Disposal of Lysodren

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.

What happened?

As I write this, I really don’t know what happened to Hunter. When he looked and felt his worst back in September, my biggest fear was that he wouldn’t live to see January 1st. I knew if he lived to January 1st, we would still have a few more years with him.

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.

Journey Ends

During the last few weeks, our baby boy was slowly losing his battle with Diabetes & Cushing's. We made the hardest decision to let our baby go. He went to sleep for the last time while I was holding him at 12:55 am on December 28, 2008.

Playing

I mentioned the other day that Hunter has been playing more. For the past few nights, after dinner, he gets one of his four stuffed toys and brings them to Vivian. She’ll be sitting on the sofa and he’ll put his toy up on the edge of the cushion. He wants her to flip the toy in the air. He used to play like this when he could see. Although, he usually would get tired out easily and would pant. We feel he probably had the beginnings of Cushings then. We’ve learned that besides the obsessive water drinking and eating, panting is also a sign of Cushings. Since he’s been regulated, he’s only panted once or twice.

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.

Update

Hunter seems to be doing pretty well. We’ve noticed this past week that he’s been playing more and more with his stuffed pets. He’s even walking around with them, which we haven’t seen him do that since July. I do have one concern and that’s his hair loss. He got a bath yesterday and he lost a large amount of hair. In fact, he has lost more hair since being on Lysodren. I'll be making an appointment for him to get the second ACTH test on December 15th, at this time I'll ask about him losing so much hair.

Insulin Shots

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.

Glucose Curve

On November 19, we did a glucose curve on Hunter. He’s not the best patient to work with. I don’t blame him either. The choice we were given was to either get a blood sample from his ear or the bottom of his paws. I opted for the bottom of his paws.

If it wasn’t our drive to get Hunter well, I’m not sure I would have been able to give the shots and draw the blood. I’m a squeamish kind of person, especially about shots and veins. I’m getting warm just typing this…no kidding.

Hopefully, if you’re reading this and your pet has been diagnosed with diabetes, you’ll have an easier time in getting a blood sample. Hunter is a fighter, although when he was at his sickest, he didn’t fight that much. He’s feeling and acting more like normal, so he’s back to being a fighter. We have to use a muzzle on him. We lay him on his side, one person holds his front legs and another straddles him. I’m the one who straddles him to get the sample. We have everything set-up and ready; the meter with the strip, lancet, and cotton ball with alcohol.

Perhaps sticking his ear would get a better sample, but after viewing videos online, there’s no way I could do that. Unfortunately, I usually have to stick him a few times to get a good sample. It’s rare to get a good sample on one try.

This was his first glucose curve since he was on the Lysodren and here are the numbers. He get’s his first shot within five minutes of him finishing his breakfast, which is around 8:45. You take the first sample two hours after shot #1 and every two hours until 10:45 pm.


Time Number
10:45 am - 170
12:45 pm - 170
2:45 - 111
4:45 - 114
6:45 - 97
8:45 - 130
10:45 pm - 205

We were a bit concerned about the last number being at 205. So, yesterday, we took a sample at 10:45 am and it was 209 and again at 2:45 pm and it was at 184.

The doctor called me back yesterday afternoon and he was very pleased with his numbers! I was so surprised since to me it looked like he was all over the place. I was busy reading on the internet before he called for a “safe” range. It seems they vary; however, the doctor recommends anywhere between 60 and 180. He wasn’t too concerned that Hunter’s numbers did reach up in the 200’s, as long as they come down.

The time to be concerned is when he starts to drink more water and needs to urinate more. I’ve decided to keep the gallon jug, which I have marked off, to track his water usage. After seeing Hunter drink so much water these past few months, it’s hard to remember what was “normal” for him. I have the jug marked off to around 5 cups. The recipe is supposed to be 1 ounce of water for every pound. Hunter has gained back some weight, in the past 2 ½ weeks and I estimate him to be around 32-34 lbs. I also started to cut back on the food a little bit, to around 1 ¼ cups of food for each feeding. I’m still adding a little less than ¼ cup of scrambled eggs to his food, or he wouldn’t eat. We’ve basically stopped all treats, except for some doggie cookies I found online for diabetic dogs.

In about three weeks, I’ll make an appointment for another ACTH test. We were hoping that we would be able to cut back on his amount of insulin, but that’s not going to happen. When I was looking for the “safe range” for glucose numbers, I did read that dogs that have Cushing’s and diabetes, usually have to take more insulin. That seems to be holding true.

ACTH Stimulation Test

I took Hunter back to GVS on November 12 for the ACTH Stimulation Test. He again had to fast from the night before. This time he only stayed for two hours. I had noticed that there had been a drastic decrease from his drinking water on the 9th. I had a gallon jug and would fill it to the half gallon mark. Some days Hunter would drink a little over a half gallon of water.

The cost of this test was $160. I had sent a syringe of insulin, but since he wouldn’t eat, they didn’t give it to him. They took a glucose reading and it was in the 400’s, which was not so bad since the last time he had had his shot was at 8:30 the previous night.

We got the result of this test the next day and it showed Hunter was in the range where the doctor wanted him to be. I was very relieved since I’ve read where some dogs don’t respond to Lysodren. I was also concerned that we may have to do a second dosing.

Tomorrow, November 18, Hunter starts his maintenance dose. The doctor said he has seen better results in halfing the maintenance dose, instead of giving it all at once. Since Hunter’s dose is 1 ¼ pills, I will give him ¾ of a pill tomorrow and two days later, I’ll give him ½ a pill. After four weeks on his maintenance schedule I’ll take him back for another ACTH test to see if he’s still in the good range.

On November 19th, we’ll take another glucose curve and see where his numbers are at. He’s still taking 21 units, twice a day. I’m hoping his numbers have improved.

I’ve noticed in the past few weeks that he’s getting around the house better and not running into walls too much. He’s walking more cautiously. I also started lightly yanking the leash up when we’re getting ready to step up onto the patio, which seems to help him a bit more. Because of finances, I’m not sure if we’ll be able to afford removing his cataracts. I was hoping we would be able to and I’m still trying to figure out a way that we can. We still haven’t sold anything at our online jewelry store, which would certainly help, but I’m still hopeful.