Kiska passed away on June 1

[Kiska'smom]

Hi Everyone,

I've been laughing to myself about your posts regarding my inability to get going here. It is completely operator error! I am no computer whiz, and "navagating the site" has been MY problem...not the site. I finally found the New Thread thingy, but Johanna had been kind enough to set things up for me already. Thank you, Johanna. Then I realized that Natalie had closed that thread, and told me how to set up my own. So here goes!

Here is a little bit (and this could get long!) about Kiska's story (she is an Alaskan Malamute). Back in November, 2007, I took Kiss to the vet because she was drinking lots of water, and her fur was thinning on her tail. The vet did a Chem. Panel, and I got a message a couple of days later saying that Kiska probably had Cushing's Disease, and that her prognosis wasn't good. When I finally got through to the vet, she told me that Kiss probably had a year left without treatment, and maybe two if we did. Needless-to-say, I was devastated! I found the CanineCushings.net site and began to pour my heart out. I have to say that they saved my sanity and have been absolutely wonderful with advice, support, and lots of love. They told me that Cushing's disease is not a death sentence, and when properly treated, dogs can live out their normal life spans. I got a different vet in the same clinic! He has been a bit of a split personality. Sometimes he is nice and very helpful...other times he is brusque and temperamental! I have taken to calling his two personas Dr. Jekyl and Mr. Hide! I can pick em, can't I?

It took about two months to put Kiska through all of the recommended tests for Cushing's. She, of course, was not cooperative, and the tests kept coming back negative! She still had all of the symptoms of Cushing's, which mimics diabetes almost exactly except for the weight loss! So, we sent off a blood serum sample to The University of Tennessee Vet. College for analysis. Kiska was diagnosed with Atypical Cushing's, which is also an endocrine system disease. The difference between the two is that regular Cushing's is caused by elevated cortisol levels. Atypical is caused by the elevation of one or more of the intermediate sex hormones. In Kiska's case, her progesterone is the culprit. The treatment for the Atypical is less intense than the recommended treatment for regular Cushing's. Kiska now has a melatonin implant, and takes one capsule a day of Flax Essence for her Atypical Cushing's disease. If she does not respond to this treatment, Lysodren may have to be added in a maintenance dose. This is a chemotherapy type of drug, and is not something that I want to try without giving the other treatment plenty of time to work. It is extraordinarily expensive, and can be dangerous if not monitored very closely.

We got Kiska started on her Atypical treatment right away. She started to look and feel a little better, but then she took a sudden nosedive! She began drinking lots of water again. Her weight began to drop, even though her appetite seemed normal. She looked awful! Her face became skull-like, her hind legs weak, and her flanks were all sunken in. It was back to the vet for more tests! Another chem. panel, and I got a call saying that Kiska had diabetes. They wanted her to come in right away for one more blood test to verify the results, and we did that. Bingo! Diabetes! Her glucose had been completely normal in mid-November at 115. By early March, it was 426!

I began giving her insulin at 25 units twice a day March 3. It took me about a week to begin doing my own BG monitoring. (Big thanks to Natalie and Johanna for all of their support!) Kiska is not regulated, and the Cushing's disease can complicate things, because progesterone is an insulin antagonist. As of yesterday, Kiska's insulin has been increased to 30 Units, and she will be on that dose for about two weeks. After that, the vet wants to do another fructosamine test. (The first one came back at 528.)

Kiska's numbers have run consistently high. She has been anywhere from 330 to 450 in the mornings before breakfast. At night, she has been anywhere from 550 to 600+ before dinner. Before last night's spike to 600+, she had come down from the mid-550's to 456. I was elated that she was showing some positive sign to the insulin. Then the "catfood incident!" I'm not even sure that it was Kiska who ate it. Our husky, Sammie, is the usual suspect! Whatever caused it, she was back in the high numbers. This morning she was at 452. That number is high from her previous morning results in the mid 330's.

So, now you are pretty much up to speed with us! I did get a reply on CC.net from Natalie saying that I would probably know if I had lost insulin, because it has a distinctive odor. I didn't smell anything, so hopefully Kiska's wet fur was from my hands that I had just washed. That was a little good news. It still doesn't explain the higher morning readings, but Kiska doesn't look any worse than usual. She is very thin, and I hope that she is not continuing to lose weight. At her last visit to the vet, she had maintained 105 pounds. She looks like an older doggie, and she isn't even eight years old yet. If Natalie can help me, I will post some pictures of Kiska before all of this happened, and some of her since.

I am so happy to be here with all of you. I am so new at all of this that I will probably be on the receiving end of any helpful information! Soon, though, I hope that I will be able to share advice and pass along what I have been learning. Thank you for looking in on our thread! Your advice is priceless, and I am so grateful!

Jeanne and Kiska

[k9diabetes]

[[[[Aaaaaahhhhh]]] (sigh of contentment).... you are here!! :)

I am happy to help you post some pictures and can also set up your avatar like you have at CC.net if you want assistance with that.

We Hope is the moderator here and will be happy to assist you too.

You have accomplished so much in such a short short time... really, it's incredible!!

Anyone interested in the history and in following Kiska's Cushings journey can read her thread at the Cushings forum (http://www.caninecushings.net/forums/showthread.php?t=5922).

Natalie

[acushdogsmom]

Hi Jeanne and Kiska! Terrific first post in your thread here! You've managed to write a really concise synopsis of Kiska's story so far, especially considering that your thread at the CanineCushings.net board is already about 37 pages long, at the time I'm typing this! :D

(For anyone here who may want to go read Jeanne and Kiska's thread over at the Canine Cushing's board, I think that Diabetes was first suspected on around page 20 of Jeanne and Kiska's thread over there)

I know that you will be making some wonderful new friends here, too, Jeanne. :)

edited to add: Here's a link to Jeanne's "photo album" in the Canine Cushing's photo gallery.

Photos of Kiska (http://www.caninecushings.net/gallery/browseimages.php?c=3&userid=1597)

Click on any of the "thumbnail" pics there, to see a larger version of any particular photo.

Kiska is such a beautiful girl!

[We Hope]

And now we all have the pleasure of saying hello to Jeanne! One thing you can say, Jeanne, is that you KNOW you're wanted here! :)

A big WELCOME to you from all of us!

If you let me know what you need in the way of posting photos and so on, I'll be glad to help--just PM me if you need any, OK?

[johanna]

Jeanne... I must say.... you made my day... anyone who knows me knows i am computer dumb!!!!!!
So to be able to help you made my day !!!!!!
Im so happy you made it here....;)
Im not going to comment yet on all thats going on with Kiska...I would rather the big guns jump in first.....
Welcome Jeanne !!!!!

[Kiska'smom]

Hello, and it already feels like home! Hi Cushy, Natalie, Johanna, and it's nice to meet you We Hope!

I just finished a post at CC.net, so I will fill you in here, as well! Tonight Kiska seems to be a little better. Her BG this morning was still high at 452, but tonight it is back down to 436. That's a whole lot better than the 600+ of last night. Clancy, my youngest son (age 22), came by tonight to give Kiska her shot. He's practicing so he can take over Kiska's care when we go on a short vacation.

This vacation has not come at the best time. I really would have preferred to have Kiska better regulated, but we have already pushed back the date a week, and now it is upon us again. Our friends from Colorado are coming to Albuquerque tomorrow to caravan with us on our trip. That made things even more difficult, as we didn't want to change their plans again. They were very nice to reschedule all of our reservations and wait another week when we told them that Kiska just wasn't settled enough to leave her.

I am really worried that the stress of our leaving may upset the apple cart again. However, Kiska and all of the pets love Clancy! He will do a good job, and hopefully the furry children will adjust quickly. We won't be all that far away, so we can come home if we need to. Thank goodness for cell phones and laptops!

If I get a chance to write while we are on the road, I will! I see that some links were set up so that you can see Kiska! When I get back, I'll send some pictures here to be posted. I'm afraid that one of you will have to do it. I have tried it before at CC.net and failed miserably! I don't know how to resize pictures, and they won't post as they are. I'll need to do an avatar, also. See, I'm already a pest! Ha!

I'll peek in tomorrow before we have to get ready for the trip! It's good to be here!

Jeanne and Kiska

[johanna]

Jeanne..
Will your son be staying at the home while your away?
How long will you be gone? I don't remember if you mentioned it..
Life has to go on, Jeannie... so go and try to have some fun....
Show your son where we are on the computer so if he needs help he can post us... and we will all be there for him....;)

[k9diabetes]

Jeanne,

Hope you have a safe, relaxing, wonderful trip!

Natalie

p.s. You should see Kiska's beautiful face next time you visit here. :)

[Kiska'smom]

Hi Everyone,

Just a quick note to say that I will miss you. We'll be gone a week. Mike has his laptop, so I may be able to keep in touch. We'll see how the WiFi works at our destination.

Thanks for standing by in case Clancy needs you! That is so nice!

Clancy will be taking care of the pets, and spending as much time here as he can. I also have two other sons in town, so I know that they will drop by as well. (The two oldest boys don't do shots, so don't worry about anyone doubling up! Clancy is my head nurse!)

I can't wait to see Kiska's beautiful face on this site, as well! Boy, I am going to miss her while we are away. I know it sounds like she is my favorite. Not true. I love them all. It's just that The Big Kiss needs me more right now; and I am a worried mother. When I get back, I'll send in some photos of Sammie and Suki, too. We'll take a "pass" on the fish!!! The furry ones own my heart!

Take care, and I'll talk to you, all, soon!

Hugs,

Jeanne and Kiska

[johanna]

Jeanne...
Have a good trip and enjoy your self.....
We all seam to think that if we are not home tending to our dogs our self the roof will fall down and the dog will suffer irreparable damage.....
Not so.... for all the time we worried and could have had a good time, we wasted our trip.....
All was fine at home... Our diabetic lived to greet us when we returned ...
so go have a good time and were all here if Clancy needs us or just gets board!;)

[Kiska'smom]

Hi Everyone,

Guess what! We're still here. Our RV broke down about 30 miles out of town. It took 10 hours to get rescued and towed back into Albuquerque. Being Easter weekend, we have been "dead in the water!" Tomorrow, the RV tech will try to fix what's wrong. We may be able to salvage part of the vacation.

In the meantime, Kiska and Sammie have had their mom back!!! You, all, were right, though. Kiska was just fine with Clancy taking care of her.

Oh, my gosh!! I was so surprised to see Kiska's pictures posted here!!! Thank you so much! With all of the bad joo-joo going on with the vacation gods, I was feeling pretty bummed. The pictures really made me smile! Big hugs, Natalie and Cushy! I'll bet you guys had something to do with this!

If we get going back on the road tomorrow or Tuesday, I'll let you know! If not, I'll be back here sitting at my computer "talking" with all of you!

Hope that all of you had a wonderful Easter!

Jeanne and the photogenic Kiska

[BestBuddy]

Hi Jeanne,
So sorry your trip has been messed up. Good news that Clancy was doing so well with Kis so at least if you can still get away for a couple of days you will know she is in good hands.
Happy Easter
Jenny & Buddy

[k9diabetes]

See the Stories forum for Kiska's stunning pictures!

[k9diabetes]

Hi Jeanne,

Well, that was quite a trip! Hope the RV's back in shape soon so you can get your vacation under way!

Natalie

[johanna]

Whats that they say......?
Be careful what you wish for.... you just might get it !!!!

You did say you didn't want to go on this trip.....;)
Well maybe now if you still go... you wont be as stressed.......
Less time away, and you also know Kiska is in good hands.......

[Kiska'smom]

LOL! Yes, be careful what you wish for...well I have had four extra days at home with "the girls." We think that the RV will be fixed by tomorrow around noon. Clancy will take over for us tomorrow evening. I think that I will feel much better about going away now. Kiss seems to be holding her own. Her BG tonight was 431. Lower, but still not where I wish it was! When we get back, I'd like to try another increase in insulin. I'm sure that I will be checking in with you guys first! Right now, she is at 30 units, morning and night. The ketodiastix still shows no ketones, but her glucose remains at "1/2" or "500." If you were going to do another increase, would it just be another two units, or would you try more? I'll do another curve when I get back. I think that Kiska is enjoying the fact that I haven't been poking her as much! So, she has another few days of vacation, too!

I'll look forward to chatting again when we get home.

Jeanne and Kiska

[k9diabetes]

Have fun!! And better luck! :) Natalie

[johanna]

Hi Jeanie.... I'm real sorry this took so long, but I did reply....earlier,
Im just trying to get use to this new way of doing things and I got a email message that you replied....
I answered it on my email....
I just now received another email from someone else and i read it better and it says " DO NOT reply here... go to the thread...
SO you never got my answer....
Well what I did say was...I didn't feel knowledgeable enough to tell you if you should up the insulin or not....
I did say you should post it and have someone more experienced with Insulin answer that for you...
Have a good trip , even though it was cut short....
How are you doing with the blood testing?

[eyelostit]

Hi, hope you are having a good time, when you get back let me know about the melatonin implant, I wondered if this is the same as melatonin people take to go to sleep, maybe this is whats wrong with Chief my cushings dog.

[Kiska'smom]

Hello All,

We're back, and Kiska survived! We did have a bit of rough road the first night out. Clancy tried to put on Kiska's muzzle, and she bit him! Clancy was so mad about it, that he said he couldn't take care of her! Once he calmed down though, he just did the shot without the muzzle. Problem solved! He said that she behaved for the rest of the vacation. In fact, he said that it was pretty light duty! I guess that he would be willing to do it again.

Kiska looked fine, but she looks even thinner to me. Her hip bones are poking out, and she has very little muscle strength there. I have no way to weight her here, so I'll have to drive her to the vet one day this week to see how she is doing. I haven't tried another BG, as I don't know if I'll be able to use the muzzle any more. Kiska doesn't like being poked with the lancet, so I'm not sure how I'm going to proceed here. I'll let you know what I end up doing. The vet wants to do another fructosamine test. I think it is a waste of money, since I know she isn't doing any better right now. Another curve would probably give me the most information. What do you guys think? I have also upped her insulin to 32 U as of today. I did the ketodiastix this morning. It is always the same. No ketones, but "1/2" or "500" on the glucose reading. I realize that the urine test is very basic, and doesn't give much useful information. Somehow, I will get a BG and let you know where we are.

I also have another question. When the insulin in the bottle gets low, do you throw it away? Is there a way to get all of it out? At this point, I don't think that I would use it (from the very first bottle, about four weeks old), but it would be nice to know if this new bottle can be used entirely. All of it has been refrigerated, of course. I just haven't thrown out the first vial, since I thought that maybe the last dose was still okay if I could get at it.

Hi Natalie, I read your email about being off-line. It didn't affect me, since I was on vacation. I'm glad, however, that everything is fine now. Thanks for letting me know what happened! You're doing a great job!

