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  #1  
Old 02-13-2009, 06:53 PM
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KramiesSister KramiesSister is offline
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Default Kramer got his wings... March 18, 2010

Hi All,
I'm a little overwhelmed right now, so I'll probably throw together a really piecey story. I apologize in advance.

Kramer is 12 (yesterday was his birthday). He's been diabetic for almost 3 years. We test his blood regularly, and home cook for him. He has high cholesterol and triglycerides....severely high and we supplement him with every natural remedy for that (niacin, omegas, CoQ10 etc.) he also gets milk thistle and samE.

Recently his blood sugars have been stubbornly high. For about a month we've been trying very hard to manage but it seems impossible. Throughout his diabetes he's been very sensitive to insulin and has issues with short duration. So it's not normal for him not to react to insulin. He was leaking urine last week so I took him in for a urinalysis in case of UTI (I hoped for a UTI) but no such luck. He had bloodwork this week and it has come back that his normally very high liver enzymes have doubled, and his normally severly high triglycerides have doubled as well. (I can't get numbers till tuesday because Monday is a holiday here in Canada).

In order to treat the triglycerides we would have to resort to a cholesterol lowering drug, which could have adverse effects on the already stressed liver. If the cholesterol is whats causing the high blood sugars, and the blood sugars are causing the liver enzymes, its a vicious cycle and we don't know where to begin.

We're now entertaining the idea of cushings, we've never tested before because he's always been so sensitive to insulin which is the opposite of a key symptom of cushings. We may book a stim test this week, but our vet says it is "impossible" to treat a dog that has cushings and diabetes....funny but thats NOT what I heard.

On top of all of that this vet has pretty much told us that Kramer is too much of a challenge for her. And we've been through other vets in the past. We live in a small city so we don't have a ton of options and we've done our research...which can sometimes bother vets...although we're not THAT demanding, this vet that we've had lately has seemed particularly insecure and I'm worried about how she may react if faced with an emergency.

I feel like we're just expected to watch Kramers health steadily decline rather than doing anything and it KILLS me. I feel particularly defeated today considering we're faced with all of this not-so-good information we also have to search for a vet who doesn't give up.

So thats about all I can think of...and probably all you want to read!
One more thing....NICE TO MEET ALL OF YOU!!!

Breanne and Kramer
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Old 02-13-2009, 07:03 PM
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Dollydog Dollydog is offline
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Default Re: Kramers Story

Hi Breanne,
If you're who I think you are (and I'm sorry that I don't have time to check right now) I think I followed your story with Kramer on the other diabetes sight almost 2 years ago.
Weren't you dealing with a specialist in Winnipeg? I hope it's not her who says that Cushings and diabetes can't be treated at the same time!!!
Please keep checking for a vet that isn't intimidated by Kramer's situation. I'll check back when I have more time!!
And tell your vet that my Lady has had Cushings for over 3 years and been diabetic for over 2!!
Wishing you all the best in your search,
Jo-Ann & Lady
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Old 02-13-2009, 07:14 PM
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We Hope We Hope is offline
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Default Re: Kramers Story

Welcome!

Is it possible for you to make some type of arrangement with an Internal Medicine specialist--one in private practice or possibly one at a University with a vet school and clinic for a consult?

This would mean Kramer's getting the benefit of the specialist's knowledge and his/her ability to consult with your vet regarding treating Kramer on an "everyday" basis. You wouldn't need to be taking Kramer to the specialist all the time--he/she could be monitoring Kramer's progress via shared medical files and test results, then the two doctors could consult.

It then wouldn't be all in the hands of your vet; Kramer would have a "health care team"; your vet might feel a little more "secure" knowing he/she can talk with the specialist when needed.

There are a lot of people here who have managed diabetes and Cushing's--Marianne managed THREE endocrine diseases--Cushing's, hypothyroid, and diabetes for Pebbles. She did a spectacular job with her girl!

True, Marianne went to Texas A & M, but I can remember something coming up and her A & M specialist worked with one of the vets nearby with Pebbles.

Any possibility something like this could be worked out?

Kathy
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Old 02-13-2009, 07:33 PM
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KramiesSister KramiesSister is offline
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Default Re: Kramers Story

We do have an IM specialist, she's actually the one who asked us to leave our previous vet (who wasn't fabulous) and see this one. And this vet seems to just push everything off on the IM specialist.

I haven't talked to the IM lately, but I called her in a panic tonite and I probably won't hear back until tuesday (usually I LOVE long weekends, but this may end up being the longest weekend EVER!!!). Its not the specialist that says that cushings and diabetes can't be treated together, its the insecure vet.

