Saturday, August 29, 2009
Some people will follow their veterinarian’s advice and their pet will get well. Unfortunately, I did follow their advice and there were a lot of symptoms missed or misdiagnosed and that’s what I write about.
JACK RUSSELL’S & CUSHING’S
A lot of searches have been on whether or not more Jack Russell’s get Cushing’s than other breeds of dogs. I don’t know if that assumption is correct or not, but from what I’ve read online, that even though any breed can get Cushing’s, terriers seem to be more pre-disposed.
I’ll start with one of the basics, feeding your pet. There have been a lot of searches about what to feed a dog with Cushing’s or Diabetes. As Hunter was first diagnosed with diabetes, I was told to put him on a high fiber diet, such as DCO by Purina. When he was diagnosed with Cushing’s, I was never told to take him off of DCO. Since Hunter’s death, I have learned that a diabetic dog should be on high fiber, whereas a dog with Cushing’s should be on a low fiber diet. So, if your pet has both, you’ll want to feed them something in-between. Discuss with your vet your options for feeding.
Besides being a picky eater, Hunter was naturally a grazer. So the trick was to get him to actually eat all his food before I would give him his insulin. Scrambled eggs are safe to give to dogs with diabetes, just be sure not to use any oils, butter, or seasoning. I would scramble a few eggs at a time and keep them in the refrigerator, just heating them slightly in the microwave. I would add a little over a tablespoon to his food.
TREATS & SUPPLEMENTS
Be sure to check the ingredients of all treats and any supplements (vitamins) you give your pet. Hunter had been taking a glucosamine/vitamin chew and I had to stop that as glucosamine is an amino sugar. Also, the majority of the treats had corn syrup or some other sugar based ingredient. Peanut butter used to be a treat and now that was eliminated.
If you do decide to make your own treats, try to include cinnamon, as it helps to lower blood sugar levels. You can also add cinnamon to your pet’s food (either canine or feline) by adding less than ¼ teaspoon for each meal. Also, be sure to only use whole wheat flour. The treats I made with oatmeal and cinnamon looked absolutely awful however, Hunter would still eat them.
I did find two sites that I would order treats for Hunter. One is called Doggies Unlimited. I would order “Maggie’s Apple Cinnamon Delights” and Hunter could smell them before I got the package open and would be begging for one. The other treat is a diabetic dog cookie at Old Dog Cookie Company. They're the perfect size when you don't want to give your pet a large treat. I would give him these when he was good about getting his shots.
*I receive no financial reimbursement for my recommendations of any products listed on this blog.
I was never instructed not to give Benadryl. Although I had been using the pill pockets, I had to switch back to molding the pills in cheese.
Hunter seemed to always have itchy skin. I think it was from a mixture of allergies and then later Cushing’s.
Sometimes, he had skin lesions which were thought to have been caused by FAD (flea allergy dermatitis), I found a shampoo and rinse which helped called Malaseb. They also have a concentrated rinse which helped greatly.
As for regular bathing, I must have bought different shampoos a few times a month. I never could find one that soothed his skin and coat. I finally found a shampoo and conditioner that seemed to work for him. Unfortunately, I came across it in the last five months of his life. I found both at Doctors Foster & Smith. The shampoo is called Septi-Soothe, and the conditioner is called Oatmeal Conditioner with oat protein, chamomile, Vitamin E, and borage and evening primrose oils. His coat looked and felt wonderful like when he was a puppy.
Note - You will also see an increase in hair loss due to Cushing’s and diabetes; especially when using Lysodren.
SYMPTOMS OF CUSHING’S
I have written what Hunter’s symptoms were here: http://k9-hunter.blogspot.com/2009/02/reflections.html.
I want to add about the symptom of pigmented skin on the belly. If you're an owner of Jack/Parson Russell, then you're already aware that they have pigmented skin, especially on the belly. I was looking back recently at pictures of Hunter from a few years ago and I noticed how pink/red his belly was. There were no bumps or rash present, but I do remember how warm/hot his belly would feel to the touch. Hunter did suffer from allergies and this could have been a result of that, but I can't help not think that possibly it was also due to Cushing's.
Remember, your pet may exhibit different symptoms at different times. Hunter didn’t start drinking & eating ravenously until after he was diagnosed with diabetes. For him, these two symptoms meant he was in the late stages of Cushing’s. Your pet may be different and these could indicate the beginning signs.
