Mini-Me's B/G chart

[alan h]

I decided to do Mini’s B/G curve yesterday. As you can see she’s not any better than she was before, maybe worse.

We don’t know what to do;
*Reduce dosage (have we gone too high?)
*Increase dosage?
*Reduce Natural Hydrocortisone?
*Try a different insulin?

We welcome and encourage any and all feedback….we’re lost!
I’m still feeding same foods since Jan.4th.

January 11, 2013 B/G Curve:

381………8:45 am…….fed & 38u
417…….10:45 am
425…….12:45 pm
402……...2:49 pm
418……...4:45 pm (took her for a walk & now has “loose” stool – don’t have any clue why)
404……...6:45 pm
294….…..8:45 pm……fed & 35u
514…....10:45 pm
499……..12:45 am
385…..….2:45 am

January 12, 2013:

291……….9:40 am…..fed & 38u

Thanks to all of you!

Jeanne, Mom of Mini-Me

[labblab]

Dear Jeanne, Al and Mini-Me,

Welcome to our forum! I've done a little research, and found that you have another ongoing thread re: Mini-Me over at our sister site, k9diabetes.com:

http://www.k9diabetes.com/forum/showthread.php?t=4526

It looks as though your reply posted above is an addition to your thread over there as well as your initial post here. I've given the link to Mini's diabetes thread so that folks can get caught up on the entire history of her diabetes treatment. But it sounds as though Mini has also been diagnosed with Atypical Cushing's, and that is the reason why you have also joined us here. So in that regard, it will help us a great deal if you'll give us the background for that Atypical diagnosis, as well as the treatment path you've travelled thus far.

I haven't yet had the chance to read through Mini's diabetes thread in detail, but it sounds as though Mini's Atypical diagnosis has been treated in a manner that would be considered unconventional by many of us here: by giving supplemental steroids. I don't say this to scare you away from posting, by any means. But just to give us all a "heads up" that probably we will be exchanging some information that is new to us.

So please do tell us more about Mini's entire health history, so that we can all put our heads together and try to sort things out.

Once again, welcome!
Marianne

[molly muffin]

Hello and welcome from me too. I haven't gone through the threads that Marianne posted yet, but I do want to say welcome and did I read say, some new information?! Nothing we love more than something we don't know about that might be working. So, do tell! Eyes wide open. (I'd say ears, but we are Reading after all, so Eyes it is).

Sharlene and Molly Muffin

[alan h]

Dear Jeanne, Al and Mini-Me,

Welcome to our forum! I've done a little research, and found that you have another ongoing thread re: Mini-Me over at our sister site, k9diabetes.com:

http://www.k9diabetes.com/forum/showthread.php?t=4526

It looks as though your reply posted above is an addition to your thread over there as well as your initial post here. I've given the link to Mini's diabetes thread so that folks can get caught up on the entire history of her diabetes treatment. But it sounds as though Mini has also been diagnosed with Atypical Cushing's, and that is the reason why you have also joined us here. So in that regard, it will help us a great deal if you'll give us the background for that Atypical diagnosis, as well as the treatment path you've travelled thus far.

I haven't yet had the chance to read through Mini's diabetes thread in detail, but it sounds as though Mini's Atypical diagnosis has been treated in a manner that would be considered unconventional by many of us here: by giving supplemental steroids. I don't say this to scare you away from posting, by any means. But just to give us all a "heads up" that probably we will be exchanging some information that is new to us.

So please do tell us more about Mini's entire health history, so that we can all put our heads together and try to sort things out.

Once again, welcome!
Marianne


So kind of you to get involved in our situation

I will do my best to address your questions and think I may be able to take a short cut through some of them by briefly explaining how this all started: approximately 5 years ago our dog registered a high ALKP (1290) which caused us to have her tested for Cushing’s. We did the ACTH, Creatinine/Cortisol (?), ultra-sound and whatever else, etc. Everything came back negative so when we were told of the treatment options for A-Typical Cushing’s by U of T we did not at all like the effects of some of the medicines that were available at that time.
As a result we were referred to people who were advocates of the Adrenal Exhaustion concept which involves treatment with low dose of steroids (4mg Medrol per day or 20 mg HC per day for 80 LB dog) and Thyroid supplementation. In retrospect, it appears today that very few agree with our decision but, it must be said that we repeatedly tried to reduce the steroids over the last several years and every time we would do so Mini would back slide (GI issues, lethargy, sad droopy eyes, etc.) I now realize that could have been caused by a variety of things but all we can do at this point is move forward and try to correct any miss steps and try to get this awful diabetes under control.
It should also be stated that, initially, our local Vet suggested and initiated all of the standard tests to try to determine Cushing’s or whatever was causing her problems. Much of the subsequent actions or inactions were a result of our making suggestions to our local Vet based upon advice we were receiving from advocates of the adrenal exhaustion group.
I hope my comments have been helpful to you and I sincerely welcome any comments and suggestions you may have. We are new at this, scared about Mini’s health, and are trying to learn as much as we can so we can do what needs to be done as quickly as we can.
Thanks again,

Al & Mini-Me

[labblab]

Hi Al,

Thanks so much for this additional info. I am somewhat familiar with the theory of adrenal exhaustion, and apologize that I do not have the time available right now to offer out an explanation for those of our members to whom it will be new. I will be upfront with you, however, and tell you that I would not personally endorse the use of supplemental steroids for the treatment of elevated adrenal hormones. I hope you will understand that I am not saying this to be judgemental of your prior decisions. There is no doubt in my mind but that you have made all your choices out of a desire to help Mini and restore her health. But I just want you to know where I'm coming from re: any suggestions that I may make.

I would have to guess that the supplemental steroid is affecting your ability to control Mini's glucose levels. And right now, those erratic glucose levels are probably the biggest single threat to Mini's health. So, in my mind, the primary question right now is: can you safely decrease the hydrocortisone in the effort to stabilize those blood sugars? However, after having been on steroids for several years now, I realize there are significant issues associated with trying to taper her off.

May I ask what your vet has to say about the hydrocortisone? From your description, it sounds as though your vet has largely been obliging the adrenal exhaustion advocates in this regard. But to be blunt, it seems to me as though you are at the stage where an endocrinology specialist's independent assessment of Mini's situation may be crucial. Do you live in an area where you can seek a second opinion from a specialist? Is this something you would consider?

Marianne

[Squirt's Mom]

Hi and welcome to you all! :)


Everything came back negative so when we were told of the treatment options for A-Typical Cushing’s by U of T we did not at all like the effects of some of the medicines that were available at that time.

Just FYI, for your information as well as members who may read your thread, the treatment for Atypical Cushing's that is recommended by UTK is melatonin and flax lignans, both very benign substances. The risk involved in using these is minimal so I am not sure what you feared in the treatment for Atypical. There are those pups who have elevations in estradiol that may not be produced in the adrenal glands and in those cases, Lysodren in added as a maintenance - an Atypical pup is NEVER loaded - but that isn't added until 3-4 months after the melatonin and lignans if needed. In my experiences, Lyso offers no more risk long-term than prednisone.; Atypical treatment as recommended by UTK is the most gentle cushing's treatment available - including this steroid treatment your baby has been on. ;)

IF things have changed out of UTK, we would LOVE to see their new recommendations for treating Atypical.

Also, if UTK has made a differentiation between Atypical and something called A-Typical Cushing's, I would also like to see their reasoning behind the change - what UTK says the difference is and how they are to be treated differently.

btw, UTK = the University of Tennessee in Knoxville which is the only lab in the world that we know of researching and testing for Atypical Cushing's.

If I were in your shoes, I would be running, not walking, RUNNING to an IMS with my baby to get them (is it male or female?) off the pred quickly and correctly, get proper testing done and proper treatment started IF needed. Right now, in my mind, the pred is at the root of much of the problems Mini is having. :(

Hugs,
Leslie and the gang

[labblab]

Al and Jeanne,

I still haven't had the opportunity to review Mini's entire thread at k9diabetes, but this excerpt did catch my eye:


Since Aug. 08 Mini has had several adrenal panels done by U of T and NVDS (this is a lab recommended by the advocates of adrenal exhaustion). Almost all showed elevated cortisol and/or estrogen. Initially, the T3 and T4 were low. Once we initiated the low dose steroid treatment (4mg Medrol) and thyroid med (.8 per day) the everything gradually improved to close to normal (except ALKP stayed high) ,even the IGa and IGg.
Don’t know why. That said, we frequently reduced the steroids and within 30 days Mini would backslide. As I said, we have no explanation.

If the UTK adrenal panel/s indicated elevated cortisol, then we here would label her as having "true" Cushing's rather than Atypical. The "Atypical" diagnosis is reserved for dogs who exhibit elevations in other adrenal hormones but a normal cortisol level. If, in fact, the UTK diagnostic panel indicated elevated cortisol, then the treatment recommendations were probably for trilostane or a full loading regimen of Lysodren -- and I am guessing those were the drugs that worried you.