It's nice to be back. I missed you guys!:)

Jeanne and Kiska

[Kiska'smom]

Hi Niki and Dolly,

I completely forgot to answer your question! The melatonin is exactly the same stuff that you can get at a health-food store. If you use the pill form, just make sure that it is not time-released. I gave Kiska 3mg in the morning and 3 mg every evening, before she got the melatonin implant. The implant is put under the skin, and releases evenly for about four to six months. Then, another one has to be purchased and inserted. They cost about $60 a pop, and are like getting a microchip (a monster needle)! According to Dr. Oliver, an Endocrinologist at the Vet school of the University of Tennessee, the implant seems to do a better job than the pill form. I haven't noticed a difference. Kiska has had the implant since February 13, 2008. However, she did become diabetic in the meantime, so maybe her reaction to the implant has been overshadowed by the diabetes. She also takes one 40 mg capsule of Flax Essence per day for her Atypical Cushing's Disease. That is the UTenn protocol for Atypical treatment. I had to order that from the Internet. I couldn't find it in a store here. It was cheap, about $8.00 a bottle! Before that, I used Barlean's Flax Seed Oil with Highest Lignans, twice a day (big pills). That was easy to find at Whole Foods (also cheap at about $8.00). Again, Dr. Oliver recommended the Flax Essence as a purer form of FSO with lignans. Hope that helps answer your question! :)

Jeanne and Kiska

[Kiska'smom]

Hello again,

I was able to do a BG tonight before Kiska's dinner. It was 410. I gave her a second dose of 32 U. Hopefully, I can do a morning BG, too. She let me do it without the muzzle. However, tonight when she got her injection, she turned her head as if she was going to bite me. I had to pull the syringe back to move out of the way, so she got poked twice when I finished what was left in the syringe. Poor girl! I feel like I'm giving the shot in the same way each time, but sometimes Kiska seems more sensitive. Of course, she's also getting more insulin. Maybe that hurts more. I don't know. Is there anyone on this site who is diabetic? I'd be curious to know from a human point of view how all of this feels. I'd also like to know if the insulin shot gives an instantaneous boost that feels good. If there is more insulin in the syringe, should I inject it more slowly? I want to do what is best for Kiss. I'd hate to think that I'm hurting her, when there might be a better way to do the injections. Thanks in advance for any advice!

Jeanne

[johanna]

Jeanne...
I'm not sure how your injecting......are you doing the tent?
Are you warming up the insulin first? it hurts if its cold...
Also O go a bit slower with Killians shot... seams I got a reaction from him when I go to fast... Too much to fast might hurt.
I think I told you that I stopped doing the tent early on...
That seamed to hurt....
I just pick up a lump of fur and skin and inject going straight down from the top It dont seem to bother him that way......

[k9diabetes]

Welcome back!! Glad all survived the trip in good shape!

I suspect that a new fructosamine won't look much different than the first one. It will tell the vet whether the increases in insulin have had any effect on her average blood sugar and if he's depending on that to make his dosage determination, it may move him to up her insulin.

Then a curve at home would tell you about the degree of fluctuation in her blood sugar between injections, also a useful piece of information. I think I mentioned before that you can do mini-curves. Premeal, 2 hours after, 6 hours after, next meal. These are easier to do after one or two detailed curves where you take frequent readings so you learn where Kiska's highest and lowest BGs are.

Chris' highest is at about 2 hours and lowest at about 4.5 hours in a 6-hour cycle on Regular.

As for the insulin bottles, I keep a puddle of insulin at the tale end of each bottle and set it aside in the fridge as a backup, throwing out the oldest backup bottle when I retire a new one. I usually have at least two such bottles with a bit of insulin in the bottom and they keep a long long time. Any time I have doubts about the quality of his current bottle of insulin, I can go back to one of those and give an injection from a backup bottle and compare the effect on his blood sugar.

The more you use an insulin bottle, the shorter the amount of time it's good for in the fridge when you're using something like NPH or Vetsulin.

It's not so much that the insulin goes bad but that repeated draws off the bottle inject air and potential contaminants and can alter the the solution because you probably never have it perfectly mixed. So Regular keeps pretty much forever in the fridge even after it's opened because there's no mixing required. Technically an open bottle is more fragile but when you consider that opening involve nothing more than flipping off the plastic lid, I think it's really more a matter of how many draws you've made from a bottle that determines how "old" it is.

Natalie

The vet wants to do another fructosamine test. I think it is a waste of money, since I know she isn't doing any better right now. Another curve would probably give me the most information. What do you guys think?

When the insulin in the bottle gets low, do you throw it away? Is there a way to get all of it out? At this point, I don't think that I would use it (from the very first bottle, about four weeks old), but it would be nice to know if this new bottle can be used entirely. All of it has been refrigerated, of course. I just haven't thrown out the first vial, since I thought that maybe the last dose was still okay if I could get at it.

[Ricksma]

Jeanne, I haven't posted on this thread, but have been keeping up. I also think the fructosamine test would not be beneficial right now...you know best. I am hoping you have continued success with the testing. I personally feel that this is one of the most useful pieces of information you can have...I think sometimes we overuse it, but I wouldn't want to be without it. Hang in there!!!;)

Love and hugs, Teresa and Ricky

[ladysmom06]

Hi Jeanne,

Welcome back - we missed you. When Lady was first dx she would let us give her the shots with no problem but after awhile she started giving us a hard time - she wouldn't stay still - I then started to give her a little of the treat she would get after her shot and that solved the problem. She is so anxious to get the treat that she doesn't pay any attention to what I'm doing. I always fill her needle about 15- 20 minutes before she eats. I hate when we have to use the muzzle too. I have never had to use it when giving a shot but when checking her bg I would. Just recently she started letting me check her without it - but that can change again. Your doing a great job with Kiska -hang in there - it does get better. Hugs to you and Kiska.

[Kiska'smom]

Hi Johanna, Natalie, Lynne, and Teresa,

Yes, I do let the insulin warm up for twenty to thirty minutes before injecting Kiska. I am still doing the "tent" thing with her skin. Maybe I will try Johanna's method. I try to inject slowly, because I figured speed would force the solution in and hurt. I've also tried giving part of her treat beforehand. Sometimes that does help. Today, she raised up, put her paws on the counter, and stole the meat before I had time to give the shot! That rascal!!! She used to steal food off of the counter, but she hasn't done that in months! Maybe she is feeling a little better!

What I am wondering is, if it is normal to take so long for the insulin to really start making a big difference. Since her numbers have pretty consistently run in the 400's for the past three weeks or so, do you think that she is getting too much food for the insulin to manage? Should I continue with two meals and two shots a day? I could probably cut the canned food in half by giving part in the morning and the other half at night (instead of giving two whole cans per day). The only reason that I haven't tried that thus far is that Kiska's weight is still a problem. She is sooooo thin.

I know that Natalie said that small differences in insulin can make big changes, and that is why I should go slowly and give the increases plenty of time to work. But how much time is necessary? How often should I increase? Is Kiska's resistance to the insulin something that might go on for a long time? This is soooo frustrating! These high numbers can't be good for her, and you'd think that there would be more urgency to get the numbers down. None of you will nickname me "Patience," will you? Ha!

I have a phone call, so I'll write again tonight!

Jeanne and Kiska


I took a couple of BG readings this morning. I was going to do a curve, but my son's car got wrecked, and we had to help him with the insurance and drive him to work. Poor Clancy! It wasn't his fault. His friend (who carpools with him) went out to warm up the car and accidentally drove it over the parking barricade into a tree!

So, the two numbers that I have are 7:00 a.m. 449 and 9:00 a.m. 481. We just can't seem to get out of the 400's! I am giving 32 Units twice a day.

[johanna]

Jeanne...
I would definitely try the way I'm doing it.... It may not be the desired way but what ever works...... and It worked for me and Killian... he don't even flinch...
as far a the food....
What exactly are you feeding? and how much and how often?
I posted a thread here " Diet's " you might want to look it over and see what everyone is doing....
I cant really help much, Im still trying to figure out one on Killian......
But "We Hope and Natale are experts on this sort of thing.....
Its not always the amount as whats in it .... Carbs ... Calories......Ect....
This is the stuff that raises the BG......
the food is sooooooooooo Important and getting the food and Insulin to work together in harmony is the goal.....
We cant respond to this with out knowing exactly what your feeding and how often and how much.....
Do let me know if you try giving the needle different then what you have been.... It made my life 100% easer for me....

[Kiska'smom]

Hello again,

Sorry about the phone call interruption! I took one more BG this evening, and it was 453. So, looking at the three that I was able to get, here are the numbers again and the approximate times: 7:00 a.m. 449, 9:00 a.m. 481, 6:30 p.m. 453. As you can see, her numbers tend to stay in the 400's and are fairly constant. We are at 32 Units of insulin twice a day. The last time that I weighed her, she was 105 pounds. She could be a couple of pounds thinner right now.

I feed her one 13 oz. can of Pedigree Lean Chicken and Rice
1/2 cup Purina Fit and Trim dry
1/2 cup Hill's ID dry
1/2 cup rice, hamburger, and green bean mixture

She gets the same meal both morning and evening. She usually gets one 5" rawhide twist (for small dogs), and one or two small dog Iam's lowfat biscuits per day. I try to give these within an hour or two of her insulin shots. I wrap her pills in either shaved turkey or roast beef. It's paper thin, so I don't think that she is really getting very much. That works out to 3 and 1/8 cups of food at each meal. That is within the recommended food allowance for a dog her size. However, I have no idea how to calculate the calories or carbs. Where do you find that information?

She also has Atypical Cushing's Disease. She has a melatonin implant, and takes two 40 mg capsules of Flax Essence a day. She also takes other supplements: Milk Thistle, Fish Oil, and Flax Seed Oil. Right now she is also on Cephalexin for a UTI. That's everything that goes down her throat!!! She used to get all kinds of people food and Alpo treats. I know that she thinks that I'm starving her!

Maybe this information will be helpful. For what it's worth, the vet said that he didn't think that Kiska would be regulated until we got to 40 to 50 units per injection. I don't know what else I can be doing. Any and all advice will be welcomed!

Thanks for looking at all of this.

Jeanne and Kiska

[k9diabetes]

Now that you're back from vacation, I think it's time to increase the insulin. You don't have to be cautious until you get into lower numbers but naturally needed to be conservative because you were going to be gone.

Perhaps just call the vet, give him your numbers, and ask about increasing the insulin. You can probably increase it 3-4 units. That would be around 10%.

Kiska's still on a relatively low dose for her size. 50 units would not be out of the range of normal and she wouldn't be considered insulin resistant until 100 units of insulin still didn't lower her blood sugar (Yuk! Can you imagine injecting 100 units at each shot!!).

Especially since it may be a while yet before the atypical Cushings treatment has a strong effect, you may need quite a bit of insulin to get better control. Now that you're home, you can talk to the vet about starting to move the dose up a bit more aggressively.

This is one of the things I don't like about the fruc test - it averages several weeks of blood sugar... hardly a dynamic picture of the effect a change in insulin makes! Home testing will tell you within a few days if you're making any progress. (Hoping you are slowly training your vet to think differently!)

Natalie

[bgdavis]

Jeanne,
Although Crissy has never attempted to bite during an injection or taking a blood test, I use a tablespoon of Mighty Dog and a tiny bit, now don't laugh, of canned cat food as a distraction during her injections. I was so concerned about her weight loss after being diagnosed that I dumped on some Mighty Dog. We saved a can (small, like a tuna fish can) and I mix the dog & cat food together in it and stick it in front of her nose. The cat food has that aroma and she is so intent on licking up every morsel in that can that I could probably inject her 4 or 5 times and she'd never notice.

Bonnie and Crissy

[Kiska'smom]

Hi Natalie,

Thanks for the encouragement. I haven't even told the vet that I upped her dose to 32 from 30. He's really "into" that fructosamine test. I hate to think that it is a money-making proposition, but at $60 a pop, I have to wonder.

Now that I am home from my vacation, I do want to approach this more aggressively. This is the second day for the 32 units. Do you think that going to 34 right away would be too soon? I could call my vet, but I know that he will push for the fructosamine test right away. I just don't see the point. Kiska is no where near being regulated. She has made some progress, but not enough to warrant a test that won't tell me anything that I don't already know.

Did you have a chance to look at Kiska's diet? Perhaps I could do some tweaking there, too.

I'm really enjoying your new site. It's good to be here!

Jeanne and Kiska

[Kiska'smom]

Hi Bonnie!

I almost missed your post. I'm getting a little punchy at this hour! I had to laugh about the catfood! What is in that stuff anyway? My dogs act like it is heaven sent! The worse it smells, the better! I have to keep our cat's food in another room with a baby-gate to keep the doggies out. They are always checking that door to see if someone forgot to put the gate back! Cheeky little devils! They are thinking, "Yummie!" I am thinking, "What died?"

I appreciate the tip! Thank you!

Jeanne and Kiska

[k9diabetes]

At this point the BG numbers look pretty level so you can stick with the diet composition. You could decrease the quantity of food simply to decrease the amount of insulin you have to give but if Kiska's gaining weight and that's what you want right now, I wouldn't do that either.

Any time you change diet, there's potentially a need to adjust insulin. More food (in terms of quantity/calories), more insulin. Less food, less insulin. This is another spot where home testing is invaluable.

If Kiska's weight is headed in the right direction, for now I'd just work the insulin up in 3-5 day intervals. When her weight is where you want it and she's regulated well enough that she's getting the benefit of all she's eating, you can adjust the diet quantity and then the insulin to match.

As far as composition (how much protein, carbs, etc.), I'd wait for lower numbers to change that. In my experience, high BGs tend to be flatter. When you get down to better numbers, you may find larger swings in blood sugar and food is one thing you can tweak then if you do find that the BG is swinging more.

For now, one variable at a time. In this case, insulin.

As for the vet, I'd suggest being very candid with him about cost and that you want to use your home testing numbers to guide you as you get Kiska closer to a good dose. That the fructosamine test is too slow for making dosage changes to get her regulated and that you want to work aggressively to get her blood sugar in a good range.

See what he says.

He needs to be willing to work with you. If he's not, you wind up working it yourself, which is essentially what you're doing already if you feel you have to make increases without telling him. NPH and syringes can be obtained without him but it's not the ideal way to go. Better to bring him on board with you if you can. Give him the opportunity to work with you. If he's smart, he will take it. If not, you're no worse off than you are now.

Natalie

[Kiska'smom]

Hi Natalie,

Of course you are right. I should just tell the vet what I think and be candid about the money situation. I'm really good at stress avoidance, and I guess this is just one of those times. Seems like I have enough on my plate without sparring with my vet; but the smart thing to do is as you say. I don't know if he will work with me. I think that is one reason that I don't want to challenge his advice. I have liked his clinic and staff very much. It would be hard to leave, since he has tried to accommodate me and care for Kiska in his own way. I'll give what you said some serious thought, and I will probably contact him this week and give him an update.

I'll continue to check Kiska's BG and give her the same foods that I have been giving her. I'll check her weight this week and let you know if we have managed to stop the weight loss.

Thanks for being here. The reality check was appreciated!

Jeanne and Kiska

[k9diabetes]

It's really hard to know how a vet will respond. Your clinic seems to pride itself on being "cutting edge" - trouble is, cutting edge in canine diabetes care just isn't all that sophisticated and, sadly, the "experts" in animal diabetes at some of the teaching hospitals are pushing less monitoring instead of more. This website and forum is partly in response to that as two of those teaching hospital experts are just down the road from me.

The good news is that I think vets have a LOT of experience with people who can't afford to do every available test so that is something they have an easy time understanding. That's why I think I'd start with the financial concern.

When we were struggling to get Chris regulated on Humulin L and it wasn't working for him, we were, at the time, relying solely on what the vets told us to do and hadn't challenged them. But I was starting to read up on curves because Chris' curves were strange.

When the expert told me and Chris' vet at the time "Don't change insulins; it's working!" very cheerfully and forcefully, that was the moment I realized that we couldn't just accept the vet's rules without question. If Chris was going to get better, I was going to have to advocate for him and demand better care. I only wish I'd done it sooner.