Another possible symptom is restlessness. Hunter would have a hard time at night getting settled. He was constantly getting up and scratching around his bedding and this was especially noticed before he was put on Lysodren. A lot of times I would get up to check on him and he would just be standing. It was like he didn't know what to do. You may possibly notice this in your pet also.
I have to stress one symptom in particular that I have seen searched as I feel this was a vital sign that Hunter had Cushing’s and that is panting. If your dog is panting for no reason other than just walking around the house or eating, get a test for Cushing’s; especially if they search for cool surfaces to lie on.
Hunter’s panting was written off as being a symptom of him being a few pounds over weight.
Hunter would get hot spots between his toes. Before he was diagnosed with Cushing’s, he had licked a sore in between his toes that would not stop bleeding. It was so bad, I had to take him to the vet and they cauterized it. However, once treatment began with Lysodren and his cortisol levels were back in the normal range, the hot spots disappeared.
I did find that using plain old witch hazel along with a cortisone cream seemed to help a bit, as Hunter hated tea tree oil.
TREATMENT FOR CUSHING’S
There are four drugs approved for treatment of Cushing’s:
Anipryl (generic Selegiline)
Be sure that you discuss the risks thoroughly with your doctor(s). Do your own research on the web as there are many informative sites.
I do have a word of caution about Lysodren, be sure that you know all the risks involved. Of all the medicines, Lysodren has the most serious side-effects, including death. Lysodren can also take your pet to the other extreme called Addison’s Disease where almost all of the adrenal cells in the body have been destroyed. Blood work will show low sodium level, high potassium level, and high kidney enzymes. An ACTH test will give you a more definitive diagnosis.
When we took Hunter to the ER, his blood work came back normal. We feel that Hunter was dying from the Lysodren. Keep in mind even though some dogs have been successfully treated with Lysodren, it is a poison. If I had known how dangerous Lysodren was at the time, I would have only used it as a last resort.
COSTS OF TESTS
I live in Atlanta, GA and the tests were given at GVA (Georgia Veterinary Specialists). The costs were from October 2008, as I’m sure they have since changed. However, you can still estimate the expense.
The initial exam included an ultrasound of abdomen, a complete urinalysis, two glucometer tests and eye drops. Also, included was the cost of the AlphaTRAK glucometer, lancets and test strips. There was also a consultation by the opthamologist as Hunter had cataracts and his eyes were bulging and inflamed. The total cost was $920.
Your pet will spend approximately 8 hours at the vet. Your pet will need to fast the night before meaning no food or water after midnight. If you have medicine that has to be given (Hunter had to take L-Thyroxin), go ahead and give it. Hunter would also take Benadryl in the morning and I just skipped that dose. Be sure that you send along food and a syringe with the dosage of insulin if your pet is diabetic. The cost of this test was $205. The cost of the second ACTH test was $160, and the third ACTH test was $146.
I highly recommend purchasing an AlphaTRAK so you can monitor your pet’s glucose at home. The AlphaTRAK is made specifically for animals (dogs & cats). Human meters don't measure the glucose as well.
By the time you’ve taken your pet back to get a glucose curve done at the vet a few times, you could have purchased one yourself. Mine cost me $105, but I’ve seen them on the net for as low as $90. You’ll also need to purchase lancets and test strips specifically for the AlphaTRAK. I talk about getting a sample here: http://k9-hunter.blogspot.com/2008/11/glucose-curve.html along with what numbers are considered in the good range.
One thing I didn’t mention about the AlphaTRAK, is that there will be times where you get an ERR message. It usually happens when your blood sample was a little too small for the strip and it timed out. I would take Hunter’s sample from the bottom of his foot pad and I’ll just say it has to be a good size drop and you have to be fast. However, there were a few times when I would try to reset the meter and nothing would happen. No numbers, no nothing. You’ll need to open up the back where the battery is and take it out and then put it back in. That seemed to fix the problem.
Also, it was never given on any instructions, but I would go ahead and wipe the spot I was going to prick with alcohol. I was just being cautious.
Instructions here: http://k9-hunter.blogspot.com/2008/12/update.html.
