Cooper - diabetes and cushings - sweet Cooper has passed

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!

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

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

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.

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.

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.

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.

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!!

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?

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.

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.

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!

Quote:

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Originally Posted by juliwilliams

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.

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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

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.

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....

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!!

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

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) - 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

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

hugs,
Sharlene and Molly Muffin

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:

Quote:

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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.

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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

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

Natalie

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.

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

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

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.

yay!
sounds good...

Quote:

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Originally Posted by k9diabetes

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

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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.

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

Oh my goodness autocorrect!!

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

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

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

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!!!!!

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.

Sounds like the perfect plan to me.

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

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.

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.

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

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

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

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!