I realize the "adrenal exhaustion" advocates offer out a different treatment theory/protocol in the face of elevated estrogen, regardless of what a dog's cortisol level may be. And the lab you are referring to (National Veterinary Diagnostics Services "NVDS") performs an alternative panel that is somewhat different from UTK's: it measures total estrogen (not just estradiol), cortisol, T3 and T4 thyroid levels, and IgA, IgG, and IgM immunoglobulin levels.

I don't want to dig into a lot of detail here, but just wanted to point out that there are differences in the theories/approaches of UTK and the adrenal exhaustion advocates. But in my own mind, what transpired four years ago is now water under the bridge. Once again, I know that you were pursuing what you thought best for Mini. And it may be the case that during this interim time period, things have shifted in such a way that supplemental steroids are truly useful to her. But I think the only way you can find that out is by exploring her current, ongoing need for the supplementation. And this will require working with a specialist who can safely explore the possibility of weaning her off the hydrocortisone if it is not helpful at this time.

Marianne

[molly muffin]

Hi, from what I've been reading, if I had to choose what to do this point and really, this is the point that matters the most. You need to find out exactly what is going on now. So, since so many, in fact majority of dogs with atypical cushings, usually end up with regular cushings, that is something to look into, however, if giving steroids, any typical testing results will reflect that and not reflect what is accurately going on.
Personally, I would want an ultrasound to take a look at, liver, adrenal glands, kidney, spleen, gall bladder. This should be done through an Internal Medicine Specialist. These dogs change so often and so quickly that it is very hard to try and keep on top of what their bodies are doing.
Anyway, an ultrasound might give you some answers and a consult with an IMS is never a bad idea.
I am of those who also, do not have any kind of firm diagnosis yet and we've been testing for almost a year. So I do understand how tricky this all is.

I should add, that I had a dog who was on steroids and it was an elephant in the room that I battled for 8 years. Their bodies grow to rely on it, just like humans when they take steroids and the after affects can be just as bad.

The body is a big circulating, counter dependent organ. So one thing affects other things. Cortisol and glucose go hand in hand together. Cortisol maintains normal blood glucose levels, kidney react to too much of it, livers become enlarged from it. It's a dual battle when combating cortisol issues and glucose issues as you trying to do. We know that this is tough.

Sharlene and Molly Muffin

[alan h]

Dear Jeanne, Al and Mini-Me,

Welcome to our forum! I've done a little research, and found that you have another ongoing thread re: Mini-Me over at our sister site, k9diabetes.com:

http://www.k9diabetes.com/forum/showthread.php?t=4526

It looks as though your reply posted above is an addition to your thread over there as well as your initial post here. I've given the link to Mini's diabetes thread so that folks can get caught up on the entire history of her diabetes treatment. But it sounds as though Mini has also been diagnosed with Atypical Cushing's, and that is the reason why you have also joined us here. So in that regard, it will help us a great deal if you'll give us the background for that Atypical diagnosis, as well as the treatment path you've travelled thus far.

I haven't yet had the chance to read through Mini's diabetes thread in detail, but it sounds as though Mini's Atypical diagnosis has been treated in a manner that would be considered unconventional by many of us here: by giving supplemental steroids. I don't say this to scare you away from posting, by any means. But just to give us all a "heads up" that probably we will be exchanging some information that is new to us.

So please do tell us more about Mini's entire health history, so that we can all put our heads together and try to sort things out.

Once again, welcome!
Marianne

Thank you for replying. Love the name LABBLAB!

We understand this treatment remains unconventional at best. Have found no one except its advocates that support it.

We continued with it because we were told it would do no harm and it seemed to work. Wish we could have a do over but must go ahead with cards we've been dealt.

We plan to determine if she needs steroids by safely reducing dosage & closely monitoring.

Also, we've been asked by Natalie, K9D, to send more test detail on Mini's original diagnosis to them & K9C. It may be too much for a post & we can't use attachments. Any ideas, as we have it on an Excel spreadsheet.

Yes, we would very much like to have a referral to an Endocrinologist that would review & consult for us. We live in SouthEast FLorida & welcome referral suggestions.

Thank you very much Marianne,

Al, Jeanne & Mini-Me:)

[alan h]

Hi and welcome to you all! :)



Just FYI, for your information as well as members who may read your thread, the treatment for Atypical Cushing's that is recommended by UTK is melatonin and flax lignans, both very benign substances. The risk involved in using these is minimal so I am not sure what you feared in the treatment for Atypical. There are those pups who have elevations in estradiol that may not be produced in the adrenal glands and in those cases, Lysodren in added as a maintenance - an Atypical pup is NEVER loaded - but that isn't added until 3-4 months after the melatonin and lignans if needed. In my experiences, Lyso offers no more risk long-term than prednisone.; Atypical treatment as recommended by UTK is the most gentle cushing's treatment available - including this steroid treatment your baby has been on. ;)

Thanks for your reply. You are right on with your comments. Unfortunately when we were first diagnosed in '08 melatonin & lignans with Lysodren in a maintenance dose were not recommended as a treatment by UTK.

We may very well wind up on that treatment protocol once we get the diabetes under control, possibly by eleminating the steroids.

IF things have changed out of UTK, we would LOVE to see their new recommendations for treating Atypical.

Also, if UTK has made a differentiation between Atypical and something called A-Typical Cushing's, I would also like to see their reasoning behind the change - what UTK says the difference is and how they are to be treated differently.

btw, UTK = the University of Tennessee in Knoxville which is the only lab in the world that we know of researching and testing for Atypical Cushing's.

If I were in your shoes, I would be running, not walking, RUNNING to an IMS with my baby to get them (is it male or female?) off the pred quickly and correctly, get proper testing done and proper treatment started IF needed. Right now, in my mind, the pred is at the root of much of the problems Mini is having. :(

Hugs,
Leslie and the gang

Thanks again, much appreciated!

Al, Jeanne & Mini-Me

[alan h]

Al and Jeanne,

I still haven't had the opportunity to review Mini's entire thread at k9diabetes, but this excerpt did catch my eye:

If the UTK adrenal panel/s indicated elevated cortisol, then we here would label her as having "true" Cushing's rather than Atypical. The "Atypical" diagnosis is reserved for dogs who exhibit elevations in other adrenal hormones but a normal cortisol level. If, in fact, the UTK diagnostic panel indicated elevated cortisol, then the treatment recommendations were probably for trilostane or a full loading regimen of Lysodren -- and I am guessing those were the drugs that worried you.

Absolutely right.

I realize the "adrenal exhaustion" advocates offer out a different treatment theory/protocol in the face of elevated estrogen, regardless of what a dog's cortisol level may be. And the lab you are referring to (National Veterinary Diagnostics Services "NVDS") performs an alternative panel that is somewhat different from UTK's: it measures total estrogen (not just estradiol), cortisol, T3 and T4 thyroid levels, and IgA, IgG, and IgM immunoglobulin levels.

Right again - I will try to post test results from both, but again there is a lot of information and I'm not sure the best way to post.

I don't want to dig into a lot of detail here, but just wanted to point out that there are differences in the theories/approaches of UTK and the adrenal exhaustion advocates. But in my own mind, what transpired four years ago is now water under the bridge. Once again, I know that you were pursuing what you thought best for Mini. And it may be the case that during this interim time period, things have shifted in such a way that supplemental steroids are truly useful to her. But I think the only way you can find that out is by exploring her current, ongoing need for the supplementation. And this will require working with a specialist who can safely explore the possibility of weaning her off the hydrocortisone if it is not helpful at this time.

Could not agree more.

Marianne

Thank you Marianne,

Al, Jeanne & Mini-Me

[alan h]

Hi, from what I've been reading, if I had to choose what to do this point and really, this is the point that matters the most. You need to find out exactly what is going on now. So, since so many, in fact majority of dogs with atypical cushings, usually end up with regular cushings, that is something to look into, however, if giving steroids, any typical testing results will reflect that and not reflect what is accurately going on.
Personally, I would want an ultrasound to take a look at, liver, adrenal glands, kidney, spleen, gall bladder. This should be done through an Internal Medicine Specialist. These dogs change so often and so quickly that it is very hard to try and keep on top of what their bodies are doing.
Anyway, an ultrasound might give you some answers and a consult with an IMS is never a bad idea.
I am of those who also, do not have any kind of firm diagnosis yet and we've been testing for almost a year. So I do understand how tricky this all is.

I should add, that I had a dog who was on steroids and it was an elephant in the room that I battled for 8 years. Their bodies grow to rely on it, just like humans when they take steroids and the after affects can be just as bad.

The body is a big circulating, counter dependent organ. So one thing affects other things. Cortisol and glucose go hand in hand together. Cortisol maintains normal blood glucose levels, kidney react to too much of it, livers become enlarged from it. It's a dual battle when combating cortisol issues and glucose issues as you trying to do. We know that this is tough.

Sharlene and Molly Muffin

Thanks for great advice. While we have had recent ultrasounds, we feel there are some tests that need to be done to give us a more updated picture of the situation, particularly after the onset of diabetes.

Al, Jeanne & Mini-Me

[labblab]

Al, thanks so much for your additional comments. I just checked Mini's thread on k9diabetes, and it looks as though you're preparing to transmit her test results to Natalie. We are extremely fortunate that Natalie is a staffer here, as well :). So it looks as though we may be able to soon coordinate a joint posting of test results.

