Cooper - diabetes and cushings - sweet Cooper has passed

[juliwilliams]

I'm a new member as we just got the confirmed cushings diagnosis today. My poor Cooper has been through a lot the last 3 months. Cooper is a (approximately) 10 year old, previously 73 pound, now 58 pound German shorthaired pointer. He's been drinking excessively for 2 years or so. He was tested multiple times for diabetes. Every time it can back normal but his liver enzymes were elevated, but not enough to be concerned about.

3 months ago he started peeing in the house and very quickly lost weight. That time his blood glucose level was over 500. We were told he also showed signs of cushings but the vet wanted to control the diabetes first. We did a steady increase in insulin (humulin n) until we reached 28 units. For the first time his blood glucose level was 230. He also had a bladder infection that required tougher and tougher antibiotics. Throughout the 3 months of insulin increases, there were so many factors that had to be considered, was the bladder infection causing insulin resistance? Was the possible cushings causing insulin resistance?

Once his bg level was somewhat acceptable, we waited 2 weeks then did a urinalysis to make sure the bladder infection was gone. Of course it wasn't and a urine culture was ordered. And the tested his bg again since the sugar was high in his urine. His level was up in the upper 300s. The vet said it's probably time to switch insulin. And he also thought it was time to test for cushings.

Cushings test was positive (I don't know the levels but it was an acth test). The vet has decided to keep him on humulin with the hope that his dose will decrease as his cushings is controlled. We'll be starting vetoryl tomorrow, along with a 6 week course of antibiotics since his bladder infection is still present.

At this point I don't have many questions since I've been doing an insane amount of research. I guess I'm just hoping for some stories of other dogs with diabetes and cushings. Specifically dogs being regulated for both at the same time. I haven't had much luck finding happy endings, which is something we're prepared for, we just want an honest idea of what to expect.

[molly muffin]

Hello and welcome to you and Cooper.
First thing, I'd like to suggest that you also join out sister site, http://www.k9diabetes.com/forum/
We do have members on both sites that are dealing with cushings and diabetes.
I'll let those who are familiar with both comment, but we have had members who have successfully controlled both. So it is doable, but it's hard and we understand that. The bladder infections just make a difficult situation that much harder of course. Definitely join the diabetes site.

Sharlene and Molly Muffin

[SoggyDoggy]

Hi and a big welcome to you and Cooper from me as well!

I can be of absolutely no use to you in anything regarding the diabetes, but I can tell you this place and the k9diabetes site is full of wonderful, caring and helpful people. It would be my guess that if anyone can guide you through the road ahead, they will be here and at k9diabetes.

Hang in there and don't assume the worst just yet.

[labblab]

Hello and welcome from me, too! Coincidentally enough, we have another new member with a little girl Cooper who is also challenged by both diabetes and Cushing's -- if you both end up posting at the same time, perhaps we'll need to shift to "Mr. Cooper" and "Ms. Cooper!" ;)

On a serious note, though, I can imagine how worried you are feeling and I "second" the recommendation that you join k9diabetes.com, too. We have several dual members of both sites, and I know you'll receive extra support. We have a long history of dogs who are very successfully managed with both diseases. So even though there may be bumps along the way, please do not give up hope.

Can you tell us what dose of trilostane Cooper will be starting with today? Also, I'm rather hoping you'll tell us he will be dosed twice daily rather than only once, because many endocrinology specialists believe that dogs being treated with insulin benefit from better management with twice daily trilostane dosing so as to keep their cortisol levels as consistent as possible at all times (rather than peaking and troughing at more inconsistent levels within every 24-hour time period).

We'll be very anxious to hear how things are going for you, so please give us an update when you are able.

Marianne

[juliwilliams]

I will definitely go join the k9diabetes website.

I can't remember what the vet said his dose would be, it was either 60 or 80 mg. The vet did not mention anything about giving it twice a day. He did say that while he's treated lots of dogs with diabetes and lots with cushings, he's never treated one with both. Which seems a bit odd since they appear to go hand in hand. The vet has been fantastic and seems to be doing everything that should be done (according to what I've been reading), but I'm going to check around for a vet that has treated both at the same time. I'd hate to do it since this vet is so attentive and Cooper is finally comfortable going to his office, but I also want to give Cooper his best chance.

[labblab]

Here's a quick link to an article that addresses twice daily dosing for diabetic dogs. Since you haven't actually started yet, I'd strongly encourage you to discuss this with your vet before purchasing the drug, if possible. Dr. Peterson is a noted authority on the treatment of endocrinological issues, and here's a quote:


In diabetic dogs with concurrent Cushing’s disease, twice-daily administration is essential in avoiding large fluctuations in serum cortisol concentrations during the day (1,2). With once-daily*trilostane*administration,*adequate*diabetic control will be next to impossible in many dogs with concurrent Cushing's syndrome.
Here's the article: http://endocrinevet.blogspot.com/2012/12/low-dose-twice-daily-trilostane.html

Here's another similar quote from Dr. Ellen Behrend:


In diabetic patients with hyperadrenocorti- cism, twice-daily dosing is absolutely recommended to avoid large fluctuations in serum cortisol con- centrations.


http://www.dechra-us.com/Files/dechraUSA/downloads/Case%20Studies/Clinicians%20Brief-trilostane.pdf

If your vet has questions about this, he can also contact Dechra directly (manufacturer of brandname Vetoryl). They have vets on staff who are happy to consult about issues such as this, and I feel confident that they will back up the recommendation for twice daily dosing in diabetic dogs, since both Dr. Peterson and Dr. Behrend provide continuing education on their behalf.

http://www.dechra-us.com/Default.aspx?ID=365

I totally understand your hope to remain with your current vet, and as long as he open to consultation with other folks, I would hope that he will be able to successfully continue to manage Cooper's care. I think that consultation is the key -- as long as your vet is open to talking with other more experienced specialists, there is no reason why he can't remain on top of things.

Marianne

[juliwilliams]

Thanks so much for that article! I just printed it out and I will bring it with me to the vet today.

[juliwilliams]

And yes my vet is very open to consultation. He has already been consulting with internists when it was just the diabetes we were trying to control so now that it's both issues I'm sure he'll be consulting like crazy!!

[labblab]

That sounds great! Also wanted to add that with twice daily dosing, you are splitting the recommended daily total into two half doses -- you are not doubling the recommended once daily total.

Marianne

[juliwilliams]

We went to the vet today. The vet said he had not read about giving it twice a day for diabetic dogs. But he said it makes sense to him and to go ahead and do it. He was going to start us at a very conservative dose of 60mg. He said to go ahead and give him one 60mg pill twice a day.

Now I have another question for anyone out there: what is loading? I keep reading about giving them a loading dose then testing. Should that be a high dose or a low dose? Right now our plan is to just test is blood glucose in a week.

[Squirt's Mom]

Hi,

I want to be sure you read Marianne's previous post about twice a day dosing. You do NOT double the dose so be sure your vet understands this. If he was going to prescribe 60mg a day he will keep very close to that total amount for the day with twice a day dosings - say 30mg in the morning and 30mg at nite.

Loading only occurs when one is using the drug Lysodren. With Trilostane (Vetoryl) there is no loading phase. Instead, ya'll Trilo parents get to play around with tweaking doses and deciding between once a day or twice a day dosing. :D

Be SURE your vet understands the dosing for twice a day BEFORE you buy or start giving the med to Cooper.

Hugs,
Leslie and the gang

[labblab]

Leslie, thanks so much for emphasizing that. Yes indeed, a daily total of 60 mg. does sound reasonable for Cooper -- but that means only 30 mg. twice a day! That's per the initial dosing formulas given in both of those links (1 mg/kg twice daily, which translates into approx. 1/2 mg. per pound twice daily).

Marianne

[Mel-Tia]

I am just chipping in as I haven't read that an ACTH test is scheduled for 10-14 days this is part of the protocol for giving vetoryl, that result will then give you a reading to determine what your next steps will be for continued testing.

Has your vet spoken to anyone at Dechra yet? Might be worthwhile nudging him in that direction sooner rather than later

Mel

Xxx

[juliwilliams]

We discussed it and he thinks 60mg twice a day is still a conservative dose for him.

We don't have an acth test scheduled for 10-14 days. The vet said 3 weeks from the start date but we'll be testing his insulin dose more often.

I just calculated that his meds are now costing us close to $400 a month. Ugh!! I hate to gripe about money when it's about a dog's life, but ugh!!! I hope the cushings meds will at least lessen his dose of insulin and save some money.

Whoever started this forum is my new hero! What a wealth of information already. Thank you all!

[Jenny & Judi in MN]

My Jenny used Lysodren but she is also diabetic and once her cushings got under control her insulin needs dropped from 7 units twice a day to 3 units twice a day. (she was 7 pounds at the time)

So it made a huge difference for her. Good luck!

[labblab]

Uh oh.....now I am getting worried. :( :( :(

I don't think your vet will find many specialists with large Cushing's practices who currently agree that starting a 59 lb. dog on a daily total of 120 mg. is a conservative dose. At one time in the past, yes. But no longer. Here's another quote from that article by Dr. Peterson:


When this drug was first used in Europe over a decade ago, the original starting dose was 4-10 mg/kg/day (7-12). However, as experience with the drug grew, it became apparent that these doses were too high in many dogs and lower doses were needed. Accordingly, the dosing recommendation on the US package insert states that an initial daily dose of 2.2-6.7 mg/kg is recommended (4).

My recommended starting dose is either 2 mg/kg given once daily or 1 mg/kg given twice daily. This is similar to the doses used in this study by Feldman (13), where the mean trilostane dose administered to his dogs was 0.86 mg/kg, twice daily (or a mean total daily dose of 1.72 mg/kg). Like Feldman, I feel that it is best to start with a daily dose that is at the low end or even lower than that recommended in the package insert. I would never start a dog on a dose at the higher end of the recommended dosage range (4-7 mg/kg), although some dogs with Cushing’s disease will eventually require daily doses that may be this high or even higher.

Dosing Cooper at 120 mg. each day works out to approx. 4 mg/kg -- exactly the level that Dr. Peterson is cautioning against! Starting Cooper at a dosage level this high not only increases the risk of unwanted side effects (which of course is the most important issue), but it also makes the drug more expensive for you. I just checked a couple of online pharmacies and as an example, find that you can purchase sixty 30 mg. capsules of brandname Vetoryl for $120 from Drs. Foster and Smith.

