Cooper - diabetes and cushings - sweet Cooper has passed

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

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

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.

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

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.

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

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.

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

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

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...rilostane.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