Angus newly diagnosed and very sick :( - Angus has crossed The Bridge

[Cazbah]

Hi Everyone
My 14 year old Jack Russell Terrier Angus received a firm diagnosis on Monday for cushings.

A bit of history
He was diagnosed with bladder cancer in Sep 2010 and began Metacam which has kept the tumour from growing (it's about the size of a golf ball).

The weekend before last he was very listless, drinking lots and nit moving much. We have been experiencing issues with him having accidents in the house for a while but they were definitely worse.

We thought his kidneys were failing and on 17/10 with heavy hearts we called the vet out to put him to sleep.

The vet wasn't convinced he has kidney failure and wanted to do tests, he was admitted and tested positive for diabetes and had ketones so had to stay overnight on a drip, his blood sugar remained unstable and 'high' but as the vet suspected cushings and was wait g for test results he wanted us to care for him at home to avoid stress.

His cushings came back positive on Monday, he started 40mg of Vetoryl is on 12 units of can insulin twice a day, has had his Metacam dose halved and had a course of anti biotics for an infection.

Yesterday he was extremely listless had no appetite and drinking lots again as well as peeing lots, last night he was sick almost every hour
had no energy and can barely stand, his legs have really gone thin and scrawny.

I can't remember the figures for cushings but vet said they were very high and off the scale and had come down after the test but were still in the high range.

Today he has been readmitted to the vet to go on a drip, he has ketones and the vet says it's this and not side affects of the Vetoryl that's made him so poorly.

We are struggling to make decisions, I know that pets can respond well to the meds and want to give him the chance but I cannot watch him suffer like this without knowing if he has a chance.

Reading up in the web is just getting me more confused.

I want to have hope he will get better. Can anyone reassure me that they too had this kind of roller coaster to start with but it got better?

[Jenny & Judi in MN]

It sounds like you have a very good vet. I know the ketones are extremely dangerous and can take 3 or 4 days at the vet to get straightened out so I think Angus is in the right place.

if you go to the K9 diabetes forum there are some folks there who have gone through what you and Angus are going through. Scary times for sure.

I remember some of them saying that after the initial scare the diabetes management became routine so I think there is hope. He is just a very sick boy right now.

My Jenny also has diabetes and Cushings and the Cushings made her insulin resistant so it took awhile to get her insulin dosage to the correct amount. Hang in there. I'm going to add the link for the diabetes forum in a minute.


Here is the link: http://k9diabetes.com/forum/index.php If you post in the Diabetes your dog section people will see it sooner.

p.s. Jenny is on Lysodren but I've read on here that the Trilo is more effective given in 2 doses as most diabetic dogs eat twice a day 12 hours apart and the Trilo is better with food. Is Angus taking it twice a day?

Judi

[frijole]

I am headed off to work but wanted to send out a welcome and warm wishes for Angus.

It really is important to provide details of all cushings tests done to dx. Non-adrenal illnesses can result in false positives. I had 7 false positives before they finally decided my dog does NOT have cushings. It can be tricky.

With the cancer and diabetes - it certainly could be a false reading, especially if you only had one test done. Is Angus under the care of an internal med specialist or a regular vet? I ask simply because with everything going on it is usually best to go to a specialist. They can work with a regular vet as a team.

I will check in later. Thanks. Kim

[frijole]

P.S. If your dog is vomiting you should not be giving trilostane. It could be the cortisol is too low. Could be other things but I would stop it for time being. Kim

[Cazbah]

The vet admitted him on Thursday morning because she believed he has ketoacidosis, he hasn't responded to the fast acting insulin his blood sugars are still seriously high. we have bought him home again, as he has stopped vomiting, it's a case of trying to keep him going until the cushings medication starts to work as it seems he has insulin resistance. he may tick along for a few more days or have another crisis and have to go back.

I am finding it hard to decide what to do for him, I want him to have a chance but don't want him to suffer unnecessarily.

With the bladder cancer, the diabetes and the cushings and his age there are lots of complications but tonight he ate some food and was interested in us again.