Also, I'm not sure how your vet has arrived at the three-week ACTH testing date, as it is not the timeframe that is recommended by Dechra. :( :(

I am including another link for you. It is Dechra's U.S. Product Insert for Vetoryl, and it contains a lot of important info re: appropriate treatment and monitoring. PLEASE DISREGARD THE DOSING CHART, because it contains the outdated dosing information to which Dr. Peterson is referring. Pay attention instead to the fact that the conservative end of the published dosing range is a daily total of 1 mg. per pound. Several of us who have spoken personally with Dechra technical reps have been advised that the 1 mg. per pound formula is the initial dosing amount that they are now generally recommending. Once again, if you or your vet have doubts or questions about this, I encourage you to contact Dechra directly.

http://www.dechra-us.com/files/dechraUSA/downloads/Product%20inserts/Vetoryl.pdf

If you already have the 60 mg. capsules in hand, I realize this presents a dilemma for you. You may be better off sticking with 60 mg. once daily until such time that you are ready to reorder new capsules as opposed to risking an early overdose. Once you have 1-2 ACTH tests under your belt, then you'd have a better idea as to what daily total Cooper truly can handle. But I would want to discuss the pros-and-cons of that approach (starting out once daily) with somebody more knowledgeable about diabetic management. And I would hope that your vet has not ordered more than just a thirty day supply at this point, since dosing changes are not at all unusual after the first thirty days of treatment and sometimes even sooner. (Plus, you likely can find less expensive options for buying your trilostane in the future if you explore options other than directly from your vet.)

Marianne

[juliwilliams]

My children kept me real busy tonight, but I'm going to give him just one pill a day until I can read through that info and talk to the vet. Getting so overwhelmed here. This sure is a steep learning curve! I have no doubt I'll get a handle on this...eventually.

[molly muffin]

Any questions you have just pop in and ask them. :) Someone will be around to answer.
Starting at 60mg once a day is a good place to start. You will eventually know way more than you probably would ever want to about dosing and standards and testing and everything else, cushings related. :)

I hope you had a good evening. Let us know how things are going!

Sharlene and Molly muffin

[labblab]

Yes, I also agree that starting with the single 60 mg. in the morning is likely the best move for the time being. We do have some diabetic dogs here who are dosed only once daily, so it's not as though it is never done. Twice daily dosing is the newer recommendation for diabetics, though, so that's why I want you and your vet to be able to consider it in the future.

Marianne

[Squirt's Mom]

Hi,

Learning curve is right! :eek::p Just don't learn while giving a massive dose of this med to Cooper. ;)

It worries me with Trilo that folks have the idea it is safe - it is NOT any safer than Lysodren so please do not take any chances with Cooper, and your vets attitude is rather cavalier. It will not hurt one little thing to wait before starting the treatment to get this business with the dosage worked out. That is much preferable to giving this dose to him and him ending up in the hospital, or worse. So learn before starting this huge dose. ;)

Hugs,
Leslie and the gang

[juliwilliams]

I just wanted to post a quick update on my Cooper. We did the 60mg dose of vetoryl once a day and 30units of insulin twice a day for about 2 weeks because we were going on vacation and didn't want to push things with Cooper while we were gone. When we got back from vacation we did a glucose check and 6 hours after his morning insulin his blood sugar was in the upper 200s (which was the absolute lowest we'd seen but still not in the desired range). The vet said to start giving 60mg of vetoryl twice a day.

He wanted us to stay at that dose for 3 weeks then do an ACTH test. We're 2 weeks into it and I just rushed him to the vet. His teeth were chattering for a bit so I left a message with the vet to see if this was some indication that the insulin was too high. Cooper went and took a nap then woke up and his back legs were twitching and he walked into a wall.

I took him straight to the vet. His blood glucose reading was 169. But she said she's more worried about him getting an overdose of vetoryl and that it sounds like he's getting addisonoid (is that a word?). His electrolytes were very low so he's spending the afternoon at the vet getting fluids and when we pick him up we'll find out how we're going to adjust his dose.

I had never heard about the teeth chattering or muscle twitching, so I thought I'd post his update so more threads would show up if people were searching!

[labblab]

Oh dear. It looks as though our worst fears have been realized as far as the possibility of overdosing Cooper with the addition of that second 60 mg. capsule. :( :(

I will keep my fingers crossed that he rebounds quickly. But depending upon how low Cooper's cortisol actually went, do be aware that Vetoryl's manufacturer advises against resuming dosing entirely until clinical symptoms reoccur and the cortisol is back to a normal level:


If the ACTH stimulation test is <1.45 μg/dL (<40 nmol/L) and/or if electrolyte imbalances characteristic of hypoadrenocorticism (hyperkalemia and hyponatremia) are found, VETORYL Capsules should be temporarily discontinued until recurrence of clinical signs consistent with hyperadrenocorticism and test results return to normal (1.45-9.1 μg/dL or 40-250 nmol/L). VETORYL Capsules may then be re-introduced at a lower dose.

Thank you so much for letting us know what has happened. We will continue to warn against starting dogs off at too high a dose, and so Cooper's experience may end up helping another doggie further down the road. :o

In the meantime, sending many healing hugs your way. Please keep up updated!

Marianne

[Jenny & Judi in MN]

My Jenny, also diabetic and Cushings went Addisonian from too much Lysodren. Thank goodness you caught it

The only hope I have for Cooper is that his BG stayed at 169. Jenny dropped as low as 40 so maybe you caught it in time.

Jenny's ACTH was at .2 after her overdose last April and she was on prednisone for about 4 months and hasn't been on anything but insulin since August 2012

It isn't the end of the world if it happens. Her hair looks better and she is frisky. And her cortisol is very very slowly coming back up

Please keep us posted. good catch. hugs, Judi

[juliwilliams]

Wait, so when they go Addisonian it's a long term, new condition sort of thing? I had assumed it was just a short term effect and that once the vetoryl was out of his system he'd go back to normal.

[labblab]

Due to the mechanism by which trilostane works, more often than not, cortisol levels do rebound relatively quickly in dogs who have "crashed" while taking the drug. However, there are exceptions and there is no way to predict in advance. For some dogs, it may take months before cortisol levels normalize. And a few dogs remain permanently "Addisonian" (meaning that they will require lifelong steroid supplementation from that point onward). But at this point, it is far too early to suspect longterm issues for Cooper. In the short term, the important thing is to stabilize him with IV support as is being done.

But since trilostane does have the potential to cause longterm adrenal suppression, you want to make sure your vet doesn't leap right back into resuming the trilo -- even at a lower dose -- until you are certain that his adrenal function has normalized once again based on his behavior and ACTH monitoring results.

Marianne

[juliwilliams]

I'm getting so antsy to talk to the vet now, there's nothing worse than looking things up on the Internet! She had mentioned doing his ACTH test early (he was scheduled for it next friday.) I'm hoping she wants to do it tomorrow, although I think I still would have to wait until Monday for the results.

[labblab]

Yes, I agree with you. If Cooper's electrolytes have dropped low enough to need IV support, he also needs to have his cortisol level checked ASAP. If it has dropped too low, he may need some oral prednisone for at least a few days in order to make up for the loss. The last thing you want is for him to go into a crisis over the weekend when your vet is unavailable. So even if the ACTH results are not known until Monday, I encourage you to ask your vet for prednisone to have on hand should Cooper appear to need it over the weekend.

I realize this is even a bigger issue for him since he's diabetic, and big changes in his steroid levels have an impact on his insulin needs. So I'd definitely want a gameplan in place before the weekend.

[juliwilliams]

Thanks! I will be sure to ask for some emergency meds in case we need them.

[Mel-Tia]

Just wondering how you and Cooper are? Hope everything is ok

Mel
Xxxxx

[juliwilliams]

Thanks for asking! He's doing well today. He got fluids all afternoon yesterday and sent home with prednisone (sp?). The vet had me give him half a 20mg tablet last night. She said to skip the vetoryl last night but to start again this morning since he really seems to need it to get his insulin to work. We're cutting back his dose from a 60mg pill twice a day to a 60mg in the morning and a 30mg at night. She said at the first sign of twitching or anything else unusual to stop the vetoryl, give him a prednisone and bring him right in.

He'll have an ACTH test in a week and a half. I think the vet is trying to hold back a bit on testing since he's got so much going on. I guess the vet wants to let his body adjust to everything. But if Cooper does have another Addisonion episode, I'll be stopping his vetoryl and making sure I don't start it again until his ACTH test comes back above 1.45 or whatever it's supposed to be.

Luckily I'm a stay at home mom and I have a 2 year old who naps around noon. Cooper had his little episode at 11am and I hate to think what would have happened if I wasn't here giving my son lunch. With the way the insulin and vetoryl work together he's most at risk 6 hours after his morning meds, which is right at noon. We're almost always home at that time for my son's nap.

[labblab]

Thanks so much for this update and I'm really glad that Cooper seems better. I must tell you, though, that I am extremely worried about your vet's decision to resume the trilostane without the benefit of an ACTH test. If I am understanding things correctly, Cooper has been taking trilostane for a month now -- and even had the trilostane doubled during that time -- without the benefit of any ACTH monitoring testing whatsoever. To now layer on an episode of electrolyte imbalance requiring IV stabilization and STILL not perform an ACTH test before immediately resuming the trilostane is truly contrary to safe protocol.

I know you will watch Cooper very closely, and you absolutely need to because he can get into serious trouble very quickly under these circumstances. I will be blunt here, but I do not understand your vet's reasoning re: postponing the recommended monitoring testing, and I do think she is putting Cooper at risk.

Please continue to keep us updated, OK?
Marianne

[molly muffin]

Hi Julie. Glad Cooper is a bit better. I too was very surprised that the vet recommended putting Cooper back on Trilostane without an ACTH test after this episode. How does she know where his cortisol level is currently at and if he needs a dosage or not? Strange.

Anyway, main thing is that Cooper is better and we know you'll have your eye on him and taking good care of him.

Sharlene and Molly Muffin

[juliwilliams]

It was my regular vet's day off yesterday so I was dealing with the other vet in the practice. I know that she did call my regular vet and consult with him. But I think I'll call tomorrow and see if he's in and set up a meeting to talk this through. I know he's never had a case as complicated as Cooper's and can probably usually breeze through on his usual protocol, but it looks like Cooper is an unusual case and I'd rather be safe than sorry. I'll skip his vetoryl tomorrow and call the vet in the morning. This evening he seems to be breathing a bit quicker than normal. He's always panting but it seems a bit more than normal tonight so I was thinking of bringing him in anyway.

[labblab]

You had mentioned earlier that your regular vet was consulting with some internists, but I am thinking that now might be a good time for Cooper to be seen directly by a specialist who is really familiar with the combination of diabetes and Cushing's. I agree with you that it sounds as though your general vet practice may be over-reaching at this point :o. For instance, when Cooper shifted to twice-daily dosing, I am worried that your vet decided to double the once-daily dose rather than halving it as is generally recommended. And once again, all of this without any monitoring tests.

Diabetes and Cushing's are tricky enough, individually. But when they are combined, it can really take the expertise of a specialist to keep things on an even keel. So if you do have an internist available to you, I'm hoping you may request a referral, at least at this early stage as you are trying to get Cooper stabilized on his medication.

Marianne

[doxiesrock912]

I agree Marianne. In fact, once diagnosed I would see a specialist asap so that they can advise your general vet. If I had done so, I would have saved quite a bit of money that I would have had for Daisy's future tests etc.

