Tony's Jessie earned her wings

[ajtony]

Just wanted to say hello to everyone and tell you a bit about our Jessie. She is an 8 year old Westie, diagnosed about 3 weeks ago with diabetes and cushings disease. Three days after diagnosis she went blind with cataracts. Her b/g level 2 weeks ago was 29 (UK measurement - US I believe 522?) and she was prescribed 5 units of caninsulin once a day and 30 mg of vetoryl. I was concerned that the vetoryl dose may be too high and mentioned this to the vet (he'd only been our vet for 10 days). The next day we got a letter saying they wouldn't be our vet anymore, the reason being, 'we cannot have clients questioning our treatment of their pet'. I was gobsmacked and tried to speak with the vet but they wouldn't say anymore.

To cut a long story short we now have a new vet. Jessie is now on 2 x 5 units of caninsulin and 30mg vetoryl, and is due to go in for a 'curve' next tuesday. Her skin is very sore and itchy and she has 'lumps' all over the place (is this due to the Cushings?) but she is eating well and manages to go for a walk each day (apart from today as her rear paw is very sore and she can't walk on it).

Everything has been a bit of a blur for the last 3 weeks - we have so much to learn about the diabetes and the cushings. We are feeding her on a dry food, 'Bakers Complete' and injecting her 8.30am and then 12 hours later, after food. We are testing her urine with diastix strips and the colour has changed from the very darkest brown, to the third one up which id green (we took this as a good sign).

I will be trawling through this website and trying to do the best for Jessie.
cheers, Tony (Scotland UK)

[Jaime]

Re: Hi guys, new member

Welcome to you and Jessie! I don't have much advice to offer being that my dog was diagnosed about 2 1/2 weeks ago, but everyone on here is very helpful.

I would recommend reading back through the posts, many of my questions were answered there!

Wow, what a vet...one would think that they would want the owner's to be involved because it shows that the owner will follow the treatment plan. You are better off without them and moving on to a vet who listens and respects that you know your pet better than anyone!

Diabetes and Cushings? They may go down the Cushing road with Abby when she is better regulated but she is doing good now.

Welcome again!

Jaime and Abby

[Margaret Boyle]

Re: Hi guys, new member

Just wanted to say hello to everyone and tell you a bit about our Jessie. She is an 8 year old Westie, diagnosed about 3 weeks ago with diabetes and cushings disease. Three days after diagnosis she went blind with cataracts. Her b/g level 2 weeks ago was 29 (UK measurement - US I believe 522?) and she was prescribed 5 units of caninsulin once a day and 30 mg of vetoryl. I was concerned that the vetoryl dose may be too high and mentioned this to the vet (he'd only been our vet for 10 days). The next day we got a letter saying they wouldn't be our vet anymore, the reason being, 'we cannot have clients questioning our treatment of their pet'. I was gobsmacked and tried to speak with the vet but they wouldn't say anymore.

To cut a long story short we now have a new vet. Jessie is now on 2 x 5 units of caninsulin and 30mg vetoryl, and is due to go in for a 'curve' next tuesday. Her skin is very sore and itchy and she has 'lumps' all over the place (is this due to the Cushings?) but she is eating well and manages to go for a walk each day (apart from today as her rear paw is very sore and she can't walk on it).

Everything has been a bit of a blur for the last 3 weeks - we have so much to learn about the diabetes and the cushings. We are feeding her on a dry food, 'Bakers Complete' and injecting her 8.30am and then 12 hours later, after food. We are testing her urine with diastix strips and the colour has changed from the very darkest brown, to the third one up which id green (we took this as a good sign).

I will be trawling through this website and trying to do the best for Jessie.
cheers, Tony (Scotland UK)

Hi Tony,

Glad to see you posting and I hope things are settling down a bit

Marg

[Dakotapix]

Re: Hi guys, new member

You and Jessie have come to the right place, Tony. Frankly, your first vet probably did you a favor by bowing out of Jessie's treatment. My own experience with vets who treated my dog was that they welcomed my seeking knowledge about my dog's welfare. Sounds as though you'll be much happier with your new association. Welcome to this forum and good luck.

[CarolW]

Re: Hi guys, new member

Hey, Tony! A big fat welcome to you and Jessie! I ADORE Westies!

That's quite a whammy of diagnoses you have on Jessie - not fun, but I truly trust you and Jessie will do really well, because you GOT RID of at least one vet, sounds as though, maybe, two!

I'm gobsmacked, too, at the letter you received from the most recent ex-vet. How ridiculous can a vet get! It's the vet's job to work WITH the human client, regardless of what the problem is.

On the other hand, I suppose I know quite a few humans who behave in similar fashion; they seem to be people who lack confidence, and maybe that vet lacked confidence [grin]

I don't follow the Cushings forum - just too busy, and my dog doesn't have it; I'd be there if he did! But I have read some - for a few months, and wondered, too about 30 mg of Vetoryl (I think that's also called Trilostane?) for a dog Jessie's size - that is, Westie-size. How much does Jessie weigh?