If our vet at the time had said "Absolutely, I want the best for Chris. Let's try another insulin," we would still be going to him. At the time his practice was overwhelmed and partly he was just too tired to deal with it. Which was another good reason to go elsewhere. He's a good vet and under other circumstances I probably could have gotten him on board with what I wanted to do. But Chris needed a change right away. So change we did.

Sometimes vets seem to forget... they probably don't, but it feels like it... that this is your dog and you have to be happy with the way your dog is being treated. A good vet will appreciate your concern. Sometimes ego does get in the way but I consider an ego issue another indicator that a doctor does not have his patient's best interests at heart, which also suggests the need for a change.

Personally, I hope your vet will see how deeply you care about Kiska and all the initiative you have taken to check her blood sugar and monitor her and appreciate that you are a loving mom to Kiska who should be supported.

Natalie

[ladysmom06]

Hi Jeanne,

Just checking in to see if the shots have gotten any better. Hoping all is going well. Hugs to you and Kiska.

[Kiska'smom]

Hi Lynne,

Yes, the shots have been going better. I started giving them while she eats. She looks at me like it bothers her a little, but so far she has been more interested in her food than in what I am doing. I also give her pills, wrapped in shaved turkey (or roast beef) as soon as she's finished with her dogfood. I used to give those before she ate, and then had to give more shaved meat as a treat after giving the shot. So far, the new routine is working out better, and Kiska seems happier about it.

I have been doing a mini-curve today. Her BG's have all been in the mid 400's. There's not much difference throughout the day. Maybe 25 points. I'm not sure what that means. Her curve will look rather flat, but she is still way too high. I will say that her fur is softer, and her skin isn't quite so dry. Other than that, we're not making much progress. Maybe I should cut back on her food. When she was healthy, she used to eat much more than she is allowed now. I hate that she is so thin, but maybe less food would allow more insulin to work and she would actually be able to use the food to better advantage. Perhaps she would even gain weight on a little less food. I don't know. I'm getting discouraged. I don't know why this has to be so hard. My poor girl.

Jeanne and Kiska

[Denise]

Hi Jeanne! I have a schnauzer with atypical, found 3 1/2 years after diabetes dx. He is atypical atypical as he never has shown any signs of Cushings. I only suspected due to blood sugar going whacko. 3 ACTH tests showed nothing, LLDS...maybe, ultrasound and radiographs...nothing conclusive so we had the adrenal panel done. He is high in both estrodial and progesterone, cortisol isn't as high as a normal Cush dog would have but it can be elevated at times.

Dr. Oliver suggested Lysodren. We tried that, didn't get him loaded the first time, on the second load he went to far and I had to feed him pred for weeks. We stopped that treatment and the old Bogie came back, finally!

In May it will be 2 years since we've treated the AC and we have bouts of high bg, peeing, drinking but nothing more and I can deal with that.

We had tried melatonin in the beginning but didn't see it helped. I've recently started it again and have another dog with more signs than Bogie in the past few weeks so are awaiting the results from U of T.

I also adopted another diabetic almost 2 years ago, have 12 cats and 5 dogs at home plus 2 more.

I've been on boards with many people here and hope to find more time to post here also!

Denise, Bogie and the Bunch

[We Hope]

Am going to bring up another thought--could Kiska be having issues with the protamine suspension in NPH insulin?

http://www.vetsulin.com/vet/DosingProblems.aspx

"Antibodies may be directed either against the insulin or against other foreign proteins in the preparation."

http://petdiabetes.wikia.com/wiki/Protamine

"Protamines are proteins derived from the sperm or testes of salmon or related fish. They are added to insulins NPH Neutral Protamine Hagedorn and PZI protamine zinc to delay their absorption.

"Protamine, like insulin itself, is a protein. In the case of antibody formation, it is possible that the insulin itself is not the cause of them; the proteins present in the suspension, such as protamine, may be."

The way this works re: insulins with protamine in them is that the body has to break down the protamine before it can get to the insulin to use it.

We had this happen when we had to switch Lucky from pork Lente to pork NPH. We read this:

http://www.provet.co.uk/health/diseases/insulinineffectiveness.htm

INSULIN INEFFECTIVENESS IN DIABETICS

and went down the list; Lucky developed lethargy, poor hair coat and neuropathy after going onto NPH insulin. It took more NPH than lente to control his bg's--basically, if you looked at only his blood tests, you'd believe everything was fine with him. It was not, and this is when we started for the importation of Caninsulin/Vetsulin. Within 2 weeks of using pork lente once more, all of the problems of NPH were gone for good.

While we still had to use the pork NPH, Lucky's hair and skin were dry and lifeless. He'd grown a very scanty winter coat and if you were to just look at him, you'd wonder if he might not have Cushing's. But he didn't. He had a normal healthy, shiny coat and no dry skin when we were still able to get pork lente insulin. During those first two weeks on Caninsulin/Vetsulin, he shed the sparse coat he grew under NPH and replacing it was his normal, healthy, shiny one for winter.

Kiska may not have problems with the human insulin itself but with the protamine that suspends NPH. Natalie's Chris also had some bones to pick with NPH insulin, which is why he's using R; he has no problems with human insulin, but with protamine. Lucky had issues with both human insulin and protamine as a suspension in any insulin.

Just a thought.

[Kiska'smom]

Hi Denise and We Hope,

Thanks for looking in on us. Denise, you really have a full house! I often feel overwhelmed by two dogs and an old kitty! You have 19 pets?! Wow! Your vet bills must rival the National Debt!

Hi We Hope,

That is really interesting information. I also give Kiska fish oil capsules everyday. I wonder if they could also contain protamine. Is there some kind of test to see if antibodies are forming? Kiska's fur seems better since we started the insulin. It isn't growing back very well on her tummy where the ultrasound was performed, and her thighs still have that weird woolly-looking fur. Her coat doesn't repel dirt the way that it used to. That could be the Cushing's. Her only elevated hormone was progesterone. The cortisol was in the high normal range after stimulation; normal before stim. The original blood work done in November showed that Kiska's results were consistent with pancreatitis. Her serum Spec. cPL was 699. She, however, had no symptoms of that and still doesn't. Her last blood work done in March didn't show a serum Spec. cPL. I don't know if I wasn't given the whole report, or it just wasn't done. That is the test that showed elevated BG.

Does it seem to you that Kiska should be having better results after one month of insulin treatment? Yesterday was the one month mark for her. We started at 25 U and have increased to 34 U. This morning her BG was 381. We are under the 400 mark, but who knows what the rest of the day will show. I guess that I should be glad that there is progress. We started out over 600, and her average BG's were in the mid 500's.

If you think that she is having an abnormal response to the Novolin N, I will contact the vet and find out what else we can use. Or maybe you have some recommendations of your own. Thanks for taking the time to explain the effect of protamine. That sure is interesting, and a possible explanation for the insulin resistence.

Jeanne and Kiska

[We Hope]

Jeanne,

They do ELISA testing for antibodies--

http://en.wikipedia.org/wiki/ELISA

When we started treating Lucky, we began with Lente-type human insulin. He responded well to it the first week of using it. By the second one, it was like giving him no insulin at all--it was nothing to see bg's in the 500-600+ range. Our initial thought was that he was using the insulin too quickly, so we tried working with some beef insulin which has a longer profile in both dogs and people.

During all of this, I started watching his physical reactions. Within a few hours of getting an injection of either of these, his immune system would destroy it as it would an invading bacteria or virus. What we'd see is that after he'd destroyed that dose of insulin, his hair would become dry, stiff and lifeless. Any blood testing would show us he was back into the high ranges after not really "dipping" much while the insulin was at work. He responded to the beef the same way he did with the initial human insulin. So technically, you could look at his coat and skin and know if he'd destroyed the insulin yet or not. The effect was not as pronounced when we had to use the pork NPH because this time his system was not destroying the insulin--that got through to control his bg's.

All of this was gone when we switched to the pork lente. He dropped about 400 points in a week into the 200's. We then knew we found the answer and it was now a matter of finding the right dose of it.

With the pork NPH, we got acceptable bg's but all of the complications he never had before cropped up. We were able to determine that he was not reacting to the insulin itself, but to the protamine and different preservatives NPH has from Lente. We said that the only thing he liked about pork NPH was that it was made from pork. There wasn't really any choice because he didn't respond to either human or beef insulin, so we just had to keep using the pork NPH until we were granted approval to import the Caninsulin/Vetsulin for him. He was on the pork NPH about 2 months when we got the approval.

Natalie took Chris off the human NPH because he was having issues with it--this is how she came to be giving him the R insulin. You might want to think about giving a schedule of R a try. R has no protamine at all in it, so going to that should tell you if Kiska's issues are with the protamine.

The other side of the coin is that she may have issues similar to Lucky's with human insulin and in that case, you'd need to be thinking of trying Vetsulin, because this is the only pork now available here without needing to import it.

We weren't dealing with Cushing's with Lucky (But believe me, we were checking for it.), but I know that once we learned what was bothering him with an insulin, he was very easily regulated after we got around it. When we had the pork NPH problems, we checked again for Cushing's and found none, so we were headed to the "insulin asylum" once more. :)

[Kiska'smom]

Hi We Hope,

Is the R insulin also available without a prescription? Is it more expensive? Should I ask my vet about trying it before I venture out on my own?

I guess what I want to know is how long I should keep trying the Novolin N? Do you think that Kiska should have been doing better after a month? Her numbers have dropped a couple of hundred points, but are still in the 400's. This morning she was at 381. Tonight she was 429. I am giving 34 U twice a day. I haven't seen any negative effects. Her fur is actually softer and looking a little more lustrous. Today, I noticed more fur trying to grow in on her tummy. It feels shaved -- you know, like new fur is growing, but it is still pretty short. She still has areas that aren't looking all that well. Her tail is still ratty and her thighs are void of guard hairs. I don't think that I could assess Kiska's use of the insulin by her fur. It doesn't look the way you described.

What complications did your dog have with the pork Lente? I'm thinking that the Atypical Cushing's may also be fighting the insulin. Her progesterone is elevated. Not by much, but I know that it is an insulin antagonist. Kiss has only been on the AC treatment for 6 weeks. Having the two diseases may make regulation quite a bit more challenging.

Anyway, I'm very grateful for all of the information that you have given me. I am keeping my journal, adding anything that might help. Thank you so much.

I'm glad that your Lucky didn't have Cushings. One disease at a time is enough to drive any of us to the "insulin asylum!"

Big hugs,

Jeanne and Kiska

[We Hope]

Hi Jeanne,

R is available just as N is--no prescription needed. The difference here is that R goes to work faster and doesn't last as long as N or Lente. You might get some pointers from Natalie if you need to think about this because she's had Chris on R for quite some time. The "down" side of R is that more shots a day are needed--I believe Natalie's now giving 4 (?) a day.

Lucky was great on pork Lente--only problem we had there was when we got a weak vial of it from Lilly. His problems were with the pork NPH-we had neuropathy, poor hair coat which was dry, dull and lifeless, dry skin and constantly irritated eyes. He also started sleeping most of the time while on pork NPH. Caninsulin/Vetsulin is a pork Lente insulin--the difference between the old Lilly pork Lente and Caninsulin/Vetsulin is the strength--Caninsulin/Vetsulin is a U 40 insulin.

Progestrone is a counteregulatory hormone--it raises bg's--

http://petdiabetes.wikia.com/wiki/Counterregulatory_hormones

It's always tougher when you have another problem which raises bg's. Has your vet given you any idea of how long before Kiska might see some results from the AC treatment? You may find everything falling into place much better once that happens. From what you're saying about her new fur, we might be seeing it starting to happen now.

I know we want it all right now but most of the time it doesn't happen that way--we wind up exercising our "patience muscles"--and we feel we're always pumping iron. It sounds to me with regard to Kiska's new fur, that you might be about ready to turn a corner here--just tell her not to be like the young boys who discover they have a bit of "peachfuzz" on their faces and think they need to shave every day. :)

[k9diabetes]

At 105 pounds, 34 units is still on the low side of a normal insulin dose. I would raise the dose 3-4 units at a time and no less than 5 days between increases and see if the blood glucose comes down still further. If, with each increase, the BG drops further, it's probably just a matter of finding the right dose.

If it doesn't drop with increases in the insulin, then there could be a resistance or allergy problem involved.

Since the BG readings are flat, she's definitely getting some effect from the insulin.

Kiska would be considered insulin resistant if she was getting 100 units of insulin per injection and still had high blood sugar. 40 or 50 or even 60 units per injection would not be unusual for her size.

And since you've been trying to get her to gain some weight, you may be feeding a fair amount, which is also requiring a larger amount of insulin.

Mainly, I think the vet's moving too slowly with increases. And in a way he has to because he relies on the fructosamine test. He can't really judge what a change in insulin has done unless he lets that dose sit for two weeks, the amount of time the fructosamine test covers.

You've got good evidence that her blood sugar is still quite high and that more insulin is needed.

I don't know if Marianne has relayed her experience with Pebbles on the Cushings board. In her case, Pebbles' BG would drop for a few days and then bounce right back up - that was from the Cushings. So the test is what do increases in the insulin dose do. If they give a long-term drop in BG, then the dose is just still too small. But if the drop doesn't last... if the BG jumps back up within a few days of each new increase in dose, then there's something else causing the problem.

Regular does have to be given 4 times a day if it's all you give...

I'd say probably try Vetsulin first if you find that the NPH is not working for her. But first bring the NPH up to a full-size dose to make sure it's not just a matter of needing more insulin.

Natalie

[We Hope]

Re: depending on fructosamine tests to change insulin doses, this is from Antech in January 2000:

http://www.antechdiagnostics.com/clients/antechnews/2000/jan00_01.htm

"Although an elevated fructosamine or glycosylated Hb level may indicate less than ideal glycemic control, these values alone cannot tell the clinician how to alter the insulin treatment in order to improve control. For example, a dog that is receiving too little insulin will have a high fructosamine level, but so will a dog receiving too much insulin. The overdose can lead to the Somogyi effect and the subsequent hyperglycemia will lead to an elevated fructosamine concentration."

Makes sense, because the Somogyi high "bounce" can't be distinguished by the test as being caused by too much insulin. It registers, just the same as the high levels caused by not enough insulin do. With just this, too much insulin and too little insulin can look the same.

[Kiska'smom]

Hi Everyone,

I think that maybe the dose is the problem. She does seem to be responding to it, but there isn't enough to really get these high numbers down. With Atypical Cushings, it sometimes takes three to four months to start seeing results from that treatment. Around April 13, it will be just the two month mark. So, if I am truly seeing hair growth and softer fur, maybe things are starting to turn around. She is also not drinking lots of water anymore. She is hungry for her meals, but not ravenous. The pot belly is long since gone. But, then, she has lost 20 pounds or more since November, 2007. Her energy level is better, and she is more playful, and is "talking" a blue streak these days. Her hips are still thin, but not as weak.

