Apollo

[Debbie & Apollo]

Hi! I found this site after being on the Canine Cushings forum- Thanks!

A brief history - Apollo is almost 9 years old. He developed pancreatitis in November of 2006. He spent 3 nights in the Vet hospital on just IV fluids. We got to bring him home and in 6 days we were back with another round of pancreatitis... again 3 nights in the hospital on just IV fluids. He came home 12/24/06 -- That was the best Christmas present ever!
After the second attack we also wound up with a different Vet (holiday time -on call rotation) That was a blessing! The new Vet got it right -- we had diabetes --
Apollo started on Vetsulin.

The next major event was he developed bladder stones. We were on the road traveling in our motor home (we are retired) - went to a different Vet to see about blood in his urine... long story short we headed home to our Vet!
Apollo had surgery and had 3 large bladder stoned removed.

Due to the stone formation he is now on Royal Canin Urinary SO - wet and dry.

We use urine strips to test his levels now - I wish we had been using them earlier we might have avoided all the complications from the bladder stones.

We have since moved - have a new vet here (we hunted harder for a vet than a house:D

I would like to start some additional supplements but I am waiting for him to get over a slight UT infection. He is presently on Baytril -- which is giving him a bit of the 'runs' and he also is on an eye drop antibiodic.
Ah, I forgot - he also take Pepcid an hour before his 1st meal.

Apollo seems to be exhibiting signs of Cushings so next week it looks like we'll be doing those tests.

Apollo has been vomiting, drinking more water and we just don't have a handle on the glucose levels - even after making increases in his insulin-- this is why the vet is suggesting we check for Cushings. They want him to feel better so we don't get poor test results.

Thanks for listening - Debbie and Apollo

[rhodesian46]

Have you thought of home testing?Is your vet doing curves? I don't know whether the food has anything to do with his Bgs as Pebbles is on Purina DCO I don't know anything about Royal Canin and my dog didn't have bladder stones.Did your vet tell you why he thinks Apollo is vomiting? Drinking more water could be due to not being regulated. Pebbles had an ultrasound,urine creantine test and ACTH stim. I do suggest that you consult with an Internal Med Dr. They deal with multiple problems in dogs all of the time. Your everyday vets usually don't. If money is an issue maybe your vet could consult with via telephone, I took Pebbles to Tx A & M after dealing with a vet that had no idea how to handle Pebbles problems and misdiagnosed her as well. I learned the hard way So it makes me more careful on who handles Pebbles care. I hope Apollo feel better And welcome to the forum

[k9diabetes]

Hi Debbie!!

Very happy to see you here!

I'll bet you'd love home blood glucose testing as you're obviously very interested in staying on top of things with Apollo.

Most of the small dogs I know are tested on the back at the base of the tail and Denise's Chihuahua is tested on the upper lip, which is where I test my medium to large dog, Chris.

You can learn more about home testing on the main website at www.k9diabetes.com/monitoring (http://www.k9diabetes.com/monitoring) and then see tutorials on many different places to test a dog's blood sugar on the BG test video page. We don't yet have a video of a base-of-the-tail test, but there's a pictorial and text description of how to do it there and videos of the lip test and testing on the pad at the dew claw: www.k9diabetes.com/bgtestvideos.html (http://www.k9diabetes.com/bgtestvideos.html).

You'd be surprised how well they handle the lip. I test Chris a minimum of three times a day because he's on faster acting insulin and gets 4 injections a day. He doesn't mind the lip a bit.

Anyway, just something to consider. It's especially helpful when you're worried that blood sugar could be low.

I always suggest people start with regular meters for people and once they're proficient then they can consider the animal-adjusted meters because the animal-adjusted meters are a LOT more expensive to use. Usually with the human meters you can get the meter free or nearly free after a rebate and the strips are half to a third of the cost of the strips for special meters, which don't actually measure the blood sugar differently. They are coded to adjust the values to an average, which works well for some dogs, not so well for others.

Welcome again!!

Natalie and Chris

[Debbie & Apollo]

Thank you for the reply.

Yes we are moving towards testing with a meter at home -- I heard an ad on TV for a free meter so I have requested one.. I received a DVD on how to use it... now I'm waiting for the meter.

In the past we have done curves - especially when he first started insulin - also since we moved here he was in for the day and had an excellent curve -- that was awhile ago however....

I told the Vet this visit about using a meter and they will help me - if I need it - this site has great info! I never thought I could give him a shot -- I learned that fast :D Apollo is an excellent patient.