Interesting that the new vet didn't drop the Caninsulin dose size when putting Jessie on twice a day. But I totally agree with the principle of injecting twice a day, rather than once. I think it makes a smoother 24-hours for the dog!

I'm starting to fall asleep at the keyboard, so will come back later - I'll be watching for your reports!

Sat, 19 Dec 2009 11:06:10 (PST)

[BestBuddy]

Re: Hi guys, new member

Hi and welcome.

It can be a tough job getting the cushings and diabetes under control but it can be done. I think i's best that you have changed vets because the only reason a vet wouldn't listen to your concerns or suggestions was if they were worried you would know more than them and over time you will be the one living with Jesse so you will know more about the diseases and her than anybody else regardless of their qualifications.

Have you had any follow up ACTH testing done to see what is happening the the cortisol levels?

Jenny

PS I don't want to overwhelm you but when you are ready (if you haven't already) head over to the cushings board for some more welcoming and support. http://www.k9cushings.com/forum/

[k9diabetes]

Re: Hi guys, new member

Hi Tony! Nice to see you hear and I am so relieved that you were able to find a vet who will work with you.

I didn't realize... and hadn't really put together the pieces... that the Cushings and diabetes were diagnosed at the same time.

I know you're participating in the CCAC Cushings group - did they feel comfortable that the Cushings diagnosis was done properly and there was no question at all about whether Jessie has Cushings?

Way too often we see a misdiagnosis of Cushings in a dog who only has diabetes because the testing can be skewed by the diabetes. So I wanted to be sure.

Re the lumps and bumps... were those present before her being treated for the Cushings and diabetes or did they start after?

If they started after, I'd be concerned about a potential allergic reaction to th one of the new meds.

Natalie

[ladysmom06]

Re: Hi guys, new member

Hi Tony,

Welcome to you and Jessie. Having diabetes and cushing's makes things a little complicated but both diseases can be treated and controlled. My little girl Lady had the two and did very well. We lost her this past March but not from either disease. Lady was first dx with cushing's and then 2 weeks later diabetes. She had diabetes when she was dx with cushing's but the vet that was treating her at that time missed the diabetes. The new vet wasn't even sure she had cushing's. Unregulated diabetes can give false positives on the cushing's tests. We tried to get the diabetes regulated and when we couldn't we repeated the tests for cushing's - we were also seeing an IMS. All cushing's tests were positive but he still wasn't sure she had cushing's. He had us switch insulin and when we still couldn't get the diabetes under control we starting treating her with trilostane. In a matter of weeks her bg's came down. Getting a cushing's dx requires more than one test. What tests were done on Jessie to confirm cushing's? What cushing's symptoms does she have? Not trying to confuse you but just want to make sure she really has cushing's. Have you joined the cushing's forum yet? Tons of info and support there. Good luck with Jessie and please keep us posted. Hugs to the two of you.

[ajtony]

Re: Hi guys, new member

Thanks Nathalie and all for the warm welcome and the advice. I hadn't even considered a misdiagnosis for Cushings. However, about 4 months ago Jessie did develop Cushing symptoms, e.g. swollen abdomen, drinking and urinating lots and eating more. She was on steroids at the time and had been for almost a year without any monitoring by the ex vet. I suggested steroid induced Cushings to the vet and we stopped the steroids immediately, and over a week or two there was a vast improvement. Then a few months later she started drinking lots again (no swelling abdomen), urinating and we noticed she had lost a few kilos in weight. I have the blood test results in front of me but they don't mean much to me apart from the fact I can read that her b/g level is high. Would it be worth posting the results on the Cushing Discussion site to see what more knowledgable people than me think.
The last two lines of figures reads:
Cortisol Base 157.3nmol/L (5.68ug/dl)
Post 678.7nmol?l (24.5ug/dl)
Jessie has had skin problems for many years but it does seem to have gone worse in last 3 weeks or so. best wishes, Tony

[k9diabetes]

Re: Hi guys, new member

Yes, please do ask the question of the Cushings group. We have seen many dogs whose cortisol tests are misleading because of the diabetes.

Our sister forum for Cushings, www.k9cushings.com, is also very skilled at evaluating the test results. I haven't really taken the time to learn to properly evaluate the results.

Your description of the recurrence and the fact that dropping off the steroids showed improvement for several months makes me think more of the steroids kicking off the diabetes at that point than Cushings and diabetics can have skin problems as well.

Of course, I don't want to tick off your new vet! I hope s/he is more flexible in approach. But I would absolutely explore this possibility with the Cushings discussions because it is a very common mistake vets make.

Usually if Cushings is suspected, we suggest treating the diabetes first since that is the life threatening condition and then see what happens with Cushings later. If the blood sugar is readily controlled, Cushings disease is very very unlikely.

So whether you can get control of the blood sugar becomes kind of a litmus test for whether Cushings is really present and often it's not.

Natalie

[k9diabetes]

Re: Hi guys, new member

I suspect, after comparing those results to Brittany's Greyson's, that they would be considered only borderline positive for Cushings.