I am still having a few problems with shots. Her newest thing is to try and bite me when I'm giving it to her on her right side. I don't know why that side is so much more sensitive. I am right handed, though, and it's more awkward. She did get me the other night, but it was definitely a warning "bite". She didn't bite down, but laid her teeth on me. It didn't hurt at all, but definitely had the desired effect. I jumped back and the needle came out. Poor girl had to get poked again to get the remaining dose. Maybe she feels my anxiety. I feel like the bigger doses hurt more, and I try not to inject quite so quickly (maybe four seconds vs. two). Maybe I should just do it fast and dirty! And then, when I'm on her right side, I am more open to a bite. I have trouble leaning over her, because then my glasses fall off (but this is the safest position)! So, the shots on the right, I'm more worried about keeping track of her big snoot! I'm trying not to muzzle her anymore, but she may give me reason. She did really well for most of the week getting the shots while she was eating. Now she will stop and give me the evil eye. Nothing is ever easy around here!

We have been at the 34 U for five days. She is staying, for the most part, in the 400's. This morning, she had an unusual 528 at 7:00 a.m. I am trying a curve today, so we'll see how the whole day works out. Her BG at 9:00 was already back down to 423. By 11:00 it was at 438. I also opened a new bottle of insulin. Maybe the last pull on the old vial (last night) wasn't strong enough. So, tomorrow should I increase her dose by another two units, or give her a couple more days on the 34?

I still haven't gotten by my vet's clinic yet. Too much going on this weekend. Mike's mom called to tell us that Mike's dad has had a couple of TIA strokes. At least, that is what I think they are, judging by her description. Mike's mom and brothers didn't take him to the doctor or emergency room! We have encouraged them to get him to a doctor this week ASAP to get checked out.

I'll try to get a weight check on Kiss very soon. Thanks for writing and giving me some encouragement. It really does sound more like the dose being off than the Atypical Cushings creating such difficulties. I'm hoping for that, anyway.

Hugs,

Jeanne and Kiska

[k9diabetes]

Hi Jeanne,

If she's still in the 400s today, you could go ahead and do an increase since she's been at this dose for 5 days - probably could go 3 units. You can proceed fairly quickly at these higher numbers. It's when she starts to get into the high 200s to low 300s that you have to slow down significantly, making very small dose adjustments and giving more time between any increases.

It's good to know she's already feeling better.

Also, there's no law that says you have to inject her on the right side. She's a big dog so you've got lots of room to rotate shots and could use just the left and rotate the area you use on the left. I had a diabetic cat and gave injections many times in a pretty small space. Maybe she is more sensitive there. Chris tends to prefer his shots on his left side and there are places on the right where he flinches when injected. It varies quite a bit too based on how far back from his front shoulder I inject.

What needle gauge are you using and what is the length of the needle?

You could try a different length needled syringe and/or a different gauge and see if that's better. Chris is happier with the short needles. I think the longer ones tended to go too far to the other side of the tent. His skin is fairly loose so I don't need much length of needle to get it subQ.

And tell your father-in-law's family to take him in next time!! My understanding is that they can blunt the effects of a stroke if treated quickly. The doctors said my mother-in-law's first stroke would have been far less debilitating if they'd taken her to the hospital right away.

Give a kiss to Kis from us,

Natalie and Chris

[forscooter]

Jeanne,

I agree with all of the above. I think you need to get the dose up on the insulin. Now I am not sure about Kiss, but I can say that I never noticed a difference between a small amount or large amount of insulin resulting in more or less of an OUCH factor.

The needle gauge is a definite possibility though! Needle gauge can not only affect the ouchies but also, for me, can affect the activity of the insulin. The larger needles are usually used for people who have "more" to inject into...and the shorter needles "less". I was told though to use the smaller needles and they didn't work as well even though they did at first and my weight didn't change....so as in Cushing's, even in diabetes there are no hard and fast rules. But it maybe something to experiment with.

Kiska may just be more sensitive on her right side than left...I can inject into the right side of my upper abdomen but not my left. My left..I would bite too! Maybe just try a little higher or lower on the right....or avoid that area if you can. It could also be it hurt once there, and now she is just leery.

Here come the margaritas....and lots of hugs too!!!!
Beth and the boys

[Kiska'smom]

Hi Everyone!

I did a curve today, and I'm excited about the results. Here's how things looked throughout the day. (Times approximate.)

7:00 a.m. 528 (Scary, and I don't know why so high, except I was at the end of an
insulin vial last night. Maybe it was going bad.)

9:00 a.m. 423

11:00 a.m. 438

1:00 p.m. 354

3:00 368

6:00 337

I know that these are still really high, but Kiss hasn't been in the 300's during the day. The only thing that has changed (except for the new vial of insulin) is that she completed her Cephalexin Saturday. I wonder if this antibiotic was raising her BG. Unfortunately, Kiss is already licking those darn elbow calluses, and I'll bet that she'll be prescribed another round soon.

Her needle size is 5/16, 30 gauge. Her skin is very tight. There's not an ounce of fat on her, and her skin is not loose. She's still got muscle up front!

I'm glad to hear that I can do the injections on one side. It's interesting, Beth, that you have sensitive sides, too! There's a lot of room to vary the injection sites on Kiss, so maybe I'll try and keep to the left for a while and see how she does. Natalie, does Chris do better when he's injected closer to the front of the rib cage or the back. The farther back I go, the worse she gets. Tonight I gave her shot on the left while she was eating. She jumped a little and gave me a look, but then went back to eating. I still had the needle in her skin and was able to hold onto it, so I just pushed the rest of the insulin in. She's fine for the first 15 to 20 units. After that, she's paying too much attention to me.

I will increase Kiska's insulin tomorrow. I'll go to 37. That will be a three unit increase. Let me know what you think of today's curve. I can't imagine why her numbers started out so high, but then dropped significantly. Her food and injection times were the same as always. I am so hopeful that this is the beginning of good things to come!

Thanks everyone for all of your help! I hope that things are still looking good tomorrow! Margaritas for everyone!!!

Luv,

Jeanne and The Big Kiss

[Kiska'smom]

P.S.

Yes, Natalie, I told my brother-in-law to get him to a hospital the next time. These TIA's are warning signs that a bigger stroke is coming. I don't know why they weren't scared enough to take him the first time! Sitting around giving him coffee the second time just doesn't make sense to me, but that's what they did. Mike's dad didn't recognize his wife or his two sons. (Mike's brothers live with them.) He came out of it in about ten minutes. He didn't want to go to the hospitial, so they listened to him. Mike and I have told them that it is no longer an option. If he has another one before his doctor's appointment, he has to go immediately. Hopefully, his doctor will be able to run some tests and find out where the blockage is. Thanks for the advice.

Hugs,

Jeanne

[ladysmom06]

Hi Jeanne,

Sorry to hear about Mike's dad. Hoping everything is ok with him.

Happy:D:D to see that Kiska had some numbers in the 300's. Lady is more sensitive on her right side. She usually jumps a little when we give the shot there. Also I can't get her to stay at all when I try and test her from her right ear. I have never been able to test there.

Didn't you read Beth's post on the cushing's board - the new drink:D:D is cranberry juice and vodka in honor of Zoe. Beth is calling it "tinkle tonic". Gotta love the name. Good that we all have a sense of humor. Hugs to you and Kiska.

[Kiska'smom]

Hi Lynne,

Oh, LOL! No, I didn't make the connection between the cranberry juice and vodka to "Tinkle Tonic." I am laughing so hard! I thought that it was a real product! Now there's a million dollar idea! I guess that I will have to do my board reading when I've had more sleep! Obviously, the ol' gray cells were not rubbing together. Oh, that was too funny!

Yes, I'm glad to see numbers in the 300's. Can you believe it, I'm wishing for 200's now. Never satisfied--that's me! This morning at 7:00 a.m., Kiska's BG was 303! At 1:00 this afternoon, it was up to 372. That old infection in her elbow is already back after being off the Cephalexin since Saturday. That bug is remarkably resistant! I'm trying some topical ointment right now, but I am sure that I will need to go to another antibiotic pill. Maybe something else. I'm still wondering if the Cephalexin kept Kiska's blood glucose so high. I guess that it could have been the infection, too. Now that it's back, who knows what will happen? Darn bacteria! If she has another UTI, I guess that I won't be looking for "Tinkle Tonic!"

Mike's dad is okay. He hasn't had another attack, as far as we know. They scheduled his doctor appointment in May!!! I'll bet money that they didn't say anything about the TIA's. No doctor's office would schedule an appointment for something like that a whole month away! Lord, I hope not!

I don't know how you do tests in Lady's ear. That seems like an ouchie place! Whatever works though, huh? :-)

I'm happy that you check in! Hope all is well with you and Miss Lady!

Hugs,

Jeanne and Kiska

[ladysmom06]

Hi Jeanne,

I'm the one wearing the dunce cap. There really is a product called tinkle tonic. I missed the post where they were talking about it:confused::confused:. I sent you a PM on the cushing's board. Sorry if I confused you - what can I say but another of my senior moments. LOL Hugs to you and Kiska.

Luv,
Lynne and Lady

[k9diabetes]

It would be interesting to see what the numbers did into the evening. If this turns out to be a typical pattern and her BGs are higher at night, she might need a little more insulin in her evening injection.

If you get this before tomorrow's injection, based on these numbers, maybe increase her just 2 units. Either way, keep an eye on her BG, especially in the late afternoon, which is when you had the lowest numbers on the curve. If there's another drop, you'll need to stay at that dose for at least five days to see what her long-term response is.

Chris prefers his injections close to the front leg around midchest vertically. The farther toward his back end we go, the more sensitive he gets. In his case, he only gets about 7 units, but I just plunge it in quickly with him. Fortunately, he's very mellow about injections...

Congratulations on 3s!!! :)

Natalie

7:00 a.m. 528
9:00 a.m. 423
11:00 a.m. 438
1:00 p.m. 354
3:00 368
6:00 337

Her needle size is 5/16, 30 gauge. Her skin is very tight. There's not an ounce of fat on her, and her skin is not loose. She's still got muscle up front!

Natalie, does Chris do better when he's injected closer to the front of the rib cage or the back.

I will increase Kiska's insulin tomorrow. I'll go to 37.

[Kiska'smom]

Hi Natalie,

I did a couple of BG checks today. At 3:00 p.m. she was at 428. By dinner she was at 366. I'll try to get a morning check soon. I have a running chart with all of her numbers. You can see the trend going down. It's just too bad that it takes weeks! At least I'm seeing the progress!

Hugs,

Jeanne and Kiska

[k9diabetes]

Hi Jeanne,

Are those numbers on the increased dose of insulin?

I'd like to see her drop into the 300s too!! But if the atypical Cushings still isn't controlled, that might be difficult to do. I still hope she just needs more insulin!

Natalie

[Kiska'smom]

Hi Natalie,

Yes, she is still in the 300's on the increased dose, 37 Units. In fact, there is no improvement at all so far. She has been off of Cephalexin for a week. One elbow is getting infected again, but I have been using a topical antibiotic, and it doesn't seem any worse. I hope that I can get it under control. I haven't done another curve, but I have been spot checking. This is how it looks:

April 8: 7:00 a.m. 303
1:00 p.m. 372
6:00 p.m. 326

April 10: 3:00 p.m. 428
7:30 p.m. 366 (an hour after her dinner)

April 12: 7:00 a.m. 377
9:45 a.m. 407

I took Kiss in for a weight check, and if the scale is correct, she has lost another 8 pounds! It said 96.7. I then took her to another vet (where I get her nails clipped) and their scale said 99.8. Either way, she is still losing; and I don't know what else to do. I have an appointment with another vet April 21. This vet is in the same clinic; my vet just had knee surgery and is out. I couldn't get in before that because they are short-handed. I don't know if the Atypical Cushings is keeping Kiska's numbers high. There isn't more that I can do on that end, unless I choose to start Lysodren. That would cost about $450 every 20 weeks. Everyone at CanineCushings.net has suggested waiting to give the melatonin implant and flax essence time to work (3 to 4 months.) The expense has gotten to a critical level, so I have hesitated to go ahead with the chemotherapy drug. If we must, we will. I am again, very frustrated and worried.

How can I get some weight on Kiska without blowing her BG numbers? Today is the fifth day on the 37 U. Her numbers at 34 U were better. Her diet has not changed. Yesterday, she was probably stressed out going to two vets. The 428 from yesterday was after that trip. So maybe things are just the same. I'm going to take a few more readings today to see how she is doing. I could also call and get another refill on her Cephalexin. I don't know if the infection is bad enough to cause elevated numbers. Last week I thought that maybe the antibiotics were keeping her numbers from falling...now I just don't know. Any advice would be welcomed. I feel like crying.

Jeanne and Kiska

[k9diabetes]

Jeannie,

Just to put things in perspective... these were her last numbers...

7:00 a.m. 528
9:00 a.m. 423
11:00 a.m. 438
1:00 p.m. 354
3:00 368
6:00 337


So actually, your new numbers are improved! Not as much as you want, of course but heading in the right direction.

April 8: 7:00 a.m. 303
1:00 p.m. 372
6:00 p.m. 326

April 10: 3:00 p.m. 428
7:30 p.m. 366 (an hour after her dinner)

April 12: 7:00 a.m. 377
9:45 a.m. 407


You might consider lysodren if you don't get the results you want.

Bonnie's Crissy, despite being atypical Cushings, had classic Cushings symptoms... have you seen her before and after pictures? She had almost no hair, her skin was a wreck. Lysodren has worked wonders for her. So if the current plan doesn't do it, it might be worth trying.

The ongoing skin problem could be more a function of Cushings than an infection. Chris' eyelid ulcers would get secondary infections but bacteria were not the cause. Not until we tried tacrolimus did we get to the cause of the skin problems.

You would have to up the insulin to go with it but you still might consider giving her more food. Could be that there just aren't enough calories going in.

How many calories is she eating per day?

There was a time early on when Chris was on WD that we just weren't feeding him enough to put weight back on. I upped his food, at a time when his blood sugar control was far from perfect, and he was able to gain weight. Some dogs are maintained at numbers that aren't much better than Kiska's so more food could be the answer.

When he was more active, Chris was eating about 1,000 calories a day. He was never extremely active. But it varies for every dog. Since he's slowed down so much this year, I had to cut that amount back and his insulin dose dropped slightly.

This can be a problem with low calories foods like DCO and WD.

Natalie

[Ricksma]

Just wanted to add my good thoughts to you and Kiss.....I hope that you find the right dose soon and things start to get a little easier for you. You deserve it!! Hang in there.

Love and hugs, Teresa and Ricky :D

[rhodesian46]

hi Jeanne,
One month prior to Dx of Diabetes I had been walking Pebbles like crazy. I brought her to may crappy vet to weigh her as we were walking fools!!! She had lost 13 lbs in 30 days She was 86 lbs before I thought oh great she is losing. She was in the vets as she had a horrible smell coming from her bottom They tested her urine and within 30 days she became full blown diabetic compared to borderline. I too was upset that she was losing too much weight and the more food you give the more insulin you need. I felt like I was starving her Some days I just want to give her french fries and a greasy hamburger just to put the weight on. Would never do that of course You are just strting out with this disease and cushings. It take time Ask Lynne she assures me every time that it will get better. I too get frustrated because as soon as I see good Bgs they change on me. Pebbles has lost more weight and is fragile in the rear Lost muscle mass Don't feel bad trilo cost me &75 a month Thats is not including her insulin,meds and script food. I think there was someone on the cushings board that gets their Lysodren from Costco? Why don't you call them to price and too get your ducks in order in case you have to put Kiska on it.I can go back 6 months and see great Bgs when Pebbles was on 30 u. Kiska may need more insulin. It is a slow process going up 2 units at a time then waiting 5 days to increase again. Hang in there Hugs to that beautiful Husky!!!

