coming over from k9 Diabetes

[meggle]

Hi everyone

I started off on the K9 Diabetes forum a few months back and now I find myself here after my dog developed Cushing's as well :(
Just recently she has started getting terrible 'hot spots' all over her body, paws, back, flanks and now the latest a huge run right down the front of her neck and throat resulting in swelling and a temp of 104 and which is incredibly painful for her. Can anyone give me an idea on what can be used to treat and heal these 'hot spots' which seems to be wet dermititis. She's making herself bleed and it became so bad she was admitted to the vet hospital where the only thing they could think of using at the time was a steroid spray which we really have to avoid. She's back at the vets again for a few days while they try and keep her sedated where they can get the skin cleaned up and give it a chance to heal without her rubbing herself raw. She's become so depressed lately and she had been doing so well with her medications for both the diabetes and Cushing's that I wanted to hear from anyone else that has been through the same thing and how it was treated without the use of steroids.

Many thanks
Meggle

[lulusmom]

Hi Meggle, and welcome to the forum.

I can only imagine what a rollercoaster ride you're on at the moment and I'm so very sorry that your girl is in such discomfort. Hopefully, your vet can bring her some much needed relief.

With diabetes involved, you are in a catch 22 situation because if steroids are administered, there's a likelihood of insulin resistance and the BG will go up. I haven't checked out your thread at k9 diabetes so I don't know what the chronological order of treatment has been nor if you've managed to get the cortisol levels down yet. If so, the problems you are seeing may be severe allergies that were being controlled by the excess cortisol and now that cortisol has been lowered with treatment, things have spun out of control.

According to your description of the problem, I would think that there is a severe bacterial infection and that your vet has put your dog on a course of strong antibiotics?? I'm familiar with severe allergies that turn bacterial and I can attest that my dog was severely depressed from the constant pain and itching. Steroids were about the only thing that brought her relief but fortunately, she was not cushingoid so the risks didn't outweigh the benefits.

I'll check in on your thread at k9diabetes and will cut and paste information that will be helpful to members here. If there is insufficient information, I'll get back to you with a request of info that will help us better understand what is going on with your girl.

Glynda

[lulusmom]

Hi again.

It appears that you don't have the same user name on k9diabetes. Can you please let us know which user name you have used there? Thanks.

Glynda

[meggle]

Sorry Glynda I've actually forgotten which user name I had on the diabetes forum :(
It's difficult to be brief as she's been through the mill since being found as an unspayed stray and diagnosed as diabetic whilst in a dog pound, she came to me in Sept '09 on 17 IU's Caninsulin twice daily, the object was to get her spayed (just in time too as she had pyometra) and stabilsed and then re homed through the welfare organisation I work for. With the help of her vet we managed to get her virtually sub clinical on just 2 IU's twice daily and re homed a month later only for her to be returned 6 weeks from then in a terrible state and 3kg heavier :mad: She was then diagnosed with Cushing's.
I decided to adopt her myself as I wasn't prepared for anyone else to muck her around again.
At the moment she is on 7 IU's Caninsulin twice daily and she was started on 60mg of Vetoryl daily when first diagnosed with Cushing's in Jan '10, after her last ACTH test showed little response it was decided to reduce her Vetoryl dose to 30mg a day and test again 2 weeks later which we've done, latest results pre stim test was 134 and post stim test was 100, vet suggested alternating her dosage 60mg Vetoryl one day and 30mg the next and see how she went for a few weeks, she's been on this alternating dose for just 5 days now.

This latest skin flare up has been the worst yet, usually it just breaks out on a paw, flank or her back and it happens so fast! Literally one minute there's nothing there and then a few scratches later and she's taken the hair right off leaving huge raw patches, this often happens at night when you don't realise what she's doing. Late Friday evening she came in from another room, sat in front of me and I saw blood on her neck and was shocked to see the amount of damage she had caused to herself. Her throat and neck had swollen badly and I was quite concerned by her panting and how hot she felt, so I took her straight in to see the emergency vet. They had a battle to get near her as she was in so much pain but eventually managed to spray a steroid onto the area give her a antihistamine pill and she was settled at the vets for the night where they could keep an eye on her. She was sent home the next day with a collar on but the area is proving hard to heal as she is constantly finding ways to aggravate it, so this afternoon she was admitted again and it's hoped that if she is given the chance to relax and prevented from scratching at the area concerned that the sensation to need to scratch at it will diminish. Her vet does not want to use any steroids on her at all so she is going to be mildly sedated and given pain relief. She also started taking a/b's twice daily 3 days ago.