Marianne

[labblab]

Back again, to thank you for sending those tests to Natalie and to let you know that we'll be lookiing them over just as soon as we can. Also, to keep our members here "in the loop," I'm adding a copy of this reply that I just posted on Mini's thread on the diabetes forum.


Hi Al and Jeanne,

As you know, I'm so glad you've started your companion thread on our k9cushings forum, and also delighted that you've transmitted those lab results to Natalie. As she's said, she has made them available to the K9C staff, and we shall be reviewing them shortly.

In the meantime, I do want to "second" Holli's suggestion that you hold off on any additional testing until you've first had the chance to consult first-hand with an endocrinology specialist. Steroid use of this duration does indeed have the potential to affect lab results, so some tests may be best deferred until Mini's hydrocortisone has decreased/ceased. On the other hand, some testing may be advisable now, at the outset of a steroid taper. One of the concerns that I have is whether, even though administered at low doses, Mini's longterm steroid use has decreased the ability of her adrenal glands to produce cortisol on their own. If it has, I believe she would be diagnosed with "Secondary Addison's," and this information could affect the manner in which the steroid taper proceeds. Tests of cortisol and/or aldosterone response as well as the naturally-occuring ACTH level (this is different from the ACTH stimulation test) may be recommended to help with this determination, so you may want to be selective re: the testing performed at this time as opposed to proceeding with UTK's full adrenal panel.

So I do think that before you advance further with the steroid taper, it will be good to arrange that specialty consultation. Also, as Natalie has asked, can you tell us whether Mini had any overt symptoms of elevated adrenal activity at the time you first sought a diagnosis?

Thanks so much,
Marianne

[alan h]

Today we have a new problem with Mini...yesterday I noticed she wasn't drinking very much (hardly at all) so I gave her some Viyo liquid that I had from our vet and she drank that but nothing else.

Last night for the first time in 3 months we decided to go out to dinner (we were out for about 1 1/2 hrs) & when we returned she had somehow injured either her left leg/foot & limping. She either licks her foot or leg so I know she's hurting. I'm treating this w/Tramadol.

I've put a call in to our vet & am waiting now for him to call back. The leg I thing we can handle it's the not drinking that has us very worried and scared.

If anyone has been thru this not drinking please let me know how/what you did. We're desperate now.

Thanks to all of you!!!!!!!!!!!

Jeanne

I have also posted this to the K9D site as well.

[lulusmom]

Hi Jeanne,

As long as Mini is not dehydrated, she shouldn't be in any immediate danger. You can check for hydration by pressing on her gums. Lift her lip and check the color of her gums. They should be a nice pink tone. Note that white gums can indicate anemia and blue gums can indicate lack of oxygen. If dehydrated the gums will feel dry and sticky/tacky. Press on the gum with your finger and release. The gum will turn white under pressure as it moves all of the blood out of the area you are pressing. When you release the pressure, the color should return to that area within a second or two, which is how long it takes to refill the capillaries. If it remains white, Mini is dehydrated and should be seen by the vet asap. She should probably see a vet sooner than later anyway for the leg issue.

Glynda

P.S. I haven't been posting much but I wanted to echo the many members who have recommended that you get Mini in to see an internal medicine specialist. Now would be a very good time to do that. I'll be back later to share some more thoughts.

[labblab]

Jeanne, I'm so sorry about these new problems. My knee-jerk response is that I'd worry that Mini is responding poorly to the decrease in her hydrocortisone. If her adrenal glands are no longer producing sufficient cortisol on their own, she may now be relying solely on the hydrocortisone. If the amount of hydrocortisone she's getting drops below the threshold of what she requires to sustain normal body function, then "Addisonian" symptoms will follow. I'm fearful this may be what you're describing.

This is why, if she were mine, I'd return to the 20 mg. of hydrocortisone and not attempt a taper until you can consult with a specialist who can guide any necessary testing beforehand.

Marianne

[Squirt's Mom]

Please, I am begging you for Mini's sake, do not play around with her steroid dosing. Steroids are very dangerous substances and should only be used, adjusted, etc under the direction of an expert, the IMS.

[lulusmom]

Hi again,

I've been out of the loop for the last several days and was unaware you are trying to withdraw Mini from the NH. I completely agree with Marianne that you should not attempt to wean her off NH without the supervision of an endocrine specialist.

Glynda

[labblab]

Just wanted to add that I've not yet had a chance to look through Mini's labwork in sufficient detail. But one thing that did catch my eye is the fact that Mini's urine cortisol reading in 2010 and baseline blood cortisol measurements in 2011 and 2012 were all abnormally low. I do believe this could be consistent wth the danger that Mini's adrenal glands have stopped producing adequate cortisol on their own.

Marianne

[molly muffin]

Personally, I'd be at the nearest Vet ER with a specialist in this area as Glynda suggested. At this point, I'm worried about an Addison's crisis from too low of cortisol, due to them no longer working as they should, as Marianne mentioned. This is a big worry.
I'm very sorry that this is happening, you must be worried sick. :(

hugs,
Sharlene and Molly Muffin

[alan h]

Personally, I'd be at the nearest Vet ER with a specialist in this area as Glynda suggested. At this point, I'm worried about an Addison's crisis from too low of cortisol, due to them no longer working as they should, as Marianne mentioned. This is a big worry.
I'm very sorry that this is happening, you must be worried sick. :(

hugs,
Sharlene and Molly Muffin

Hi Sharlene,

I just posted on K9D and thought I would copy it here also in order for you and anyone else that has any suggestions.

Thank you for your concern. And yes we are worried sick!:(


Posted on K9D:

Marianne, Natalie, Glynda, Jenny, Holli & Patty,

I want to thank all of you for your concern, questions and advice!

I also want you all to know it was not our idea to lower Mini's NHC, it was from our vet. Now we are second guessing his advice. We're not sure if he is in over his head w/our situation.

A different vet that Al spoke w/yesterday suggested giving her 1mg of Medrol along with the 15mg NHC she is getting to date. She has in the past always "bounced" back when we switched back to the Medrol and had a strong thirst & appetite. I was the one who wanted to get her off of Medrol due to the high ALKP. We're talking this over & will contact our vet to see if he agrees. I know most of you told us NOT to change her NHC and I'm beginning to think you all are correct. Interestingly, our vet hasn't mentioned that at all. He just keeps saying keep her where she is.

She still isn't drinking water. She will drink some chicken broth, which our vet also suggested, and he also suggested we give her SPIRONOLACTONE, which I bought from him last night. I'm to give her 1 tablet x 2 a day, which I started last night. As of this mornings feeding she has a total of 2 tablets in her system so far.....and nothing as far as going to her water bowl. This med supposedly will increase her thirst....still waiting.

I have also googled "Veterinary Endocrinologists in Southeast Florida" and can not find anyone who specializes in this. Do any of you know of one??? Or one that would consult with us via phone, of course we would pay for this consult.

We are very desperate at this point, we just don't know which way to turn.

If you have any suggestions please, please let me know.

Thanks to everyone,

Jeanne, Distressed Mom of Mini-Me

p.s. Her B/G this morning was 203!
__________________
Al, Jeanne & Mini-Me -- Pointer/Lab | 75 lbs | 11.5 yrs |diagnosed 10/2012 | A-Typical Cushings (Adrenal Exhaustion) since 2008 treated w/small doses of steroids | home test w/meter | baked chicken breasts - no skin/bones, frozen green beans, cottage cheese, and oatmeal

[labblab]

I am very worried about Mini, too. Here is a link that will list all the board-certified internal medicine specialists in your area:

http://www.acvim.org/websites/acvim/index.php?p=3

On the "Specialty" line, select "Small Animal Internal Medicine." Then select "Florida," and then perform the search. Once you identify vets or specialty practices near you, you can Google them by name to find out about their areas of expertise. Ideally, you will be looking for an Internal Medicine Specialist with an interest in endocrinology. But just by virtue of having been certified as an Internal Medicine Specialist, these vets will have pursued additional training re: complicated illnesses and conditions. They may or may not require a referral from your regular vet.

Please keep us updated, OK?

Marianne

[lulusmom]

Hi Al and Jeanne,

I do hope you can get Mini in to see an internal medicine specialist as soon as possible as I do believe your vet is in way over his head. Actually, most general practitioners would be in over their heads with Mini's case.

I believe the spironolactone was prescribed for the high blood pressure, not to stimulate the thirst. It's a heavy duty diuretic so eventually Mini will want to drink water to stay hydrated and i don't think the drug acts that quickly. It is used primarily for congestive heart failure and it also inhibits production of aldosterone. If Aldosterone is elevated, and Mini's was at one time on the UTK panel, it can cause all kinds of problems, including congestive heart failure/fluid retention. Did your vet do any xrays yesterday and/or mention any heart irregularities or edema?

I don't disagree with your vet about weaning Mini off of the natural hydrocortisone...she needs to get off the steroids. They certaily aren't helping with the high blood pressure. However, if she were mine, I would only taper her off under the direction of an internal medicine specialist. She has been on them way too long and you need a specialist who is trained and experienced with the complexities of hormonal imbalances and their affect on metabolic functions to guide you through the process.