[Kiska'smom]

Hi Everyone,

I may try giving Kiss more food, but I have to say that my Husky, Sammie, is getting obese on the same amount of food that Kiska is getting. The Lysodren might be an option. I did check the Sam's Club price, and it is about $450 for 100 pills. Kiss would go through those in 20 weeks. We have a vet visit scheduled for April 21. I'm making a list of questions, and I will ask about a maintenance dose of Lysodren. However, Kiska's cortisol is normal. It is her progesterone that is slightly elevated. I don't know if Lysodren would throw her into Addison's. Again, those will be questions for the vet!

Marianne, I know what you mean about a greasy hamburger and fries. I would love to give Kiss something really fattening! If we start the Lysodren, it would cost us about $90 to $110 per month. Then you have to add all of those extra ACTH tests at $90 a pop! Then, $45 every two weeks for the insulin and we just bought our second box of syringes. Then our doggie food costs about tripled with the Science Diet and canned food. Mike is about at his limit. I just put my mother's cello up for sale. If I can get a couple of thousand for it, that would really help. After that, I may need to find a street corner!

These are Kiska's latest BG's:

April 12: 37 units

7:00 a.m. 377
9:45 a.m. 407
12:00 422
3:00 p.m. 382
5:45 p.m. 410

April 13: Spot checks

38 units

7:00 a.m. 374
6:30 p.m. 335

Thanks, all, for checking in on us. I know that I can blow off some steam here, and you will understand.

Hugs,

Jeanne and Kiska

[Kiska'smom]

Hello again,

I have been on the Internet this morning. Kiska's numbers this morning are running in the 400's again on the 38 U. The elbow infection is a little worse. I have a call in to the vet to see about another antibiotic prescription. I am also going to ask about the W/D vs. I/D food.

I have been researching pancreatitis. Kiska had a Pancreas Specific Lipase done in November, which came back with high numbers that were "consistant" with pancreatitis. She has never had any symptoms of it, but I think that this is what threw her into diabetes. There is a medication that can be used to control the pancreatic enzymes. It is called Viokase. Has anyone here used it or know of it? According to the sites that I have been on, pancreatitis causes insulin resistance. I can also use antioxidants to reduce inflammation of the pancreas, but none were mentioned by name. Any ideas here? Vitamin B 12 can be used, but it mentions injections. Is there a pill?

Now there are three things that all have the same symptoms! (Cushing's Disease, Diabetes, and Pancreatitis!) Arghhhhh! How does anyone ever control anything when there are so many variables? I am also making of list of these same questions for the vet. It would be nice to get a few answered today, but I'm guessing that I will have to wait until next week to take up that much time.

Did you know that 40% of diabetic dogs have acute or chronic pancreatitis? It is thought that pancreatitis causes as much as 30% of the diabetes seen in dogs. This was news to me! I lost my Internet connection while I was looking, so I'll have to go back and see if I can find the site. It would be nice to post it here.

So that is all for now. I will post again later after I have talked with the vet.

Jeanne and Kiska

[gpgscott]

Hi Everyone,

The Lysodren might be an option. I did check the Sam's Club price, and it is about $450 for 100 pills. Kiss would go through those in 20 weeks. We have a vet visit scheduled for April 21. I'm making a list of questions, and I will ask about a maintenance dose of Lysodren. However, Kiska's cortisol is normal.
Jeanne and Kiska

Hi Jeanne,

I am glad you are giving additional treatment some consideration. Moria is not Diabetic but I know Diabetics and they usually respond to treatment better that 'Kis has, so I have to believe the Cushing's is interfering with the insulin.

It might not take a very large dose of Lysodren to knock down the intermediates that are elevated, esp, since you are on the melatonin and lignans. Also Ketoconazole will cause rapid decline of many hormones including cortisol and all of the intermediates. What I am thinking it is worth trying some sort of test by giving either Lysodren or Keto for a short period of time to see if that makes the insulin treatment more potent.

Just a few thoughts.

Best to you and 'Kis.

Scott

[We Hope]

Jeanne,

Maybe some of these links will help:

http://petdiabetes.wikia.com/wiki/Pancreatitis

Pancreatitis

http://petdiabetes.wikia.com/wiki/Pancreatic_insufficiency

Pancreatic insufficiency/maldigestion syndrome

http://www.peteducation.com/article.cfm?cls=2&cat=1661&articleid=664

Fats

"Another problem with acutely overfeeding fat can be pancreatitis, a severe and sometimes life-threatening disease often associated with feeding fatty table scraps. Fat malabsorption and resultant diarrhea due to decreased pancreatic enzymes is a problem in some dogs. Additives such as Pancreazyme and Viokase are used to replace the missing enzymes."

http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/190309.htm

Merck Vet Manual Drugs Affecting Digestive Functions

"Pancrealipase contains the pancreatic enzymes lipase, amylase, and protease. It is derived from the pancreatic tissues of swine. These enzymes help to digest and absorb fats, proteins, and carbohydrates. Pancrealipase is used to treat dogs and cats with exocrine pancreatic insufficiency. There are several formulations available, including oral capsules, tablets, and delayed-release capsules and tablets. The powdered forms can be added to food, and the dosage adjusted to maintain normal feces. Antacids may diminish the efficacy of pancrealipase, while H2-receptor antagonists may increase the amount of pancrealipase that reaches the duodenum."

http://www.drugs.com/cons/viokase.html

Drugs.com--Viokase and all brand names for the enzymes.

http://www.ncbi.nlm.nih.gov/pubmed/11570130?dopt=Abstract

Fleeman & Rand Management of Canine Diabetes, 2001

"Evidence of acute or chronic pancreatitis occurs in about 40% of diabetic dogs."

[forscooter]

Hey Jeanne,

You may be on to something here....definitely worth asking about. The pancreas is the critical organ for diabetes. I don't know anything about the drug you mentioned but I think it warrants looking into.

I still am thinking too, though, that with the intermediate hormones still elevated, you need to tackle the Cushing's too. I know you said Dr. O refers you back to your vet, but maybe you can let him know your vet is out injured and you just wanted another point of view and you weren't sure if you should pursue treating the Cushing's with the Lysodren too?

Just my thoughts...lots of hugs!!!! Beth and the boys

[Kiska'smom]

Hi Scott and We Hope!

Yes, Scott, I am about at wits end. I will ask the vet about trying Lysodren, if she thinks that it won't affect the cortisol and cause Addison's. I just can't get Kiska's numbers down! Today she had nothing out of the 400's. Last week at a lower dose of insulin, she was in the 300's. That elbow infection is back, and Kiss was put on another 10 days worth of Cephalexin. I hope that it works quickly. It would be great to see some better results. We also changed her Science Diet from I/D to W/D. Kiss and Sammie both liked it. We'll see if that helps as well. Nothing else is new in Kiska's diet or routine. The lady at the clinic thinks that another blood test will be run next week to see where Kiss is. She put a note in the computer to specifically test for pancreatitis again.

We Hope, you and I were existing in a parallel universe today! Most of the sites that you gave me, I was on this morning! I have been taking notes and have a running list of questions for the vet next Monday. While I was at the clinic getting the new Science Diet, I asked to see the latest blood work that was done March 1. I had a copy, but it didn't have the SPEC cPL that the November analysis had. Turns out, they didn't run another one! So I have no idea how the pancreas has been functioning. I don't know why that wouldn't have been run again. That makes no sense to me.

Kiss had her insulin shot at 6:30 along with her new Science W/D and her antibiotics. I am going to test her blood tomorrow morning. I'll let you know if anything made a difference.

Thanks for everything!

Jeanne and Kiska

[Kiska'smom]

Hi Beth,

Our paths just crossed! Dr. O has recommended Lysodren in a maintenance dose if the Atypical Cushing's isn't under control in three to four months. However, he doesn't know that she became diabetic and is having all these other problems. I just don't know if he would even comment, since he is a "lab" kinda guy and doesn't actually treat animals. He has told me on more than one occasion that I need to discuss options with my vet because he has the whole picture. To me, that says, "ask your vet."

So, I will ask the vet as soon as I can!!! I really appreciate your thoughts.

Did your mom have her second treatment today? If so, I hope that all went well. How are you?

Big hugs,

Jeanne and Kiska

[gpgscott]

Hi Jeanne,

Dr. Oliver might be more inclined to expand on his thoughts about treatment if your Dr. contacted him.

Scott

[Denise]

Jeanne, Bogie is diabetic and atypical, his cortisol wasn't a real issue it was the estrodial and progesterone. We did the first Lysodren load, I got nervous after 10 days and had another ACTH done and numbers were down, vet was ok with these numbers but I found out they weren't low enough. Started another load and in 3 days I had one sick dog. I missed his losing interest in his food, later to find out that if they even pause to look up during a meal that that is a sign! Well, we did the pred thing and it took quite awhile for him to feel well. His bg was easier to control but since there were no other signs of Cushings I was never sure if the PU/PD was due to diabetes or Cushings. I stopped the Lysodren and he hasn't had anything since.

Now today I got the dx that Reba has atypical Cushings. She has all elevated adrenal hormones except Aldosterone. Still need to do an ultrasound but want to get her on something! She is PU/PD, bad coat, panting, seeking cool places, weight gain, hunger....ALK PHOS was only 341 so vet looked at me strangly when I said I wanted an adrenal panel but I was right, they were wrong! I usually get some satisfaction from being right but not so much this time. I was hoping it was thyroid!

I'm curious about the melatonin inplant.

[bgdavis]

Jeanne,

My Crissy has a form of atypical Cushings' (and is diabetic & hypothyroid), called Congential Adrenal Hyperplasia-like Syndrome. The only adrenal hormone that is excessive is 17-hydroxyprogesterone. Dr. Oliver recommended that Criss be put on Lysodren when she was diagnosed in July 2004.

At the time Crissy weighed around 60 pounds (had dropped from 90) and was 'loaded' with 1500mg. of Lysodren. The loading and maintenance doses are based on the dog's weight. She has been on a maintenance dose of Lysodren of 1500mg. spread across 8 days (she gets 1 500mg. tablet on every 4th. day).

I buy Lysodren from Canada. It used to be a bargain, but since the US dollar has dropped so far, now it's just a 'good' price. I just got a refill of 50 tablets last week. Total cost was $206, which included shipping.

Crissy's condition was first studied in Pomeranians and is now recognized to occur more frequently in the 'Nordic' breeds.

Bonnie and Crissy

[Kiska'smom]

Hi Scott, Denise, and Bonnie,

Scott, you are right about Dr. O talking to my vet, but my vet has never called him, even when I gave him the email address and phone number. I don't know why he doesn't. Maybe he thinks he already knows it all. Dr. O has said that he would be glad to speak with him. I know that it isn't Dr. O.

Denise, you had quite an experience with the Lysodren. I was surprised to see that you did a "loading" phase. As I understand it, a maintenance dose does not including the loading. You just give the maintenance dose from the beginning, when your dog has atypical. Am I wrong? The melatonin implant comes in three sizes, and must be put in the dog like a microchip (big needle!) It then releases the melatonin evenly throughout the day. Dr. Oliver seems to like the implant over the pills. The implant runs out in four to six months, then needs to be replaced. They cost between $50 and $60.

Hi Bonnie! I see that you, too, loaded with Lysodren, even though Crissy is Atypical. Another furbaby mom said that her dog was thrown into Addison's on Lysodren, because the cortisol was not one of the elevated hormones. I guess that you have not had that problem. I'd be interested in the Canadian pharmacy that you use for Lysodren. I want to have all of my ducks in a row when I see the vet again. I have read about the Congenital Adrenal Hyperplasia-like Syndrome in Pomeranians. I knew that it was also frequently seen in Nordic breeds. Kiska's case didn't quite seem to fit; but she has been a puzzle all along. Her Alk. Phos. was high, and I think that the information I read said that your type of atypical had normal values for liver function. Did Crissy stop losing weight once you put her on Lysodren? Has she gained back any of her weight? Did her fur grow back?

Today, at 5:30 a.m. Kiska started screaming!! I jumped out of bed and got to her in two seconds. She screamed for 45 to 60 seconds. I could not see anything hurting her. I held her, stroked her, and told her that everything would be all right. She finally settled down. I sat with her, stroking her fur for another hour. After that, I got up to get her insulin ready and food ready for both dogs. Kiska got up and came into the kitchen, wagging her tail and acting normally. I have no idea what happened. I was afraid that she was having a heart attack. I called the vet as soon as they opened this morning. I have yet to receive a call back, and it is now 1:00 p.m. here. Has anything like this happened to anyone here?

Jeanne and Kiska

[k9diabetes]

Was she lying down?

I don't know that Chris' case is similar but he has a back problem and if he gets in the wrong position he yelps and writhes trying to get out of it. Once he does, he usually wants to stay very still for a while, at least 20 minutes or so.

When he does get up, there's no obvious residual pain.

This has happened when he's slipped on a walk, when he's rolling in the backyard, and the other night it happened while we were sleeping. He was on the floor next to me and I woke up to him yelping so I don't know what position he was in at the time.

Chris has some bad discs plus some bone spurs on his spine and he flinches if we run a hand down his back with any pressure. We presume this is the cause of his getting hung up and yelping in pain.

Natalie

[Denise]

Bogie's loading phase was a pretty small dose, I can't even remember how much but it was recommended by Dr. Oliver to give less then normal for his weight.

I've never had a dog scream! I don't think I want to hear this no less be woke up by it! I WOULD have heart failure!

Bad dream? I can't help on this part. I hope it's nothing and she doesn't do it again!

Bogie's atypical is so much different than Reba's. The vet was supposed to call today and didn't! Argh!

Thanks for the implant info. How much is Kiska getting per day from this implant then?

[Kiska'smom]

Hi,

Kiska was sleeping when this happened. She was on her side, and was still in that position when I got to her. She would lift her head a little, but didn't move her body. When she finally tried to roll up onto her elbows, she held one of her paws up, as though it had a thorn in it. I saw nothing in it, and then she laid back down and slept for an hour. Someone on the CC.net said that it sounds like a seizure! OMG!

The vet called at 2:30 on my cell phone, but I didn't hear it ring. I called the vet back, but I am still waiting for a return call. Kiss still seems okay. She has slept a lot today.

Denise, I don't know how much melatonin the implant releases. I assume that it is about 6 mg per day. The implants come in sizes for different weight dogs. I don't recall anything about the amount released. About the screaming, I did almost have a heart attack! I was so scared, and Mike is OOT!

I wish the darn vet would call back.

Jeanne and Kiska

[gpgscott]

Hi Denise, (to hijack Jeanne's thread)

I am from the cushing's site and Moria is Atypical. We did the oral melatonin for 3 months and then switched to the implant. She is better behaving with the implant but we have not got the life of the implant down yet. We retested and replaced after 5 months on the first one and the numbers which had previously been in decline had gone the other way. This time we are retesting (full panel UTK) at 3 monts post implant.

The implant is not costly, should be less than $50.00 and for Moria it helps her behavior a lot.

Hi Jeanne,

I commented to you on the CC site earlier and I really hope there is not a repeat of the screaming. It sounds like pain and I think the most likely cause is degeneration of muscle resulting in nerve impingment somewhere.

Right now I think the most important thing is to find out why 'Kis is insulin resistant and get her bg under control.

Best to you all.