Our Vet is in contact with an endocronoligist (sp?) at the Univ of Tenn.
The last visit we were with her over an hour checking and talking. I have to say this site and the Cushings site.... well you can't put a price tag on it!
The idea of an Internal Med Dr maybe the way to go -

As of tonight Apollo is feeling much better -- he stole my slippers and put them in his little bed (which is beside my side of the bed). I'm walking around in socks and loving every minute of it!

[Debbie & Apollo]

Hi -- between here and the Cushings Forum I have had fantastic input, and suggestions!
I am beginning to think Apollo may be having the beginnings of another bout of Pancreatitis. That's why we had the vomiting etc...

I have scheduled the Cushings test for Monday morning. It will take a week to get the results.

Also the Vet was on the phone today with me and we are going to try and swich Apollo over to Hills W/D and use Gold-Vet Potassium Citrate Granules to control the bladder stones (calcium oxalate stones).

Today was a good day -- glucose numbers look very good!

Debbie

[k9diabetes]

I saw that you were getting some very good information on pancreatitis and hyperlipidemia over at the Cushings board. When I get a chance I'm gonna catch up on Munchie's (I think that was the one) thread on the lipidemia.

Very happy to hear that Apollo's feeling better!!

Natalie

[Debbie & Apollo]

Thanks Natalie,

yes I am getting fantastic information!
So much is trial and error --- I am sorry to say!
We had changed Apollos food last summer because of the bladder stones - on our Florida Vets advice. But I think it would have been much better to keep him on the low fat (Hills Science Diet -Lite) and add Potassium Citrate to his food.

This is most likely the direction we will be going in--- I do think we will go to the W/D if he will eat it. I really don't see a big difference in the W/D and the Lite.... but the W/D is geared for the Diabetic so....

Anyhow -- tomorrow morning we'll at the Vet - with my list of questions :)
and my checkbook ;)

thanks
Debbie

[We Hope]

Just a note re: switching to W/D. Do it gradually and keep a good eye on Apollo as it can have quite an effect on insulin requirements--lessening them considerably.

When we switched Lucky, we were also going to switch insulin as what he was using at the time was at resistance level and not doing anything. This was before Vetsulin was in the US, so we were going to Lilly Iletin II Lente (pork Lente-discontinued by them in 2003). The insulin was identical to Vetsulin in everything except strength--Iletin was U 100, Vetsulin is U 40.

Since we had to order the Iletin, we switched him to the W/D first. Within 24 hours of that, he had a lot less PU/PD. To be cautious, we decreased the insulin that we were replacing. I believe if he had been on pork Lente at the time we went to W/D, he would have had a hypo.

We had another little guy at the other board who was very easy to control and did well with human NPH insulin. His vet thought switching to W/D would be better for him. When he was switched to the W/D, he did go hypo. He needed less insulin permanently because of the W/D.

You may want to talk with Apollo's vet about the possibility of the W/D lessening Apollo's insulin needs. ;)

[Debbie & Apollo]

Thank you for the headsup on the possible need to lower the insulin!!!
We have already adjusted down to 5 1/2 units since his readings have gone down in both the AM and PM testing.

We are familiar with hypo spells! after his bladder stone surgery we didn't realize what effect getting the infection cleared up would have on him -- that was a learning curve I don't want to repeat. We keep kayro syrup close by -- even when we travel in the car.

I am still waiting for the meter to arrive - Tomorrow I will pick up the new food and get him going gradually. I still need to get the potassium citrate (looks like I'll have to buy it over the internet). However, until Apollo is on the new food 100% the vet said don't add it to the food.

thanks again

Debbie

[k9diabetes]

Hi Debbie,

There is very little difference at all between Science Diet Lite you can buy off the shelf and WD. I think you could use either one.

You can compare their ingredients and content in terms of protein, fat, and fiber here:

Prescription Diets: http://www.hillspet.com/hillspet/products/prescriptionDiet/prescriptionDietSearchResults.hjsp?d-49653-p=4

Regular Diets: http://www.hillspet.com/hillspet/products/scienceDiet/scienceDiet.hjsp

The one difference we found was that there is soy in the Science Diet Lite and not in the WD, at least not a couple of years ago. For Chris that turned out to make a big difference as we discovered he was allergic to soy.

[BestBuddy]

Hi Debbie,
Just wanted to say hi and tell you that Buddy was put on WD when he was first dx. He did well on it but it was expensive and we had to order from the vet 10 days in advance to get it. After a few months I did a bit of research and came up with Science Diet Lite as an alternative so we switched. It worked just as good for him so that is what we fed for the next 4 years, we have changed but only because of Buddy's age and now we are using the Science Diet Mature.
Jenny & Buddy

[Debbie & Apollo]

Interesting about the W/D and the Lite.