Glynda

[alan h]

Hi Al and Jeanne,

I do hope you can get Mini in to see an internal medicine specialist as soon as possible as I do believe your vet is in way over his head. Actually, most general practitioners would be in over their heads with Mini's case.

I believe the spironolactone was prescribed for the high blood pressure, not to stimulate the thirst. It's a heavy duty diuretic so eventually Mini will want to drink water to stay hydrated and i don't think the drug acts that quickly. It is used primarily for congestive heart failure and it also inhibits production of aldosterone. If Aldosterone is elevated, and Mini's was at one time on the UTK panel, it can cause all kinds of problems, including congestive heart failure/fluid retention. Did your vet do any xrays yesterday and/or mention any heart irregularities or edema?

I don't disagree with your vet about weaning Mini off of the natural hydrocortisone...she needs to get off the steroids. They certaily aren't helping with the high blood pressure. However, if she were mine, I would only taper her off under the direction of an internal medicine specialist. She has been on them way too long and you need a specialist who is trained and experienced with the complexities of hormonal imbalances and their affect on metabolic functions to guide you through the process.

Glynda

Please...I didn't mean to alarm any of you regarding Mini's drinking.

That being said, she did drink 2 cans of chicken broth (low sodium) with a cup of water mixed in this afternoon. However, even on those meds I picked up last night she still will not drink from her water bowl, ONLY if I mix it with the broth.

I can only hope that this will be better than no drinking at all. We'll just have to keep a good supply on hand.

We're still up in the air about putting her back to the 20mg NHC or switch to the Medrol again.

This morning her B/G was 203...I just tested her again @ 4:00pm and she is at 368! I'm not sure if this is from the pain in her leg/foot or something else. I did give her 2 tablets of Tramadol @ 4:00 just in case she is still hurting. I have to say that she isn't limping as bad as she was, seems to be a little better.

Yes Glynda the prescription bottle I got last night does say "to increase thirst" and no he didn't mention anything about x-rays, etc. Just told me to give her these pills & that should help. I definitely think he's in over his head and we will find someone that will help us!:(

As it stands right now Al has an appt w/Vet in Ft. Lauderdale tomorrow as a consult on Mini's health. It he doesn't come thru we will try the site given to find a "specialist" in our area that can lead us down the right path to help her.

I will keep you posted...

Jeanne

[alan h]

Hi Marianne,

Thank you for the information/web site. As I said to Glynda, Al is meeting with someone tomorrow to see if we can get more help from a "specialist".

I will definitely keep everyone posted.

Jeanne

[StarDeb55]

Jeanne, I have not posted to you before, but have been following Mini's story. I noticed that you've been giving her chicken broth to try to help with her hydration. You must make absolutely sure that no canned broth that you might use contains any onion or onion powder. Onions can cause a life-threatening anemia in our canine buddies.

Debbie

[lulusmom]

Hi Jeanne,

Unless Al is taking Mini to a specialist tomorrow, I really think it's a bad idea to get another general practitioner involved as they simply do not have the extensive training and experience needed for Mini's case. We are all very concerned about your girl and I am so concerned that I've been calling veterinary facilities in southeast Florida trying to find a specialist for you. I am happy to report that I have met with success.

I just spoke with Lauderdale Veterinary Specialists and they have an internal medicine department with an internal medicine specialist on staff. Her name is Dr. Allison Cannon and she is in M-F. She did her internal medicine residency at UC Davis so that's usually a good thing. This facility does not require a referral from your vet but they will want to see Mini's extensive medical records. This facility is also open 24/7 which is a real plus. More good news.....they accept Care Credit. If you are not familiar with this, it's like a credit card and depending on how much the bill is, you can get interest free terms anywhere from 90 days to a year. It has saved my butt many times.

I see that Natalie is also researching possibilities for you so she may come up with more names. Since a trusted veterinary source is supplying her with names, I'd probably go with whoever her source recommends. Maybe she can check Dr. Cannon out with her source??? Regardless, please, please make an internal medicine specialist your next appointment. Use link below for contact information.

http://www.lauderdalevets.com/

Glynda

[molly muffin]

Hi again. I have to say that I'd go with a specialist over a GP vet too. Mimi's case is very difficult and I think someone who has actually trained in the area you need is what is called for at this point.

I didn't know anything about specialists in Internal Medicine for dogs when I came here and had only seen my GP vet for my dog and for my dog before this one. I am so glad that I found a specialist to go to. They will work with your regular vet or they will take over the case depending on what you feel most comfortable with. They also can do the high res ultrasound to actually take a look inside of mimi and see what is what. You need to know what the adrenal glands look like at this point. You need to see the liver, kidneys, spleen, gall bladder and pancreas too. All of that will give you invaluable information on how to move forward and do what Mimi needs now.

It just feels like the gp vets and everyone is working blind, without that crucial information.

We worry a lot on here for all of our furbabies. You've just joined a group of worry warts, but it's a group with years and years of experience behind them and that is a good thing to have on your side. I at least feel 10 times better knowing that I go in armed with the best information that I can have and never just take a vet at face value. Question everything, you are Mimi's voice, you are her advocate, the only one she has.

We'll get through this together and try our hardest to get you hooked up with the kind of specialist that you need to see. You will be shocked at the difference between seeing a specialist and a gp vet. (I was!)

So, sending you both big hugs and a belly rub to Mimi. You're not alone! :)

hugs,
Sharlene and Molly muffin

[alan h]

Thanks Debbie,
Excellent observation that I would never have thought to check.Happy to report chicken broth (low sodium) is OK but beef broth was 0 sodium but had onion powder and sugar.
Great catch by you and thanks again.
Jeanne

[alan h]

Hi Jeanne,

Unless Al is taking Mini to a specialist tomorrow, I really think it's a bad idea to get another general practitioner involved as they simply do not have the extensive training and experience needed for Mini's case. We are all very concerned about your girl and I am so concerned that I've been calling veterinary facilities in southeast Florida trying to find a specialist for you. I am happy to report that I have met with success.

Al is going to consult with a "Board Certified Specialist" also located in Ft. Lauderdale. I'll keep all of you posted as to how that goes.

I just spoke with Lauderdale Veterinary Specialists and they have an internal medicine department with an internal medicine specialist on staff. Her name is Dr. Allison Cannon and she is in M-F. She did her internal medicine residency at UC Davis so that's usually a good thing. This facility does not require a referral from your vet but they will want to see Mini's extensive medical records. This facility is also open 24/7 which is a real plus. More good news.....they accept Care Credit. If you are not familiar with this, it's like a credit card and depending on how much the bill is, you can get interest free terms anywhere from 90 days to a year. It has saved my butt many times.

We will definitely keep her in our mind if Dr. (Terri Carro) Al is seeing doesn't work out. I can't get over how great everyone is on this site. It brings me to tears that you all go out of your way to help so much. I just get so down & depressed over Mini & what is happening to her. I don't have enough words in my vocabulary to thank you all enough!

I see that Natalie is also researching possibilities for you so she may come up with more names. Since a trusted veterinary source is supplying her with names, I'd probably go with whoever her source recommends. Maybe she can check Dr. Cannon out with her source??? Regardless, please, please make an internal medicine specialist your next appointment. Use link below for contact information.

http://www.lauderdalevets.com/



Glynda

Again Glynda thank you.



Jeanne

[alan h]

Hi again. I have to say that I'd go with a specialist over a GP vet too. Mimi's case is very difficult and I think someone who has actually trained in the area you need is what is called for at this point.

Yes and it seems it's getting more difficult every day.

I didn't know anything about specialists in Internal Medicine for dogs when I came here and had only seen my GP vet for my dog and for my dog before this one. I am so glad that I found a specialist to go to. They will work with your regular vet or they will take over the case depending on what you feel most comfortable with. They also can do the high res ultrasound to actually take a look inside of mimi and see what is what. You need to know what the adrenal glands look like at this point. You need to see the liver, kidneys, spleen, gall bladder and pancreas too. All of that will give you invaluable information on how to move forward and do what Mimi needs now.

We didn't know either before all of this with Mini.

It just feels like the gp vets and everyone is working blind, without that crucial information.

I agree. Al will be meeting with a "Board Certified Specialist" tomorrow for a consultation. Will kee you all posted.

We worry a lot on here for all of our furbabies. You've just joined a group of worry warts, but it's a group with years and years of experience behind them and that is a good thing to have on your side. I at least feel 10 times better knowing that I go in armed with the best information that I can have and never just take a vet at face value. Question everything, you are Mimi's voice, you are her advocate, the only one she has.

You are so VERY RIGHT!!! I have a call in to my vet and at present waiting for him to call. I have lots of questions & comments for him.

We'll get through this together and try our hardest to get you hooked up with the kind of specialist that you need to see. You will be shocked at the difference between seeing a specialist and a gp vet. (I was!)

Yes, I can see that just from the short time I've been here. It's like one big family helping each other with whatever they can. This site is the GREATEST.:)

So, sending you both big hugs and a belly rub to Mimi. You're not alone! :)

hugs,
Sharlene and Molly muffin

Thank you Sharlene for everything & thanks to all of you for being there when we need you the most.