Scott

[Kiska'smom]

Hi Scott,

You may be right about the nerve pain. I just hope that it never comes back! As for finding out why Kiss is so insulin resistant, I'm with you. It has taken way too long for this to resolve. Hopefully, I will have better information after Monday's vet visit. However, they send all blood tests out, so I won't know anything about that until Tuesday. Thanks for looking in on us at both sites!

Hi Denise,

We have liked the implant, too. It is one less pill! I think that the treatment is also starting to work. Aside from the other problems, Kiska's fur is growing a little! Her coat is softer and has more shine. I looked back through my invoices from the vet. The implant cost about $32. However, he charged $25 for a "brief office visit" to put it in. So it was about $57. Hope that helps!

Jeanne and Kiska

[Kiska'smom]

Hi Everyone,

I just have a few minutes to check in before going to the vet with Sammie for a blood test. Kiska's latest fructosamine test was 422. Still not good, but better than it was. We did more blood work and her pancreas and liver are still not functioning well. It is time to try Lysodren. I'm sad about that, but I don't know what else to do. Both diseases seem to be resisting treatment. So, say prayers that the Lysodren will control the Atypical Cushing's and let the insulin help the diabetes. My heart aches, and the financial burden is getting critical. Now Sammie isn't doing well. It just doesn't stop!

I'll check back in later.

Jeanne and Kiska

[BestBuddy]

Hi Jeanne,
I am sorry things are not going smooth for you and Kis. I know it is scary but maybe Lysodren will be the answer. You know you have a lot of friends and really smart people at the Cushing board to help you through too.
Jenny & Buddy

[We Hope]

Jeanne,

I hope that Lysodren is the answer for Kiska--know what it's like to want answers so badly when you don't have them. Also hope that Sammie will be feeling better soon too!

[forscooter]

Jeanne,

It comes in bunches and I wish I knew why! I posted you over at the Cush board too, but wanted to leave my very best here too in case you miss it.
The Lysodren, I think, is the right thing to do...and you know I am standing by to help however I can....and the 'ritas are all chilled and ready!!!

Lots of hugs to you! I hope Sammie is OK too!!!!
Beth and the boys

[k9diabetes]

Hi Jeanne,

I know you're worried but I've seen lysodren save so many dog's lives that it seems most likely this will be the best thing for Kiska too. Plus, if it cuts her need for insulin, you'll save a little money on insulin that you can spend on lysodren...:o

It seems like plenty of caution is being used. That's good. They haven't rushed to lysodren treatment. I hope it's just what she needs to get back to normal.

Natalie


Hi Everyone,

I just have a few minutes to check in before going to the vet with Sammie for a blood test. Kiska's latest fructosamine test was 422. Still not good, but better than it was. We did more blood work and her pancreas and liver are still not functioning well. It is time to try Lysodren. I'm sad about that, but I don't know what else to do. Both diseases seem to be resisting treatment. So, say prayers that the Lysodren will control the Atypical Cushing's and let the insulin help the diabetes. My heart aches, and the financial burden is getting critical. Now Sammie isn't doing well. It just doesn't stop!

I'll check back in later.

Jeanne and Kiska

[Kiska'smom]

Hi Everyone,

I'm really tired and worn out from the vet visit today. If you haven't been on CC.net for the gory details, I'll try to give you the short version. First, the fructosamine test wasn't 422 as the vet said. It was 497! That is only 31 points better than it was a month ago. I have increased Kiska's insulin to 40 tonight.

Sammie went in for a thyroid test. I had already told the other vet that I couldn't afford more expensive tests if Kiska was going to need Lysodren. She said come in and she'd have a tech take blood just for a thyroid test. My vet was there and said that he wouldn't okay the test unless he had a chance to examine Sammie. I said okay. He did a very brief (and that is an understatement) exam, and said that Sammie looked good except for the weight gain and that a thyroid test was appropriate. When I checked out, I had been charged $43 for an "extensive" exam. Ha!

We talked about adding a maintenance dose of Lysodren for Kiska, but my vet went rabid on me about Dr. Oliver and his unsubstantiated treatments! He said that there was no other research done to support Dr. O's claims that a maintenance dose of Lysodren would work. He said that Kiska needed to be "loaded" for seven days with lysodren (no more, no less) and then given another ACTH to see what was happening to the adrenal function. When I piped up and said, "Or until she shows signs of being loaded..." he said, "NO! Seven days!" The bottom line is, he doesn't believe that there is something other than Cushing's Disease. He has no faith in Dr. Oliver's research that proves there is Atypical Cushing's. He wants to treat Kiska for regular Cushing's, and he obviously has his set way of handling it. It was a very unpleasant visit. He finally said that I could do whatever I wanted. It was a snide remark that meant, you can be an idiot if you choose to be one! So, I left and paid my $90 bill. God knows what Sammie is in for. It would be a blessing if she just needs a little thyroid pill. With my luck, the thyroid will be fine, and I won't know what is wrong with her. She has been gaining lots of weight lately...about 14 pounds in the last 6 months or so. I am terrified that she will become diabetic, too.

So now I don't know what to do about Kiska. Dr. Oliver says to add a maintenance dose of Lysodren without "loading." My vet thinks this is foolish and a waste of money. Meanwhile, I am not finding any good prices for the stuff. The best price I found was from a pharmacy in Canada; but I have been told that people have had trouble getting their meds from Canada after paying for them. Sam's Club was the cheapest in town at $432 a bottle of 100 pills. Kiska would need four pills a week on maintenance. It is so expensive, and the vet planted that seed of doubt about wasting the money if I don't do things his way. With money as tight as it is, I am so confused about what to do.

Kiska's blood work was very disappointing. She has made no improvements in two months. In fact, all of her numbers got worse. Add to that the trouble she has had adjusting to her insulin, and it seems like I need to do something different. If that "something" is Lysodren, then maybe I need to try it. Now I just need to decide if I'm going to follow Dr. Oliver's advice, or my vet's. I don't know what to do, and I'm too upset tonight to make any decisions. I do know that Kiska needs extra help to control the Atypical Cushing's and let the insulin do its work.

Maybe tomorrow I will find perspective.

Thanks all!

Jeanne and Kiska

[k9diabetes]

Jeanne,

Let me dig through my files and see what I can find on protocols for atypical Cushings. I have access to a site that supplies proceedings from international conferences, etc.

I know Cushy has said that the docs at UC Davis have been top notch as far as their Cushings protocols. I know a few folks over there and might be able to get hold of some information if they have anything on atypical Cushings.

You know, I've never cared for your vet... do you have any options in that regard?

Natalie

[ladysmom06]

Hi Jeanne,

Sorry that Kiska is still having problems. We use trilo so can't help with the lysodren but there are many on the cushing's board who can. I don't know anything about atypical cushing's either so I can't say if your vet is right or wrong about loading first. Hoping Natalie can get hold of some info for you. Hang in there and know we're all here for you. Hugs to you and Kiska.

[bgdavis]

OK, Jeannie,

Now I'm angry! I guess your vet doesn't believe anything from the American Veterinary Medical Association! Apparently, he thinks his way of treating Cushings' is better than their published protocols!

If you'd like you could refer him to this AVMA Journal article, but he's probably too cheap to subscribe. http://avmajournals.avma.org/doi/abs/10.2460/javma.2005.226.1494?cookieSet=1&journalCode=javma

Here's a link to the place I get Criss' Lysodren from:
http://www.canadianpharmacylink.com/aboutus.html

I think they have a referral program, so if you decide to use them, send me an email and I can provide by information.

But before you start, how much does Kiska weigh right now? Did Dr. Oliver tell you to give 4 500mg. tablets? How does he think the dose should be split?

Can't you find another vet who doesn't think he has all the answers?

Bonnie and Crissy

[We Hope]

Jeanne,

Don't know if you've ever seen this paper or not. The doctor's name isn't Oliver, either.:)

http://www.michvma.org/documents/MVC%20Proceedings/Nichols2.pdf

Michigan Veterinary Medical Association

Canine Cushing's Syndrone: Diagnosis and Treatment

Part 1: Typical, Atypical and Pseudo Cushing's Disease

Like Dr. Oliver, Dr. Nichols is also a member of ACVIM.

[acushdogsmom]

Just replied to you on the Cushing's board, but thought I'd also copy my reply to you here. I hope that's okay. :) (my online time is rather limited at the moment, but I want to make sure you see my reply)

Jeanne,

I must tell you, if it were me, I would have left that Vet of yours after the first (or second) time that he treated you this way. You are trying so very hard to do what's right for Kiska and to get her well again, and the way he treats you is really not helping Kiska nor is it heping you to help her.

I know that money is tight, but I really really think you need to get in with a Specialist. The Specialist cannot properly advise you without actually examining Kiska, but hey, I really think you need to get a Specialist directly on her case anyway, not just for a quick consultation, but for the long term..

I just checked back in your thread at the Cushing's board and saw that when the idea of an Internal Medicine Specialist referral came up before, I had found that there were several Boarded Internists listed in your area, three of them, in fact, at two different Specialty Clinics that I found. One was the "VCA" Clinic and the other one was the "Veterinary Emergency and Specialty Center of New Mexico".

I don't personally know anything about any of the Specialists in your area, but the second Specialty Clinic that I found the first time I looked up Specialists in your area (not at the "VCA" Clinic, but at the other one, where the Internal Medicine Specialist is Dr. Jennifer Strasser) apparently accepts Care Credit, which would very likely help you out quite a bit with the financial part of the Vet visits and care. You could get a real ACVIM Specialist on Kiska's case and care credit could help to make the payments affordable.

So here's that information again:

Dr. Jennifer Strasser (who is a Boarded ACVIM Diplomate) works here:

Jennifer Strasser

Veterinary Specialists of New Mexico
4000 Montgomery Blvd. NE
Albuquerque, NM 87109
Phone: 505-883-8387
Fax: 505-884-6679

Specialty: Small Animal Internal Medicine
Species Preference: Small Animal

And there's a website for that Specialty Clinic too:

http://www.vetspecialistofnm.com/mission.shtml

http://www.vetspecialistofnm.com/about.shtml

http://www.vetspecialistofnm.com/index.shtml

http://www.vetspecialistofnm.com/staff.shtml

I notice that they also have 24/7 emergency care available there and that they also have several other Specialty services (other Specialists) available there, and something just tells me that Dr. Strasser won't "pooh pooh" Dr. Oliver and his treatment recommendations at that clinic. After all, Dr. Oliver has been an invited Speaker at at least two of the recent ACVIM Conferences, so she must know about him and about his work at UTenn.

She couldn't possibly know less than your current Vet does about Diabetes either. :rolleyes:

(even if she does suggest doing fructosamine tests instead of curves, like your current Vet, you can do your own bg curves at home anyway :))

Once Dr. Strasser meets you and Kiska, and sees how much you have tried to learn up to this point about what she needs to get better, she might actually be very impressed, and very pleased to work with a client like you who cares enough to learn as much as she can about what's wrong with her dog and how to get her feeling better.

That was my experience anyway ... there was such a huge difference between my GP Vet and the bright young Internal Med Specialist that we found to treat my dog ... it was like night and day!

Here's where it says on the Specialty Clinic site that they accept Care Credit:

http://www.vetspecialistofnm.com/about.shtml
Payment Options
VESCNM offers many flexible payment options. We accept cash, personal checks, American Express, Discover, Visa, Mastercard. Financing is also available through an independent company, Care Credit. For more information regarding Care Credit, please ask one of our customer service representatives

Not sure if this search result link will work, but here's the link to the search that I also did on the Care Credit website, that told me that they do accept Care Credit there:

http://www.carecredit.com/providerloc/results2.html?Profession=7&Specialty=57&SubSpecialty=0&Zip=87109&Radius=0&Find=1&x=38&y=12

The main Care Credit Site is here:
http://www.carecredit.com/index.html

The Veterinary Care Credit page is here:
http://www.carecredit.com/vetmed/whycc.html

You will likely need a referral from a GP Vet in order to get in to see Dr. Strasser, but your Vet (or his associate) has to give you a referral if you ask for it, and once you get in with the Specialist, you can do what I (and many others here) did ... which is to insist that the Specialist will be the one in charge of Kiska's case from here on in. (especially anything to do with the Diabetes and/or the Cushing's).

If I remember correctly, my Specialist did try to "send me back" to my GP Vet after the initial consultation with her ... she sort of had to do that, so that she wouldn't be perceived as stepping on the referring Vet's toes, but I told her straight out that I wanted the best possible care for my dog, that I did not feel that my GP Vet had that necessary level of expertise that I wanted in the Vet who was going to direct my dog's treatment and that I would not go back to my GP Vet for my dog's Cushing's care. I told her that I would be willing to tell my Vet that it was my decision to keep my dog in the Specialist's care, and ultimately she did decide to keep us as long-term clients. Best move we ever made, bar none!

Your Vet must fax all the relevant test results to Dr. Strasser before your first appt with her, so that she can familiarise herself with the case and so that you don't have to repeat certain tests.

Honestly, with your current Vet, you just never know whether you'll be dealing with the nice and caring side of him or the mean and nasty side of him, when you see him. That's just way too much stress, and and not helping Kiska or you the way you need to be helped by a Vet on this "journey" to get Kiska feeling well again.

Gotta run. If I can think of anything else that might help I'll be back here posting again later today.

edited to add:

I see that the VCA Specialty Clinic also accepts care credit.

http://www.vcavetcare.com/

(click on appointments and then look under financial information and payment policies)

When I did a search for an Internal Medicine Specialist on the ACVIM website, two board certified Internist names came up as being at the VCA Specialty Clinic (Dr. Philip Ries and Dr. Thomas Hribernik)

Thomas Hribernik
VCA Veterinary Care Animal Hospital
9901 Montgomery Ave.
Albuquerque, NM 87111
Phone: 505-292-5353
Fax:
Email: thribernik@comcast.net

Specialty: Small Animal Internal Medicine
Species Preference: Small Animal
-------------------------------------------
Philip Ries
VCA Veterinary Care Animal Hospital
9901 Montgomery Ave..
Albuquerque, NM 87111
Phone: 505-292-5353
Fax: 505-293-9402
Email: phil.ries@vcamail.com

Specialty: Small Animal Internal Medicine
Species Preference: Small Animal

... while on the VCA website, however, I only see one of those two ACVIM Specialists listed (Thomas Hribernik) ... although it's possible that either one of the two websites just hasn't been recently updated to include or remove some names.

[acushdogsmom]

Like Dr. Oliver, Dr. Nichols is also a member of ACVIM.Just a slight correction to the quote above ....

Dr. Oliver is not an ACVIM Diplomate. He is, however, a Professor at the UTenn School of Veterinary Medicine and he is the Director of the Clinical Endocrinology Service, whose training is in the area of physiology, pharmacology and endocrinology.

http://www.vet.utk.edu/faculty/oliver

http://www.vet.utk.edu/diagnostic/endocrinology/personnel.shtml

Jack W. Oliver, D.V.M., Ph.D., Professor and Director of the Clinical Endocrinology Service, whose training is in the area of physiology, pharmacology and endocrinology. Dr. Oliver was responsible for developing the Service for the College in 1978, and has been involved with diagnostic endocrinology procedure and treatment development for the past 30 years. Dr. Oliver became a faculty member of the College in 1975.

