Buddy will also be having surgery to remove a lump on his tail near his rump and will have his teeth cleaned while he's under anaesthesia. Just had Dolly (my MegaEsophagus dog) in to the vet this past week, too. She inhaled a Pepto Bismol tablet into her lungs, has been vomitting, 103.8 fever and has Aspiration Pneumonia! (My vet bills are going to be HUGE!) But they're worth it! They're our family!

Will keep you all informed. Thanks so much for all your support!!!
Karen, Saralisa (my daughter),
Buddy (Cushings) & Dolly (MegaEsophagus)

[Harley PoMMom]

Hi Karen,

If you could get copies of the blood tests & urinalysis test and post the results here, it would really help us alot, also we all keep copies of all tests that are done on our pups. Also what dose of Lysodren is Buddy going to be on?


Just had Dolly (my MegaEsophagus dog) in to the vet this past week, too. She inhaled a Pepto Bismol tablet into her lungs, has been vomitting, 103.8 fever and has Aspiration Pneumonia! OMGoodness, you poor dear, you most certainly have your hands full and, yes, your checkbook empty!:eek::D This is the way it seems to go when you have more than one pup, as soon as you get alittle $$ put away or things are running smoothing...swoosh something happens. :eek: But a Pepto Bismol tablet...hmmm...don't think I heard of that one. I do hope Dolly is resting comfortably.

Let us know how you make out with Buddy.

Love and hugs.
Lori

[Kakesie]

Hi Lori,

Thanks so much for your reply. I recently posted Buddy's Cushing's results from the test he had done last April. I haven't gotten anything yet from his tests on Friday, but they just drew blood once, so it won't be the Onset - 4 hrs. - 8 hrs. test.

Yes, Dolly inhaling the pepto bismol tablet into her lung is quite a weird and scary situation! She has Mega Esophagus Disease, which is quite hard to manage. Most dogs diagnosed with it are given a death sentence. They usually die from Aspiration Pneumonia, but I've managed to keep her alive for 3 years now. But I don't know what will happen now that she has a foreign body in her lung. I belong to another online support group that deals with that disease.

The vet I'm seeing now is excellent, but he's also the most expensive one in town. But these dogs are everything to my daughter and me!

Well, that's all I know for now,
Thanks to everyone for your support!!!
Karen, Saralisa (daughter)
Buddy (Cushings) & Dolly (Mega Esophagus)

[Squirt's Mom]

Hi Karen,

Oh my! I sure hope Dolly will be alright! How scary! :eek:

Here is a link to Lysodren Loading and Tips from our Resource section that will help you a great deal in the coming days.

http://www.k9cushings.com/forum/showthread.php?t=181

Let us know when you are ready to start! And don't worry...we will be right here with you!

Sending prayers for Dolly's swift recovery!
Hugs,
Leslie and the girls