Will let you know how tomorrow goes..

Jeanne, Mom of Mini-Me

[molly muffin]

Oh I am so glad you will be seeing a specialist. I do hope that they can finally get to the bottom of these problems.
Remember it is a process. What we all want immediately is to make sure that Mimi is stabilized and then get on a treatment plan that will alleviate all of this up and down and back and forth. A long term solution is what we all hope you get for this, that will give her years of a good quality life.
This is step 200 of the many baby steps that you have taken. I do remember that this all started for you quite a few years ago.
Wishing you the very best for tomorrow and can't wait to hear the latest.
We are one big family here and none of us ever forget it. We Know how difficult cortisol issues are to treat and diabetes issues. It's not easy and we do understand that.

Oh I almost forgot to mention and I did want to throw this in. Not all specialist are created equal, so be sure and ask the one you are going to, how many cases of cushings/cortisol issue and diabetes together she has treated. Every one of the specialist, specialize in their own area of interest. So make sure that the one you are going to have treat Mimi, is very familiar with these issues (as they are Mimi specific) and by specializing in endocrinology they should be up on the more well known specialist recent papers and research in this area. I literally had a chat with the specialist we saw, about the latest findings, research and recommendations involved in cortisol treatment. This is a crucial point too, as you don't want someone who specializes in something that has nothing to do with Mimi's issues treating a cortisol/insulin problem.

hugs,
Sharlene and Molly Muffin

[alan h]

Hi everyone,

Just wanted to give you an update on Mini-Me. I spoke w/our vet last night around 10:30 pm told him what was going on with her and that the "new" meds (that were to make her thirsty) didn't seem to be working very well.

He said I could stop giving the meds that are supposed to "make her thirsty" since she only had 2 pills. The info I found out about this med said NOT to stop giving the meds cold turkey, however my vet said that is meant for the canines who are taking it for their heart.

He also said we should either go back on Medrol (which is supposedly stronger than NHC) or up her NHC. We chose to go back to the Medrol, which I still don't like but we're doing whatever it takes to get her back to almost "normal" as we think she was beginning to back slide.

This morning I took her out & she did her business & then walked around the house to the back yard. There was a duck in the yard & she started to chase it even with her sore leg/foot! I had to make her stop. FYI - Our neighbor next door feeds all kinds of ducks, moorhens, squirrels, birds, egrets, & 3 hawks for the winter etc. & has a "pond" which we call "the cesspool". Anyway we always have some sort of bird/ducks in our yard during the day. Which we are not happy with but unfortunately there is nothing we can do about this.

I was definitely surprised by her reaction. Maybe we are on the right course with the Medrol. Time will tell.

I also know I have to keep a close watch on her B/G while being back on Medrol.

She still hasn't had a drink of plain water as yet. I still have to add the chicken broth. The vet said this should change by this afternoon or tomorrow. In the mean time I have no problem giving her the low sodium chicken broth if that's what it takes to get her to drink.

I think that's it, my mind is so scrambled (more than usual) right now, but will definitely keep all of you informed as we go along.

Oh, also will let you know what becomes of the meeting Al has this afternoon with the "specialist".

Again I give all of you heartfelt thank you's for all your help & support!
Don't think we could make it through all of this without you all.

Thanks again,

Jeanne, Hopeful(?) Mom of Mini-Me
__________________

[labblab]

Jeanne, I'm very relieved to hear that the immediate crisis has slacked off a bit. But after the events of these last couple of days, I'm absolutely convinced that you've got to enlist a specialist to oversee Mini's treatment from this point onward. So if things don't work out with the specialist with whom Al is talking this afternoon, you really need to press forward immediately to find somebody else.

I think that, right now, you're living from "band-aid to band-aid." But you're soon going to be at the point where major crisis cannot be averted. And it will be too late to try to connect with a specialist at that point -- you've got to get somebody on board now. I really do believe that. Even though it is probably the right thing to stabilize Mini back on the steroids right at this moment, the longterm picture may be very different, as we've discussed. So please, please, please let us know how things develop this afternoon with the specialist. And if they don't work out, let us all put our heads together to find somebody who can help your girl.

Marianne

[k9diabetes]

Hi Alan and Jeanne,

The veterinarian in Miami recommends Dr. Alison Cannon.

Natalie

[alan h]

Jeanne, I'm very relieved to hear that the immediate crisis has slacked off a bit. But after the events of these last couple of days, I'm absolutely convinced that you've got to enlist a specialist to oversee Mini's treatment from this point onward. So if things don't work out with the specialist with whom Al is talking this afternoon, you really need to press forward immediately to find somebody else.

I think that, right now, you're living from "band-aid to band-aid." But you're soon going to be at the point where major crisis cannot be averted. And it will be too late to try to connect with a specialist at that point -- you've got to get somebody on board now. I really do believe that. Even though it is probably the right thing to stabilize Mini back on the steroids right at this moment, the longterm picture may be very different, as we've discussed. So please, please, please let us know how things develop this afternoon with the specialist. And if they don't work out, let us all put our heads together to find somebody who can help your girl.

Marianne

I couldn't agree more with you, Marianne. You are absolutely right!

We are living "band-aid to band aid" and it's horrible.

Natalie also found a specialist for us to confer with. I'm going to tell Al as soon as I hear from him.:)

These diseases are soooo scary, and trying to do the best we can is even harder & scarier.:confused:

I promise I will definitely keep you all up to date as soon as I know something.

Thank you,

Jeanne

[alan h]

Oh I am so glad you will be seeing a specialist. I do hope that they can finally get to the bottom of these problems.
Remember it is a process. What we all want immediately is to make sure that Mimi is stabilized and then get on a treatment plan that will alleviate all of this up and down and back and forth. A long term solution is what we all hope you get for this, that will give her years of a good quality life.
This is step 200 of the many baby steps that you have taken. I do remember that this all started for you quite a few years ago.
Wishing you the very best for tomorrow and can't wait to hear the latest.
We are one big family here and none of us ever forget it. We Know how difficult cortisol issues are to treat and diabetes issues. It's not easy and we do understand that.

Oh I almost forgot to mention and I did want to throw this in. Not all specialist are created equal, so be sure and ask the one you are going to, how many cases of cushings/cortisol issue and diabetes together she has treated. Every one of the specialist, specialize in their own area of interest. So make sure that the one you are going to have treat Mimi, is very familiar with these issues (as they are Mimi specific) and by specializing in endocrinology they should be up on the more well known specialist recent papers and research in this area. I literally had a chat with the specialist we saw, about the latest findings, research and recommendations involved in cortisol treatment. This is a crucial point too, as you don't want someone who specializes in something that has nothing to do with Mimi's issues treating a cortisol/insulin problem.

hugs,
Sharlene and Molly Muffin

Hi Sharlene & Molly Muffin,

What great advice. I did relay this information to Al while he was on his way to see this Dr. I haven't heard back from him yet but will let you all know what took place & was suggested by her.

At this point all I can do is keep an eye on Mini and pray for the best!

Hugs back to you & Molly Muffin!

Jeanne

[alan h]

Hi everyone,

The vet that Al met w/yesterday (Dr. Terri Carro) asked us to have blood work done; blood work - wellness, adrenal profile, thyroid profile (which will go to Dr. Dodd), urine culture & have her blood pressure taken (never heard of this before). After everyone gets the results she will consult with our vet.

She also said to up her insulin & try to keep her B/G under 300 as she could go blind if it stays above that number and stays high for some time. I started last night giving her 38u & this morning 40u. I checked her B/G last night before she ate & it was 423, this morning it is 377. I will be checking her this afternoon & evening also.

Also Natalie I wanted to let you know that Al has an appt w/Dr. Cannon on Tuesday as she is off today. Will let you know the results of that consult as well.

She still will only drink if I use the chicken broth. Our vet & Dr. Carro have no explanation for this. I guess we'll have to see what the tests show.

Mini did go for 2 walks w/me yesterday & last night, which is good. She hasn't been doing that for a few days.

I have to get ready now to take our daughter (23 yrs old) to a plastic surgeon this morning due to a dog bite (on her face) she rec'd on Nov 4th. It got infected & she was in the hospital for a week and was being seen by an Infectious Disease Dr. It's healed now but still is painful so we have to find out what's going on.

But back to Mini, I will keep all of you informed as we go along.

Again we can't thank all of you enough. You all are a world of great information and we are so thankful that we found you!!!

Jeanne, Mom of Mini-Me

[lulusmom]

Hi Jeanne.

First I'd like to wish your daughter a speedy recovery and a successful visit with her specialist. I'm so sorry that she had to go through such a traumatic ordeal. :(

Now let's talk about Mini's specialist. Dr. Carro is an internal medicine specialist so unless Al is unhappy with her, I don't see the need for you to incur the expense of another consult with Dr. Cannon. If it were me, I'd give Dr. Carro a chance to review Mini's history and assess the results of fresh tests she is recommending. I am glad to hear that a specimen will be sent to Dr. Jean Dodds for a full thryoid assay. She really is the best.

