Diabetic for over a year now has EPI (and more)

[KarenC]

Ahh Karen, i hear ya..........the last few years of Izzy's life she went all blind in one eye and about 80% blind in the other eye....it broke my heart when she would be "hesitant" when walking in unfamiliar areas.... this was my fearless little dog who tackled everything with heart and chutzpa! So whenever she displayed uncertainty.. i used to tug on her little lead and reassure her with the word "Izzy, I got you!"... in time, she actually got confidence from these same words and would proceed as if she could see.

We learned not to change placements of things in the house.... and we played games with her in contained areas that she was familiar with ... this helped with her confidence even though she couldn't see much. But when we took her for walks outside the home... i had to use the reassuring words......

I know it's hard... and my heart hurts for you!

Thanks! It is really nice to know there are people who understand it all which makes the group here a comfort. We are not alone in any of this.

Some good news is that Luke had his annual today and the Doc thinks he looks really good and she says he feels really good too, the best she has felt him in many months, like he has gained muscle and not fat. He has gained weight and is now at 59.6 lbs! up from 55. So we know he is absorbing and she is pleased with that. I don't want him to gain more tho and become heavier than he can manage. She is also surprised that he is not totally blind yet. She seemed quite happy with him which makes me feel better too. I think her consults with an internist and endocrinologist have helped guide her because Luke has stumped her on more than one occasion.

This coming Wednesday he will have his Cushing's test done again, BG curve and the x-ray that will hopefully show clear lungs from the pneumonia. I want to say we have his EPI under control but I know things can take a turn at any moment too. But the EPI seems to be steady and I'll take that as a positive for sure.

Thanks, Olesia (and others!) for always being here on this journey as I recount the steps along the way

[Olesia711]

YOu are more than welcome.... and YES!!! it is a huge comfort to know that others have been on the same journey and sometimes it's the little "tips" that help so very much.

Good luck with the Cushings test !

[KarenC]

A little pupdate on Luke.

EPI still seems managed. He has gained a few lbs but I did not change his dosing of enzymes. He is eating well, pooping well so staying the course here.

His chest x-ray shows clear now. Tho he still has some sporadic hacking type thing happening.

Diabetes is still not managed. However, he has had his best curve yet: 3`18, 288. 374. 391 Nothing over 400 this time around and his last curve ranged from low 400's to over 600! So, what this means, I am not sure but for him it is an improvement. Our vet increased his vetsulin to 18 units now. Maybe some of the tweaks to food and injecting have helped or it's coincidence.

Cushing's Test was confirmed. His numbers were higher than his first test. This test confirmed pituitary-dependent hyperadrenocorticism . That was pretty much expected. Our vet wants to either put him on a dose of Trilostane and retest in 2 weeks with close monitoring of clinical signs or.....wait 2 months and see.

I did not get to talk to her on the phone because I was out when she called so I am not sure what the wait 2 months is about. Probably a retest and go from there.

After $10k plus on surgery and testing this year alone I don't know how we can manage this financially. If the med works to regulate his cortisol then that in turn might help regulate his glucose levels and overall extend his life vs no treatment. I hate that this comes down to finances now after so much.

[Olesia711]

Hi Karen, sorry for my late reply, i took a few days off...

So glad to hear that Luke's BG numbers are coming down.....in addition to insulin, food has a HUGE impact on better managing the diabetic BGs.

Now to the Cushing's condition.... been there done that... definitely treat.. as this will also help get the diabetes more in line and once regulated you probably won't need to use so much insulin.

HOWEVER....i strongly suggest that you speak to your vet and beg for Lysodren vs. Trilostane if possible. the reason is two fold:
#1 Trilostane (Vetoryl) isn't always the best drug to take for Cushings in dogs.... Lysodren has a much better batting average.
#2 Lysodren is also a people drug.... SOOOoooooo what you can do is go to a small pharmacy (you might be able to work this out with a big box pharmacy too, so it wouldn't hurt to ask) and instead of filling the monthly prescription of Lysodren for whatever the vet writes, tell the pharmacist you want to BUY the entire bottle... this way the pharmacy doesn't have to break open the bottle and charge you much more for a handful of pills.

My dog Rico had CUshings.... we started on Lysodren... i freaked out at the price .. back then it was $7 per pill. we did that for a few months and then one day the pharmacists said....you know, i can give you a better deal IF you buy the whole bottle all at once. It was $500... so i saved $200 and for us, it lasted 9 months. How long it will last you depends on the dose amount that the dog requires to manage the Cushings.

After a few years, i asked my vet about Trilostane (a friend of my, her dog was on it) and my vet said, no, it is not as good as Lysodren. Sure enough, years later, reports started coming out that Trilostane may or may not work well.... so i was glad i stuck with Lysodren.

Just saying.....................

P.S. My dog Rico lived for 11 years AFTER being diagnosed with Cushings..........

[KarenC]

Wow! Rico was diagnosed young with Cushing's then? That is still amazing.

I am glad for your input on the Cushing's. Researching more about it this morning I now see why we started treatment as we did but that is no longer going to work and it seems that a prescrip is needed.

I have read the prescrips are expensive and then we need to test again in 2 weeks.....I can't imagine not doing this but have to figure it out financially first.

I thought Lysodren was not good with insulin. I will have to research more. Honestly, both therapies sound scary! And it has contributed to my hesitation in deciding what to do.

Especially, since this past week he has been more like his younger self than I have seen in so long. It's bizarre! But wonderful!