Her diabetes is still all over the place with blood glucose levels of anywhere between 1.3 mmol/L and then so high the Alphatrak won't even register a reading :( She's currently weighing 17kg and losing weight. Electrolytes were done less than a week ago and her Na/k ratio was 38.1 so that rules out Addison's as I was worried at one stage she was heading that way as she was being sick a lot. Water intake has dropped off over the last few days too as she had been drinking at least 5 pints a day recently.
Appetite is very good and she can be positively hyperactive when she's not so depressed, her mood swings have been all over the place lately but over the last week she has been very quiet and sleepy.
If I've missed anything out that might help in someone being able to recommend something for her problems which won't affect either the diabetes or Cushing's I'd be really grateful, maybe holistic?

Many thanks for reading
Sandy (Meggle being the patient!)

[BestBuddy]

Hi Sandy,

Is this you? http://k9diabetes.com/forum/showthread.php?t=1685&highlight=sandy

Welcome.

Jenny

[meggle]

:D Yes Jenny, thank you!!
My head is all over the place lately, she's putting me through it I can tell you!
Sandy

[meggle]

Have looked at using Sudocrem to help with the skin flare ups, no steroids in it just zinc oxide 15.25%, benzyl alcohol 0.39%, benzyl benzoate 1.01%, benzyl cinnamate 0.15%
She should be allowed home later today but vet has also shown concern over her recent weight loss so will draw some blood and see if there's anything else going on. Thought something would have been noticed when electrolytes were done a week ago but all came back within normal range then :confused:

Sandy

[lulusmom]

Hi Sandy

I don't have time to use the link to your k9d thread that Jenny has provided but I'll try to check in later today.

Glynda

[k9diabetes]

Hi Sandy!

In case you don't remember your password at K9D, you can request a reset or I can reset it for you.

I just went back through your thread and see that I already talked quite a bit about the link between cortisol levels and blood sugar levels there.

I have often thought that a diabetic dog on Trilostane might benefit greatly from being given Trilostane twice a day. The Trilostane/Vetoryl has a pretty short peak effect as I understand it. Not a problem necessarily for a lot of Cushing's dogs but in a dog with diabetes that fluctuating cortisol level could lead to a rollercoaster of blood sugar.

The other big factor is the skin and that inflammation and possibly secondary infection also could make her blood sugar very unstable. Any infection or inflammation can do that.

It is really important to stay away from low blood sugar - better for it be a bit higher so she can get to a stable point.

Those lows generate all kinds of hormonal triggers and could be responsible for the fluctuations you are seeing all by themselves.

I sure feel for you with the skin problem... do the vets have any idea what is behind it?

There are autoimmune skin disorders and perhaps with her cortisol lowered an otherwise manageable skin condition is running amok.

If her cortisol is on the low end of what they are aiming for, she might feel a little better if they let it rise a bit so she could get the benefit for other problems and still not blow her blood sugar out of the water. If I had to choose between the skin condition and slightly elevated cortisol, I'd go for the cortisol elevation.

Chris had just small lesions that seem to have been auto-immune related and it was so miserable. I can't imagine what it would be like to be dealing with large patches. Poor girl.

She sure is lucky to have landed at your house! :)

Natalie

[meggle]

Hi Natalie

Thanks for your reply. Meggie came back home yesterday wearing a collar, the minute the collar comes off she's at it! They have given me Fuciderm Gel to apply several times a day to get the sting out of it. When I went o give her insulin this morning I felt a small marble sized lump in her scruff a few hours later this has now doubled in size so I called the vets to find out what she'd been given and she was injected with Vetergesic in that area and seems to have reacted to it which they say is quite unusual so I have to monitor it through the day.
I have taken a pic of the area currently on the go, she has a small one on a back paw as well but this is the worse one she's had so far :( Vet just thinks it related to her Cushing's and not sure they are going to investigate it further :rolleyes: Her bg was 15 yesterday so that's better than being low as you mentioned. I'll speak to the vet about giving the Vetoryl twice daily too. Hope you can see this picture of the infected area.
http://i1043.photobucket.com/albums/b434/gundogs44/meggiesneck002.jpg

Thanks
Sandy

[meggle]

I had a good chat to my vet today and as Natalie suggested he's happy for us to try the Vetoryl twice daily so as of today she is having 30mg every 12 hours.
He aspirated the lump that appeared on her scruff and it was filled with nasty looking gunk which he's going to check out later. I'm going to continue taking her bg levels every six hours over the next week to see if the extra Vetoryl dose makes a difference to her blood sugar level. I'm also trying out a herbal formula, comfrey & calendula balm, on her skin to see if that helps with her hot spots :)

Sandy