I haven't got the bloodwork results but may be able to get them on Monday when we see the vet again.

Nobody can tell me what to do I know but if anyone can help with a take on what they have experienced it may help me massively.

I have registered on the diabetes forum but have had no confirmation email so can't post a thread :(

[labblab]

I have registered on the diabetes forum but have had no confirmation email so can't post a thread :(

I am so sorry that Angus is having such serious problems. The site administrator for k9diabetes.com is also an administrator here, so I have sent her a message in hopes that she can help sort out your registration when she next returns online. In the meantime, please do double-check your spam folder to make sure that your registration confirmation hasn't gotten "lost" or otherwise misdirected.

Marianne

[k9diabetes]

Hi,

I just approved your membership at the K9diabetes forum.

Natalie

[k9diabetes]

Has the vet given a large dose of the fast acting insulin? If the dose is too conservative, he might not show any affect. I've known a few terriers in a better spot healthwise than Angus who weighed about 24 pounds and needed 21 units of insulin per injection to regulate their diabetes.

Having his test results would help a great deal in possibly offering some advice. If his cortisol level was sky high, it could take a lot of insulin to make a dent in his blood sugar.

If he's had a large dose of fast acting insulin and absolutely no response at all, he could be one of a very few dogs who do not respond to the human insulin molecule. In which case the vet would need to get hold of some Caninsulin as quickly as possible and try that. Caninsulin is pork-based and is a moleecular match to a dog's natural insulin.

Getting the blood sugar down somehow has to be the first priority as he can't go through ketoacidosis for any length of time and survive. If you can find out as much detail as possible about exactly what the vet has done, all test results, what insulin was given and how much... maybe I could offer some thoughts.

Natalie

[Cazbah]

Thank you Natalie, he weighs 11kg and has 12 units of caninsulin every 12 hours, they have been giving him novorapid 0.2 iu/kg initially followed by 0.100/kg hourly whilst he was admitted. he was also on saline drip and eating little meals. Hid blood sugar never dropped below 22 even when he had the fast acting stuff.

He is quite settled tonight sleeping and waking to wee and drink.

his cortisol was something like 259 and 160 after second test by memory

[k9diabetes]

At 11 kg, that's about 24 pounds. He could need quite a bit more than 12 units of Caninsulin to get his blood sugar down.

He wouldn't be technically insulin resistant by definitions I've seen until he's on 24 units of insulin per injection and still has high blood sugar. I don't have the link handy and won't have time to track it down right now.

As I mentioned, I've known two terriers, one a Jack Russell and the other a fox terrier I think, who needed inordinately large amounts of insulin to regulate. Both weighed around 24-25 pounds and were getting 21 units of insulin per injection. Their blood sugar was very well regulated - they just needed a lot more than the average dog to get there.

If it was my dog, I'd be pushing hard for an increase in the insuiln dose. Stopping at half a unit per pound would be an artificial limit that the vet should be willing to push past in Angus' case where the situation is very serious.

Natalie

[Cazbah]

I will try calling the vet in the morning and asking them if we can t least try, if I make sure I have some glucose in I can at least do something if it goes the other way, I wonder why they haven't suggested trying it are they afraid that I will kick off if it goes wrong?

[k9diabetes]

Dr. Feldman at UC Davis in 2005 said insulin resistance should be "suspected" when poor control on 1.5 units per kg, which for Angus would be 16.5 units:


It is important to recognize that there is no insulin dose that clearly defines insulin resistance; however, for most dogs (and cats), good control can be achieved with a dose of insulin near or less than 1 U/kg/dose, and insulin resistance should be suspected if the dog or cat has poor glycemic control and is receiving a dose of insulin greater than 1.5 u/kg/dose.


PDF that came from on the subject of insulin resistance:
http://www.ivis.org/proceedings/navc/2005/SAE/127.pdf?LA=1

You can print that out and show it to the vet or tell them about it over the phone to back up your interest in raising the insulin dose. Let them know who wrote it and who published it so they know it's a valid source.