I want to stress the importance of getting your pet's glucose numbers down. When Hunter first started getting insulin shots, our vets were not aggressive. They would tell me to increase his insulin dosage and get back with them in a few weeks for them to check his glucose. In the meantime, his cataracts were getting worse and Hunter literally went blind in a few weeks.
I learned from the internist that once you increase the insulin dose, it only takes two to three days for the body to adjust to the increased dosage. So, the weeks that I was told to wait by our regular vets was unnecessary. I can’t stress this enough, but your vet needs to be treating the diabetes aggressively. If your vet is making you wait, like mine did, for weeks before increasing the dosage, challenge them. Also, be sure that you keep a watchful eye for hypoglycemia and have your corn syrup handy. A reminder be sure the insulin is at room temperature as cold insulin shots hurt.
If your pet has stopped eating and you need to give them a shot of insulin, the reason is either one of two things. They’ve become stubborn about eating or they’re starting to go downhill. You can distinguish which way it is by how they are behaving. Are they still energetic? Or, have they become withdrawn?
If they are still energetic, you can try these foods. Remember, no oil, butter, or seasoning, but you can try garlic. First try scrambled eggs or poached eggs with runny yolk. If this doesn’t work, consider boiling some chicken or make brown rice. Don’t use white rice as it will raise their sugar levels.
If you still can’t get your pet to eat, call your vet or an emergency vet hospital. It’s very dangerous to give them an insulin shot with no food as it will cause their sugar level to drop dangerously low and can cause them to die.
If you’ve gone ahead and have given them a shot of insulin, watch their behavior closely. If they become lethargic and when you call them they don’t move, give them some corn syrup (Karo) immediately by rubbing the syrup on their cheeks and gums. Don’t try to get your pet to drink it as they could be having a convulsion and may bite you. You’ll need to rush your pet to the vet’s or an ER.
NON-TREATMENT FOR CUSHING’S
If you decide not to treat your pet for Cushing’s for whatever reason, be sure that you are well informed as to what your pet will go through.
My sister has a friend whose pet died from Cushing’s. Unfortunately, this was not a choice for my sister’s friend, as her vet failed to inform her that she had treatment options. What was even more upsetting was the fact that Lydia most likely got Cushing’s due to her using steroids for her arthritis. If the steroids had been decreased, most likely her cortisol levels would have returned to normal.
Besides diabetes, your pet can die from congestive heart failure, liver and kidney failure, neurological disorders such as, seizures and coma. Lydia died while having a seizure.
This is the biggest problem about Cushing's. Most times, by the time your vet has finally diagnosed your pet with Cushing's it is too late. If your pet has all or a majority of the symptoms of Cushing's and your vet tells you that it's due to their age and that little nagging feeling comes, follow your instincts. Make your vet do a Cushing's test.
This was the most painful part when Hunter was diagnosed. Through research, we were able to put together that Hunter had developed diabetes because of his undiagnosed Cushing’s. I have read recently that by the time they develop diabetes, they have passed the point of no, but you still want to try to make them better. For Hunter, he went downhill really fast.
CUSHING'S & UNCONTROLLED DIABETES
I hate to add this, but I feel some of you will need to be prepared. Once we got Hunter’s Cushing’s under control, even for a little while, his diabetes was finally under control. I have corresponded with several people and a common theme was that everything seemed to be going well and then all of a sudden their diabetes went to being uncontrolled again. In each case, this happened in the last few weeks of life.
LENGTH OF LIFE
Several people have searched on how long does a pet live with Cushing’s and diabetes. I only have Hunter’s experience to go by and he only lived for five months. He was diagnosed with diabetes in July and finally Cushing’s in October.
We believe strongly that Hunter had undiagnosed Cushing’s for a good three to four years previous. However, when he went on to develop diabetes he was in his final stages. This is why I am stressing the importance of early diagnosis of Cushing’s. I can’t help but believe if he had been properly diagnosed with Cushing’s and treated, he would have lived longer and never would have developed diabetes.
END OF LIFE (End Stages)
This is one of the hardest decisions to make. If you are thinking about when to end a life, try to remember it is no longer about your feelings or your loss, it is about their comfort.
When Hunter looked his worse back in September, I could still see in his eyes that he still had the fight in him. However, on December 26th and when he came home for the last time on the 28th, the fight was gone and he looked sad and tired. I knew at this time he was never going to get better and I did not want him to die while having a seizure or going into a coma. I felt hope was gone and the doctor confirmed it for me.