I noticed on Mini's UTK adrenal panel back in 2008, her post stimulated aldosterone was pretty elevated, which goes hand in hand with hypertension in atypical and typical cushingoid dogs. Cushing's whether naturally occurring or iatrogenic (brought on by administration of steroids) messes with all of the the body's metabolic functions, which is why if left untreated, a dog is predisposed to diabetes, pancreatitis, high blood pressure, cruciate ligament injuries, osteoporosis, etc. It is very difficult to get an accurate blood pressure measurement from a dog without the right equipment, a skilled operator and the right atmosphere. You want to make it as stress free as possible so a good number of dogs do better with their owner present during thie test. I'm sure Dr. Carro is very experienced because internal medicine specialists deal with endocrine hypertension all the time. Did Al mention to her that Mini is on Spironolactone? If not, please make sure she knows because this drug lowers blood pressure.

I'll be watching for your updates. You can find a copy of this post on your thread at k9diabetes as well.

Glynda

[alan h]

Sorry I haven't been on in a few days......everyone here has been down & worried.

I forgot to mention that our vet upped Mini's insulin up to 40u in the am & 38u in the pm. Today will be the 3rd day with the new units and actually this morning was the first decent reading we've had in a while...239. I wish & hope I can keep her around this number, but time will tell because of the Medrol (4mg) she gets every morning now.

She did drink "some" plain water yesterday morning but back again to the broth, which is okay with me as long as she drinks. Both vets have no idea why she is doing this.:confused:

She also took a walk with me on Friday, yesterday was nothing but rain, so she wouldn't go out except when she had too.

She seems a little perkier which is good. Her appetite is great, of course always has been, especially with taking the Medrol.

Thank you Glynda for your wishes for my daughter, that it appreciated and very nice of you.:)

Al is going to postpone his appt w/Dr. Cannon till the following week, just in case. We should have the test results by the middle/end of this week. Will definitely let you all know of the results. You all have been very, very helpful in your comments, suggestions, etc.

Again we are so happy & fortunate to have found this site as well as K9D.

Jeanne, (Anxious) Mom of Mini-Me:o

[alan h]

Well shut my mouth........I spoke too soon.

Her B/G this afternoon was 468! AND the chicken broth I was mixing with her water has dextrose in it. I didn't know that plus the beef broth Al bought also has dextrose in it and onion powder. OMG I can't believe I did that to her, no wonder her number was high this afternoon.

Al bought some chicken breasts that I am boiling and from now on will be making our own chicken broth for her.

It seems as though we take 1 step forward and then screw everything up. I know you learn thru your mistakes but we can't afford any more.

Thanks for listening to me & thank you all for the well wishes for our daughter.

Jeanne

[molly muffin]

I think making your own broth and boiling the chicken to do it, is a good idea.

:) Hang in there.

Sharlene and Molly Muffin

[Squirt's Mom]

I am VERY glad to hear you are no longer giving commercial broth. I have seen several pups who got very ill from canned broths, some didn't recover. :( Too often we don't really know nor pay attention to what is in some of the human food stuffs we offer our babies. Onions are NEVER a good bet, and in Mini's case, the dextrose certainly isn't. ;)

A tip on the homemade broth. Set it in the fridge overnite so the fat congeals on the top. Skim that fat off and offer the rest to Mini. There will be plenty of taste and fats left in what you keep without adding additional stress on her pancreas with added fats she doesn't need. ;)

Hugs,
Leslie and the gang

PS. How is your daughter doing? I hope she is feeling much better.

[alan h]

Hi Everyone,

I haven't been on this site or the K9D site for a while as I was waiting for all of Mini's test results to come back. We're still waiting on the results from UTK and urine culture (our vets office messed up the first one & we had to do another this past Monday). We should have the results end of this week or beginning of next.

On January 22nd we started cutting her 4mg medrol into quarters and have given her 1mg medrol w/breakfast, 1mg w/snack in the afternoon (about 6 hrs apart) and 1 mg in the evening with her dinner - for a total of 3 mg per day. This seemed to be working for her B/G as she was for days under 200. Now today she is in the 300's; this am she was 342 & at 2:30 this afternoon she is 361. I don't know what's going on. I haven't changed anything as far as her food goes. She still refuses to drink unless I put my homemade chicken broth in it, which I guess is okay.

I put a call in to our vet to ask him his opinion as what to do?? I have also noticed in the past week that she has started to shed a lot.

Her thyroid test from Dr. Dodd came back okay, thank God.

Her blood wellness came back a little confusing. Her ALKP is the lowest it's been since before she was diagnosed w/Atypical Cushings, it was in the 600's which is still high but she was in the thousands for 5 years. Also, her WBC & Neutrophils are way high. Our vet said this could be from her being so stressed out when they were taking her blood. She hates going to the vet. We won't know for sure what's going on until we hear from UTK and the urine culture results. I will keep you all up to date as soon as I hear something.

We're just totally lost at this moment.

And I have to say it's very hard for me right now sending this info to you all as I'm crying like a baby over the recent losses that I just read about. Life just shouldn't be this hard especially for our furry friends who can't tell us what hurts or feels wrong.

Thanks for listening to me & if you have any input please let me know.

My best to you all & hugs to your furry babies!

Jeanne, Mom of Mini-Me

MODERATOR'S NOTE: I have merged this post into Mini-Me's original Thread as we like to keep all info about a pup in one place.

[labblab]

I was just thinking about you guys today and hoping we'd soon be getting an update! And now here you are! Is Mini under Dr. Carro's care now or did you end up consulting with Dr. Cannon, too?

Marianne

[alan h]

Hi Marianne,

Al did see Dr. Carro, and she told him what tests to have. As soon as we get all the test results back (soon we hope) he is going to forward them to Dr. Carro and he still wants to make an appointment w/Dr. Cannon. He feels that there can never be enough information to gain.

Her B/G this morning was 309 @ 8:45 & this afternoon is 372 @ 2:30! I spoke w/our vet last night & he suggested going up 1 unit in the am & pm, so this morning she received 43u and tonight I will give her 41u of Humulin N. We just don't understand why all of a sudden she is going back in the 300's??? Especially when we really haven't changed anything with regards to her food & snack.

We're hoping that the test results from UTK & Urine Culture will tell us more. Our vet did mention that she might be a Cushings Pup now due to the fact that I have noticed over the past week or so that she is really shedding, more than normal.

Time will tell all, but we want to know now.

Jeanne

[Squirt's Mom]

Al did see Dr. Carro...

That's real nice, but Dr. Carro didn't get to see Mini? ;)

[lulusmom]

Her B/G this morning was 309 @ 8:45 & this afternoon is 372 @ 2:30! I spoke w/our vet last night & he suggested going up 1 unit in the am & pm, so this morning she received 43u and tonight I will give her 41u of Humulin N. We just don't understand why all of a sudden she is going back in the 300's??? Especially when we really haven't changed anything with regards to her food & snack.

Jeanne, Medrol is contraindicated for a dog with diabetes as it messes with the metabolic processes. Upward adjustment of insulin is to be expected. I would have thought Dr. Carro would have mentioned this to Al. Did she talk to Al about weaning Mini off of Medrol completely?


We're hoping that the test results from UTK & Urine Culture will tell us more. Our vet did mention that she might be a Cushings Pup now due to the fact that I have noticed over the past week or so that she is really shedding, more than normal.


Did Dr. Carro order the UTK panel? I know that Medrol can render an acth stimulation test useless for purposes of determining circulating and stimulated cortisol levels but I'm not sure what effect it has on the intermediate hormones. If Mini truly is cushingoig, there is no way to tell if it's iatrogenic cushing's caused by the Medrol or naturally occurring cushing's. I sure hope you can get Mini off of the Medrol because it is really complicating things. Does Dr. Carro think you can slowly wean her off so that she doesn't experience any ill effects?

[molly muffin]

Hi, glad to see you back again.
A UTI could also cause WBC to go up I think. Any infection can. That would also play havoc with her glucose levels. It will be interesting to see what those results are. Was she checked for a UTI? I can't remember.

When are they expecting the results to come back on the UTK panel?

Sharlene and molly muffin

[alan h]

Hi Everyone,

It's been a couple of weeks since I've been on...waiting for all the tests to come in and also what the "new vet" had to say about everything. Which so far has been NOTHING regarding the test results!

I already posted Mini's Wellness Test results now on with UTK (adrenal profile) came back as normal. Her urine culture finally came back and she was diagnosed with e-coli infection We have no idea where that came from, other than from our neighbor...he has what he calls a "pond" & we call it a "cess pool" as he feeds a lot of Muscovi Ducks & the Brown Ducks (not sure of the correct name) plus birds, feral cats, etc. Of course they constantly come into our yard, driveway, etc. Mini loves to chase them when she feels up to it. Anyway, we have been treating her with an antibiotic (zeniquin 100mg -one a day ) from the vets and will have her re-tested in a few weeks.

I've been testing her B/G on & off and she has been running anywhere from 91 to 428. I did a B/G curve on Thursday and her lowest # was 237 (1st thing in a.m.) and highest # was 428 @ 10:30 p.m. And I am taking the advice that I have been given from you all...I'm not getting nervous....yet.