Apollo was on the Lite orginally. I will take the nutritional info with me tomorrow and see what the Vet says.

One thing... I bet the Lite will be cheaper in the long run!

I do remember there was a lot of 'Poop' with the Lite and I think the W/D will have the same results :rolleyes:

I'll also check out the Science Diet Mature!

thanks
Debbie & Apollo

[Debbie & Apollo]

Hi well we did the test for Cushings test today -- Apollo did super!

The Vet was thrilled about all the information I had learned --
You guys get a GOLD STAR! :D

I have started to switch his food to W/D. We came to that conclusion after seeing the protein and calorie counts in the Lite and some of the other brands.
The less protein the better for Apollo -- bladder stone problem
and the less fat and calories -- since his Trigl was sooo high.

Hi glucose reading was 159! that's fantastic for him!

I am going to monitor his insulin needs very closely, as you suggested, since we are making the food change... The Vet gave me instructions about how to watch and adjust. Since he is still on Baytril I will go extra slow making the transition to all new food.

thanks again

Debbie and Apollo

[We Hope]

Debbie,

Years before diabetes, Lucky had a huge bladder stone removed. Matter of fact, that's where I initially thought his problems were coming from when I brought him in on "D" (diabetes dx) day. We'd been told that everything was fine with the bladder biopsies, but that we had to make sure any UTIs were handled promptly. When I saw he urinated in the house, I made an appointment for that afternoon.

We never had any further problems with his bladder once we got the stone removed and the irritation cleared up with H-Ray laser treatments.

Apollo gets a Gold Star too--he did FANTASTIC today! ;)

[Debbie & Apollo]

Just wanted to give a brief update -
Apollo will have the last of the Baytril today -
maybe we can get the poop back to normal now :D

His glucose levels have been very good - we actually have been able to go down to 5 1/2 units in the AM and PM.

The new food (W/D) seems to agree with him - we are still mixing with the old food and will most likely mix all next week - I am thinking ...since he's coming off the Baytril it may shock his system ??

We still don't have the meter -- but the urine strips seem to be working ok for us now.


thanks for listening
Debbie and Apollo

[Debbie & Apollo]

Does anyone use an eye wash on their babies?

(I also posted this at the Cushings site)

Apollo - is a Yorkie and gets a discharge/mucous or tearing -
I believe it actually corresponds to how his glucose levels are doing - when he is not as well regulated the discharge/tearing becomes more pronounced.

We just got off an antibiotic eye drop from the Vet called Butler Ned-Poly-Gram and they cleared up very nicely!
But it's an antibiotic -- we can't use it forever.

This moring his glucose was HIGH - he has just finished the Baytril -- I hope we aren't back to square one!

Any suggestions?

thanks
Debbie & Apollo

[We Hope]

Debbie,

I believe I'd check to see if the bladder infection has been 100% cleared up with the Baytril and also if there's still something going on with the eyes.

You were doing quite well with the bg's while Apollo was on both the Baytril and the Ned-Poly-Gram, so I'd suspect that maybe one or both of these problems isn't 100% gone.

Apollo may need to go back on one or both of these or possibly get something different which will eliminate the infection(s), if one or both are still there.

http://petdiabetes.wikia.com/wiki/UTI

UTI's can often be hidden, with no clinical signs and normal-looking urinalysis results. Urine culture may help detect these hidden infections. Some dogs have chronic urinary tract infections with no evidence of it in their blood glucose levels.

Recurring urinary tract infections may be the first 'alert' regarding an underlying disease or condition. The 2003 study link below of 100 dogs who had various recurrent urinary tract infections found that 71 of them had other diseases or conditions which would make them more prone to having UTIs. Those who had their predisposing disorder(s) AND their urinary infections treated were much less likely to suffer recurrences of their urinary problems than those whose UTIs alone were treated.

http://www.ncbi.nlm.nih.gov/pubmed/14529127?dopt=abstractplus

Journal of Veterinary Internal Medicine Sep-Oct 2003

Persistent urinary tract infections and reinfections in 100 dogs (1989-1999).

http://www.ncbi.nlm.nih.gov/pubmed/12428885?dopt=abstractplus

Journal of the American Animal Hospital Association Nov-Dec 2002

Detection of occult urinary tract infections in dogs with diabetes mellitus.

"Dogs with diabetes mellitus may develop occult urinary tract infections. In this study, diabetic dogs with negative and positive bacterial urine cultures were compared. Records from 51 dogs with diabetes mellitus were reviewed at the University of Illinois. No difference was identified between the groups in urine specific gravity, pH, glucose, ketones, protein, red blood cells, white blood cells, or epithelial cells. Dogs with occult urinary tract infection did have an increased incidence of bacteriuria, but this was not a consistent finding. Therefore, the urine on all diabetic dogs should be cultured to accurately identify the presence or absence of bacterial urinary tract infections."