I so wish we weren't 28 hours from A&M but we are. We're also 8 hours from a vet college. BAH

Waiting sucks!

Breanne and Kramer
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Old 02-13-2009, 08:17 PM
pgcor pgcor is offline
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Default Re: Kramers Story

Breanne I'm so sorry about this! I wish I had some words of wisdom, but I'm praying that Kramer is better and soon. I know how horrible the waiting is. You and Kramer have been through so much! Hang in there!
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Old 02-13-2009, 11:06 PM
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Default Re: Kramers Story

Hi Breanne,

Happy 12th birthday Kramer!!

Can you bring us up to speed with Kramer...

How much does he weigh?

What's his current insulin and dose?

What is his blood sugar currently running?

Any changes to his diet at all? What does he eat?

And then of course give us the test results when you can get them.

Monday is President's Day here - what's the holiday there?

I assume you've tried all the standard stuff like at least two new bottles of insulin from different lots/shipments. There was a time a few years ago when a handful of dogs scattered across North American who were on Vetsulin lost their regulation - seemed to be a bad batch of insulin from the manufacturer. And whole lots or shipments can be damaged, especially by extreme weather. Just want to make sure that base has been thoroughly covered.

The high cholesterol and triglycerides is a pretty common Schnauzer thing, isn't it?

Any outward signs of Cushings?

Given the situation with the vet, is it possible for you to take Kramer to the IM? It seems to me that a thorough evaluation that would include an ultrasound and perhaps the blood sample sent to Jack Oliver at UTenn (I hope you can do that from Canada) would give you the best shot at determining what's up with Kramer.

Loss of regulation could come from totally unrelated things that cover a lot more ground than Cushings so something like x-rays and an ultrasound could help ferret it out. Pain, inflammation, infection, allergies, resistance to the insulin, and scarier stuff we won't go into.

Much of this your vet could do in consult with the IM but it probably would be best if the IM could do the ultrasound herself. If you could go in for one comprehensive day and do it all and then let the IM guide everything from there, that would work.

Kay, when Bo started having his horrible diarrhea problems, eventually found an IM who worked with her mostly over the phone for many months after initially evaluating Bo and she made a huge difference in his care.

I know you're tired and frustrated and getting scared. You just need someone to help you and the vet isn't doing it - the last thing anyone needs is a vet who isn't up to a challenge - that's how Chris wound up seeing the bad endocrinologist!

Definitely go over all of this with the IM on the phone and make a plan from there.

I'll be looking for the test results next week.

Natalie
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  #7  
Old 02-13-2009, 11:24 PM
AlisonandMia AlisonandMia is offline
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Default Re: Kramers Story

Quote:
Loss of regulation could come from totally unrelated things that cover a lot more ground than Cushings so something like x-rays and an ultrasound could help ferret it out. Pain, inflammation, infection, allergies, resistance to the insulin, and scarier stuff we won't go into.
Hi - I was going to reply on the Cushing's forum but I'll reply here as Natalie has brought up more or less what I was going to bring up over there.

Another thing that Schnauzers can be particularly prone to is gall bladder problems, usually in the form of sludge or what is called a mucocele that acts like a gallstone in a human and can block the flow of bile. This can cause rises in liver enzymes and could also cause inflammation and general illness sufficient to send diabetes out of kilter. It is usually diagnosed with high-resolution ultrasound.

High res ultrasound (the IMS is probably equipped to do this) is part of a standard Cushing's workup so maybe getting that done first may be the way to go.

Diabetes - and any other illness or stress- can throw out Cushing's tests and produce false positives. Many diabetic dogs, particularly if their diabetes is not under control, will test positive on the Low Dose Dexamethasone Suppression test particularly and this test is often not of much value in a diabetic - the ACTH stim test is more reliable in this sort of situation.

Alison
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Old 02-14-2009, 06:45 AM
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Default Re: Kramers Story

Hi Breanne and Kramer

I remember you both from the other site. Hopefully Natalie and the others can help you get back on the right track. I hate to hear you are having so much trouble.

I'll keep checking back to see how things are going. I keep you both in my prayers.
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  #9  
Old 02-14-2009, 12:19 PM
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KramiesSister KramiesSister is offline
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Default Re: Kramers Story



not sure if i did that right
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  #10  
Old 02-14-2009, 01:36 PM
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Default Re: Kramers Story

Breanne,

You did it exactly right. Is it possible for you to also post a link to the report so we might be able to see a little bigger version of it?

Kathy
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