Natalie

[janspack]

Re: Hi guys, new member

I suspect, after comparing those results to Brittany's Greyson's, that they would be considered only borderline positive for Cushings.

Natalie

Hi Tony,

I tend to agree with Natalie. I was wondering if the ACTH test was the only one carried out by the vet? To definitively dx Cushings, a second test should be performed to be certain. This is either a Low Dose or a High Dose Dexamethasone Suppression test. This takes 8 hours and you have three different readings at the end of it rather than just the two.

It's usually not considered good practice to start a dog on a chemotherapy drug such as trilostane or lysodren without doing one or other of these further tests and probably an ultrasound of the adrenal glands as well. These tests define too whether it is adrenal dependent or pituitary dependent Cushings. Something else that is really needed to be able to treat a Cushings dog properly. I've had two Cushings dogs (father and son) so have a little bit of experience with the disease.

In your shoes, I think I would want to have a discussion with your vet about the Cushings diagnosis. If it's at all possible, I think a referral to an internal medicine specialist might be a good idea in the circumstances.

The fact that Jesse was on Steroids was probably the cause of the initial symptoms (Iatrogenic Cushings Syndrome) as they cleared up when they were stopped. The recurrent thirst, urinating and weight loss could just as well have been due to the Diabetes.

Sorry to worry you Tony but I really do think it all needs looking into again - unless of course one of the vets did do the LDD or HDD test and got a positive result from that.

After all that, welcome to the forum - you'll get no end of help and support here.

[ajtony]

Problem with shots

Hi Guys, We've been injecting Jessie for about 3 weeks now with 2 x 5 units of caninsulin using U-40 1ml/cc 28Gx1/2" syringes that are supplied by Caninsulin. It's never been easy and takes two of us. Lately it is getting more difficult for us. For example it took over an hour to give the injection this morning. The first syringe, the needle bent as I tried to insert it. I've read all the tips/advice on this site but I seem to be doing something wrong. I'm making the tent but most of the time the needle itself won't go into the skin. As you will all know it is very stressful and not fair on Jessie. Any advice please. Would it be beneficial changing syringes to a higher gauge. Jessie is 8yrs old, a blind Westie, also diagnosed with Cushings Disease and is a real wimp. She howls when we grab the skin to make the tent yet when the needle eventually does go in she mostly doesn't seem to feel it. Thanks, Tony.

[Margaret Boyle]

Re: Problem with shots

Hi Guys, We've been injecting Jessie for about 3 weeks now with 2 x 5 units of caninsulin using U-40 1ml/cc 28Gx1/2" syringes that are supplied by Caninsulin. It's never been easy and takes two of us. Lately it is getting more difficult for us. For example it took over an hour to give the injection this morning. The first syringe, the needle bent as I tried to insert it. I've read all the tips/advice on this site but I seem to be doing something wrong. I'm making the tent but most of the time the needle itself won't go into the skin. As you will all know it is very stressful and not fair on Jessie. Any advice please. Would it be beneficial changing syringes to a higher gauge. Jessie is 8yrs old, a blind Westie, also diagnosed with Cushings Disease and is a real wimp. She howls when we grab the skin to make the tent yet when the needle eventually does go in she mostly doesn't seem to feel it. Thanks, Tony.

Hi Tony,

It is Margaret from Scotland.

Some dogs do not like their skin being tented, I do not tent Lucy's skin I gently hold the skin and put it in at a flatter angle. Bevel side of tip of needle
face up.

Another tip is do not force the needle against the skin, do not hesitate when inserting the needle put it in quite quickly, then inject your insulin.

Tony you can get a U40 29G x 1/2" 1ml/cc at Pet Drugs this is what I use on Lucy.

Sometimes if their fur is long it can be difficult, I always keep Lucy's back and sides trimmed and you can do this with Westies as well, and you can also do this yourself in between going to the groomers.

I know Jessie is blind and it sometimes makes it more difficult, you and your wife are worrying about Jessie being stressed.

If you are stressed Tony this can also be picked up by Jessie.
Try and relax plenty of hugs for Jessie. Also her wee treat I use boiled turkey
cut up into small cubes about the size of my nail.

I promise you it will get easier. Try and get your 29G as this is a finer needle.

You will get plenty more tips from everyone Tony.

I was nursing and we were taught to dart the needle when putting the needle in. If you are holding it against the skin and pushing slowly this can bend your needle.

I hope this helps some.

Marg

[pgcor]

Re: Problem with shots

Hi Tony:

I can tell you what we did....my dog is very hyper and had to be muzzled for a while until he got used to the shots.

I'm lucky in that Pip loves to eat. I break up two diabetic cookies and put them on a plate. I make up the needle and when Pip is done eating I pick him up and put him on our counter. I put the plate of broken diabetic cookies in front of him and while he's eating I give him his injection.

As soon as he feels me tent his skin he stops eating to look at me but as soon as I'm done he goes back to eating.

I have tried shooting him fast, slow and every which way in between. I found the way that works for me from trial and error over the past two years. It has been key for us to remain calm and matter of fact while in the process of giving him insulin.

Good Luck!!!!

Pam