Occult means hidden--all testing appears normal but there's still an infection present.

http://www.ncbi.nlm.nih.gov/pubmed/10587255?dopt=AbstractPlus

Journal of the American Animal Hospital Association Nov-Dec 1999

Retrospective evaluation of urinary tract infection in 42 dogs with hyperadrenocorticism or diabetes mellitus or both.

"We conclude that UTIs are common in dogs with hyperadrenocorticism, diabetes mellitus, or both diseases. Clinical signs of UTI, however, are uncommon and results of urinalysis may be normal. Therefore, it is appropriate to recommend urine culture as part of the evaluation of dogs with these endocrine disorders."

Here you see it again-no clinical signs but there is an infection.

While you do have a possible clinical sign--the hyperglycemia--that there may still be an infection somewhere-the best thing to do would be getting in touch with Apollo's vet and telling him/her that the bg's are high now that the antibiotics are done.

HTH!

[k9diabetes]

How did the Cushings test come out?

The high sugar could be rebound if, after the antibiotics, clearing up the infection reduced his insulin needs still further.

If the blood sugar goes too low, they can "rebound" into high blood sugar when the body releases some stored glucose to protect them from the excess insulin.

If the infection is cleared, you may need at least some spot checks and preferably a curve to sort out whether perhaps he actually needs less insulin now.

Natalie

[Debbie & Apollo]

The Vet called yesterday and the Cushings results were basically
"numbers too low to be conclusive"

His Cortisil baseline was 38.09 (2-56 is the normal range)
His Post admin of the shot was 163 (70-151 normal range)

I do not have any other numbers. Right now I am going to start him on Denosyl, and from all I've heard I think I will also get some Milk Thistle, and continue to change his food over this week.

The vet wants me to call back at the end of the week and see how Apollo is doing.
I did a urine test this morning -- everything on the strip looked good EXCEPT for the glucose which was high. We Hope - thanks for the UT info -- if things don't improve I will talk to Vet and see if we can do additional tests for something hidden.

I will test him midday.... I AM STILL WAITING for the meter - that would give me more accurate numbers but I already know he's high.

Natalie what you wrote:

The high sugar could be rebound if, after the antibiotics, clearing up the infection reduced his insulin needs still further.

If the blood sugar goes too low, they can "rebound" into high blood sugar when the body releases some stored glucose to protect them from the excess insulin.


Is there anyway I can tell if this is really the case? Or am I in a just wait, and see mode? I was feeling really good about having a handle on this new episode but.... looks like we are into another chapter.

thanks for your insight guys!
Debbie and Apollo

[k9diabetes]

Rebound will occur if there's both low and high blood sugar. If he's a very obedient provider of urine samples, you could test him throughout the day and see if you're getting some negatives and some very high sugar readings but it can be difficult to sort out with urine testing only since there is some delay before the high blood sugar spills into the urine and the urine collects the glucose over time.

The other thing to keep in mind is that the ACTH test itself can raise their blood sugar for at least 48 hours. The test purposely stimulates the release of cortisol and that raises blood sugar. Chris, after an ACTH test, needed considerably more insulin for a full 48 hours after the test.

So that may have raised his blood sugar and you're still seeing higher numbers.

You might consider going out and getting a meter that you can start using right away as these are complex issues to try to tease out without accurate blood glucose information. You can usually get a meter like the OneTouch or Freestyle (Freestyle seems to work really well with tiny guys like Apollo and requires a very small drop of blood) free or nearly free.

Once you can sort out whether there's any other infection going on in the eyes or urine, that will clear up one question. Then testing his blood glucose with a curve will tell you if he's high all the time or swinging through highs and lows from rebound.

Let me see if I can find a good discussion of rebound... We Hope do you have one? I think I've referenced the petdiabetes.org pages, which were still offline last time I looked. Will see what I can find.

Natalie

[k9diabetes]

Here's one from BD's pages... looks like I need to do some work on the links on www.k9diabetes.com (http://www.k9diabetes.com).

http://www.bddiabetes.com/us/main.aspx?cat=1&id=402

[k9diabetes]

There's also a discussion of rebound in Intervet's manual, which you can download at http://www.vetsulin.com/PDF/20585.pdf

[We Hope]

Somogyi Rebound page from the Pet Diabetes Wiki:

http://petdiabetes.wikia.com/wiki/Somogyi

I don't personally know anyone who's used this meter with their pet, but it's made by the same company who does the TrueTrack, which is quite popular as the "store brand" meter for some major pharmacies, etc.

http://www.homediagnosticsinc.com/products-sidekick.asp

Sidekick® Blood Glucose Testing System
Convenient, All-in-One Blood Glucose Testing System
Always There. Anytime. Anywhere.™

There's nothing else like it on the market today! It's a vial of 50 test strips with a built-in meter.