[molly muffin]

Poking my head in to see how Cooper is today? Is he still breathing really fast? Did you get hold of your vet to have a chat? :)
let us know when you get a chance!
Sharlene and Molly Muffin

[juliwilliams]

He had another little episode today. He went to get up and his back legs didn't work for a few steps, he just kind of dragged them. Then his back legs were twitchy again. I gave him a prednisone and rushed him in. His blood glucose was 330, they didn't check his electrolytes. We're going to keep him on the prednisone and off vetoryl for the weekend and then they want me to check in with them on Monday to see what to do next. I'm going to ask for a referral for a specialist then. I know it's going to be a whole lot more expensive, but hopefully it will keep us from having to go so often and keep him from going through so many swings. It has to be so rough on him.

[molly muffin]

Oh my, not good. I'm glad you won't be giving any more vetoryl for the moment. Frankly, it sounds like Cooper is being overdosed on trilostane. I wouldn't even think of starting back on that without knowing where the cortisol levels are at. This is very dangerous in combination with the diabetes. I do hope that you get to see a specialist and that they can get Cooper back on track. You guys need some worry free days and a break from this stress and Cooper needs to be well. :( I'm so sorry that this has happened.
Sharlene and Molly Muffin

[Harley PoMMom]

So sorry to hear that Cooper is feeling unwell. If this were me I would insist on having his electrolytes checked along with his cortisol levels ( an ACTH stim test.)

Please do keep us updated and I hope Cooper is feeling much better soon.

Love and hugs,
Lori

[molly muffin]

I think I should clarify why so many of us are worried. The experts, do recommend that with a dog with both diabetes and cushings that twice a day dosing is optimal for control and not getting spikes. However, you don't go from 60 mg, once a day to 60 mg's twice a day. You split the dose and give 30mg in the morning and 30 mg in the evening, approximately 12 hours apart to start with. Your vet absolutely double his dosage from 60mg once a day to 120 mgs, split to twice a day. I have Never heard or read of this being an acceptable protocol and frankly, it scared the bejeebes out of me. All of this without any testing to see where the cortisol is at. Cortisol can very much mess with the insulin and his diabetes.
I think this is why Cooper is currently having so many issues.
I would recommend this article and even have it printed out for your vet if you want by Dr. Peterson.
In it he talks about dosage for one a day and twice a day dosing and further into the article, he talks about dosing in relation to diabetes.

http://endocrinevet.blogspot.ca/2012/12/low-dose-twice-daily-trilostane.html

I hope this helps and you already know we are worry warts here, but for good reason. It's too easy for vets to not follow proper protocols and we are finicky about making sure that every advantage possible for successful treatment is given to both person and their furbaby.

hugs,
Sharlene and Molly Muffin

[juliwilliams]

Yes, I'm seeing why everyone is worried. I am too. It all seems to make sense when they explain things, then I come home, look things up, and start second guessing everything.

And just to clarify, the vet didn't doubled it with no test results, he just ran a blood glucose not an ACTH. The vet started us on once a day at 60mg. At this point we had already spent months trying to get his insulin regulated. The vet said, and everything I've read has said the same thing, that we had to get his diabetes under control before we should even run the ACTH for cushings. Cooper was at 30 units twice a day of insulin and still getting ridiculously high blood glucose readings. He did stop losing weight though which seemed like a good sign that the insulin was doing something. The vet thought it was insulin resistance due to cushings. He was going to switch insulin, but it seems as though getting other types of insulin is pretty expensive and somewhat hard to find. So, he ran the ACTH test and I hate to say but I never got the actual number that came back.

The vet started him on vetoryl. One 60mg pill once a day. I showed him that article and he did some research and said we should do twice a day when we returned from a vacation. He did a glucose test before we upped his dose. The reading was in the 200s which was a huge improvement, but not in the desired range. Based on that he doubled it and we switched to a 60mg pill two times a day, I'm guessing he thought the vetoryl was having a good effect on his insulin resistance but we weren't quite there yet. Now that I'm reading more on how these medicines work, I'm thinking that 30mg twice a day would have a far different effect on his insulin than 60mg once a day.

I will be sure to get ACTH tests before any changes to his vetoryl!! I don't think that my vet is a terrible vet or anything, in fact quite the opposite. They are by far the best bets we've ever had. But I think they just don't quite know what to do. My vet has never had a dog with both cushings and diabetes and I feel like he's just feeling his way through this. Given all the problems Cooper has had, I think it's definitely time to see someone with some experience with this!

Sorry for rambling! It's very late and it's been a long day!

[frijole]

Julie, We understand that the vet did blood test for glucose but you can't just double the dosage of the vetoryl without doing an acth test. It measures cortisol which is what is high in cushing's dogs. You must always test to find out where the cortisol is before making any dosage changes. If it is low or close to desired range there is no reason to double the dose. In fact you put the dog at risk. Giving the same amount twice a day would have been the logical next step as others have said.

Just wanting to clarify what we are talking about. Not doing an acth test before increasing the dose would be exactly like doubling the insulin amount without doing a glucose reading. Unacceptable. Kim

[labblab]

Hi again, Julie.

I am so sorry that Cooper had another episode and that he had to be taken in once again. I am really glad to hear that you will be requesting a referral to a specialist. You may find out that there is not really that much greater expense involved when you are only taking Cooper in for some regular office visits with the internist. These emergency visits, especially involving IV meds and overnight hospitalization, have to be expensive for you. And in truth, you really shouldn't have to pay for either of these last two episodes because they have resulted from your vet violating standard recommended protocol. Especially after a serious electrolyte imbalance, there was absolutely no way your vet should have immediately resumed the Vetoryl without testing the cortisol level. If your vet is treating other Cushing's dogs, with or without diabetes, he really needs to familiarize himself with the proper testing protocol that accompanies the prescribing directives for the medication. Because in the absence of proper testing, any other dog he treats has the potential to crash just as Cooper as done. If this is the first time it has happened for your vet, he is just plain lucky.

I hope it doesn't feel as though we are piling on here. But I am just trying to stress the importance of getting that referral for Cooper. At this point, your vet has already struck out twice. The third strike could have even worse results. :(

Do hang in there! It is great that you otherwise have had a really good relationship with your vet. And consulting a specialist doesn't mean that you need to "lose" your vet in the long-term or in conjunction with other more routine aspects of Cooper's medical care. But on behalf of all his patients, your vet definitely needs some guidance re: Vetoryl, and at this point, I don't want poor Cooper to continue to be the guinea pig. :o

Marianne

[juliwilliams]

Cooper is the guinea pig...that's exactly how I feel! I know he's treated lots of dogs with cushings and some very successfully for long periods. I know he's never had a case as hard as cooper but i can't imagine they're all easy and he's lucked out. I don't know why they're dropping the ball so much with Cooper. One of my friends just had her dog diagnosed with it and sees the same vet. I'm going to call her and make sure she knows about testing first before he changes the dose.

[juliwilliams]

Oh, and I'd say clinical signs of cushings are returning. He woke us up at 4am so he could lee and drink a bowl of water. Smells like he peed somewhere in the house overnight but I can't find it. He hasn't done that in a while.

[labblab]

Julie, how much prednisone are you giving Cooper? If he is receiving more prednisone than he needs to replace lost cortisol, then the prednisone will cause exactly the same symptoms as Cushing's. I've forgotten what the "replacement" formula is for prednisone, but I'll look it up and come back. Plus, there's always the chance that Cooper's cortisol has not ever dropped too low and he didn't need the prednisone at all. Electrolyte imbalances can occur while taking trilostane even in the absence of low cortisol. That's why the ACTH testing is so important in the event of an imbalance -- to find out what the issue is.

[labblab]

OK, the formula for calculating the "rescue" dose of prednisone for a dog who has crashed is .25 mg/kg. So if Cooper weighs 59 pounds (and my math is correct :o), then the most prednisone he could need to replace lost cortisol is approx. 6-7 mg. (59 divided by 2.2, times .25). So if, in fact, his natural cortisol is being oversuppressed, he should not need any more prednisone than that. And again, that is assuming that his cortisol really is too low. We do not know if that is the case.

Oh, and so you'll know, you cannot perform an ACTH accurately within 24 hours of Cooper having been given prednisone. This is because the prednisone will skew the test and register as though it was his natural cortisol. So this is another reason why you would have wanted the ACTH performed when he first presented last week in crisis with his electrolytes -- to find out whether his natural cortisol had truly bottomed out without the confounding addition of the prednisone.

[juliwilliams]

He's getting half a 20mg tablet, so 10mg every 12 hours. That's probably as close as we could get to 6 or 7mg.

I'm going to stop with the prednisone for now. I really don't want to compound things at this point. I'm just going to keep him on his insulin, antibiotics (he's on a 6 week dose to try and get rid of a lingering bladder infection), and proin (for some incontinence issues).

Hopefully we'll be able to get in and see a specialist early in the week and I want to make sure the prednisone is out of his system.

Thank you all so much!! I really appreciate all this help and such quick responses!!

[labblab]

Julie, that rescue dose of 6-7 mg. of prednisone is the daily total! If you have been giving 10 mg. twice daily, then Cooper has been getting a daily total of 20 mg. which is definitely WAY too much even if he had crashed, and that much prednisone would totally account for the "Cushing's" symptoms.

I am so beyond annoyed with your vet right now I could scream!!!!!

But given Cooper's diabetes and insulin needs, I really don't know whether or not it is now safe for you to completely quit the prednisone altogether after you've had him on that high dose of prednisone for a couple of days. You may need to cut back more gradually so as not to totally disrupt his glucose/insulin level -- like maybe give at least 10 mg. for a couple of days before attempting to cut back even more. Plus, he may actually need "some" prednisone in rescue -- just not 20 mg.! What a mess.

I am not a vet, and truly do not know what you should be doing right now, especially because I am not that knowledgeable about diabetes. Do you test his glucose level at home? Has it stayed OK in the face of the prednisone?

[juliwilliams]

Ah!! This is a clusterf*** if I ever saw one!! Besides the increase in water he seems to be ok. He's been real tired since his first episode on Thursday and hasn't really gotten his energy back. But it's also getting close to 80 degrees here in Texas and he doesn't do well with heat. I'm going to look up some stuff about prednisone and see if he should be weened off it. If so I'll cut back to one dose a day.
I'll call the vet first thing in the morning and let you all know when we'll be seeing a specialist.

[juliwilliams]

OK, just a quick update here. Cooper is doing well today, still real tired and drinking a lot but no other issues. I called the vet and he suggested starting the vetoryl again tonight at 60mg once a day then doing an ACTH test on friday, while also weening him off the prednisone for the next 4 days. I asked for a referral to a specialist. I just got back from registering my daughter for kindergarten and now I'm off to call the new vet and see when I can bring him in. I'm hoping today and in the meantime I am not going to start a vetoryl again.