I subscribe to a magazine from Best Friends (www.bestfriends.org) and in July (2009) there was an article on Veterinary Hospice: End of Life Care. One part of the article struck me, “For other people who desire a natural death for their pet, we walk them through what that death might look like. In many disease conditions, the death is not peaceful, and we have to have pretty frank conversations about that. Euthanasia is a controlled process and, done appropriately, is peaceful. Natural death is completely unknown, and that makes some vets uncomfortable. They’re worried about the animal’s welfare and the client’s welfare." If there is still time, I sincerely hope that people will consider giving their beloved pet a peaceful death.
My aim for starting this blog changed when Hunter lost his battle. I hope this blog will help you with asking questions of your doctor that you might not have thought of. Also, please use your gut instincts and be sure to voice your concern if something you are told just doesn’t feel right.
One last suggestion start a blog, write a book or go to pet boards and tell your pet's story. Get the message out about the devastating effects of Cushing's.
Sunday, February 15, 2009
Everything seems to be a bit fuzzy now, but I believe it was five or six years ago that Hunter was first diagnosed with hypothyroidism. Hunter’s weight would fluctuate between being 6, 8 to 10 pounds overweight. Hunter’s eating habits could be characterized as a “grazer.” He never sat and ate his food in one feeding. I tried to feed him that way and he wouldn’t eat. I had discussed this with his vet and he said that Hunter was a natural grazer. So, I filled his bowl and he ate throughout the day. He always had food left over in his bowl.
Other than his food, Hunter did get a few treats and chews. However, I don’t think any of them were enough to have caused him to be overweight. Then around age seven, his activity slowed down. It was attributed to him now being a “senior.”
Unfortunately, this is one of those cases of “if I knew then, what I know now,” I would have had Hunter tested for Cushing’s Disease then and every subsequent year. Like most, I had never heard of Cushing’s. I have learned, since Hunter’s death, pouring over the internet that Cushing’s can lead to hypothyroidism, along with the fact that Hunter had extremely dry skin. I mentioned before about what happened to Hunter’s coat when we found one flea. Apparently, the damage that was done to his fur was most likely due to the fact of him having Cushing’s. Their immune system is compromised and so one flea bite could cause all that damage and the painful sores because his system wouldn’t be able to fight it off.
Cushing’s was probably not thought of because he didn’t have the “classic symptoms” of ravenous eating or obsessive drinking of water. In fact, Hunter never had these two symptoms until he was diagnosed with diabetes in July 2008. Apparently, a lot of vets put off these symptoms as just normal signs of aging. Why vets don’t recommend testing for Cushing’s is beyond me. If it’s because of cost, let the owner’s make that decision. If you were like me, when Hunter was a “senior,” I opted for the complete blood panel for geriatric dogs. Two hundred dollars more would not have made a big difference to me.
Here is a list of the symptoms of Cushing’s Hunter had, which should have been red flags:
Predisposed to hypothyroidism
Routine blood work reflected elevated liver enzymes
Exercise intolerance, lethargy
Thinning hair on torso
Dull, dry coat
Panting – laying on cool surfaces
Slow or no re-growth of hair after clipping
Pigmented skin, especially on belly *
*For Jack Russell's, may notice belly is pink to red and feels warm/hot to touch.
Symptoms five months prior to being put to sleep:
Obsessive water consumption
As you can see, Hunter had a number of symptoms years before he was diagnosed with diabetes.
Hunter was diagnosed with hypothyroidism about six years ago. After being put on medication, he still looked overweight, with a pot-belly. His liver enzymes were a little off, but were never so much to be of any concern to the vet. I was unaware that Hunter’s cholesterol levels were high until a month before he died. I was talking to our vet and he mentioned that his cholesterol levels were in the 400’s and then said offhandedly, “he has always had high cholesterol levels.” Well, that was news to me!
His lethargy was written off by the vets by his being overweight, even though he barely ate. In fact, I went over how much he ate with one of the vets. He was barely eating two cups of food a day. His concern was that Hunter wasn’t getting any essential minerals and vitamins. That’s when I was adding canned food to his diet and looking for higher quality food. That’s also the time when all the dog food was recalled and I had switched him to Purina natural blends with chicken and oatmeal. Finally, I found a food where he ate most of it, instead of pushing it around with his nose or picking out pieces.
