Cooper - diabetic and cushings

[charansuri]

Hi everyone,

I am new to this board. It's been stressful month or so for us and I am happy to find this forum where I can find some support and advice.

Cooper is 8 years old miniature Schnauzer. He used to be one of the most hyper-active, curious, always-smiling dog in our household (he has 2 buddies). He weighs around 19 pounds now. He used to be around 23 lbs during his healthy days.

In May of 2012, he got sick, drinking lots of water, peeing often and becoming dull and less active. The vet diagnosed for diabetes. Since then we have been giving him insulin shots. A month ago, he was at 10 units. We have had several Glucose monitoring done on him in a year time and kept adjusting his insulin dose. He also went blind quickly and now gets 3 eye drops every day.

Truth be told, when we started on insulin, he did pretty well. But, he had phases when he would go down, start drinking more water, peeing more again which lead the vet to keep increasing the insulin dose.

His insulin was increased to 10 units in May 2013 and by June he started drinking more water again. We took him to the vet (new doctor at the clinic) and told her that we keep increasing his insulin and its not making much of difference. She suspected Cushing's because his body was getting resistant to insulin and the main vet ran tests, spoke to his specialist friends and confirmed he has Cooper has Cushing's. The main vet has been the family vet for years.

We started him on Vetoryl, 10 mg capsules last Friday. Since he is diabetic, the vet started him on low dose, twice a day (10 mg in the morning and 10 mg in the evening). His insulin reduced from 10 to 8 units. Past 4 days, Cooper did amazingly well and we thought he was getting back to his old self.

But, as of Wednesday (5 days since we started him on Vetoryl), he pooped in his crate in the afternoon (never does that!) and vomited all of his dinner just an hour ago. He got 10 mg Vetoryl and 8 units of insulin, twice. I don't plan to give him any more Vetoryl starting today. It's July 4th and the vet is closed. I have an appointment with vet to check his Glucose on Monday but I am going to take him in on Friday since this new development.

I am just feeling very low and depressed at this point. I feel like it's back to square one and feel very helpless. I was so hopeful he was getting better, but this is a major set back... he is laying on his dog bed now. I hope stopping Vetoryl will make him feel little better, at least till I can take him back to vet.

We are expecting a baby in a month and I really wanted to get Cooper's health under control before the baby arrives. I am just too stressed out about him and an emotional wreck... ((

[frijole]

Hi and welcome. You are right to stop the trilostane - vomit could mean that the dose is too high. Your vet did do the right thing by starting on a low dose. We so often see cases where dogs are misdiagnosed and the combination of diabetes and cushings makes it even more complicated.

Could you please tell us what tests were done to determime cushings? Was a blood panel done? If so what enzymes were elevated? What specific cushings tests were done? What were the results on it?

Do you have access to an internal med specialist (IMS) in your area? I ask because it is tricky to work with a dog with these two concurrent illnesses and it may be necessary to go to a specialist, at least to get things under control. Kim

[charansuri]

Thanks Frijole for your reply. I had been up since 1 am, fell asleep for a bit, and woke up to poop on carpet (more liquidy). So, I guess it's safe to say he vomited and has diarrhea... sigh...

Our vet had instructed to stop Vetoryl immediately, in case these side effects happen. Our vet performed low-dose dexamethasone test. Cooper was at the vet for whole day and blood work was done on him every 4 hours. He wasn't able to confirm if it was pituitary related issue. He was planning to run ACTH test on Cooper after 2 weeks on Vetoryl. As it stands now, I don't know he will do.

Our vet admitted that he has only seen 3 cases of Cushing's in all of his career and he is an older gentleman. I think Cooper is his first Diabetic-cum-Cushing's patient. Vet also told us that he needed help reading the test results and had to discuss with some specialist friend of his to confirm his findings. we feel he really did all he could before confirming the results. That said, it's unfortunate he doesn't have much experience with this complicated situation.