[Jenny & Judi in MN]

I like your instincts. I had a vet who wanted me to give Jenny Lysodren and prednisone at the same time. It seemed insane to me and that is when we went to the specialist. Keep us posted!

[labblab]

I called the vet and he suggested starting the vetoryl again tonight at 60mg once a day then doing an ACTH test on friday, while also weening him off the prednisone for the next 4 days. I asked for a referral to a specialist.
Good for you, Julie!!!!!

In my opinion, the dosing/testing protocol your vet is suggesting is absolutely idiotic, and for multiple reasons. I'll try to come back and write more later.

Marianane

[lulusmom]

Hi Julie,

I've been MIA a lot lately and am just trying to catch up on things and wow, my mouth is still hanging open in horror after reading your thread:eek::eek::eek:. I actually had to read it three times to make sure I didn't miss something that could possibily excuse your vet's complete and utter ignorance. Thank God Marianne has been here to provide you with valuable information and I'm beyond ecstatic that you are not going to give Cooper any more Vetoryl and are taking him to a specialist. Good for you. I only wish Cooper hadn't had to go through so much to get to this point.

I have so many questions, I don't even know where to start but the most logical place would be the cushing's diagnosis. We've seen lots of breeds with cushing's here but Cooper's breed is not one of them and while I may not have immediately questioned the diagnosis after reading your first post, it became more and more suspect as your vet's inexperience continued to take a toll on Cooper's physical well being.

Did Cooper have any symptoms other than excessive drinking and peeing that would be consistent with cushing's, such as thinning or loss of coat, skin issues, panting or a voracious appetite? Did your vet run any differentiation or validating tests such as an abdominal ultrasound or endogenous acth test? Did your vet ever tell you which form of cushing's Cooper has..adrenal or pituitary? If not, I seriously doubt that he did either of these tests.

Dr. Mark Peterson, a world renown endocrine specialist, defines insulin resistance as doses greater than 1unit per pound to control hyperglycemia, and Cooper had a ways to go before he reached that point. I therefore believe your vet was premature in jumping on the cushing's bandwagon and then it appears he did an inadequate job of testing for it. Some breeds are known for being insulin resistant but regardless of breeding, dogs with high lipids in their blood or hypothyroidism (low thyroid) can cause insulin resistance. I don't think you have posted the results of any tests that have been done so I'd like to request that you round those up and post the results now. With respect to the blood chemistry and cbc, you need only post the highs and lows and please include the normal reference range. If triglycerides and cholesterol are moderately to severely elevated, lipids could be the problem. Cushing's and diabetes can transiently lower the thyroid hormone, T-4 which usually normalizes once the underlying problem is addressed. However, it could be that a dog with diabetes and low T-4 could have primary hypothyroidism, requiring thryoid supplementaton. If Cooper had low T-4 your vet should have ruled this out. Honestly, seeing those test results will help us all understand more about Cooper's history.

I'm sure I'll think of some more questions later but I wanted to give you some more food for thought before you have a consult with the specialist. Take a note pad so you can take notes and don't be afraid to ask questions because that's how we learn. Believe me, our IMS may appreciate me now but in the beginning, I'm sure he hated to see me coming. :D

Looking forward to your response to my questions and test results.

Glynda

P.S. Members have recommended that you join our sister site, k9diabetes.com. I do hope you have done so but if not, I strongly suggest you consider it. In the meantime, I'm going to ask Natalie to check in on your thread here. She is not only one of our admins but she is also the owner of k9diabetes and I dare say you'll not find anybody with more experience and knowledge of diabetes mellitus than Natalie.

[lemstar]

Julie--
I am sorta jumping in in the middle of things, and I don't know if you've seen my posts, but my Strider has diabetes and maybe Cushings too.

In short, my vet, who is very experienced with both, just returned from a conference, where our approach was confirmed as the way to go: keep adjusting insulin until we reach that 1u/lb of body weight. Strider weighs 60 lbs, although he should weigh 70 or 75 lbs, and we are up to 50u of HumulinN twice daily. His ketones stay negative, but glucose stays up. We have not seen it go below 400 since diagnosis, and at his last curve, it was up over 500 all day long.

Within a week or two, we may hit that 60u mark, and then we will re-evaluate.
Hope Cooper does well....and your new vet is awesome....

[juliwilliams]

Cushings has been a consideration for years. He started drinking a lot 2 or 3 years ago. I first thought diabetes and took him to our previous vet in Ohio. He said no on the diabetes but ran bloodwork and said his liver enzymes levels were high and we had to keep an eye on it. Two or so years go by with regular 6 month checks and his liver enzymes were holding steady at slightly elevated.

Then this past thanksgiving he started drinking even more than normal and having accidents in the house and early December (I think) he started losing weight very, very quickly. He is a German shorthaired pointer but has longer than average fur, at the nape of his neck it's about 2 inches long. We shaved him in the early spring last year and it grew back very quick then we shaved him again in the summer (he really hates the heat and we moved him to Texas so we thought he could use some relief) that time the fur never grew back. He definitely had the pot bellied look to him before he started losing weight. And his skin became very thin, like he lost the fat layer underneath. He was panting like crazy, and still does. And he started stealing food from our other dog and our children. I honestly think the cushings diagnosis is correct.

Our vet never did any differentiation tests, he just did the ACTH. He said if we wanted he could run tests to tell us which kind he had but that he'd treat them both the same so there was no real reason to spend the money on it.

I don't have any test results. I'm going to request them tomorrow, if I remember. Unfortunately I always have a very active 2 year old in tow and most of the time a 4 year old too. So usually I'm pretty scatterbrained and trying to keep my 2 year old from jumping off the counter! I do know his thyroid was tested when we were first diagnosed with diabetes and the results were normal.

In terms of insulin resistance. The vet thought it was possibly insulin resistance brought on by a bladder infection or from the cushings. He had a raging infection and we're still on antibiotics for it. After the first few rounds of antibiotics he did a urine culture and found out it was enterobacter and is treating it with a 6 week course of antibiotics specifically for enterobacter. We were going to do a urinalysis when he was done with the antibiotics.

He did finally do the ACTH test when we were at 28 or 30 units of insulin. He wanted to get the diabetes under control but Cooper was really not doing well. If he had cushings we needed to start treating it so he wouldn't spiral downhill anymore.

I think I answered everything, Glynda, except for test results (which is probably the most important part).

I think I joined k9diabetes, I'll have to double check. I don't have too much time nonlinear but I do need to spend more time on both of these sites!!

[labblab]

OK Julie, I am finally back again. I am so glad to see that Glynda has joined in the discussion and I will leave the initial diagnostic piece alone for the moment and just address my immediate concerns about your vet's proposed schedule for this week.

First, even if no other issues were involved, it would not be a good idea to begin once daily dosing in the evening. Dogs who receive only one trilostane dose each day need to receive it in the morning with breakfast so that the drug is metabolized properly and so that the monitoring ACTH test can be performed 4-6 hours after dosing.

Secondly, if no other issues had been involved and f the monitoring test was intended to gauge how well a 60 mg. dose was working, you would want the dog to have been maintained consistently on that dose for 10-14 days, not for for just 4 days, and not while it was being given simultaneously with a prednisone taper.

And finally and most importantly in your case, if the goal is to check the safety of even resuming trilostane at all after an electrolyte crash, you would perform the ACTH prior to beginning the dosing at all, and at least 24 hours after dosing with prednisone.

So I honestly don't see any logic to your vet's instructions. I don't know what a specialist will advise you to do this week. But assuming the Cushing's diagnosis is correct, one possibility may be setting up an appropriate prednisone taper, then performing an ACTH and electrolyte recheck, and then if the labwork/behavior gives the green light -- start over with the trilostane at either 60 mg. once daily (in the morning) or 30 mg. twice daily as we discussed may be the better option for a diabetic dog. That was an appropriate initial daily total given Cooper's weight, and he seemed to tolerate that dose OK with a positive response in his glucose level. But that's when the wheels came off the cart. This time around, you'd perform another ACTH after 10-14 days or certainly before any additional increase. Just some thoughts, although the specialist may go in a different direction. Bottom line, I'm so glad you've requested the referral!

Marianne

[k9diabetes]

Hi Juli,

I am the administrator of the K9 Diabetes forum - I checked and it looks like you are not yet a member (www.k9diabetes.com/forum (http://www.k9diabetes.com/forum)) - and I have had only a quick skim of your thread.

But what I have had time to read and digest is scaring the pants off of me.

A couple of weeks ago, I might have been able to give you some fairly direct advice about an approach to take with Cooper with his insulin and the Cushing's question... now, in the face of two overdoses of Trilostane and no reliable idea of what his current natural levels of cortisol are...

The overall picture is a muddy mess and I don't think anyone can tell you what should be done with Cooper as far as Cushing's goes until things can be settled on a routine that keeps Cooper safe without Cushing's treatment and his natural cortisol production level can be determined.

If Cooper was my dog, I would, not give any more Trilostane, period.

Even in a diabetic dog, there is no rush to treat Cushing's disease, and Cooper's insulin dose was never raised to a level high enough to come close to determining whether he was "resistant" to insulin.

In fact, there were numerous signs that he responded well to insulin. Blood sugar in the 200s was quite good.

I'm gonna continue in a second post to address some other issues.

Natalie

[molly muffin]

Hi Julie, where you able to get in to see the new vet today?

hugs,
Sharlene and Molly Muffin

[k9diabetes]

Me again! :)

I understand how it can feel wrong to second guess a kind and compassionate veterinarian. I have been in your exact spot and that's exactly what I had to do. Best decision I ever made.

I can tell you, based on my 10 years of intense experience with diabetic dogs, 5 years with my own diabetic dog, and association with the great folks here regarding Cushing's disease, that the veterinarian has very badly mismanaged Cooper's care. To the point that I wouldn't allow your veterinarian to make another single decision about his care.

I know the vet doesn't adequately understand Cushing's, diabetes, Trilostane, and prednisone based on a just one piece of information:


I just wanted to post a quick update on my Cooper. We did the 60mg dose of vetoryl once a day and 30units of insulin twice a day for about 2 weeks because we were going on vacation and didn't want to push things with Cooper while we were gone. When we got back from vacation we did a glucose check and 6 hours after his morning insulin his blood sugar was in the upper 200s (which was the absolute lowest we'd seen but still not in the desired range). The vet said to start giving 60mg of vetoryl twice a day.


When you got home to a dog on 30 units of insulin twice a day and 60 mg of Trilostane once a day whose blood sugar was in the upper 200s, regardless of the time of day of that reading, Cooper's Trilostane dose absolutely should NOT have been increased. An overdose of Trilostane and/or dangerously low blood sugar were all but guaranteed when the vet did that.

Two crashes later and the vet still does not seem to understand the problem.

In addition, the vet has you giving two medicines that oppose each other!

Prednisone is basically cortisol in pill form. So the vet seems to have suggested that you (1) give prednisone (cortisol), and (2) simultaneously give Trilostane (anti-cortisol).