His water consumption didn’t increase much, perhaps less than 1 cup in 2006. I have now learned that in the early stages of Cushing’s the water consumption will not be much, but will increase in time. In fact, in July 2008 when he was diagnosed with diabetes, his water consumption was unreal. I would literally have to pull him away from the water. He would drink the water so fast, I thought he would drown. Even though Cushing’s was mentioned in 2006, I believe it was disregarded because he didn’t have the ravenous appetite.
His extremely dry skin was also written off as his allergies. When the cancer was removed from his inner thigh, the area where the hair was shaved never grew back. I mentioned this to the vet, there was no concern.
He started panting in 2007 and when he did pant, his belly would be pink to red in color. I also brought this up to the vet and was told he was a “hot” dog and all this was probably due to his being a few pounds overweight.
After Hunter was put to sleep, I came across a site where a woman had a picture of her German Shepherd. One picture in particular caught my attention. She had taken a picture of her dog’s belly. I could have sworn I was looking at Hunter. There was the thinning hair and pigmented skin on the belly. Luckily, her dog was a lot younger than Hunter and was reacting positively towards being on Lysodren.
I feel the internist failed Hunter and should have taken his symptom of drinking less water more seriously, as I have learned (from an animal hospital’s website) the first sign of toxicity is decreased water intake. I also feel our private vet(s) also failed Hunter for years.
The pain and guilt (did I do enough?) has been overwhelming. My daughters have been the ones to remind me that the internist was the “expert” on Lysodren, not me.
I don’t know even if the internist had acted correctly and had instructed me to take Hunter off of Lysodren on the 22nd and bring him in immediately, if that would have saved his life or not. That is something we’ll never know, but deep inside of me, I know Hunter was dying because of the Lysodren.
The thing about Cushing’s is that many pet owners aren’t even aware of what Cushing’s is and that more pets are diagnosed with Cushing’s than in the past. Unfortunately, like us, many pet owners are only able to piece together the symptoms of Cushing’s and realize (too late) that their pet had had it for a few years before they were diagnosed.
I went with the recommendation of Lysodren, because the internist said he had had better results with it than with Trilostane (Vetoryl). Trilostane was approved in January of this year by the FDA for the treatment of Cushing’s in dogs. Trilostane reduces the amount of cortisol the adrenal glands produce, without completely stopping the cortisol production; unlike Lysodren which can go too far and cause the adrenal gland from producing cortisol altogether.
I wish I had had all this knowledge prior to having Hunter treated. I would have pushed for Trilostane or Anipryl. These drugs may have taken longer to take effect, as they're not a chemotherapeutic drug. Lysodren would have definitely been a last resort. Unfortunately, I didn’t do that and I live with that regret.
I started this blog for Hunter because I wanted to bring all the information I had gathered together about his journey with Cushing’s and diabetes. Although, I never expected it to be such a short journey, the aim is still the same….to help others.
Saturday, January 31, 2009
My oldest daughter has a rare disorder called Ehlers Danlos. I’ll never forget what our family doctor said, that I’ll find I’ll know more about Ehlers than so-called “experts.” Dr. McCutchen was right, and I have been reminded about his statement in doing research on canine Cushing’s.
I’m in the process of writing a review of things that went wrong with diagnosing Hunter. There were signs and symptoms of Cushing’s years before he was finally diagnosed. I firmly believe that if Hunter had been correctly diagnosed and treated for Cushing’s three to four years ago, we could have avoided him getting worse and it leading to diabetes.
However, this is instructions about disposing of Lysodren. Remember, this is a drug used for chemotherapy and is extremely toxic. You can’t simply just throw it away. I called Walmart, which is where I purchased it and asked if I could bring it back and have them dispose of it. The pharmacist, for whatever reason, instructed me to try and dispose of it at our veterinary office. If I was unable to do that, they would dispose of it.
I called my vet’s office and the receptionist was going to find out if any local shelters could use what was left, which was 12 pills. If not, they had a toxic waste disposal. So, please check with your vet’s office or the pharmacy where you purchased Lysodren and have it disposed of safely.