Sidekick® is very easy to use. Remove a test strip from the vial, insert it into the meter on top, and test. When you're out of test strips, or upon the expiration date, simply discard the unit. It's that simple.

With the Sidekick® Convenient, All-in-One Blood Glucose Testing System, You'll Enjoy:

No Coding – just start testing

1 uL blood sample – less blood means less pain

2 simple steps – just insert strip and test

Less than 10 seconds – fast results mean more convenience"

This is basically a disposable meter set to be tossed when the 50 strips are gone.

http://www.homediagnosticsinc.com/pdf/SK011r0_comp_chart.pdf

Feature comparison of Sidekick to other permanent meters.

http://www.homediagnosticsinc.com/products-buy.asp

Where Sidekick is carried.

http://www.homediagnosticsinc.com/products-sidekick.asp

This page has a link for how to use information and link to a video showing you the same thing.

My thought is that this might work fine until the meter that's been ordered arrives.

[We Hope]

I just uploaded a Flash movie on rebound/Somogyi. You will need to adjust the size of the browser you open it in, as the movie's a lot smaller than the standard web page. Making the browser window smaller "focuses" the text and keeps it from blurring.

http://home.att.net/~plattbrat/rebound.swf

[Debbie & Apollo]

We Hope the Flash Movie was SOOO helpful! and the discussion Natalie sent.

I think I see the light! plus, A picture is worth a 1,000 words :)
By actually increasing the dosage of insulin you can in reality being making the situation worse!

This morning Apollos' glucose was 150 :)

We started Milk Thistle last night and today I am going to run and get that Side Kick meter -- it will be a good one to have on hand and carry in my purse.... everything else goes in there ;) (I always carry a thermos of water for the dogs)

I am going by the vets today to pick up his Cushing Test results... I can keep them for my files... that file folder is getting full!

have a good day all

Debbie and Apollo

[We Hope]

Debbie,

Since I see you're in Virginia, I'm going to believe that your area would have a need for heartworm prevention. Don't know if you're using anything for Apollo or not, but am going to give you this possibility.

Some dogs with diabetes have their bg's raised quite high temporarily from their heartworm meds and/or things like flea treatments. This isn't an across the board phenomenon--doesn't happen to all of those who use them, but it does happen with some.

Lucky was one of those who fit this category. After he was regulated well with the old Lilly Iletin II Lente pork insulin, we got a reading that made our hair stand on end. He was giving us a 500-600 and the last we'd seen of those numbers was when we started him on the pork insulin.

He wasn't ill at all, but still we had this horrible bg. What was different here was that he'd taken his monthly heartworm med within 24 hours of being tested. What we did was not to change his insulin dose at all, but did more testing over that week. You could see the numbers reverting to normal as his system "got over" the heartworm pill.

We'd had people on the other board report that this was happening with their dogs after using flea or tick medications and/or heartworm ones. They'd seen the pattern also, but we were able to "catch it in the act" by doing professional testing on Lucky.

We went back on all his previous testing and sure enough, we had not done any that close to the date he took his heartworm pill--not until we got that awful reading.

None of the heartworm meds have anything in their professional information about the med possibly raising bg's in animals with diabetes; we went over the professional leaflets of all heartworm medication on the market then--not one word to that effect.

There was also a case like this on the other board--person joined and posted because his/her dog was very well-regulated--and then periodically would come up with high bg readings for no apparent reason. It wasn't illness, etc. And so I asked the person if he/she was using heartworm meds--telling the same story I've just told. Sure enough, it was the heartworm med for this dog, just as it was for Lucky.

To continue using heartworm prevention or to stop using it is something that needs to be worked out with you and your vet on an individual basis. We went over the risks for Lucky and his lifestyle and for him, we determined he was at more risk from having his bg's raised monthly than he was for heartworm. We continued to do a yearly blood test to see if he had them--it was always negative.

I'm hoping more people will make the connection between the flea and tick and heartworm meds because I'm also thinking about what can happen if the insulin dose is raised in response to the temporarily high bg's. When the body begins "settling down" from responding to the med and the bg's do the same, that looks like a recipe for hypo to me.