Cooper needs a reboot with a really good specialist who will thoroughly assess his ability to produce his own cortisol and his current level of diabetes regulation and then basically start over.

If you are close enough to Texas A&M, they are a pretty good teaching hospital, among my top four or five in the country in terms of dealing with these two diseases.

Just so you don't think I'm a crackpot (maybe too late!), I will refer you to the long sad story of regulation of our dog Chris. We saw the man who literally wrote the book on Cushing's disease and diabetes, and he got it wrong with our dog. In the end, I regulated him myself through home blood glucose testing. He taught a lot of vet students rather poorly when it comes to diabetes and too many dogs are suffering from the results...

www.k9diabetes.com/k9diabetes.pdf (http://www.k9diabetes.com/k9diabetes.pdf)

You are always free to email me also. k9diabetes@gmail.com

Natalie

[juliwilliams]

We didn't get in to see a specialist today. We'll be going tomorrow morning to see an internal medicine specialist and I'll let everyone know how it goes. I'm hoping for (and will push for) a clean slate. I want to taper him off the predisone, then do a glucose curve to see where he's at. After that we'll see what the vet recommends. I think his body needs a rest before we try anything else with the cushings. My poor boy has been through so much. And my poor other dog must feel so ignored.

[k9diabetes]

That sounds like a good plan. I wouldn't let anyone talk you out of it frankly.

I can remember like it was yesterday instead of 9 years ago the day I realized I was going to have to start making decisions for our diabetic dog Chris. We had seen the guy who wrote the book on diabetes at the teaching hospital and his response to curves going from 100 to as high as 500 in 12 hours was "Don't change a thing! It's working!" His goal for diabetic regulation was the dog stops urinating in the house and becomes an acceptable pet again. Well, Chris had never urinated in the house so that wasn't a very helpful standard.

So I'm in the car on the phone with the GP vet and the GP vet isn't confident enough to counter the Teaching Hospital vet's advice and refuses to try a different insulin.

I knew in my gut as strongly as I have ever known anything in my life that what we were currently doing for Chris wasn't the best that we could do. I hung up the cell phone, looked at my husband in the driver's seat, and said "We have to find a new vet."

I have to tell you that it wasn't easy. I was disagreeing with the advice of one of the top vets in the country on endocrine disorders and had to change vets despite the fact that the GP vet was and is a smart, kind, compassionate and caring doctor who had done great things for our dog in the past.

From that day forward, I went with the attitude that the vet works FOR me and my dog and we make decisions together or we don't work with the vet at all. And every day thereafter Chris' regulation got better and better.

I recognize that I've had the luxury of concentrating on one disease, diabetes, and associated conditions like Cushing's and that that has allowed me to dig deeper into it than a GP vet generally has time to do, with the added advantage that I know my dog better than anyone on the planet and, through home blood sugar testing, knew my dog's blood sugar patterns better than anyone on the planet.

Dogs don't read the book, or even care much at all about the book! So you learn to read your dog's book and be an advocate for him and learn as much as you can on your own so you can recognize poor care when you see it.

I hope the IMS is good. But if not and you don't get a satisfactory approach and answer, you are in an area with lots of choices and no need to settle.

Natalie

[k9diabetes]

In terms of insulin, I think others already mentioned that a dog isn't considered insulin resistant until he is getting 1 unit per pound and still has high blood sugar all the time.

That is very different from a dog who has blood sugar of, say, 500 at meal time but whose blood sugar drops down into the 200s, as Cooper's did, and then goes back to 500 by dinner time.

That dog is absolutely responding to the insulin and the problem is more a matter of balance - sugar and insulin need to go together. If they don't, the blood sugar will drop far, eating up all of the insulin, and then rise back up again.

Also, the textbook curve is a lowest blood sugar at about six hours. BUT I can tell you that lots of dogs don't do that. Some respond very quickly to NPH and can have lowest blood sugar an hour to two hours after eating.

I've seen every curve imaginable in dogs, including "mountain" curves, where the lowest blood sugar is at mealtime. If that was happening with Cooper, the high 200s reading at six hours could have been the highest his blood sugar went.

One last thing. Some dogs need a lot less insulin than average and some dogs a lot more.

Our Chris was sensitive to insulin and at 62 pounds, he needed only about 8-9 units of NPH. Two terriers I have known, on the other hand, were not very sensitive to insulin. They both weighed about 24 pounds and each needed about 21 units of insulin twice a day! Definitely not "typical"! :) But they were well regulated on that amount.

So Cooper's needing 30 or 35 or 40 units of insulin would be well within normal units, just higher than average.

By the way, are you getting the insulin at Walmart? They sell Novolin N as "Relion N" - it's a house label, not generic - for $25 a bottle while the name brand Humulin and Novolin sells for more like $65-75 a bottle these days.

Do you test blood sugar at home?

Natalie

[juliwilliams]

Just got back from the IMS. Things went well and I have much more confidence in her. I left Cooper there for the morning. She wants to do a urine culture. He's about 5 weeks into a 6 week course of antibiotics for a bladder infection. She wants to make sure the infection is gone while he's on the antibiotics since they seem to reoccur pretty fast once we stop antibiotics.

She's also doing an ultrasound to look at the adrenals. My 2 year old was a disaster while I was there so I've forgotten half of what was said. I believe she said if he has an adrenal tumor that we wouldn't treat it with the vetoryl, or it could have been the opposite.

Like a few of you have said, she wants to do more frequent glucose curves to see if perhaps Cooper is not hitting his lowest blood glucose level 6 hours after his morning dose.

She wants to do an ACTH test again after he's off the prednisone for 24 hours to see where his levels are at now.

She talked to me for a good 15 minutes about everything. Including how the twitching could have been from complications from either disease. She said we need to be patient and take things real slow. Phew!! I'm so glad she's not going to rush into anything and just start throwing medication at him. She pretty much wants to start over. I'm glad we're going to give his body a bit of a rest but man this is going to hurt the wallet. I don't even want to know how much I've spent so far!

He should be done around 3 today and then I'm going to talk to the vet again about the ultrasound results and where to go from here.

[lemstar]

yay!
sounds good...

[juliwilliams]

By the way, are you getting the insulin at Walmart? They sell Novolin N as "Relion N" - it's a house label, not generic - for $25 a bottle while the name brand Humulin and Novolin sells for more like $65-75 a bottle these days.

Do you test blood sugar at home?

Natalie

Outran vet said not to get from walmart and not to use anything that's not landless humulin n. Is that right? Could I be using the $25 bottle instead of the $75 bottle??

We do not test at home yet. I'm willing to try it. The old vet said it would be good to do once he was regulated. I'll see what the new vet says about it.

[Squirt's Mom]

Great! Now do Cooper a HUGE favor and never take him back to his old vet. ;)

[juliwilliams]

Oh my goodness autocorrect!!

Our vet said not to get from walmart or use anything not labeled humulin n.

[lemstar]

My vet also insists on only brand name HumulinN. She says she has seen too many problems with Novolin.

[lulusmom]

Hi Julie,

Based on everything you have told us, there is no other conclusion I can come to but that Cooper's urgent care requirments (both times)were a direct result of your vet's complete and utter breach of treatment protocol. What he did was unconsienable and you are very lucky that you still have Cooper with you. I would hate to think what would have happened had Cooper's blood glucose crashed in addition to his cortisol levels. He easily could have not survived. If I were in your shoes, I'd be spitting nails...actually I am spitting nails over this. If I were in your shoes, I'd tell the vet with complete conviction that he needs to write off any charges for Cooper's er care as both addisonian crises were a direct result of his negligence. If he resists, Marianne has given you plenty of ammunition to give him which clearly proves his guilt. If you need more, let me know and we'll get it to you. You can use that money to help pay for the IMS charges.

You are in very company of those of us who have had inexperienced and ignorant gp vets. I believed the sun rose and set on my old beloved vet, who had treated all of my pets for almost 20 years and it was beyond horrible to discover that he was a complete nincompoop when it came to endocrine disorders. My dog paid the price for his ignorance and my own. As a pet owner, at least I had an excuse...he didn't. You don't fly by the seat of your pants at your patient's expense, you refer them to somebody who knows what they are doing. Once I knew what we were dealing with, I made it a point to learn everything I could so that I never had to place blind faith in another vet, not even a specialist.

I am so happy that your IMS visit went well. I think Cooper is in good hands now and I know a few of us will sleep much better tonight; however, as Natalie mentioned earlier, not all specialists are the best thing since sliced bread. Okay, so Natalie didn't really say that but you know what I mean. :D

I know how frazzled I was when my first cushdog was diagnosed so I can't even imagine what it must be like to cope with everything while taking care of a toddler too. My hat is off to you, Julie.

We'll be looking forward to hearing about the results of those new tests.

Glynda

[doxiesrock912]

Natalie!
I take the same approach with doctors for humans and they don't like it very much but too bad.

I'm so happy that you found someone whom you like finally!!!!!

[juliwilliams]

If I didn't have another dog I might talk to the vet about covering his bill. But i have to say, even though he was in over his head and obviously should have admitted it, he was very fair with billing. Even though he was in there multiple times a month (and sometimes multiple times a week), we were never charged for a visit after his first one. I saw the vet every time, even for a quick glucose check, not just a vet tech. We were only charged for tests done and medications and never for his time.

While Cooper will not go back to him for anything, I do have another relatively healthy dog and this vet is close to home and completely capable of giving him his routine shots. I'd hate to have to drive 25 minutes with the dog and 2 kids for a few shots when I have this vet 7 minutes away. But trust me, if Trapper ever shows signs of sickness, I'll be looking for a new vet for him, too.

[doxiesrock912]

Sounds like the perfect plan to me.

[molly muffin]

Julie, I am so happy that you have an IMS for Cooper now. I like the sound of starting over from scratch and seeing whats what with both the diabetes and the cortisol. That was Your plan and I'm glad this vet agrees with you. Cooper is not the easiest case in the book, but then none of them actually read the book anyway, so you have to figure it out. Just like with your kids, you have to sometimes take the bull by the horns and get done what needs to be done. You did that and we're all so very proud of you for doing so. We know it isn't easy, especially when it means going against your regular vet. That is Never easy to do.
I do hope that this stepping back and starting over is exactly what Cooper needs and you too. You need this under control so that your home life and having little ones I'm sure it is always hectic, can get into some sort of routine. Cooper will do better with a routine too I'm sure.
I just wanted to say that. I know we have all harped on you about this situation and literally some have not slept well, worrying for you and cooper. (yea, it's a mother hen type of forum, we worry together, we laugh together, just like family) :)
So, take some really big deep breaths. You have a plan now. A plan can be just about the best thing in the world sometimes.

hugs,
Sharlene and Molly Muffin

[juliwilliams]

The ulrasound showed enlarged adrenalin glands and liver but no tumors in the adrenalin glands so it should be pituatary dependent cushings, which seems like the good kind to have.