Friday, January 2, 2009
He had been doing so well. In the past, Hunter had always been a picky eater. Now, he was eating so well and was back to drinking a normal amount of water. He had even gained back 6 to 8 pounds and didn’t have bones sticking out anymore. His energy level had also increased and he was playing again. In fact, you wouldn’t know that anything was wrong with him except for the fact that he had cataracts. Even that wasn’t too noticeable anymore since he got around so well. I had really been feeling good about his progress and didn’t fear that he wouldn’t make it to January 1st.
I had taken Hunter back to GVS for his second ACTH test on December 15th. The test showed that his cortisol levels were perfect and just where the doctor wanted them to be. Hunter was still eating good and drinking close to 4 cups of water a day. I had asked about the hair loss and was told it was typical for them to lose a lot of hair due to the Lysodren.
Then I noticed on the 19th that he was consuming about 3 cups of water. I had figured Hunter’s weight to be around 32 pounds and I was beginning to be concerned. On the 20th, he consumed a little over 2 cups of water. So, on December 21st, we did a glucose curve. Hunter registered high, two hours after eating and having his insulin. It wasn’t until four hours later he started to register with his glucose being 338. Over the next several hours his numbers continued to drop and at 8 hours after his insulin his number was at 166, then 132 two hours later and at 12 hours after his insulin shot at 8:30 am, he was at 168. I fed him dinner and gave him his second shot at 8:30 pm, and at 10:30 pm, his numbers had gone back up to 351. I searched online and came across the term “food spike” or “sugar spike” for diabetics. I read that splitting up his meals into smaller ones can sometimes help this. Also, something told me to look-up how long I should be waiting to give him his shot. We were first initially told to give him his insulin shot within five minutes of him finishing eating. I found a pet center in London and a vet’s book online that said it was best to wait 30 minutes after a pet eats to give them the insulin shot, because the insulin would work better with the glucose.
December 23rd, I called GVS and left a message with the doctor that I had Hunter’s glucose curve numbers. He called me back that afternoon and after giving him Hunter’s number, he said to increase his insulin to 23 units. I asked the doctor if splitting up his feedings would help. He said to split his food into four feeding times. I told him that I was concerned about the drop in Hunter’s water consumption. Even though Hunter’s glucose numbers were high, he wasn’t that concerned with the drop in his water usage, because the biggest concern is water increase. My gut told me this wasn’t right.
Wednesday, December 24th, Hunter was leaving a lot of food in his bowl. Splitting his meals up, he was getting 1 cup for breakfast and two smaller meals of ½ cup every four hours until dinner time, when he would get 1 cup. He was eating a little over ½ cup for breakfast and dinner and barely touching the two snacks. He drank a little over a cup of water that day.
On Christmas, he was still eating less food. I was able to get him to drink a little more water. He didn’t eat his snacks at all. For dinner, he wasn’t that hungry so I poached an egg for him. I also added a ¼ cup of water to his food. He finally ate all his food. When I measured his water consumption he had drank a little over two cups. I was hoping we were making progress. Christmas dinner would be the last time he ate.
Friday, December 26th, I tried everything to get Hunter to eat. I scrambled eggs, I poached an egg, I even gave him some white rice, he would not eat. I boiled some chicken and I fed him a few pieces. He ate so little, I wasn’t able to give him his insulin shot. I even skipped giving him his L-thyroxine and Benadryl. He was drinking water though. I was so upset and frantic to find anything to get him to eat. I even tried wet food and sprinkled some garlic on it. He would just turn his head. I sat next to him, rubbing him and talking to him. I told him how much I loved him, like I did every day, and told him to fight.
Hunter had the most beautiful brown eyes that would make my heart melt. I looked into his eyes and I could tell he was sad and tired. I didn't want to believe I was losing him and decided I would fight one last time.
We went to a pet store and bought some high fiber food by Science Diet. We also bought some canned food by them. As soon as we got home I opened the canned food and tried to get him to eat. He still refused. He threw-up in the kitchen three times. It was yellow and appeared to be all the water he had drank. I again boiled some chicken and got him to eat a few pieces. I checked his glucose and it was “high.” It was around 6:30 pm and I decided to go ahead and give him his shot of insulin at 23 units. We checked his glucose around 8:30 pm and it had gone down to 441. Hunter was still showing no interest in food. He was quivering more and I was becoming more and more frightened. I decided to call the emergency vet hospital that was less than 10 minutes from where we live. They told me to bring him in.