For information by Dr. Oliver regarding "Atypical Cushing's", see:
http://www.vet.utk.edu/diagnostic/endocrinology/articles.shtml

Steroid Profiles in the Diagnosis of Canine Adrenal Disorders.
Jack W. Oliver, Proceedings 25th ACVIM Forum, Pp. 471-473, Seattle, WA. 2007.
http://www.vet.utk.edu/diagnostic/endocrinology/pdf/Steroids%20Profiles%20in%20the%20Diagnosis%20of%20 .doc

Diagnostic Laboratory Insight with Regard to Adrenal Disease.
Jack W. Oliver, Proceedings 20th ACVIM Forum, Pp. 541-543, Dallas, TX. 2002.
http://www.vet.utk.edu/diagnostic/endocrinology/pdf/Diagnostic%20Laboratory%20Insight%20with,%20ACVIM% 20Mtg,%202002.doc

Client Information Adrenal Steroid Profiles in the Diagnosis of Adrenal Disease.
http://www.vet.utk.edu/diagnostic/endocrinology/pdf/Client%20Info,%20Atypical%20Cushings,%202006.doc

And a document from UTenn Endocrinology Lab which explains how the tests that they do should be performed:
http://www.vet.utk.edu/diagnostic/endocrinology/pdf/endo_tests_info_07.pdf

[acushdogsmom]

Just one more thought ....

I really do think you need to get a Specialist on Kiska's case, but I'm thinking that you also may want to change GP's and find one who really works well with the Specialist. That way, you can choose to have some of the testing done at a GP Vet's office if you want to, and still be sure that the Specialist will be consulted and that her input will not be ignored. And you can stay in touch with both of the Vets, the GP and the Specialist.

I was just surfing around the 'net and found this website ... I know nothing at all about it, but this one looks like a nice GP Vet Clinic:

http://www.deserthillsvet.com/dhvet/index.html

What impresses me is that it's obvious that the GP Vet there does work with Specialists on a regular basis ... there is even a page on their own site (the GP Vet's website) that gives the contact info for Dr. Strasser and for some of the other Specialists with whom they consult.

http://www.deserthillsvet.com/dhvet/index-3.html

Jeanne, I know first hand how hard it is to start with a new Vet ... I remember when I switched my boy into the Specialist's care, thinking how we didn't know anything about each other and that we would be "starting from scratch", relationship-wise, so to speak. But I did it anyway (ditched the "familiar" GP Vet) and put my boy into the care of a new Vet I didn't know at all, and who also happened to be an Internal Med Specialist. It wasn't long before we both realised that we (the new Vet and I) were on the very same page and that we were going to be able to make a really great team together, and work well together to get my boy well again.

Any new Vet you choose (GP or Specialist) will likely not want to discuss Kiska's case with you on the phone before ever actually seeing and examining her. But it really isn't very ethical for a Vet to try to give someone input on the phone about treatment options without having ever seen the dog or any of the test results etc. So you've got to try to find a Vet you think can really help Kiska and who will work with you, and then get Kiska in to see that Vet.

I guess what I'm trying to say is that I think that although it's hard to make a change sometimes it's the best thing to do. And even though it's not always easy to do, you probably do need to start fresh ... get a Specialist Vet on the case who has the knowledge and expertise to really help Kiska. And maybe a new GP Vet is a good idea too ... one who works well with Specialists and who doesn't resent having clients see Specialist Vets when it's needed ... a GP Vet who is not on any kind of ego trip and who has the dog's best interests at heart.

[rhodesian46]

Hi Jeanne,
I do agree that you need to find a specialist I also have Care Credit but A & M doesn't take it so I have to save. It will be expensive at first but they are so much more knowledgeable than a regular vet Kiska has 2 complicated diseases I still have not properly regulated Pebbles Your vet sounds like a butt hole Time to look for another one Wish I had listened to all when people on the forum told me to switch I could of saved pebbles unecessary diagnostics Instead I had to repeat it all. I ( this is my opinion) will not take pebbles to any vet in Austin and will save and drive 1 1./2 hours awayPlease consider getting a second opinion from an IMS maybe they will be willing to work with who ever u use a a reg vet That saves costs. has Kiskas blood pressure ever been taken?I never knew that vets should do this I too have spent a fortune on Pebbles and her care is expensive every month I realize that some money is hard to come by and some can't pay an IMS. You did read my post on Pebbles visit to the IMS His instructions were in detail about what to watch for and what is considered dangerous. You should of told that vet off I have a bad taste for reg vets as I am still fuming over him telling me Pebs had Diabetes Insipitus and I had spent almost $2000 in meds When all along pebbles had cushings.

[eyelostit]

I'm so sorry you are having so much worry with Kiska, let alone poor Kiska.

My other dog chief who is 14 now was diag with cushings in 2005, 3 yrs ago, I did not go with the treatments, we used the Ketoconazlole for a few days which zonked him out, I was afraid to do the Lysodren and the other med, with the side effects and the cost, I decided not to go with the Lysodren, at the time of Diag chief was 11, he had lost a little hair and his body fat got re distributed, but he is still here after 3 yrs with cushings and he' s a happy dog, he has trouble with his hips now with his age. But when i discussed the treatment for him, his age, the costs, all was factored into my decision.

So I had to make that decision, Chief has lived a good spoiled doggies life, he's 14 now and I don't know if he will make it thru the summer with his hips.

My vet is amazed he is still here, she told me he would die in a year, so they can be wrong, I had it in mind he was going to die if I didn't get treatment, then I looked up some info, some people choose not to treat cushings, if he was 11 & diag with cushings at the age I would think he would of left me a long time ago listening to the vet.

But chief did not have diabetes, he does not drink excessively or pee alot, he just could keep eating if he could.

I hope things are better now.

[Kiska'smom]

Hi Everyone,

Wow, I am blessed to have all of you in my life! Thank you a thousand times! Before I start to try and answer your questions, let me fill you in on today's events. I got a call from my vet's clinic, but it was not my vet who made the call. It was his associate (the lady doc that I like)! She said that the results of Sammie's thyroid test came back, and Sammie is, indeed, hypothyroid. She told me that she would get the pills ready for me, and promised that it would be inexpensive. (It was! Only $8.55). I asked if I could get the med from WalMart, but she said that dogs take much higher doses of thyroid medications than people, and that I probably couldn't get the .8 mg there. Then she said that she had read Dr. Oliver's emails! I asked her what she thought, and told her that my doc had said that they had conferred about this and did not agree with Dr. O's recommendations. She told me that Dr. Oliver was the expert in this field, and even though the Atypical diagnosis and treatments were new to her, she could not see any reason not to try the maintenance dose of Lysodren just as Dr. O suggested. Worst case scenario, it would not work, and we would simply have to do a loading dose at a later time. Best case scenario, Kiska would start feeling better and both diseases would start to come under control. I can't tell you what a difference it was talking with her! I said that I had come to the same conclusion this morning. Other than a little time and money, we had nothing to lose by trying Dr. Oliver's treatment. So, that is our plan!

A friend of mine (one of whom recommended this clinic) said that she started out with my vet, but ended up using his associates because she couldn't stand him! She said that I would probably like this lady vet and be able to work well with her. So, now I am thinking again about staying for a while under the care of a new vet. I am looking on the Internet for the best price that I can find for the Lysodren. It is more expensive locally. When I finally place the order and have the medication on the way, I will call this new vet and get started with the treatment.

Bonnie, you asked about Kiska's weight and the dose of Lysodren. Kiska weighs about 100 pounds, give or take a couple of pounds.

(I am going to try and post this much, as I have been gone for more than two hours talking with a friend!) Hopefully it will post, and then I can continue with the story!)

[eyelostit]

Good News is always good, i wanted to post a picture of chief, but i have to do the photobucket thing.........maybe next time

[eyelostit]

http://i102.photobucket.com/albums/m115/sungduk/CHIEFXMAS3.jpg,

Chiefs picture

[Kiska'smom]

Hi! It worked, so I will continue...

The lady vet said that Kiss would need 2000 mg of Lysodren per week on a maintenance dose. She would split it into 1000 mg doses given over two days. I don't remember if she said those days would be back to back or spread out over the week. That's all that I remember about what she said. I was still in shock that she was on board with Dr. Oliver's treatment recommendation! As for a specialist, the one that Cushy found on Montgomery Blvd. is really close to me. I could get there in 10 minutes. I will have to ask this new vet if she will work with a specialist. My guess is that she would. She doesn't seem to have the ego that Mr. Hyde has.

A friend of mine is taking her dog to her vet on Friday. She has invited me to go along and check him out, too, as a possible new vet. So, I guess that I have some options, and I can relax about what has gone before!

I found a Canadian drug company called Affordmeds.com. They list 100 pills of Lysodren at $350, plus $12 shipping. That is the cheapest that I have seen; however, with the dollar losing value, I don't know if that price will still be current. I will email and find out. Does anyone use this company?

Hi Natalie! I know that you have been underwhelmed with my vet. That makes about 10 of us! LOL! He owns the clinic, so he will always be around; but I won't have to make appointments with him. I almost think that he will be happy that I am out of his hair! The lady vet was impressed that I was home testing. When she called to give me the test results, she said that my journal entries were pretty much in line with the fructosamine results. (She did, however, read off the glucose number instead of the fructosamine number.) Even so, she seemed to think that I was keeping good track of Kiska's progress, and that I already knew about where Kiska's numbers were. I'll bet that she won't insist on more fructosamine tests. I'll just bring my journal to each visit.

Even if I stay at this clinic for a while, I will probably keep looking for a vet that is closer. It would be great if the specialist on Montgomery Blvd. turned out to be a good choice. Tonight I am feeling better, and know that I have plenty of options.

Hi We Hope. So many of you sent wonderful replies; I hope that I am remembering what you said specifically. I have read the Internet entries by Dr. Nichols. I was looking for that supporting evidence that my vet wanted. This vet acknowledges the different types of Cushing's disease, but I didn't see any references or supporting studies. I will have to go back and click on your sites to be sure. Last night I was trying to dig up enough information to refute everything that my vet said. After a while, it hit me. I don't need to do this! He should be doing this to keep current. So I gave up and went to bed! I would really love to pick Dr. Oliver's brain about his research; but then I might have to tell him why I was interested. He probably already knows that some vets will not value his research; but I will not tell him about Mr Hyde. I would not hurt Dr. O's feelings for the world.

So, that is where we are tonight! Kiska's BG's have not been very good all week. She has been mostly in the 400's again. I don't know why, and I have increased her insulin to 40 in the morning, and 41 at night. My vet said that he didn't think that Kiss was insulin resistant. He said that she still isn't taking enough insulin for her weight. He shot off a bunch of numbers per pound per dose, and finally said that Kiska wasn't there yet. When I tried to get him to slow down and explain, he said that he had another patient waiting. So, that was the end of that. Natalie, maybe you can make better sense of that for me sometime!

Lynne, thank you for the support. It is always nice to know that folks are out there who really care.

Marianne, thank you for telling me more about Pebbles' story. You have been through a lot, too. I will seriously look into getting an IMS on board, if I can afford to do it. I have my mother's cello on consignment, and hope that it will sell soon. Then I will have a little more money to work with. It is all ear-marked for Kiska.

Well, it is late, and I am tired. I will check in again soon. I will also go back and read through all of your replies. I need to check out all of the sites that you were so kind to include. If I have overlooked anyone, please forgive me. I will make it up to you later!

Hugs,

Jeanne and Kiska

[k9diabetes]

Hi Jeanne,

I am SO EXCITED for you - your report about the lady vet is very encouraging. I wonder what it's like for her to work with him as he is clearly aware that she's more popular and makes snide remarks about seeing her instead. Someone who will sort it out, or work with the IM, or refer to the IM is what you need. And if the IM is good, since he's close, you can work with him if you prefer. Choices!! :)

I was thinking exactly the same thing the two of you were - there's no harm in trying the no-load and it's the safer, more conservative of the two options. If it doesn't work, it doesn't work and you do a loading!

My vet said that he didn't think that Kiss was insulin resistant. He said that she still isn't taking enough insulin for her weight. He shot off a bunch of numbers per pound per dose, and finally said that Kiska wasn't there yet. When I tried to get him to slow down and explain, he said that he had another patient waiting. So, that was the end of that. Natalie, maybe you can make better sense of that for me sometime!

Will be interesting to see what the lysodren does for her insulin needs.

The most common dose of insulin for diabetic dogs is 1/4 to 1/2 unit per pound. Most dogs need something in that range. So Kiska could need 50 units and be well within what's typical.

A dog is considered "insulin resistant" when 1 unit per pound does not effectively control their blood sugar. So if Kiska was getting 100 units of insulin per injection and still had blood sugar in the 400s, she'd either be insulin resistant or flaming Cushinoid! If she needed 60 or 70 units, that would be higher than typical but not wildy so.

But the fact that her glucose keeps jumping back up to 400 after each increase reminds me a lot of Pebble's experience so I suspect the Cushings is at work there and hope that lysodren will give her control on what she's getting now or less.

Natalie

[Kiska'smom]

Hi Natalie!

Yes, that 1/4 to 1/2 unit per pound was what he was talking about! Now it finally makes sense! And, how long did that take? Certainly another patient couldn't have waited 10 seconds more for him to explain that a little better. Thank you!

Bonnie, I looked at your Canadian site, and they list 100 pills of Lysodren for $380.73. Does it cost you more to order less? Or is the shipping really high? (You said that you pay $206 for 50 pills including shipping. If I double that, it comes to $412 for 100.)If I choose to use this site, I will let you know and work out that referal for you. Thanks for the info!

Hi Eyelostit! (Sorry, I don't know your first name!) Thank you for the picture of Chief. What a beauty!

Hello Lynne! I appreciate the support! You guys are the best!

As for Kiska's BG, this morning she was back to 303!!!! Yipeeeee! Now if the Lysodren actually helps, she could be on her way to feeling much better. I'm anxious to get the Lysodren ordered and get started!

Hugs to all,

Jeanne and Kiska

PS: Sammie started her thyroid meds last night. I have no idea what they will do for her. Hopefully, she will be able to slim down a bit!

[bgdavis]

Jeanne,

I only order 50 tablets at a time. I think the shipping is like $20, but it has only taken from 7 to 10 days for me to get them. We've had no trouble with the US trying to stop the importation of drugs.... maybe because they mark the package that it's for a canine.

I'm not sure if I still have the invoice from the last shipment at home or not. I'll check it out.

Bonnie and Crissy

[Kiska'smom]

Hi Bonnie,

I haven't made a decision yet about where to order the Lysodren. I really would like to take advantage of a Canadian Pharmacy, since their prices are so much better. I am really glad to hear that you haven't had any trouble importing your order. Thanks for checking on your invoice!

Jeanne and Kiska

[bgdavis]

Jeanne,

I found the invoice. It actually comes from Granville Pharmacy in Vancouver. I ordered 50 tablets (that's what my vet wrote the prescription for) and the sub total was $196.36. Shipping was $9.99, all in US dollars. I have a coupon for their referral program, but it looks like all you need is my name and phone number. It would give me a $10 credit on my next order, although I'm never sure with Crissy if there'll be another order.

Also has a toll-free phone number for price quotes and enquiries: 1-888-730-3338.

Bonnie and Crissy

[Kiska'smom]

Hi Bonnie,

Thank you for looking up that invoice. If I double your order (my vet wrote the script for 100 tablets) it looks like it would cost about $392 plus shipping. That's not as bad as some prices I have seen. I wanted to say, that's a "good" price, but then I stopped myself and said, "Are you crazy?!" There is no such thing as a "good" price for this stuff! All I can say is that it better work!!! I just sent an email to Dr. Oliver, asking how the Lysodren can work for Atypical Cushing's without the loading dose. I'm really hoping that I can avoid it, since it would use about 28 pills in a week! Ouch!!! Whatever works, though; I'm getting desperate!

