Diabetic Australian Cattle Dog

[labblab]

Thanks for this report. Hopefully the liver issues are the type that are frequently associated with Cushing’s and will stabilize with continued treatment alongside the Denamarin. Overall, it continues to sound as though the spay may be a key piece of the puzzle, so I’ll surely be hoping you can proceed next month. It must have been frustrating to feel as though your work on the pdf was ignored. Perhaps now that you’ve established Bear as a bona fide patient, they’ll be more mindful of your input. But if they’re really busy, perhaps not <SIGH>. Anyway, good work on getting her in and keep letting us know how things proceed.

Marianne

[Zoology1603]

She said the liver was a result of cushings and why she wanted to raise the dosage. I know you were hoping for an ACTH test but I don't believe that is done around here. Too rural I guess. We do have larger and more expensive vets often called hospitals but they have many bad reviews and reputations around here. We ourselves had bad results from a dog years back going to one of the larger institutes. I forgot to ask for a copy of the blood test so I'm going to try and get it over email, we'll see.

[labblab]

Yes, that’ll be really good if you can get a copy of the results. And yeah, I’ve been figuring all along that an ACTH was going to be a big ask. But the basic cortisol level can be measured in a general blood draw along with any other other cell counts and blood chemistries. So nothing special is required in terms of the mechanics of the blood draw — the vet just has to ask for the cortisol to be added to the results panel. The logistical problem is that, to be used for dosing decisions about increases, it should be measured right *before* the next dose of trilostane is given. So in Bear’s case, you’d like to have the blood drawn before either breakfast or dinner and her meds.

Since you’re having to drive a long way to the vet and the waiting time there is likely variable, this window of time may be difficult to navigate. But honestly, at this point, I’d be curious to see Bear’s cortisol at any time of day just to make sure it’s not dropping too low. You shouldn’t make decisions about trilostane increases based on random cortisol draws throughout the day because so many factors (including just stress) can temporarily elevate the level. But you can at least make sure the cortisol isn’t dropping too low. A dog whose adrenal function is being oversuppressed due to too much medication won’t be able to generate a suitable level of cortisol at any time. So I encourage you to ask your vet to add basic cortisol to your next blood draw. The closer to a pre-meal/medication time the better, but whenever it can be drawn as a back-up.

I know you’re juggling a lot of balls right now, what with all these issues. I sure hope that Bear will rebound enough for her surgery, and I know you do, too. Please give her a pat for me, OK?

Marianne

[Zoology1603]

She says thank you!

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[labblab]

Oh, what a little sweetheart! No wonder you love her so…

[Zoology1603]

Here is her bloodwork for those interested and can read lab work:

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[Zoology1603]

I just discovered she has a cut on one of her nipples and it is infected. She's now on antibiotics. I don't know how long I have been overlooking it, pretty stupid. She managed to hide it pretty well. I just thought it was her heat cycle or a loose tooth. The vet wants to try and move up her surgery.

[jesse girl]

Glad you found the infection . Hope for quick healing

[labblab]

Glad you found the infection . Hope for quick healing

I totally agree! I just now looked at Bear’s labwork, and her liver elevations (ALP and ALT) as well as her elevated platelets are quite typical of Cushing’s. I know her ALP looks really high, but we frequently see elevations of that nature with Cushpups. The comforting piece is that typically it doesn’t herald actual liver damage, per se, but it does reflect an effect from high levels of circulating cortisol. Even after cortisol levels come under control with treatment, that elevation may lower but never actually return to a totally normal reading. We just learn to try not to freak out about it.

I’m not knowledgeable about the effect of diabetes on those elevations, but at least wanted to offer you some info from the Cushing’s realm.

[Zoology1603]

Thanks, I knew you would be able to explain her lab work. Her surgery was moved up to next Thursday. She still has high blood glucose numbers, despite increasing her insulin dose to 11. Her infection is still red but the swelling has gone down. I hope she is able to make it through surgery all right. It's pretty scary to be honest about it.

[labblab]

I totally understand. I would be a nervous wreck myself. These next couple days are probably gonna be rough — in the words of the immortal Tom Petty: “The waiting is the hardest part…”

As soon as you are able to on Thursday, please do let us know how things have gone. It’s a red-letter day on my calendar now, too, and I’ll be sending every healing wish to Bear that I possibly can. Hang in there yourself!

(And I realize I’m probably giving away my age with that song lyric, but in my book, good songs truly are immortal as well ;-)

[MomtoMax]

I totally agree! I would be terrified and will keep both you and Bear in my thoughts and prayers!
Donna and Max the Corgi

[Zoology1603]

Thank you for the support and well wishes, we both appreciate it!

I'm most concerned about doing the right thing the morning of the surgery. The vet has said to cut her morning meal in half with the full dose of trilostane and antibiotics and give her half her usual dose of insulin. I've researched and found some data that says a small meal 3 hours before surgery is okay. Hopefully this is the right move and she doesn't have any stomach issues during the surgery.

I will keep everyone updated as we go along.

[k9diabetes]

We will be anxious waiting for news on Thursday and wishing for happy news!

[labblab]

Thinking of you and Bear this morning and hoping, so much, that all goes well today.