Don't misunderstand that I am against flea/tick and/or heartworm meds, as I'm not. We would have continued on with the heartworm pill had it not had such a terrible effect on Lucky's bgs--they reverted back to the values we'd seen when we fought to find his answer. We had to make choices here, and for Lucky, the right choice was to stop using heartworm meds--this may not be right for anyone else.

[Debbie & Apollo]

WOW about the heartworm/flea info! I had never heard that.... I have asked the Vets!

Yes we have always used prevention with Apollo -- from when he was just a 'wee little fellow' :) We used to live in Florida and we had a lot of trees... so we also had to worry about ticks, on top of the fleas, and he also took Heartguard.

Right now we have switched to Revolution... (the heart worm is in with the flea meds.) He has had his treatment for this month, next month I will be sure to monitor! (No I was not monitoring for a glucose reaction!) He hates the stuff anyhow -- he always runs around like a crazy man ... the reaction always bothered me.... we mentioned it to our vets and they said each dog is different....
if I see a change I believe I will stop using. Our other dog (Atlas) is a Maltese and he doesn't react to the treatment at all!

Also, Apollo is with us all the time -- he only goes out to pee and poo - his walks have also cut down.

again thanks for mentioning it!

We just got back form the Vet office -- I picked up his Denosyl.... I will start it tomorro morning.... on an empty tummy :cool:
I have read enough to know it needs to be on an empty tummy --- the vet didn't tell me and it was not written on his script instructions :(

glad I can read. glad I do read! thanks again!

Debbie and Apollo

[We Hope]

Lucky took the same heartworm treatment for years--the only trouble we had with it came post-diabetes dx. He was having no other "bad" reactions--never did before or after diabetes.

If it does temporarily raise the blood glucose of some non-diabetic animals, first of all we're not looking for it because we're not testing their blood or urine for glucose regularly. Second, if it does do that, the properly working pancreas of the dogs for which it does, automatically respond with more insulin to get their bg's back to normal levels.

When people who don't have diabetes eat something like a giant banana split with all the toppings, their blood glucose goes up too. (This is why you need to fast before some blood testing--if not, your blood glucose could be elevated and you might receive a false diabetes dx.) But because their pancreas is working properly, more insulin is produced when their bg's do go up from it and that gets a handle on the bg's.

Those with diabetes aren't able to produce enough insulin for their body's needs and/or to handle the increases in blood glucose from the things they eat. They either need to take oral meds which help the pancreas produce more insulin or need to use insulin to handle it. While we're able to either get the pancreas to produce needed insulin with oral drugs or to simply replace what it doesn't make by insulin injections, these are not 100% perfect systems. The "ideal" would be to have a perfectly working pancreas that produces enough insulin automatically. :)

[Debbie & Apollo]

It's been a fairly good two weeks, so I made an appointment for Apollo to go the grommer. Our groomer is located in the same place as our vet. This time I stayed in the waiting room until they were done with Apollo -- the less stress the better. His weight only changed by +1 ounce - he had lost 6 ounces.

Anyhow the groomer found what she thought was puss in his ear -- our regular Vet is on vacation this week so we got to see her partner -- She did a few tests, Apollo has a yeast infection, on a scale of 1 to 4 she said he had a 4 1/2! She even let me come into the back room and I got to look at the slide! This might explain why the glucose numbers were going a little wacky again.

Now how I missed it I'll never know!! Man I look into his eyes and I wanted to cry! This has been one of those months. I have even been cleaning his ears almost everyday with an ear cleaning solution! So another $150+ we are back home. At least it is a topical medication -- I hate to think about the 'runs' he gets when he goes on antibiodics! The Vet was very through on what side effects to watch out for. She said it was hard to tell if the eardrum was invloved since it was so inflamed.

He has just about been totaly weaned off his old food (only up +1 oz in weight!) and in 3-4 weeks we'll do another blood workup to check his Trig and Chlor. ....if we see no change we will do the next level of testing for Cushings - I believe the test will be to see if he has Atypical Cushings.

Well the one good thing about today -- yes, the infection was found but we are now in touch with a second Vet in case our regular Vet is not available -- and I liked her and more importantly Apollo liked her!

Thanks
Debbie & Apollo

[We Hope]

Debbie,

Don't beat yourself up. Diabetes means a predispostion to infections.

Making this even tougher is that they can be what's called occult or hidden infections, where there is an infection, but there are no signs of one.

http://petdiabetes.wikia.com/wiki/Hidden_infection

Hidden infections in diabetic cats or dogs may have no outward signs at all except unexplained hyperglycemia. Infections can also be the cause of hypoglycemia.

Hidden infections may be anywhere in the body, including dental, urinary tract, or elsewhere.