A Pet Place Article defined insulin resistance as:

Insulin resistance is defined as:


Persistent high blood sugar levels throughout the day when 3 units of insulin per 4 pounds of patient body weight are used
or A unit or more of insulin per pound of patient body weight (or more) is needed to achieve regulation


You can see the original article here: http://www.veterinarypartner.com/Content.plx?P=A&C=&A=3055&SourceID=

Three units per four pounds of body weight for Angus would be 18 units of insulin. One unit per pound would be 24 units.

He seems to be responding to the Caninsulin so that's the one I would increase and there is plenty of room for the dose to go up.

Dr. Feldman's article noted that:


insulin resistance can be mild, and thus easily overcome by increasing the insulin dosage


So it's not like the label "insulin resistant" means there's nothing you can do. I have known one dog who had to have corticosteroids to survive due to severe allergies and he was also diabetic. He needed a big dose of insulin and his regulation certainly wasn't flawless but it was good enough that he did okay.


A friend of mine had the only dog I have ever know who didn't respond to human insulin at all. His body just rejected it and giving him human insulin was like shooting water. It's really rare but it does happen. Her dog regulated absolutely beautifully on Caninsulin.


We are talking about Angus' survival. If the current vet is inflexible or throws up his or her hands and gives up, refusing to try a larger dose, I would find another vet to work with. When you're talking about ketoacidosis, the risk associated with doing nothing is huge so there's no reason not to try a larger insulin dose to see if his body will respond even if they think it's too much insulin.


Natalie

[Cazbah]

Angus had a settled night and has thrown us a curve ball this morning by testing at 18.9 wow! he ate some chicken and I have given him 12 units of caninsulin, I am scared about a low now so will test 2 hourly and have liquid glucose to hand.

Hoping this means that after 5 days of vetoryl he is starting to stabilise but not getting too excited yet! x

[Cazbah]

Today he has tested,18.9, 20.2, 22.2, 32.1 hoping that his second dose of caninsulin will bring him down again this is the best readings we have had since 17/10 when he was so poorly.

He is drinking less more settled, able to warn us when he needs a wee hoping that the Vetoryl is starting to do it's work on day 6 xxx

[Jenny & Judi in MN]

I'm so glad Angus is making progress, this is excellent news

[k9diabetes]

Yahoo!!!! :) I'm so happy to hear this.

Natalie

[Cazbah]

Despite everything Angus has been sick this morning and looks quite under the weather, blood sugar was 29.6 he has refused to eat so I have given him 6 units of caninsulin half his usual dose, have a vets appointment tomorrow at 09.20 will be taking the insulin info along with me.

It is a real roller coaster, I felt quite positive yesterday but today my heart is sinking :(

[addy]

I am so sorry for the roller coaster ride you are on and I hope your vet visit gives you some in sight.

Sending prayers and thinking of you,
hugs,
addy

[Cazbah]

We had to take him back and admit him as he is in ketoacidosis again, I am going to post on the diabetes forum as well but I am feeling that we may be kidding ourselves we can help my little man, I love him so much and I cannot bear watching him suffer like this.

[Jenny & Judi in MN]

hang in there. Sending positive thoughts for you and Angus.

Judi

[Cazbah]

Just had a call from the vet and she is really pleased with him, he has returned readings around 15 which is the upper limit of the normal range and has only tested +1 on ketones which is better than Friday she thinks today was a blip and we did the right thing. Hopefully the cushings meds are staring to kick in and he may be over this hurdle although I fear there may be more x

[Skye]

thinking of you......sending you all prayers and strength. Your doing all you can and are a great pet parent. ((((hugs))))

[Cyn719]

Praying for Angus - Hope he is feeling better soon!!! Please keep up updated xo

[Polkaroo]

The diabetes Cushings combo in JRT's is a difficult one to manage. We had a terrible time getting our Bazil regulated. Once she started responding to the Trilostene(Ventoryl, her need for insulin finally stabilized somewhat. She lasted a year after her diabetes diagnosis (it was due to delaying treating of her Cushings). We ended up putting her on a home cooked diet full of glucose reducing foods, monitoring her blood sugars 6 times a day and watching her like a hawk. In the end she died of an aneurysm at age 14.

