Cooper - diabetes and cushings - sweet Cooper has passed

[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.

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