I took her in to our vets yesterday (Friday) as she needed to be expressed, they said she was very full. She's always had trouble expressing naturally.

So when I e-mailed the B/G curve to the "new" specialized vet that Al saw I asked her if Mini was in some pain from the fullness of her anal sac could that have caused her curve to be so high? She sent me an e-mail this morning suggesting that I change Mini's food from home made to W/D, DM from Purina or Glucose Control from Royal Canin. She never mentioned my question about the pain. I was very, very disappointed. We gave this vet everything we have on Mini's health care (we made a binder from the beginning of her diagnosis to present & gave her one to keep for her records). She also stated that she wants me to do another B/G curve about 2 weeks after we change her diet.

I don't understand...I thought my home made diet was good food for her. I either bake or boil skinless chicken breasts, sometimes I throw in chicken thighs also skinless, also bake fresh salmon for her occassionally, boiled frozen green beans & oatmeal. Al is, I think, more frustrated than I am. One of the vets he consulted with told him that most vets recommend the W/D, I/D, etc. foods because that's where they make their money!!! I just don't know, I have read the ingredients on those diabetic foods and am not impressed with them at all. Do any of you all feed these foods to your baby? If so would you please let me know how that is working for you & your furbaby? I don't know what to do. Al plans to go to the Specialist recommended by Natalie.

I spoke with my vet last night about the curve results & also asked him if he's talked with "new vet" yet & he told me she sent him an e-mail telling him that she requested the Urine Culture. That's been it!

Thank you again for listening to me & I welcome all comments, suggestions, etc.

Jeanne, Frustrated Mom of Mini-Me

[labblab]

Hi again, Jeanne.

I am glad to see your update, although I am sorry that your news is still sounding discouraging. I just checked at k9diabetes.com and am pleased that you've posted your update there, as well. Because in terms of food recommendations for diabetic dogs, I think they will be your best guide. I believe there is a thread there that is devoted to discussion about commercial diabetic foods, but in addition, I'll bet folks will give you some specific feedback on your own thread there. Here's a link to the food discussion thread over there:

http://www.k9diabetes.com/forum/showthread.php?t=651

Before commenting further on Mini's other issues, can you please give us the actual numerical results for her UTK testing? And was this a full adrenal panel of pre- and post-ACTH results, or instead a panel of baseline results only? Even though you are reporting that the results all fell within normal range, it will help us to have the actual numbers to compare to her previous testing.

Thanks so much in advance for this additional info,
Marianne

[labblab]

I just wanted to add that even if Mini's UTK results were within normal limits, they still could shed some light on the effects of her steroid supplementation. For instance, if the full pre- and post-ACTH panel was performed, it will be very interesting to see whether or not her post-ACTH cortisol response was any higher than her baseline cortisol level. Even if the results fell within the normal range, the pattern of the results may offer a clue as to whether the steroid supplementation has affected the ability of her adrenals to produce cortisol on their own.

Marianne

[Squirt's Mom]

Al plans to go to the Specialist recommended by Natalie.

Is he planning to take Mini with him so the specialist can see the patient? :D;)

[alan h]

Before commenting further on Mini's other issues, can you please give us the actual numerical results for her UTK testing? And was this a full adrenal panel of pre- and post-ACTH results, or instead a panel of baseline results only? Even though you are reporting that the results all fell within normal range, it will help us to have the actual numbers to compare to her previous testing.

Thanks so much in advance for this additional info,
Marianne

No problem at all Marianne - thank you for your interest:)

University of Tennessee, Knoxville 1/29/2013:

Cortisol ng/ml : Result(Baseline) 5.0 Normal Range**2.1-58.8

Androstenedione ng/ml : Result 0.06 Normal Range 0.05-0.57

Estradiol pg/ml : Result = 60.0 Normal Range = 30.8-69.9

Progesterone ng/ml : Result = 0.29 Normal Range = 0.03-0.49

17 OH Progesterone ng/ml : Result = <0.08 Normal Range = 0.08-0.77

Aldosterone pg/ml*** : Result = 96.9 Normal Range = 11-139.9

* Above or below reference range
**Mean normal range values for female spayed dogs (N=36); QNS = Insufficient Sample
***Normal range values for male & female dogs (N=72 baseline, N=23 post-ACTH)
These results are within normal limits. Comments: Within reference range. Normal

This wasn't as easy as I thought it would be...I copied & pasted but the columns didn't come out right so.....the first number that you see is the RESULT (Baseline) and the second set of numbers are the NORMAL RANGE**

I hope this helps you in reading what I have posted.

Jeanne

[alan h]

I believe he wants to have a consult with her first & give her all the info we have compiled over the years, which we put in a binder for her.

He hasn't made any appointments yet but will probably do so tomorrow or Tuesday.

Jeanne

[labblab]

Dear Jeanne,

Thanks so much for taking the time to type out the results. Since a non-ACTH-stimulated blood sample was the only one submitted to UTK for analysis, however, we are still left with uncertainty as to one of the key questions re: Mini's treatment: can she be safely weaned off the supplemental steroid and if so, at what rate?

On the face of these baseline results, you may think, "Fine, her cortisol was within normal range." But her baseline cortisol was actually quite low, even after having been dosed with her steroid. The normal range for UTK translates into .21 - 5.9 ug/dl. Mini's baseline cortisol result was only .5 ug/dl, so that is very low-normal, according to UTK's range. Generally, in dogs for whom Addisonian issues are suspected, you additionally want to know what the result would have been for her adrenal reserves subsequent to ACTH stimulation. If the post-ACTH result is also low and flat, then I do believe you'd suspect that a dog in Mini's situation is suffering from Addison's secondary to longterm steroid supplementation, and prompt some additional testing. If confirmed, this would definitely affect the treatment plan going forward.

Another key element, though, is that the steroid supplementation itself can affect the ACTH result. So that is why you need a knowledgeable vet to oversee the testing process for a dog who is in the midst of longterm steroid supplementation. Did the specialist with whom you consulted know that you were planning to perform only a baseline UTK panel? And I guess she has not made any comment about the low cortisol result? I do believe these are important questions that need to be addressed, if not with the original specialist, with the new one.

Marianne

[alan h]

Well the time has come that I'm worried.

I'm posting this info here to see if anyone has a Cushings/Atypical Cushings baby that also has diabetes. And if you have any info on ketones and what to do as I need all the help I can get at this time.:(

Since changing Mini's insulin to Levemir on Friday morning has been a challenge...she started reading in the 500's Friday night and has continued thru to this morning (573). I'm trying to handle that, HOWEVER, we have been testing her urine for ketones and this morning she showed a "trace".

I don't know what to do now??? Everyone including our vet said to keep an eye on this, but didn't tell us what to do if she does show ketones. Al wants me to up her insulin from 3u to 4u, due to the fact that she also has to take Medrol (2mg in am & 2 mg with afternoon snack) which definitely ups the B/G. And even our vet said that 3u was really low to start.

I'm not sure what to do now. I have put a call into him this morning at 8:00am and again at 10:00am but I don't think he comes in on Sunday so I asked one of the girls I spoke with to put a call into him at home. He told me I could call him anytime, however, I haven't heard anything from him as yet.

Any comments, suggestions, etc.??? I need help before Al & I go crazy for sure.

Thanks,

Jeanne, Worried Mom of Mini-Me

[labblab]

I've just been over at k9diabetes.com and am really glad to see that you've posted this same note over there and you are starting to get replies. I hope Mini will soon get straightened out.

Marianne

[alan h]

Need lots of positive mojo to come this way...

Mini has been on Levemir for 6 days now. We know we started low at 3u am & pm., and she has been showing a "trace" of ketones since Sunday. The vet told me to up her Levemir to 4u am & pm.

Now this morning I had to up her from 4u to 5u as she is showing "small amt" of ketones and her B/G this morning before breakfast was 609.

I talked to our vet this morning & he told me to check her around 2:00pm & let him know how she's doing & what her B/G is. Also to keep checking her for ketones through out the day. He also told me that if she continues with a high B/G & "small" amount of ketones that I can give her 10u of the Humilin N that we still have in order to get more insulin in her. He said we can't go up more than 1 unit (Levemir) every 3 - 4 days as she could rebound, therefore we should use the Humilin N if necessary.

I have been doing everything to get her to drink also. She did go back to drinking plain water a few days ago but now I'm also putting some of my homemade chicken broth in her water to entice her to drink even more.

I just took her out to walk around the house & yard (we have a big yard) a little while ago and she dropped down and started rolling around kicking her back & front legs to itch her back...she did enjoy this & it made me feel a little better.

Also, she's been in the 500's since Friday night...had a couple of high 400's but this mornings reading really has me scared.

We've also decided to lower her Medrol 1mg to see if that will help lower her B/G. Will keep you all posted as we go along.

Thanks for listening,

Jeanne, Mom of Mini-Me

[Mel-Tia]

Sending you and Mini some positive mojo from the UK

I know nothing about diabetes but it seems to me you are doing all you can

Hope that glucose goes down soon

Xxxxx

[alan h]

Sending you and Mini some positive mojo from the UK

I know nothing about diabetes but it seems to me you are doing all you can

Hope that glucose goes down soon

Xxxxx

Thank you...I will grab all that comes this way.