If you can hang in there, and let the (Ventoryl) get the Cushings under control, the diabetes should follow suit. It will be a hard road and will take a while but eventually the need for insulin should stabilize. In Bazil's case, we were even able to reduce her Canninsulin a bit.

If you need to chat with someone who has been there, PM me any time. Good luck!

[Cazbah]

Sadly we lost our boy today, he took a turn for the worst and was fading fast before our eyes, when I could see no more we took him to the vets where he was put to sleep in my arms and passed peacefully. I guess he was too poorly with too many complications.
RIP Angus 10/05/97-01/11/11 :'-(

[Squirt's Mom]

Dear Cazbah,

I am so so sorry to hear about Angus. Know you did everything you could for him and that he left this old Earth on wings of your love.

Angus' name has been added to our Remembering List for 2011 where he will always be honored as a member of our family here at K9C.
http://www.k9cushings.com/forum/showthread.php?t=2865

Our thoughts and prayers are with you.

With deepest sympathies,
Leslie, Squirt, Trinket, Brick and our Angels, Ruby and Crystal

[Cyn719]

I am so sad to hear that Angus is gone- just remember you were wonderful to him and he lived a good life with you - you did everything you could for him - he may be gone but you have the special memories to hold to forever - Angel Angus will always be with you - Sending Love Hugs Prayers and Strength to you xo

[addy]

I am so sorry to hear of Agnus. Rest in peace little one.

Sending prayers and hugs,

Addy

[Roxee's Dad]

Dear Cazbah,
I am so very sorry for your loss. Rest in Peace sweet Angus. You are newest and brightest star in the sky.

[Casey's Mom]

Dear Cazbah, so very sorry to hear of Angus passing. RIP sweet little one, our newest angel.

Love and many hugs,

[mypuppy]

I am deeply sorry for your great loss. I know Angus's spirit will live on in your heart and thoughts. He is at peace..

May lasting and precious memories sustain you during this difficult time.

God bless you Angus....

xo Jeanette and Princess

[jmac]

I am so sorry to hear about Angus. You did the right thing. It is so hard to see them struggling, and that is the last thing we want for them. I hope your memories will bring you some peace and comfort.

Julie & Hannah

[Leena]

Aw...I am so sorry for the loss of your baby...Rest in the knowledge that you loved him and did everything you could for him. He is running free and happy now, and you will be together again..

[frijole]

RIP dear Angus - run free of pain, eat tons of treats and know you were loved and are missed. May all the wonderful memories sustain you as you recover from this loss. Kim

[bgdavis]

I'm so very sorry for your loss. Angus is free from pain and being very ill and is now running and playing at the Bridge. I'll ask Crissy to show him around.

Bonnie and Angel Criss

[Polkaroo]

I'm so sorry for your loss. :(

[jrepac]

Rest in Peace Angus....another terrier baby is romping around up there!

Jeff, Angel Mandy & the Girls

[Bichonluver3]

I am so sorry to read of your loss. I know that no words can take away the pain but please know we admire what you did for Angus and we share in your grief. God bless and godspeed sweet Angus. Fly free and healthy across the fields of heaven with all your new friends.
Love,
Carrol & Chloe

[Bailey's Mom]

Dear Cazbah,

I have just read your story and am so very sorry for your loss. I know all too well how tough and rough it is when they start sliding and you can't seem to find answers. As has been said-please know you did your very best. Angus had a wonderful parent. There is a lot to be said for not letting the suffering continue when there seems to be no hope.

Angus-fly, run and romp! Palmer and all the many other friends will welcome you into your new community/family. Cazbah, you will be reunited. You will see each other again.

Take care.
Susan