When you see the word "occult" in medical reports, abstracts and articles, it has nothing to do with the paranormal. It describes anything which is hidden and therefore difficult to spot under normal conditions.

Infections and diseases can also be referred to as 'subclinical'; this means the condition is present but there are no easily discerned signs or symptoms of it. Using urinary tract infections as an example, it is possible for one to be present, but not evoke the traditional signs which tell us it's there. A traditional urinanalysis might not turn it up, but doing futher testing and performing urine culture tests may be the only way to spot it.

On UTI's:

http://petdiabetes.wikia.com/wiki/Urinary_tract_infection

UTI's can often be hidden, with no clinical signs and normal-looking urinalysis results. Urine culture may help detect these hidden infections. Some dogs have chronic urinary tract infections with no evidence of it in their blood glucose levels.

http://www.ncbi.nlm.nih.gov/pubmed/12428885?dopt=abstractplus

Journal of the American Animal Hospital Association-Nov-Dec 2002
Detection of occult urinary tract infections in dogs with diabetes mellitus.

"Dogs with diabetes mellitus may develop occult urinary tract infections. In this study, diabetic dogs with negative and positive bacterial urine cultures were compared. Records from 51 dogs with diabetes mellitus were reviewed at the University of Illinois. No difference was identified between the groups in urine specific gravity, pH, glucose, ketones, protein, red blood cells, white blood cells, or epithelial cells. Dogs with occult urinary tract infection did have an increased incidence of bacteriuria, but this was not a consistent finding. Therefore, the urine on all diabetic dogs should be cultured to accurately identify the presence or absence of bacterial urinary tract infections."

http://www.ncbi.nlm.nih.gov/pubmed/10587255?dopt=AbstractPlus

Journal of Veterinary Internal Medicine--Nov-Dec 1999
Retrospective evaluation of urinary tract infection in 42 dogs with hyperadrenocorticism or diabetes mellitus or both.

"We conclude that UTIs are common in dogs with hyperadrenocorticism, diabetes mellitus, or both diseases. Clinical signs of UTI, however, are uncommon and results of urinalysis may be normal. Therefore, it is appropriate to recommend urine culture as part of the evaluation of dogs with these endocrine disorders."

So you're in good company, as the hidden infections baffle the experts plenty of times too. The most important thing is that it's been found and being treated now. :)

[k9diabetes]

I love a vet that will let you look at the slide!

Be careful with any ear washes that contain chlorhexadine. If there is access to the inner ear through a ruptured or torn eardrum, chlorhexadine and probably others as well can cause deafness. It sounds like she couldn't see the ear drum to ensure that it is intact.

I personally know of several dogs who lost their hearing this way.

Hope the yeast is mainly in the outer ear and you have an ointment that won't travel inward.

He probably hasn't had this very long or he would have shown more signs of it. I wonder if his ears are staying too wet after rinsing... has he had a lot of ear problems?

Natalie

[Debbie & Apollo]

Hi Natalie and We Hope

thanks again -- you guys have great information!
I will look on the ear wash bottle....

and Natalie you may be right -- I may have let his ear stay damp after I used the wash --and excellent point! I never really thought that would cause a problem - The Vet did warn me about the eardrum -- so far no bad reaction to the meds -- To this date we have not had ear problems.
Natalie the slide was really interesting -- all pretty purple things swimming around --- so pretty and yet so very nasty!

Yorkies have all kinds of hair and it grows :) Since Apollo was not feeling well we were tardy in getting to visit the grommer -- so the hair was longer than usual. I actually did a trim around his body but didn't go near the ears...

We Hope, the info on hidden infections! WOW! Nice to know I am in good company :cool:
I wish our little guys could talk and tell us what's going on...
He is handling the drops fine --

So far he has no side affects from the Denosyl or the Milk THistle

Debbie & Apollo

[k9diabetes]

Meant to mention earlier that Chris too gets a little boost to his blood sugar when he gets his monthly flea/heartworm tab. He gets Sentinel.

[Debbie & Apollo]

Well tomorrow is the day for Apollos - flea/tick/heartguard
He is on Revolution.

I was going to relax with the glucose testing for a few days but...I am anxious to see if the Revolution makes a difference.

Otherwise he is still holding ok -- we have cut back is insulin to 5.5 2x's a day.

Nat - you mentioned (in a different thread) about not knowing if you can skip Milk Thistle without causing a problem ---
On the paper work I have about Milk Thistle they actually recommend you give for 5 days and take off 2. Do that for 5 weeks and take a whole week off.

I'll let you know how we do with the Revolution.

Debbie & Apollo

[ladysmom06]

Hi Debbie,

Just wanted to let you know that the milk thistle is helping Lady:D:D. She's only been on it since the end of May and her alk/phos has dropped from 212 to 186. Hugs to you and Apollo.