I'm going to ween him off the prednisone for 9 days. 3 days with once daily half a tablet then half a tablet every other day for the next 3 doses. She wants to do an ACTH test 2 weeks after he's been weened off the prednisone with no vetoryl in the meantime. She's also going to do a glucose curve then.

The urine culture will take a few days.

We're going to stay at 30 units of insulin twice a day for now.

If he has anymore twitching episodes she wants me to try to video tape it so her and the neurologists on staff can see it.

I'm very happy with this plan and it makes sense to me with everything I've read and everything you all have told me.

My only concern now is that the weight loss will start again. He was starting to get a pot belly again as he was gaining weight and it's starting to disappear again since we've stopped the vetoryl. He weighed 2 pounds less today than on Thursday, but it was a different scale so he may not have lost anything. I'll be keeping an eye on him and calling the new vet if he looks like he's starting the weight loss again.

[juliwilliams]

I appreciate the "harping", although I didn't see it as a negative thing! You all really helped me see how serious this was. If it wasn't for all of you I'd still be giving him vetoryl and see no problem with it. I shudder to think what would have happened to Cooper. I'm pretty positive he would not have survived much longer under the other vet. I don't know what his future is and if he's going to respond well to treatment, but I do know we won't be putting him through any unnecessary pain anymore.

[molly muffin]

Oh good, glad you didn't see it as a bad thing. Not that we would have stopped. :)

Here is the thing, diabetes can be a real bugger to get control of, cushings can be a real bugger to get control of, mix them together and it can be a disaster without a pro that is experienced in treating them both together.

I'd say almost every dog with both, or even one, ends up need a specialist because most gp vets are just not familiar with treating them. Some vets are not really experienced at treating cushings at all.

This is a forum with people who live cushings 24 hours a day 7 days a week, 365 days a year and have been doing so for years and years and years. The road you travel now, is a road traveled by many before you and you gain from their experience. That is a luxury actually that most vets don't have. A specialist is different, in that they train specifically in these kind of things and you hope that you get one that is very experienced in the disorders that you are dealing with when you go in.

We have members who read every new report put out by the top specialist in the field in the USA, Europe, Australia, New Zealand, and on and on. So, whatever advice is given here, is based on many things, but it always has a sound foundation from somewhere that can be quoted if need be, to any vet.
We aren't vets, but we have good knowledge from the best around to help us out.

Both of these disease are treatable with a good vet on board and a knowledgeable owners to advocate for their precious companions. So once you get control of this and your specialist has it figured out about correct dosages, your life and Coopers will get much easier I think.

Just hang in there. You are doing really well. It was a rough start maybe, but hopefully that will be put behind you and the road forward will not be nearly so rocky.

hugs,
Sharlene and Molly Muffin

[labblab]

Julie, I am so glad that your meeting with the IMS went so well. I know there has been additional expense up-front, but I do hope that, in the long run, both you and Cooper will benefit both financially and also in terms of stable treatment and care. I am SOOO relieved that the IMS has fashioned this prednisone taper for Cooper because that was one of my greatest immediate worries for a diabetic dog -- how to safely decrease the steroid without upsetting his glucose levels and insulin needs. Everything the IMS has suggested seems very reasonable to me, so I am so pleased and so relieved. :)

Absolutely, please keep us updated every step of the way. And please give Cooper some huge pats from his k9cushings family!

Marianne

[molly muffin]

Hi! Checking in to see how things are going with you and Cooper. :) Are you on the weaning from prednison phase still (you said 9 days right)? How is that going?

Hope all is well, let us know when you get a chance.

hugs,
Sharlene and Molly Muffin

[juliwilliams]

He's doing well right now. His water consumption is up for probably a variety of reasons. He gets his last dose of prednisone tomorrow morning! The vet wants him off prednisone for 2 weeks then we'll do an ACTH test and glucose curve. In the meantime he's totally off cushings meds. He looks like he's lost some weight, but not a lot.

His urine culture came back that he still has a bladder infection. It's the same type of bacteria, enterobacter I think, but it's no longer sensitive to the antibiotics he was on. The vet started him on a 2-3 week course of Baytril. She wants to do another culture after he's been on the antibiotics for 10 days to make sure it's gone and hasn't developed resistance to this antibiotic. I'm going to get a weight on him then and talk to the vet if he's lost more than it seems.

He's got more energy, which is so nice to see! He was hunting a frog in the backyard the other day and I broke into tears! It's been months since he's shown so much interest in things. Granted he's sleeping pretty heavily between his bouts of energy, but it's so much better than sleeping all day!

[molly muffin]

As long as he has a bladder infection I wouldn't do the ACTH test. The results can be off from having an infection. Dratted things. I do hope that he responds to the baytril. Must be one of those infections that just really hang on and are hard to get rid of. My molly had an intestinal one that she ended up being on antibiotic for almost a month for. It just didn't want to go away. That with the florflora helped though.

hugs,
Sharlene and Molly Muffin

[juliwilliams]

The vet said it could mess with the results if we don't have it cleared up. Hopefully it will clear up. He's been battling this since he was first diagnosed with diabetes almost 5 months ago. The old vet would give him antibiotics and assume it was gone then he'd show symptoms again and we'd start stronger antibiotics. I'm afraid it's been giving far too much time to build up some serious resistance!

[doxiesrock912]

Look!!!!! I just found Fortiflora on sale here.
http://www.probioticsmart.com/pets/canine-fortiflora.html

[molly muffin]

oh good price Valerie.
I will say that I gave the floriflora with the antibiotic and then even continued for a few weeks longer than the antibiotics and it really did help her and she loved the taste, so that was good!

hugs,
Sharlene and Molly Muffin

[juliwilliams]

Finally a bit of good news for Cooper...his urine culture came back negative! He's finally free from this nagging bladder infection!! We're continuing the antibiotics (baytril) for 2 more weeks.

Our next step is his ACTH test and glucose curve next Thursday.

[molly muffin]

Yay!!! that is Very good news!
Good job!
hugs,
Sharlene and Molly Muffin

[juliwilliams]

And I finally uploaded a picture of my handsome man. That's Cooper in my avatar!

[Budsters Mom]

Yes, Cooper is very handsome indeed!:D
Great news on his bladder infection!:)
You are doing a wonderful job Julie:)

Hugs,
Kathy and Buddy:cool:

[molly muffin]

Aww, soulful eyes. Handsome guy :)

hugs,
Sharlene and Molly Muffin

[juliwilliams]

I finally joined k9diabetes.com and I posted this there too, but I wanted to post it here as well. Cooper went for a glucose curve and ACTH test today.

OK, here's what the vet wrote on her summary when I picked Coop up today:
______________________

Cooper's glucose remained in the 300s all day indicating poor control of his diabetes. If he has uncontrolled Cushings disease, then this could be the cause of his dysregulation. However, there is still the chance he is on too much insulin. I do not want to change his dose until seeing his ACTH stimulation test results to know if Cushings is contributing to this curve. I will call with there results tomorrow.

Blood Glucose Curve:
8a: 323mg/dl
10a: 310mg/dl
12p: 314mg/dl
2p: 345mg/dl
______________________

We're maintaining his 30units until I hear more from the vet. And despite looking like he's lost 5 or 6 pounds in the last 2 weeks, he has actually maintained his weight. Don't know what's going on there but I'm glad he didn't lose any weight!

And he may be developing cataracts. His pupils were a bit cloudy, but it has gotten worse. She said it could be from old age or from cataracts, but that she could see the back of his eye so he can still see (for now!). Don't know what I'd do if he goes blind. I'm pretty sure we wouldn't do any surgeries. I think he'd do well without it and I'd hate to put him through any more procedures than necessary. He's not exactly a spry puppy anymore and he doesn't need any more stress! Although being blind would probably be pretty stressful too!

[juliwilliams]

Cooper's ACTH test came back. I just talked to the vet on the phone so I don't have the full results, but his ATCH post reading was 24.8. I'm trying to look back at other people's threads to see how high that is, but I keep on winding up in threads where they do different tests! The vet said a "high normal" is 17. And I see on the vetoryl insert that 1.45 - 5.4 is the desired range. 24.8 seems super high.

We're going to start trilostane again. He'll be getting 30mg twice a day. The vet is still not sure if it's actually cushings or if the elevated levels are from the uncontrolled diabetes. There doesn't seem to be a real way of knowing I guess. When I told her Cooper did well on the trilo until we doubled it and that he had glucose readings in the low 200s while on it, she said we should go ahead and try it. We're going to do another glucose curve and ACTH test along with a urine culture in 2 weeks.

I feel good about this, I think!

[molly muffin]

17 would be a high normal for a dog not being treated with medication for cushings. Once you are on vetoryl, then you want 9, with symptoms controlled or 1.45 - 5.4 as a target post number.

Hopefully treating will bring both the cortisol and the curve numbers down.

Just do the normal watch to make sure he is tolerating this dosage well.

hugs,
Sharlene and Molly Muffin

[juliwilliams]

Thanks! I took it as 17 was a high number for a normal dog, not that it was a high number for an unmedicated cushings dog. I really have to stick to my list of questions i always write out when the kids are around!

[juliwilliams]

Just a quick Cooper update... he's rapidly losing his eyesight. He walked into a chair 2 days ago and he's tripping over everything on the floor. My poor boy! And I think his sense of smell might be going a bit. He was licking a paper plate yesterday that my daughter finger painted weeks ago. I guess he thought the dark paint was food.

I sure hope we get things under control for him before he gets any worse. I scheduled his next ACTH/glucose curve/urine culture for next Thursday, and it can't come soon enough!

[molly muffin]

oh poor Cooper Well, there are adjustments that you can make and we have a some here that can help you with that, having blind furbabies also.
I agree, got to get those next tests.

hugs,
Sharlene and Molly Muffin

[Skye]

How are things going for coop? get any more results from vet or see changes from the meds helping at all? however maybe enough time hasn't elapsed for all that yet. Wanted to say hello, been following along with some threads, then have been mia for week or so, and trying to check on everyone that i had been reading and following along with. I cant believe how attached I am to so many of these furbabies and angels, get to feeling insecure, sad, and worried when i cant get on here to check and visit.

[juliwilliams]

No changes yet. It's just been a week on the trilostane. When he was on it about a month ago, I remember an immediate improvement in his energy levels. He's still tired, hungry, and thirsty. But I'm sure the adjustment to losing his eyesight so quickly would take a lot out of him.

We've made the big, painful decision to probably stop testing soon. We're going to do testing on Thursday, but if there's no change we will probably pull him off the trilostane and just do insulin. There are still so many things that could be wrong and so many unexplored avenues of treatment. We could put him through test after test for months and still not be any closer. We set aside my husbands bonus and our tax refund for testing and we've already blown through that. With 2 little kids and a single income we just can't afford to go into massive debt. We feel that he's maintaining now and that may be the best we can hope for. He doesn't need to go through much more, especially not spending the day at the vet now that he's almost blind. I still have my fingers crossed that the next ACTH test will show a major improvement and it will just be a matter of adjusting his dose, but we have a plan just in case there's no change.