Your Crissy is so pretty!

Hi Natalie,

Kiska's BG's are back in the 300's. Yesterday she was at 303 at breakfast, and 355 at dinner. This morning, she was at 321. I will stay at the 40 U in the morning and 41 at dinner for at least a week. We'll see how she is maintaining. If I buy the Lysodren locally and start it this week, I will do more testing throughout the day to make sure that she doesn't drop suddenly. I have no idea how all of this works in combination, so it will be a little scary!!! My vet doesn't understand using Lysodren without a loading phase, so he can't help me with that information. Hopefully, Dr. Oliver will be able to shed some light there! Anyway, we're hopefully going to make more progress now!

Jeanne and Kiska

[BestBuddy]

Hi Jeanne,
I really don't know much about atypical or that much about lysodren either but I am sure you wouldn't have to use 28 pills a week. Even the loading dose is only a pill or two a day. I don't know what strength the pills come in but everyone says it is cheaper than trilostane. I may be wrong but make sure you check out the dosage instruction as too much lysodren would be really dangerous.
Jenny & Buddy

Just done some reading and I understand the 28 pills a week (4 a day) would have been worked out as a loading dose which may only have to be given 2-5 days but it sounds like you would be going straight to a maintenance dose of 4 pills a week which sounds a lot better and cheaper.

[Kiska'smom]

Hi Jenny,

Yes, you are spot on with the loading dose. That is the killer!!! Anyway, Dr. Oliver says that I can go straight to the maintenance dose (four pills a week) so even though the prices are making me sick, at least the pills will last a while! Thanks for the information! I didn't know that Lysodren was "cheaper" than Trilostane. OMG! What does that stuff cost?!

Hugs,

Jeanne and Kiska

[ladysmom06]

Hi Jeanne,

Happy to see that you have a plan for Kiska. Once you get Kiska cushing's controlled you should see better bg's and her insulin dose could decrease. Before Lady started the trilo she was on 11 units of insulin - that's a lot for a dog her size - but within weeks we were able to decrease her dose to 5 units. Sending prayers and positive thoughts that the lysodren does the job and Kiska is back to feeling well. Hugs to you and Kiska.

[acushdogsmom]

Just copying my post to you (from earlier today) at the Cushing's board, to your thread here. :)

Dr. Oliver replied to your e-mail and said:

"Lysodren will cause a lowering of these hormones: cortisol, androstenedione, progesterone, 17-OHP and aldosterone. Estradiol is more variable, and it can be suppressed by Lysodren, but other times it may have no effect at all. The "loading dose" causes a significant inhibition of adrenal function which is then maintained by "maintenance dose" therapy. If you don't do the "loading dose", you will still have some suppressive effect with a maintenance dose; just not as much, and this smaller dose would not affect the aldosterone level that much."Actually, the way I learned it, Lysodren doesn't usually lower aldosterone production very much, if at all.

There's an explanation of the anatomy of the adrenal glands here:

http://www.lbah.com/canine/cushings.htm#anatomy


The internal architecture of the adrenal gland is made up of several distinct zones.

Cortex
The cortex of the adrenal gland is made up of 3 anatomical parts:

Zona Glomerulosa:
This is the outer layer of the adrenal gland. This section secretes the mineralcorticoid aldosterone. Aldosterone is vital to proper sodium and potassium regulation.

Zona Fasciculata:
This is the next layer as you go inward, and produces the glucocorticoid cortisol. The cells in this area are the ones that cause Cushing's.

Zona Reticularis:
As we continue inward we come across this section that secretes the sex hormones known as androgens (male sex hormones), estrogen (female sex hormones), and sex steroids. These are usually secreted in such small amounts as to be of no major significance in healthy animals.

Medulla
This consists of the very center of the adrenal gland. It secretes hormones called catecholamines. The two important ones are epinephrine (adrenaline) and norepinephrine.
Lysodren usually specifically targets only 2 of the 3 adrenal cortex layers (Zona Fasciculata and Zona Reticularis) and usually "spares" the third layer of the adrenal cortex (Zona Glomerulosa) so the cortisol and "sex hormones" and "sex steroids" are lowered by the Lysodren, but the aldosterone production is not usually affected much, if at all. Aldosterone production is, however, sometimes affected if/when a dog is overdosed with the Lysodren, and usually that would happen (if it happens) during the loading phase.

My dog's Specialist actually drew me a diagram of the adrenal glands before we started the Lysodren treatment, to help me understand the anatomy of the adrenal glands and the effect that the Lysodren would have and her drawings and explanation was pretty much exactly as I just quoted and explained above.

All that said, what Dr. O. is saying about using a maintenance dose of Lysodren without first doing a loading makes total sense to me. A maintenance dose of Lysodren really shouldn't have any effect at all on the aldosterone production (aldosterone is what regulates the electrolytes), but it should have some suppressive effect on the cortisol and sex hormone and sex steroid production, which is what you would be aiming to accomplish.

This is what I would consider to be tailoring the drug treatment to the actual needs of the dog, rather than just following a protocol that is set out to treat a typical Cushing's case. I think that's what your (ex) Vet did not understand ... that the drug can be used in a sort of unusual way that would work well for Kiska even if it would not work very well for a frank case of Cushing's (where cortisol is very elevated).

Fingers crossed that it works exactly as planned, and that by lowering the cortisol and sex hormone production to some degree with the maintenance dosing, the bg will come down to exactly where you want it to be, too.

(((hugs)))

[Kiska'smom]

Hi Cushy,

I just love your posts! You always have the best information! Thank you. I will be posting Dr. Oliver's latest recommendations on CC.net today. Things have gone back and forth a bit, since I last posted here.

Hi Lynne, it was good to hear that you were able to lower Lady's insulin after the Cushing's was brought under control! I love to hear positive stories!!! Thank you!

Hi Natalie!

I just have to post the best news last...Kiska's BG was down in the 200's for the first time ever! This morning it was 261!!!!! Yipeeeeeee! Nothing new with regard to diet or insulin, so maybe she is just making progress. I have been euphoric all morning!

Luv and hugs,

Jeanne and Kisa

[BestBuddy]

Jeanne,
Yippee :D. The 200's is certainly worth celebrating. Fingers crossed that it will continue to improve.
Jenny & Buddy

[We Hope]

http://media.bigoo.ws/content/gif/dogs/dogs_166.gif

HURRAY!

[k9diabetes]

Sweet.... (but mostly sugar free!)!!! Congratulations!!!! :cool:

Natalie and Chris

[Kiska'smom]

Hello Everyone,

I know that I have been a bit absent. We have had some family trouble (Mike's dad was diagnosed with a brain tumor), but things are back on track for now. I also have a sick modum that keeps kicking me off of my sites. So, I will try to get this down before it goes on a snit again.

Kiska continues to do well. I just increased her insulin again by one notch May 3. She is up to 42 U bid. We are now seeing numbers in the high 100's!!! Finally!!! She has some of her old spark back, and I am very pleased. I did order the Lysodren, but had some trouble with my Canadian contact; and I may not be able to get it from this supplier. So, even if I manage to place another order today, I won't have it for a couple more weeks. Things never seem to go as planned! Anyway, when it comes, I will start Kiss on her maintenance dose and watch to see if her insulin requirement goes down. That would be nice.

Kiska has fallen into a regular routine with her shots and her meals. We have finally found a place where she is comfortable. She comes right over for her shot and sits quietly while I give it. Then she gets a lot of love pats and praise, before a little treat of shaved turkey. It's working, and I'm not going to make any changes! She's doing so well!

Her last blood work still shows signs of liver damage and pancreatitis. I have started giving her Pepcid before her meals. I know that she will need the Pepcid for sure when she starts the Lysodren. So, we're adding things a little at a time. She is doing well with this also.

Mike's dad will see a specialist this week. We don't know what kind of tumor he has, or if it is operable. He has two new medications that have reduced the swelling in his brain. He is doing so much better now. He is able to talk and communicate well. We hope that this is a good sign; but we won't know until the tumor is biopsied. We are taking the little good news that we have and appreciating every moment of his improved health!

So that brings you up to date. Oh, except for the French bread episode. Kiska managed to steal a whole loaf of French bread off the top of my stove. She ate the whole thing topped with butter! I had to take her to the emergency vet, where she was made to throw it up! That was one expensive loaf of bread! Anyway, Kiska has been fine ever since. I now put everything up high where she can't reach it! She used to be a real counter-surfer, but hadn't been doing that since she got sick. Obviously, she is feeling a whole lot better! She is up to her old tricks!

Hope that everyone is doing well. Hopefully, I will get this modum problem fixed so that I can cruise around the Internet as usual!

Hugs,

Jeanne and Kiska

[Kiska'smom]

Good morning!

We have a new record! Kiska's Bg was 156 this morning! Things seem to be going down all of a sudden. I'm so pleased, but also wondering if this is normal. She isn't even on the Lysodren yet. I wish that I could do a curve today, but I will be at an appointment most of the day.

I did read the new thread about low blood sugar. What good timing! I now have a list of signs posted on my refrigerator! I already have syrup and honey on hand. When and if Kiska has low blood sugar, I know that I will be scared to death, but better prepared to handle it. Thank you for making that information available!

Just to ease my curiosity, should I expect Kiska's BG to level off or keep dropping this week? I upped her dose from 41 U to 42 U May 3. It seemed like such a small thing to do, but it has made a dramatic difference. I also started Kiss on Pepcid about three days ago. Could that lower BG? When we first started on this particular journey, I remember Natalie telling me that when Kiss was close to regulation, small changes could bring big results. I guess that she was spot on with that information!

Anyway, I am thrilled to pieces! I just wanted to let everyone know!

Have a good day!

Hugs,

Jeanne and Kiska

[BestBuddy]

Jeanne,
Wow what a good number. I am so pleased for you and Kis, it seems like it has taken a while but the result is just as sweet.
Jenny & Buddy

[We Hope]

Jeanne,

It sounds like you're getting close! ;) Getting into and keeping to a pattern is more help to getting and staying regulated than some people realize. When we had the weak Iletin and the only choice until another vial could be ordered was to use the older, less than 100% potent one, basically all we had to bank on was to be consistent with everything. It took 3 days to totally get rid of Lucky's visible post-meal spike with the old vial, but being consistent with it got us there.

I don't see any advisories re: diabetes and/or changes in blood sugar with the Pepcid:

http://www.drugs.com/pepcid.html

Our Old English (not diabetic, thank heaven!) was a bread fanatic. When he was not yet full grown, he managed to work a loaf of bread off the table while we were out. He very politely took it out of the bag, ate every slice and left the bag on the floor. :D

I think I see the light at the end of the tunnel and it's a lot brighter than a candle! :)

[Kiska'smom]

Hi Jenny and We Hope!

Yes, I am still feeling really good about Kiska's numbers coming down!

We Hope, so you have a bread story, too? If Kiska had not been diabetic, I would have watched her through the night, but not felt too sorry for her! This is not the first time that we have had a dog wolf down something that they shouldn't have eaten. I was just afraid to take the chance, with all of Kiska's problems!

Thanks for the update on the Pepcid. Maybe her numbers are just coming down normally. Maybe the melatonin and flax seed oil have been helping!

Hope you are both doing well!

Hugs,

Jeanne and Kiska

[rhodesian46]

Jeanne,
I have learned not to tell anyone about Pebbles lower Bgs because every time I did she would go erratic. So shhh about Kiska great job Mom!!!

[forscooter]

Hey Jeanne!

Yes, my sister is here from NM!:D

I wanted to reply quickly bc I am exhausted after my appt. today...I was told by my nurse practitioner at the endo's office that I have to be careful with some of the stomach meds like Pepcid, Nexium, etc bc they can interfere with BG levels. I'm not sure how or why...but I am going to see if I can find anything. Of course, this is all people-related as you know...but I am thinking it is a possibility....

I'll see if I find anything and will be back!!!
Hugs and kissies, Beth and the boys

Geez, I can't find anything...and I do remember looking into it for me a few years ago when I had gastritis...and I was surprised she said that. I recall asking her about it bc I thought it didn't have any effect at all but for whatever reason she said no, it can...:confused:....I was having lows at the time and she thought it may have been that.
I'm wondering if Kiss has a good stomach day, maybe stop the Pepcid for a day or two and see what happens...then you'll know.
I'm sorry...I know I am a big help here. I wish I had asked her more about it now!!:(

[Kiska'smom]

Hello everyone!

Marianne, I will whisper when Kiss has another good BG day!!! You are so right, I haven't seen another 150 range number since!

Hi Beth, thanks for the information. I don't know if the Pepcid is having an effect on Kiska's BG numbers. Right now, I'm more concerned about the possible pancreatitis, and trying everything that I can to avoid it. If she has a couple of good days, I might drop the Pepcid and see what happens! However, lows are what I'm after!!!

How did your appointment go? Did you have a good time with your sister? Hope all is well with your mom, too!

Hugs to you both,

Jeanne and Kiska

[Kiska'smom]

Hi Folks!

Sorry to have been away for so long. Mike's dad is not doing well. The brain tumor is the worst possible, and we have been told that he only has a year or less to live. He had another seizure in the hospital, and he has suffered a big setback. Russell is out of the ICU, but has not been able to communicate, and his right side is not functioning well. My visits will be sporatic, at best, for a while.

Kiska's BG's are doing great! We even had a 114 this week! I haven't started the Lysodren, as it hasn't arrived yet from Canada. Kiss seems pretty content for the moment! She did manage to steal a bite of cornbread off of the counter the other night. Luckily, it wasn't the whole pan! She obviously feels good enough to still cruise the counter.

Hope that all of you are hanging in there. I apologize for my absence, but I know that you understand!

Hugs,

Jeanne and Kiska

[k9diabetes]

From Marianne at K9C...

It is with sadness that I share the news that Kiska passed on to Rainbow Bridge on June 1st. She had developed a massive liver tumor, and so Jeanne gave her beloved Kiska the final gift of release. Although it has been a while since Jeanne has posted here, there are many of us who remember both she and Kiska with such great fondness. And for those who had not had the chance to meet them -- I feel certain that you will also join with us in wishing Kiska farewell, and sending Jeanne our sincerest sympathy.

In loving memory of sweet Kiska, and with thoughts of comfort for her mother who loves and misses her so ~

Marianne

[MaryLea]

In loving memory of sweet Kiska, and with thoughts of comfort for her mother who loves and misses her so ~[/COLOR]

Marianne

Only those who have loved and lost a pet truely know the feelings. We send our deepest sympathies to Jeanne. As I've said many times, if we didn't love them so much, we wouldn't miss them so much.

I suspect Kiska welcomed Ruffles and they are frolicking together.

In memory of our beloved furry friends,

Mary

[k9diabetes]

There is a story and some beautiful pictures of Kiska in the Stories section:

http://www.k9diabetes.com/forum/showthread.php?t=44

[buddingartist]

What an absolutely beautiful fur baby Kiska was.

It is always so sad to read such news but I take comfort in thinking that they were well taken care of and that they are now free of pain.

Louise

[Patty]

Jeanne,
I'm so sorry to hear about Kiska. Sending healing prayers and thoughts your way.
God bless,
Patty