Beyond this, I currently don't know details about the result itself. I can ask for a report from the vet. I don't know of any IMS in town but I can sure find out. I will also ask my vet about it. Do IMS people directly treat the pets or do they work with the vet to determine dose?

Cooper was really hungry this morning. I think his body was pretty flushed out. I fed him a cup of green beans and he hogged it and he is drinking water. I was worried he is going to be dehydrated with all the vomiting and diarrhea. I am going to feed him small amount of dog food frequently during the day. I hope his belly can handle it. I plan on giving him his insulin this morning.

Is there any advice on how to control the vomiting and diarrhea for now?

Also, what kind of questions should I ask vet about this situation? Sometimes, it's all Greek and Latin to me.

I appreciate everyone for taking time and letting me share my experiences. I am at a point where I feel I need a support group to even handle this.

[molly muffin]

Hello and welcome from me too.
We have a sister site for diabetes that you should also join.

www.k9diabetes.com they are wonderful people who can help you with the diabetes aspect while we see whats going on with the cushings.

Stopping the vetoryl any time you see vomiting, etc, is a good thing. It's a delicate balance, but you can get there. It just takes a bit of time to work it all out.

I know this is very stressful. Hang in there

Sharlene and Molly Muffin

[charansuri]

Thank you.
My husband and I are just baffled that he got sick all of a sudden. He was so fine yesterday morning and doing so well for last 4 days on Vetoryl. We thought we finally saw the light at the end of this tunnel. So, we are just little shocked and bummed to see him sick again.

We are really doing our best to be positive and make sure we try everything and that Cooper is comfortable. But some days are just emotionally draining...

[molly muffin]

If they can give you a copy of the LDDS, then we see plenty of results and can usually give you and idea of what they mean.

Also any blood work, like the CBC, and urinalysis, would be helpful. We only need to know abnormal results high/low with range.

It might be that insulin that was off high/low causing the upset or it might be the vetoryl. Which is why we always stop and re-evaluate.

Many vets aren't familiar with cushings, the medications and the testing protocols. So, getting up to speed yourself is the best course of action, always. We help with that.

IMS usually will work with the vets. It sounds like the vet might currently be consulting an IMS? As he said he needed some help on interpretation.

Sharlene and Molly Muffin

[charansuri]

Ok. I will be taking Cooper over to the vet tomorrow. I will be sure to ask for the reports.

[Tina]

Hi, and welcome from me too. I have two Miniature Schnauzers, Jasper is my cushpup. You did great to stop the Vetoryl, the rule of thumb is to never give it when your pup isn't feeling well. When you take Cooper to the vet tomorrow, ask about having his electrolytes checked. They can get out of whack very quickly with vomiting and diarrhea, and also if the Vetoryl dose is too high.

I hope the vomiting and diarrhea stop as the Vetoryl gets out of his system. Yes, it is very stressful, and this type of thing always seems to happen on a holiday or weekend when the vet is not available.

Tina and Jasper

[frijole]

The test that you had done is the low dose dex suppression test and it is prone to false positives when something else is going on - that includes diabetes. I would insist on having an acth test done NOW. It could be that your dog doesn't even have cushings which would explain the vomit and diarrhea.

I appreciate the fact that your vet was honest that he isn't experienced with treating cushings. At least you know for sure that his experience is lacking. To be honest we see this alot and frankly that is why this forum was created - we help alot of people through this and in some cases they coach their vets.

If you tell us where you are located we might be able to help you find a specialist in your area. Yes they can work with your local/regular vet.

Kim

[charansuri]

Thank you, Tina and Frijole!

Since this morning, Cooper hasn't had an episode of vomiting yet. Touch wood! He ate just green beans. I might brave it and give him some dog food in half hour. He did seem like restless, but for now he is laying down.

Frijole - Thank you so much for willing to help with finding the right help. We are in Reno, Nevada. I tried to browse online but didn't find anyone specific. Maybe I am not looking the right way...

When I go in tomorrow, I will ask the vet to run ACTH test and look at those results. Once again, I appreciate all the support so much!

- Suri and Cooper