[Skye]

check into care credit. it has helped me out so much i cant even express how much. I get long term interest free on nearly everything. and that is awesome.

[juliwilliams]

I saw their pamphlet at the vet. I'll pick one up on Thursday.

[Harley PoMMom]

From our Resource Thread you can find information about Carecredit and more here: Financial Resources to help with Vet bills (http://www.k9cushings.com/forum/showthread.php?t=212)

I, too, use carecredit and really like it.

[juliwilliams]

Finally I have some good news!! Cooper's cushings seems to be under control. His ACTH test Thursday was pre 2.7 and post 7.1!!

His glucose curve was worse than his last one, his numbers were in the 300s and 400s all day. We're going to try cutting his insulin back from 30 to 14 units to see if he's been overdosing on insulin. I'm going to start hometesting his glucose as soon as I get all the stuff I need.

We also did a urine culture and we're waiting for the results but I think he has another bladder infection. Hopefully we'll know by Monday.

[Harley PoMMom]

Are all Cooper's Cushing's symptoms controlled? If, so, then those are good numbers!!

[juliwilliams]

Hmmm, I can't tell if the symptoms are controlled. He's got so much else going on, it's hard to say what's causing what. He's still drinking a lot (actually it's increased lately), but I think he's got a new bladder infection which would cause the excessive drinking. He's always looking for food, but his diabetes isn't controlled and that could make him hungry.

His excessive panting has stopped though even though the temperatures have really warmed up here the last week.

[Skye]

hey
stopping by to see how things are........
did he have a bladder infection? increased drinking might be from warmer weather do you think? i hope all is okay. i am glad to see some test results came back with good numbers.

[juliwilliams]

I keep forgetting which forums I've posted in! I'm on this group and the k9diabetes forums too.

Yes, he does have another bladder infection and it's the same bacteria that it has been the last 2 cultures. It must be hiding out in his system somewhere!

There's been no change good or bad on his new insulin dose other than drinking a bit more. His glucose meter should get here on Wednesday and I'll do a curve on Friday (although I plan on playing around a bit on Thursday to figure the thing out!)

[juliwilliams]

It's been awhile since I posted here. I'he been sticking mostly to the k9diabetes forum since the cushings seems to be pretty well managed right now.

I do have a cushings question though. Will an ACTH test cause blood glucose levels to rise for a few days afterwards?

Cooper went in for a blood glucose curve, ACTH test, and urine culture Friday. I had increased his insulin by 2 units that week. His curve was worse than the week before. The curve was done in the morning followed by his ACTH test. I took a few readings today and his numbers were even higher.
Last week: blood glucose in the 200s and 300s, 28 units insulin
Friday: blood glucose in the 300s and 400s, 30 units insulin
Saturday: boll glucose in the 400s and 500s, 30 units insulin

Someone on the k9diabetes forum thought that the ACTH test could be the cause of today's increased levels. Is that possible?

Cooper seems to have been free from a bladder infection for a few weeks, but I think he may have developed a new one a few days ago. I'll know Monday when the urine culture results come back. We just can't seem to keep these bladder infections away long enough to regulate his insulin dose.

[molly muffin]

It is possible that the ACTH could cause it to rise for a bit. In some dogs we see more symptoms for the first day to 48 hours after an ACTH test. If he has a bladder infection though that too could be affecting this BG.
I'm glad that his cushings is mostly controlled. I think that diabetes can be much harder to get control of than cushings.

You're doing great though keeping on top of all of this. It can get so confusing, when everything seems to affect everything else.

hugs,
Sharlene and Molly Muffin

[juliwilliams]

Thanks! This has been far tougher than I ever imagined! We've been so close to just giving up so many times and I must admit I'm there again. My husband thinks we should just leave him at his current doses of medicines and stop with all the testing and adjusting. But that's just because he's not the one who has to let him out twice a night when he has bladder infections! I swear it's like having a newborn in the house again!

We had a glimmer of hope for about a week where he seemed to be feeling better but the last few days he's been back to his sick self. I really wonder what sort of pain he's in and what his real quality of life is like. I feel like we keep saying he's got go turn a corner soon, but he just never does.

[molly muffin]

None of this is easy and it can at times be quite heart breaking. Only you know what Cooper's quality of life is, as you know him best. I know sometimes that is more guessing then true knowledge. If he seems happy to see you, and he wags his tail, wouldn't mind playing a bit and hanging out with you, then those are things that you can use to try and figure out how he is doing quality wise. It still isn't easy though. I know it would be much better if the infections would stop and the insulin could be brought under control. You're right k9diabetes is a wonderful group and very supportive and knowledgeable.

hugs,
Sharlene and Molly Muffin

[doxiesrock912]

Juli, ask your vet about Tylan powder.
I just went through something similar with Daisy. She kept getting diarrhea. I stopped the meds for a time to see if they were causing this and nothing changed.

Dogs can have underlying systemic infections, like e-Coli which take a bit of time to eradicate. Daisy's diarrhea was constant and so bad! Baytril worked but as soon as I stopped it, the diarrhea came back worse than ever.

The Tylan powder is a natural form of antibiotic so there is also less chance of becoming resistant to it.

The medical name is Tylosin.

Might be worth a shot.

[juliwilliams]

Thanks Valerie. I'll ask her about Tylan powder when we talk on Monday. I've got quite a list of questions for her this week!

[doxiesrock912]

Questions are good Juli.
The Tylan is still working its magic with Daisy.
She has had normal poops since I began giving it to her. The change is truly amazing and her energy level is increasing too.

Keep is posted and good luck tomorrow!

[Jenny & Judi in MN]

Thanks! This has been far tougher than I ever imagined! We've been so close to just giving up so many times and I must admit I'm there again. My husband thinks we should just leave him at his current doses of medicines and stop with all the testing and adjusting. But that's just because he's not the one who has to let him out twice a night when he has bladder infections! I swear it's like having a newborn in the house again!

We had a glimmer of hope for about a week where he seemed to be feeling better but the last few days he's been back to his sick self. I really wonder what sort of pain he's in and what his real quality of life is like. I feel like we keep saying he's got go turn a corner soon, but he just never does.

hang in there if you can. Jenny was diagnosed with both in May 2011 and I was an emotional wreck until January. I had been researching so much that the vet told me until my husband just asked me what would hurt if we just went with what he said. So we did.

Granted he killed off Jenny's cortisol by overdosing her on Lysodren but she is healthier and spunkier now, 2 years later, than she was that horrible roller coaster ride of a summer.

So I totally empathize with your feelings. Hugs to you, your family & Cooper

[Budsters Mom]

I'm so sorry that your continuing to have such a hard time. None of this stuff is ever easy it seems. Only you can answer the quality-of-life question. That's not a question any of us ever want to think about, but eventually we get there.:( We are here to help anyway that we can. Please continue to talk with us and ask questions and and let us know how Cooper's doing.
Big hugs, and a belly rub for Cooper,
Kathy

[juliwilliams]

Cooper ACTH test came back with his cortisol a little low. Pre was less than 0.7 and post was 2.7 We're cutting him back from 30mg of trilo twice a day to 30mg in the morning and 10mg at night with another test in 2 weeks.

I'm a little confused because i thought optimum control was when the post was between 1 and 9, which his is. The vet gave me the test result as post 2.7 (8-17). I know (8-17) is some sort of reference range, but I don't know what it means.

His urine culture came back positive for the same bacteria he keeps getting. Another $150 antibiotics prescription. Ugh! I'm waiting to hear from the vet about what to do with his insulin while he has the infection.

Thank you all for the support! I'm still on the fence about what to do. We can't keep on testing for and treating bladder infections on top of the insulin and trilo meds. We're past the point of breaking the bank. Every few weeks we're spending hundreds of dollars on complications on top of the hundreds of dollars we spend on medication each month. But I can't imagine just stopping because I know it's a death sentence for him.

[Simba's Mom]

Sending hugs and prayers for you and Cooper, just keep taking one day at a time....

[molly muffin]

I think this is a response to his pre number being a bit on the low side. His post number is good though.
I know this retesting and retesting is a money hog. :(
Cutting back should bring his pre back up a bit. You are right about what the post number should be, and he is good on that front. Maybe since it is just the pre you are concerned about at this point, a base cortisol test instead of a full ACTH would tell you what you need to know.

hugs,
Sharlene and Molly Muffin

[juliwilliams]

After decreasing Cooper's trilo to 30mg in the morning and 10mg at night, his ACTH test came back even worse! Both pre and post were less than 0.7 The vet said that given the numbers she would consider putting him on steroids but he's not showing any real symptoms of Addison's yet. He's panting just a bit and has a bit of loose stool, but not too bad. She said to keep a real close eye on him and bring him in if he starts looking sick.

The vet did another urine culture to see if while on the antibiotics the bladder infection is actually gone. If it is, then we'll be starting a low dose daily antibiotic to try to keep him free of infections so we can finally get the diabetes under control. He's been bumped up to 34 units of insulin twice a day.

We had to go to our old vet the other day because he also has an eye infection. Nothing too bad, just needs a few drops in his eyes a few times a day. I'm just hoping his sick old body can fight it off and we don't have recurring eye infections now too. My poor guy has really been through the wringer lately, but he's tough as nails and you'd never know it by looking at him!

[frijole]

OK - when a dog goes as low as yours did they ARE considered Addisonian. Are you going to a specialist? (IMS) I am very concerned that you are not giving any prednisone for relief. Is Cooper able to walk, get up etc on his own?

Given those low numbers you cannot give any more trilostane until after you wait long enough for cortisol to be normal again - which may be never. The only way you will know is to wait and do another acth test.

Kim

[juliwilliams]

I'be been seeing an IMS for a few months now. We're stopping the trilo indefinitely. We're not going to rush to another ACTH test. The vet said to wait until he starts getting symptomatic again, if he ever does.

He's acting completely normal! For him at least. A little big of loose stool and panting, but not bad. He had overdosed once when we were seeing our general vet and it was very obvious to me. He was weak, twitching, and fell into a wall. Right now, he's normal. But she said to rush him in if anything changes.

[doxiesrock912]

Might the low dose antibiotic be Tylan powder? If not, ask the vet about it because you don't want Cooper to become resistant to them.

[molly muffin]

Did they give you any prednisone to have on hand in case he starts to act worse and did they check his electrolytes at the same time?

Sharlene and Molly Muffin

[juliwilliams]

Valerie: the antibiotics will probably be simplicef since that's what his infection is responding too right now.

Sharlene: they did not check his electrolytes. He hasn't been in since his ACTH test on Tuesday. I called today to see what dose of prednisone I should give him if he has any issues over the weekend. The vet said 5mg twice a day.