During the day, I had been looking up what could be causing him not to eat and drink. I came across diabetic ketoacidosis or DKA. DKA is when there is an elevated concentration of blood sugar and the presence of ketones in the urine and reduced concentrations of bicarbonate in the blood. Ketones or ketone bodies, are used for energy in the body’s tissues and form when fatty acids are released from fatty tissue. The liver makes ketones from the fatty acids. DKA happens when there is an excessive production of ketones when diabetes is uncontrolled. If Hunter had DKA, he would need intravenous fluids and a short-acting insulin to bring his glucose under control immediately.
I mentioned to the emergency veterinary doctor, Dr. Lee, that my concern was that Hunter might have DKA. She said they would run a test for this and examine him. She wanted to keep Hunter over night and possibly over the weekend to administer fluids and try to get his glucose under control. Her shift ended at 8 the next morning and she would call me before she left to let me know how Hunter was doing.
Dr Lee called me the next morning, December 27, and told me the urine test for ketones was negative. To double check that, she also checked for ketones using blood serum and it too came back negative.
When they checked his blood the night before, his electrolytes were off. I asked her that if this happened again, and Hunter’s water consumption decreased, was it ok to give him Pedialyte? She said this was a very good question and that she really wasn’t sure. I told her that I had checked to see if there was a Pedialyte product for diabetics and that I couldn’t find any, and that I knew it contained dextrose; however, I felt that perhaps it would be ok so he wouldn’t become dehydrated. She felt that it would probably be ok, for the short term.
Hunter’s liver enzymes were also elevated. For years, Hunter’s enzymes have always been off a little. He was also negative for a urine infection or any infection. She also told me that around 6 that morning, Hunter’s glucose registered at 57. This meant he was crashing and they gave him more dextrose, which raised his level to around 160. They had not given him any insulin, so this was from the shot I had given him the night before at 6:30.
Dr. Lee said we could visit Hunter in the afternoon and to bring his insulin and some food to see if he would eat. We went to visit him, and he was so happy. I can still see him coming into the room and the minute he heard our voices he perked up and began to wag his tail. He kept walking around and licking all of us in our faces. His body looked a lot fuller and his hair felt so soft. We tried to get him to eat his food and I knew he wouldn’t, and he didn’t. He just kept walking around and licking us. I was very pleased by how he looked and was hopeful he could come home.
Dr. Lee had said to give her a call after 8 pm to see if he was still doing well. She would then decide if he could come home.
I called a little after 8 that evening and spoke to her. They had re-checked his blood work and everything was now in the normal ranges. She asked me what I thought about how he looked. I told her he looked wonderful and his energy was up. So, we got ready to pick him up. Again, he was so happy that we were there. Dr. Lee talked to us about leaving his tubes in just in case we had to bring him back. The test would be to see if we could get him to eat. She went over the instructions for his insulin. If Hunter didn’t eat, he was to get just 6 units of insulin. However, if I could get him to eat, then I would give him 12 units. She felt that I needed to discuss adjusting the number of units of insulin I was giving him with the doctor at GVS. At this point, Dr. Lee was unsure what was going on with Hunter. She asked if he could have eaten anything toxic or if he had eaten anything out in the yard. He didn’t. In the back of my mind, the only thing toxic he had taken was Lysodren.
When we got home, Hunter urinated for the longest time. I realized that the stinker didn’t urinate the whole time he was there. I got his food ready and tapped the bowl. Hunter walked over and sniffed it and sniffed his water and then turned away. Panic waved over me. We tried to hand feed him and he turned away. I quickly boiled some chicken and again he turned away.
He went to his bedding and scratched at his baby blanket. He couldn’t get settled. He got up and seemed to roam around. He was not happy like he was earlier that day. His tail was tucked and we noticed that he was starting to quiver again.
We tried over and over again to get him to eat or drink and he would turn his head. We all talked to him and tried to get him to eat. He just wasn’t interested.
Again, Hunter tried to get comfortable and lay down. He then got up and had some dry heaves. I moved him and realized he had some diarrhea on him. I knew then he had to go back and we were all so torn. The hardest part was telling the girls that they might want to say a final goodbye to Hunter. Stefanie and Vivian didn’t want to hear that we would have to let him go. I told them that I would ask the doctor if he was dying, but they needed to prepare themselves. I prayed to God to give me the strength to do this.