Jeanne

[Mel-Tia]

Did the 14:00 reading improve?

You hanging in there?

More positive mojo being sent your way

Xxxxx



Need lots of positive mojo to come this way...

Mini has been on Levemir for 6 days now. We know we started low at 3u am & pm., and she has been showing a "trace" of ketones since Sunday. The vet told me to up her Levemir to 4u am & pm.

Now this morning I had to up her from 4u to 5u as she is showing "small amt" of ketones and her B/G this morning before breakfast was 609.

I talked to our vet this morning & he told me to check her around 2:00pm & let him know how she's doing & what her B/G is. Also to keep checking her for ketones through out the day. He also told me that if she continues with a high B/G & "small" amount of ketones that I can give her 10u of the Humilin N that we still have in order to get more insulin in her. He said we can't go up more than 1 unit (Levemir) every 3 - 4 days as she could rebound, therefore we should use the Humilin N if necessary.

I have been doing everything to get her to drink also. She did go back to drinking plain water a few days ago but now I'm also putting some of my homemade chicken broth in her water to entice her to drink even more.

I just took her out to walk around the house & yard (we have a big yard) a little while ago and she dropped down and started rolling around kicking her back & front legs to itch her back...she did enjoy this & it made me feel a little better.

Also, she's been in the 500's since Friday night...had a couple of high 400's but this mornings reading really has me scared.

We've also decided to lower her Medrol 1mg to see if that will help lower her B/G. Will keep you all posted as we go along.

Thanks for listening,

Jeanne, Mom of Mini-Me

[alan h]

Here's the latest update.......

I tested Mini at 2:30pm today and her B/G dropped to 521 from 609 this morning, plus she is now showing a "trace" amount of ketones, so that has dropped also. We took a long walk after and it wore her out, she got very tired, but did drink when we got home.

Al just got back from visiting our vet & the vet agrees that we started to low on the Levemir & he also said he's never used Levemir & is not that familiar with it, only what he has read. He also told Al that I should go to 6u tonight & see how she does in the morning. If she still has high B/G then I should up her 1u and go from there, and keep going up until we see B/G respond & ketones drop off to normal as they were before the change.

Al is beside himself as he has been saying what all of you have been saying since day 1. Now he's taking a very pro active position as what even the so called "specialists" have always told him..."the #1 factor in evaluating your own dog is to observe their behavior and respond & seek treatment accordingly".

I agree, Marianne, that we should keep her Medrol dosage the same. We don't need anything else to complicate matters. You're absolutely right.

Have any of you had this kind of problem with starting out too low on Levemir??? Just wondering how you handled it.

As it stands now I'm going to up her Levemir to 6u tonight and keep checking her urine & B/G and go from there.

All comments, questions, etc. are most welcome!

Jeanne
__________________

[alan h]

Did the 14:00 reading improve?

You hanging in there?

More positive mojo being sent your way

Xxxxx

Yes, her 2:30 pm reading was 521, last night it was 544 and this morning it was 529. I'll be testing again at 2:30 this afternoon.

I'm hanging....but sometimes it feels like "by a thread".

Thank you for the positive mojo, I'll grab that up for sure. :)

Jeanne

[Mel-Tia]

There is plenty more where that came from

I can imagine its tough going with all the testing and getting those numbers, hope it calms down soon

Xxxxx

[alan h]

There is plenty more where that came from

I can imagine its tough going with all the testing and getting those numbers, hope it calms down soon

Xxxxx

Again, thank you! :)

This has been tough going. It was hard to take when she was diagnosed with atypical cushings but now with the diabetes it's even harder, especially trying to get the right dosage and getting her regulated. The Medrol certainly does not help. :(

Her B/G this afternoon at 2:30pm was 482! Not great but she's under 500! Keeping my fingers & toes crossed for tonights reading.

Jeanne, Mom of Mini-Me

[labblab]

Hi again, Jeanne.

For the benefit of all our readers here, I am including a link to Mini's ongoing thread on the diabetes forum. I know we have been having some "parallel" conversations over there, and this way our readers will have access to the diabetic advice you are being given:

http://www.k9diabetes.com/forum/showthread.php?t=4615

As I said in my reply over there, I really don't know what the right answer is regarding the Medrol. It was my hope that the specialist would be able to guide you in that respect. I was basing my suggestion that you temporarily leave the Medrol unchanged on the dual facts that: a) we really don't know whether or not Mini's adrenals are capable of producing enough cortisol on their own, and b) she has recently done poorly on the occasions that you've tried to reduce the steroid on your own. On the face of it, the specialist's suggestion that you wait to start the weaning until Mini's insulin is stabilized does make sense to me. But I truly don't know what is medically advisable re: the Medrol at this time.

I'm certainly hoping that you'll soon see more improvement in Mini's insulin response.

Marianne

[Mel-Tia]

How are you all today?

Hoping that b/g has come down

Xxxx

[Mel-Tia]

Hey Jeanne

How are you and Mini doing??

Mel
Xxx

[alan h]

I haven't been on this site for quite some time but now need your help, if possible.

We definitely have been having trouble regulating her diabetes. Which brings me to a question if anyone can help. I want to wean her off of the medrol (because it also raises herB/G) and put her on melatonin and lignans but don't know how or where to turn for information. I'm aware of the fact that the U of T recommends melatonin & lignans now to help w/atypical cushings. They did not have this as a treatment when she was diagnosed, unfortunately.

My question: has anyone had experience with this? Can you give me suggestions or advice on what I should do or research?

Any comments, etc. are definitely welcome, :)

I have also copied my latest post from K9Diabetes for your info.

My thanks in advance to all of you.

Jeanne, Mom of Mini-Me


Posted on K9D:

My thanks go out to you all; Holli, Barb & Judi!

My vet did agree with me. He told me to stay on 16u but keep a close eye on her to make sure she doesn't go too low, which I have been doing.

Today we had another LOUD storm and I gave her 10mg of melatonin. I take it at night to go to sleep and I know that is what the U of T recommends now for a-typical cushings so I figured it might relax her during the storm...not a chance. She was very scared and stayed right next to me the whole time.

Yes Holli, I give her 2 tramadol am & pm, however the vet said that I could give her 2 in the middle of the day. I haven't really tried that yet but will try it tomorrow and see if that helps her.

I'm checking into getting her off of the medrol which also helps raise her B/G but she has been on it for about 5 years now for the a-typical cushings disease. I know now that they recommend giving your furbaby melatonin and lignans. I have to find out what the dosage I would give for Mini (she's 77.8 lbs.) and if anyone has any experience with their furbaby in this regard.

I will also post this on K9Cushings to see if anyone on that site can lead me in the right direction. I'm not sure my vet would know this.

Again I can't thank you all enough. Thanks for being there for me when I needed help!

[Harley PoMMom]

We have information in our Resource Thread regarding Atypical Cushing's and the treatment with melatonin/lignans, here's a link: Congenital adrenal hyperplasia-like syndrome/ Hyperestrinism/ "atypical Cushing's" (http://www.k9cushings.com/forum/showthread.php?t=198)

[labblab]

Hi again, Jeanne! I'm so glad Lori has given you that link. But for the benefit of our other members, I just want to clarify that UTK has recommended melatonin & lignans for the treatment of certain elevated intermediate adrenal hormones other than cortisol for several years now. This is the condition that they label as "Atypical Cushing's." When Mini's tests were originally analyzed at UTK, I believe she exhibited elevated cortisol which placed her in their category of conventional Cushing's. It was for that reason that UTK recommended medications other than the melatonin & lignans that would have been suggested had her cortisol not been elevated. Your labelling of Mini as suffering from "Atypical Cushing's" came from folks other than UTK who recommended an entirely different treatment protocol which led to the Medrol. Whew, I know this is confusing. But I just don't want people to think that melatonin/lignans is a new treatment out of UTK.

Which leads me to this question: Have you had recent UTK testing performed for Mini indicating that intermediate hormones remain elevated for which you are seeking treatment? This would require a full adrenal panel including ACTH testing, and not just "resting" or baseline hormone levels. Otherwise, I am not understanding why you would be starting the melatonin/lignans. From our previous conversations, I do understand why you would want to wean Mini off the Medrol. But that presents a different set of issues since it involves cortisol, and not the intermediate hormones for which melatonin/lignans are typically prescribed. So I'm hoping you can give us some more information as to your specific goal with the treatment.

Marianne

[alan h]

We have information in our Resource Thread regarding Atypical Cushing's and the treatment with melatonin/lignans, here's a link: Congenital adrenal hyperplasia-like syndrome/ Hyperestrinism/ "atypical Cushing's" (http://www.k9cushings.com/forum/showthread.php?t=198)

Thank you very much Lori. I appreciate the info as anything that I can get my hands on to help Mini I will take under consideration. I haven't changed anything and probably won't. I just get so darn frustrated when I'm trying so hard to help her every day.

Hope you & Harley have a great day!!!!:D

Jeanne