He's doing well. The panting hasn't increased. If anything I'd say he's even perkier then a few days ago. The vet said he could still crash over the weekend so we're going to stay close to home to keep an eye on him.

The only new thing going on is he's shedding a bit. Granted it's July in Texas, but he's not a shedder. I'm off to research if that's something I need to worry about.

[juliwilliams]

Cooper wound up on prednisone Friday. His back legs collapsed under him a few times. I brought him into our old vet (since it was 430 in the afternoon and they're 5 minutes away). I had prednisone on hand, but just wanted his electrolytes checked. I didn't get a printout, but I believe she said his sodium was 120 and normal range starts at 121 and his potassium was 100 and normal range starts at 101. She said he didn't need fluids but should start the prednisone. He's getting 5mg twice a day (he's 63 pounds now). We're going in this morning to the specialist, she wants to check him out and test his electrolytes again.

I'm going to discuss the possibility of not treating the cushings if it comes back (he started drinking tons of water again so it may be coming back already). The first time he overdosed on vetoryl I thought was completely my old vet's fault but now he's gone addisonian even with close monitoring. I'd rather deal with getting up to let him out multiple times at night than putting him through all this extra testing and risks. I'm sure she'll say that we can't regulate the diabetes without treating it, but it's worth having a discussion about.

[Squirt's Mom]

I hate to hear this! It sounds like he may be quite sensitive to Trilo... or perhaps something else is going on instead of Cushing's? How is Cooper today? I hope he's feeling much better now. Let us know what you learn at the vet today.

Hugs,
Leslie and the gang

[juliwilliams]

We're back from the vet. His electrolytes were perfect. He has been drinking a lot more the last day so the vet said to cut him back to 5mg once a day of prednisone and keep her up to date on any changes.

She said if the cushings comes back that we have to treat it if there's any hope of getting his diabetes under control. She said if we ever need to put him back on the trilo, we'll start with 10mg twice a day and just hope to lower his cortisol levels but perhaps not get them into the recommended range. Hopefully that will keep him from crashing again.

[Jenny & Judi in MN]

It could be the prednisone making him thirsty. My Jenny hasn't had any cushings meds for over a year we killed her cortisol production so much.

but the specialist we met with did tell me that if the ravenous appetite started to show up, to get her in and treat the cushings again since she would be miserable.

I feel for you and Cooper, you need a little smooth sailing time. Cushings is way more stressful to me to deal with than the diabetes.

Judi

[molly muffin]

Oh no, poor Cooper. That might work if the cushings comes back to just try to get it a bit lower and don't worry about range, just whatever works for Cooper.

Some vets say that if they go Addison, then it's a lot easier to get things stablized than it is with cushings. I don't know, I just know in Europe they use to advocate that as a method of treatment. I don't know if they still do though, I haven't heard that for a long time.

Hang in there!
hugs,
Sharlene and Molly Muffin

[juliwilliams]

I've heard about killing off the cortisol production to make life easier. Given how sensitive and unpredictable he is with the trilo, I would never want to try it. I was kind of hoping that's what happened. It would be a whole lot cheaper and easier to regulate. It's still possible it happened, but this is playing out just like when he overdosed on trilo before. I'm expecting him to be off prednisone and back on trilo in a few weeks!

His hair started growing back a bit! We shaved him last summer and his hair never grew back. After a year, his brown hair was sun bleached and golden brown. His legs, belly, and middle of his back are his normal liver and white ticking. His shoulders and hind quarters are still golden brown though! I thought he'd never look like his old self again. I hope it grows back to its old length (his got long hair for a shorthaired pointer!)

[juliwilliams]

The daily drama with Cooper just never ends. Starting on Friday there was a very dramatic increase in his thirst and peeing. I let the vet know and she said to cut him back to 2.5mg of prednisone once a day. It's Sunday and he's still drinking and peeing a lot. I think he's going Cushings again.

I don't know what to do anymore. How much more can I really do for him? I feel like the rest of his life is going to be ACTH tests, glucose curves, and urine cultures. One thing gets under control for a few days then something else flares up. UGH!!

He's up to 40 units of insulin twice a day. His blood glucose numbers came down just a little bit from his last curve, but that was on Wednesday before the drinking and peeing started again. I'm going to curve him again on Tuesday and see if perhaps it's another bladder infection and he's gone insulin resistant again.

Has anyone out there given up on trying to get everything under control? I feel like it's just never going to happen and in the meantime we're just throwing money down the drain. We're 8 months in and the only improvement is that he doesn't pee in the house every night. Granted that a huge improvement!! We're at 40 units of insulin and his numbers are only slightly better than they were at 8 units. Every time we start treating the cushings he goes addisonian. It's so amazingly frustrating!! But, he's doesn't seem to be in pain or uncomfortable, he's just tired and thirsty, so how can I stop trying my hardest to make him better?!

[jgr789]

Anything happening with Cooper these days?

[juliwilliams]

Cooper is doing well. He's currently getting 50 units of insulin twice a day and that's the only medicine he's on. I've switched him to a new food. He was eating royal canin diabetic, but our other dog has some serious stomach problems and we tried him on grain free food (Zignature lamb). It's a low glycemic index food so I switched Cooper onto it too and he's doing well on it.

He is drinking and peeing a lot and is possibly getting another bladder infection or cushings again. But he hasn't gotten too bad yet and we're in the middle of a big move and I'm not ready to find a new vet yet. We just drove from Texas to NY over the last 4 days. We're staying with family while our house in Texas sells then we're moving to Connecticut. I know if I take him somewhere now they're going to want to do a bunch of tests so I'd rather wait until we're settled in Connecticut.

3 nights in hotel and now staying at a house with a deck with no railing around it has been difficult with a blind dog, but he's really adjusting better than I thought. We have the dogs gated into the den cause I'm afraid of Cooper being near the stairs or walking head first into my parents glass curio cabinet. I think that's helping him stay calm. He figured his way around the room pretty quickly.

[molly muffin]

Cooper is a smart boy obviously to find his way around so well.

Wow, that is a big move. Hope you can find a good vet in your new area. Hope he isn't getting another infection. He sure is prone to them. Course an infection is easier to deal with than cushings, so ....

Gosh you are showing up just in time for winter months to hit. Big change after Texas I bet. I moved from Texas to Pennsylvania in the fall months too once and it was a definite hit to my goose prone body. Course now being in Canada, LOL, I'm adapted back to cold weather again.

Sharlene and Molly Muffin

[doxiesrock912]

Julie,
Where in CT?

I'm born and raised here so I might have some useful input. Fire away.

[juliwilliams]

Thankfully we were only in Texas for 2 years and Ohio before that for 4 years. I should adjust pretty well but my son is constantly shivering. He was 6 months when we moved to Texas so he doesn't know cold! The dogs are loving the cool weather!!

My husband's job is in Windsor, we're looking around granby, suffield, and hebron area. Hoping to find a cute rural town!

[juliwilliams]

I just wanted to let everyone know that Cooper passed away earlier this month. I feel like I need to tell the end of his story for people who are doing all the research that goes along with a diabetes/cushing diagnosis.

Cooper was doing real well on 50 units insulin and didn't have any cushinngs signs. Then he started drinking and peeing again, which turned out to be another bladder infection. We treated it for a long time. Then he was infection free for a few weeks. The infection came back yet again and we were at the point that we were just going to leave him on antibiotics long term.

Even after his urine cultures started coming back clear, he was drinking and peeing a lot. The vet and I thought he was getting cushings again. At that point we didn't want to put him through anymore. He was completely blind and we had moved to Connecticut. We were going to a new vet and I didn't want to leave him there for the testing and the possible repeat visits if he overdosed on the cushings meds again. We figured he'd been through enough and it was time to let him live out his days with us.

His blood sugar levels were high. The vet said we could try to keep up with the diabetes as best we can but eventually we wouldn't be able to control it anymore. We bumped him up to 52 units of insulin twice a day and his blood sugar levels were in the 100s all day, which is the lowest they'd ever been. He was still drinking and peeing a lot though.

Everything seemed fine for a couple of weeks (I think, I lost track of time in there somewhere!) Then Cooper started eating only half his meals and his levels were up in the 300s. I called the vet right away. The vet tech said to try some very watered down bacon fat poured on his food to get him to eat. It worked.

2 days later I had been out with my daughter all morning going from teeball to girl scouts. We came home and my husband said in passing that Cooper kept falling down. He would take 2 or 3 steps and his back legs would collapse. I immediately ran inside and did a glucose test. The reading was 300 but his lips and gums were white and cold. While we were trying to find the closest emergency vet, the kids discovered throw up. We put him in the passenger seat of the car and I took him to the emergency vet. He leaned against me and I pet him the whole drive. He passed away in the car about a mile from the vet. I didn't ask to speak with a vet, but I'm guessing it was kidney failure.

We miss him terribly. I don't think there's a thing we would have changed about his treatment (aside from seeing a specialist sooner). And I'm so glad I was with him when he passed.

Run free old man! We love you!

[molly muffin]

Oh Julie I am so sorry that Cooper has passed on.

What a time he had with those infections :(

I'm very happy that he spent his remaining days just being Cooper and that you were with him when his time came. I know he felt very safe in your arms.

I have changed your thread title to reflect Coopers passing and he will be added to our In Loving Memory thread.

My sincerest condolences
Sharlene and molly muffin

[goldengirl88]

So sorry to hear of Cooper's passing. I know how you must be feeling and hope you and your family are able to get thru this. Run free Cooper and play with all the other cush babies.Blessings
Patti

[Renee]

Rest in peace Cooper. Thank you for coming back and sharing your story.

[Robert]

So very sorry for your loss. Praying for you and cooper on his journey .
Cooper is now in some very good canine company

[Trish]

My condolences on the passing of Cooper, sorry to read this news. Big hugs to you and your family.

[Squirt's Mom]

Dear Julie,

I am so sorry to learn of Copper's passing but I am glad you were home to be with him in his last moments. I know the touch of your hand brought him much comfort. We are never ready for "the" day no matter the circumstances especially when we have fought so hard for each day with them. I know your heart is broken today, so empty still. But know your sweet boy is now well, his body strong and healthy once again and he is running wild and free in the Rainbow Fields with all who knew and loved him as well as with many new friends found there.

Our deepest sympathies,
Leslie, Trinket, Brick, Sophie, Fox and all our Angels


I ONLY WANTED YOU

They say memories are golden
well maybe that is true
I never wanted memories,
I only wanted you.

A million times I needed you,
a million times I cried.
If love alone could have saved you
you never would have died.

In life I loved you dearly,
In death I love you still.
In my heart you hold a place
no one could ever fill.

If tears could build a stairway
and heartache make a lane,
I'd walk the path to heaven
and bring you back again.

Our family chain is broken,
and nothing seems the same.
But as God calls us one by one,
the chain will link again.

--- Anonymous ---

[jxeno13]

So sorry to hear of the loss of your baby, Cooper. You're in our thoughts and prayers.

Jo Ann and Eli