[Olesia711]

Hi Karen,

My dog, Rico, that had Cushing did not have Diabetes.... (my EPI dog, Izzy is the one that had Diabetes and EPI and a whole bunch of other conditions.....).... SO..... i am not aware (actually I am uninformed!) regarding the possibility that Lysodren may not be good for dogs with Diabetes.... you'll have to check on that with your vet and via your own research.

I know careful diets will help with Cushings.... but quite honestly the Cushing meds are so so much better. However, you are correct, they are expensive, that is why i was thrilled to be able to buy a whole bottle of Lysodren and save a lot of money.... If Lysodren is a no -go because of the Diabetes, maybe talk to your vet and ask what other meds for dogs with Cushings are also human drugs, so that you can possibly buy a whole unopened bottle at the pharmacy and save a lot of money......

In the beginning with my Rico..... he too had to be tested a couple of times in the beginning.... and following years, he was only tested a few more times and then the dosage was pretty stable for him... for 11 years... he lived to be 16!

[KarenC]

Luke has had a couple of episodes where he has snapped badly at our other dog over food. Twice in particular. Not very often but one of those times was pretty bad. When we got a puppy he snapped badly at him over water. These were all before his many diagnoses'. I used to think it was just ' a dog thing' but now I know better.

At first, I thought it was the EPI causing him such over enthusiastic responses to food and feeding times. But since he was diagnosed with EPI and Cushing's at the same time, it was hard to know. Since learning a lot more about Cushing's many owners claim their pets have ravenous appetites and similar exuberance over meal times.

Luke's excitement was still there after a few months of treatment for both but he did seem to relax a bit until recently when he snapped at the puppy (well, he is almost 2 now ) over food on the counter when puppy got near.

We started Vetoryl today. I am nervous and not sure we can afford to keep up treatment but we will wait and see what his tests say in 2 weeks.

So I wonder if this is Cushing's related and not EPI. I may never know with so many different things going on with him and all of those with similar symptoms.

But what I do know is that I am glad my vet gave me this website right away. It has been a source of comfort, like a guiding hand at a time when things were very overwhelming. So, thank you to all who responded and especially to Olesia711. Your kindness, patience and knowledge is truly appreciated.

To everyone, I wish you all the best with your furbabies in the coming year!

[Olesia711]

Hi Karen,
it
I know the Cushing drugs ARE expensive.... but having witnessed the difference in my Rico when he started on them it was worth it.... very expensive but worth it............

Regarding the snapping with food.... you are correct.... it is hard to discern whether this could be from :
1. Cushings ( before treatment, my Rico WAS very cranky and did indeed snap at others around food.... but after 1 week on the Cushing meds..... i saw an amazing turn-around with him... so.... this "could" be the Cushings.... or.........
2. EPI.... with our EPI dogs, before properly treated some become almost feral.... sometimes... even after proper treatment, this has then become a learned condition, although, i would have suspected that this would have been on-going and from your post it doesn't sound like it........
However.... with EPI.... if when the B12 starts plummeting.... then getting cranky over food could be a possibility, if the B12 levels are low
Also... with EPI... sometimes as the dog ages, they need a pinch more enzymes to properly "maintain" the EPI condition... so this could be another possibility

So... as you surmised, it's kind of hard to tell.... i'm curious to see if after being on the Cushing med, Vetoryl, will alleviate this problem... i sure hope so, cause that would be an easy fix...... Please keep us posted....

Wishing you a VERY Happy Holiday !!!!

[KarenC]

So, after I posted about Luke's "enthusiasm" or more realistically, mild aggression over food, we had another incident. This time it scared me and it was over an object with food debris. Apparently, the bbq brush that we scrape the grill with fell in the laundry room. He ended up finding it and when I caught him he held on tight and just about lunged at me when I tried to get it. I went to get the broom to pull it away with distance between us and he then latched on to the broom bristles. All I could think of was "please! don't let the younger dog come in here" I was afraid it would escalate. Now I was blocked in the laundry room but luckily the fridge was right there so I grabbed some cheese. I started tossing pieces until he let go and moved.

Sheesh! I have started giving him a pinch more enzymes just in case that could be part of it. But now that he is on vetoryl I wonder if his cortisol is a bit low and causing this issue. I don't want to change much at this point, he goes for his ACTH on Monday so we will see then for sure.

So far no issues with his pooping, no vomit, no side effects of the med that I see but I think his drinking and urination are a bit different. I don't want to say more because he was always the kind that didn't do things frequently like drink constantly but when he did go for water he would drink a lot at that one time. It was always hard to tell since he was like that since puppyhood. Now I see a shift of more frequency (slightly) but not as much at each time. He is also starting to lick places more- elbow, sheath.

It might be something that won't ever change with him. He does have some toy guarding issues also. It is weird because I can take his bowl away and while he does scramble to eat whatever before i take it he doesn't show aggression toward me. He is back to licking all the empty bowls again tho.

[Olesia711]

I am so sorry to hear that this happened.... but quite honestly, aggression can be one of the symptoms of dogs dealing with Cushings..... HOWEVER.... that being said.... talk to your vet, cause i "think" once they find the right level of vetoryl to keep things under control.... i do think that will help with some of the aggression.... but i am not 100% sure.

WHen my dog, Rico developed A-Typical Cushings.... he was "cranky" but once they found the right level to give him, his temperament improved ... mostly. We did have an incidence years later, it seemed out of the blue though, he attacked my mom's Jack Russel who happened to simply walk by a bone that Rico had his eye on.... it was IMHO, an unprovoked attacked.... but i do think it was his Cushings disease that caused/contributed to this.... as he was always a gentle pup until Cushings happened........