I rode in the backseat with Hunter. I was praying the whole way there for help and the strength to do what was right for him. They took him to the back and we waited for Dr. Lee. We told her all that happened at home. She went back over his papers and said that all of his blood work looked good. There were no infections and no ketones, and his kidneys were functioning with no problems. She didn’t know what was going on unless he had an underlying condition that they weren’t able to detect. She said they could keep him on fluids and on Monday, I would need to take him back to GVS and see if they could do an ultrasound. Unfortunately, they didn’t have an ultrasound there. I told her that he had had an ultrasound in October and at that time, all of his organs were good and that there was nothing wrong except for his adrenal gland.
Joe mentioned that on the way in Hunter was pulling on the leash and he seemed so strong. Then I mentioned how good he looked when we visited him earlier and that it seemed like he crashed once we got him home. She said it was all due to adrenaline, and that she was afraid that once he got back home in his surroundings, that he would go downhill.
I then asked her if Hunter was dying. She looked at me and said, he has two strikes against him. I told her I couldn’t keep putting him through this. We then prepared to put him to sleep.
The tech came in and put a blanket on the floor and a second blanket to put over him. They brought him in and he perked up when he heard my voice. He came over to me and Joe, giving us both kisses. I got him to lay down and I put my arms around him. He didn’t try to get up and the tech put the blanket over him. He let me hold him and Joe was facing him. He was giving him kisses and I was telling him how much we all loved him. Dr. Lee came in and started the drug, and then he was gone. She hugged me and said that I did the right thing.
It’s taken me a few days to finish this. It’s now January 2, 2009 and in a little while, Vivian and I will go to Deceased Pet Care and bring our baby boy home for good. We had Hunter cremated and he's in a beautiful urn with dog prints.
Tuesday, December 30, 2008
Saturday, December 6, 2008
It was so much fun watching him play. Apparently each toy has a different smell because he would pass the others by until he found the right one. Last night he played with his red bow and he found it each time. Vivian would praise him when he found it and brought it back to her. You could tell he was having a great time. He played for about 10 to 15 minutes, which was the longest we’ve seen him play in a long time. It was wonderful.
Wednesday, December 3, 2008
First, I mark on the calendar when I puncture the insulin bottle. I count up 28 days and note that on the calendar. However, giving Hunter 21 units, twice a day, I use the bottle up before 28 days.
Before I give Hunter his shot, I take the insulin out 30-45 minutes before injection and let the insulin get close to room temperature. Remember, cold insulin hurts. Be sure to gently roll the insulin between your palms and don’t shake it. Letting the insulin get to room temp also helps in not having so many air bubbles. For me, it’s easier for me to completely fill the plunger and then tap the tube to make any air bubbles go to the top and then push them out. Sometimes, especially if it’s a new bottle, I won’t have to push all the insulin out of the tube and can then make the adjustment. There are a lot of times though where I get huge bubbles and just have to keep filling and emptying over and over. There have been some occasions where the plunger just isn’t working and I have to use a new syringe.
I mainly give Hunter his shots by myself. It’s a ritual now after he’s eaten and I’ve given him his Benadryl and L-thyroxine with cheese. I get the shot ready and then I call him over and put my arm around him and start to massage him. Once he consents (don’t force) and lays down I give him a short body rub and then proceed to pinch up his skin between his shoulders. Since he’s lost weight, it’s easier to pinch the skin up. You want to inject the needle in just below the skin. Push the needle in right below where your thumb and forefinger are holding the skin up. Our vet had said to push the needle in “between” your forefinger and thumb. Well, my daughter and I both had nicked our fingers with the needle and once I pushed the needle right through Hunter’s skin and when I pushed the plunger, insulin sprayed out onto the carpet! That’s not what you want. So that’s why I aim for right below the fingers.
When you inject the needle and start to push the plunger, I let go of the skin. Make sure that you have injected all the insulin before you remove the needle. There were two or three times in the beginning where I had pulled the needle out before all the insulin had been injected. If that happens, just let it and don’t try to re-inject more insulin. I then rub that area and then it’s time for the eye drops. I don’t let him get up and I position myself behind his head to give him his drops. It’s easier for me to give him a shot than to put drops in his eyes. If your dog is like Hunter and is a kicker, be sure those legs are away from you. Believe me, it’s easier to give eye drops when he’s lying down and his legs aren’t pointed towards me.