Luv,
Lynne and Lady

[ladysmom06]

Hi Debbie,

Just saw on another thread that you are off to visit your kids and grandkids - have a safe trip and enjoy your time with your family. We're expecting our first grandchild in October:D:D:D:D - can't wait. My daughter is planning on going back to work in January so my husband and me will be watching the baby - we're also retired. Hugs to you and Apollo.

Luv,
Lynne and Lady

[Debbie & Apollo]

That's great about the Milk Thistle!!

And you first grandbaby! How exciting!
We have 9 grandchildren! but between you and me the first is an awesome experience and you get to watch the new addition!

We had both of our daughters living with us at different times -- and the kids were always a blessed addition. We miss them. The best part is we get to spoil them!

When the kids tease about how spolied the dogs are I remind them that they do not have to go out and make a living :D

October will be her before you know it!

Debbie and Apollo

[Debbie & Apollo]

Good Morning Everyone!

An Apollo update : :)

We received a meter (an Utlra One Touch) - This morning we took Apollo to the Vet to have blood drawn - I also asked for help using the meter for the first time... I have read and watched all the suggested sites but call me a chicken... anyhow our Vet had the Lab Tech come in and together we had SUCCESS! Our meter said 161 --- :) Then they decided to check with their meter -- they got 169. Pretty close! Apollo was sooooo good!

Anyhow -- I've seen it done -- our vet shaved a small spot on both of his ears ...we are good to go. I will not try again today as II think he had his quote of being pooked for the day -- when we do it all by oursleves I will have a fireworks display! ;)

Tomorrow we'll have the results of the full blood workup - I am interested in seeing how some of the other numbers are since we have changed food and added supplements.

He still has a bit of a yeast thing going on in his ear -- The vet was very patient and showed me how to clean them better. Apollo wasn't too thrilled but that's ok :D

thanks for listening.

Debbie and Apollo

[k9diabetes]

Glad you got a chance to see a test done - that makes it a bit less intimidating. What meter did the vet use? AlphaTrak?

Let us know how the test results come out!

Natalie

[Debbie & Apollo]

OK -- I have the test results in hand.

Apollos Glucose was 178 - this was at 10 AM (our meter showed 161 - the vet meter (Alpha Trak) showed 169.

It's the other numbers we are thrilled with!
Triglycerides - 918 -- they were 1686
Cholesterol - 300 --- it was 537

ALT - 17 - was 24
Ast - 22 - was 24

Some of his other numbers also improved. His weight has also stayed steady:)

So for now we just continue with the supplements - Milk Thistle, and Denosyl (SAMe). We are also treating his ears to keep yeast infections away.

DH and I are going to try and test later today:)

Later guys!
Debbie and Apollo

[Ricksma]

I have great confidence in you guys...this is very doable. Apollo is gorgeous, and I am so happy to hear the lab results are so much better. Hang in there!

Love and hugs, Teresa and Ricky

[Debbie & Apollo]

I am very happy to report that Apollo is doing well!
AND .... drumroll please....
he turns 9 years old tomorrow!!! At the end of the month we are marking 2 full yrs since we began this journey.

Thanks everyone! We couldn't have done it witout you!

signed: the Birthday Boy!
Debbie and Apollo

[We Hope]

http://www.ipass.net/a1idpirat/pty-ani-cake5.gif

[k9diabetes]

Happy dance for Apollo.... we look funny doing it but it's heartfelt! Congratulations!!! And happy birthday big little guy! :)

Natalie

[eyelostit]

Happy Birthday Apollo and congrats on your 2 yr anniversary, your are getting to be a pro now Debbie, give yourself a big pat on the back.:)

[Debbie & Apollo]

Thanks everyone!

I got Apollo a new toy --- he's having a blast!
We are having great weather in Virginia right now -- I think a walk in the park would be great!

Debbie

[eyelostit]

Ditto........we are having some nice weather in PA also, hopefully tommorrow I'll get outside for awhile to finish some things, Niki already had her walk she always gets to do what she wants :rolleyes:

[Debbie & Apollo]

Ok -- I am going to get on a bandwagon here!

Apollo was acting a bit down and depressed - right after he has been doing SUPER! No I don't think think he knew to pout about getting old - HA!

I got to thinking -- we were getting to the bottom of his insulin bottle ---- huuummmm! ya think???

anyhow -- it's was about time for a blood work up so we took him in to the vet. And I started a fresh bottle!

MY man is back! We continue to learn! and put the pieces together! Today was a good day!

Debbie and Apollo

[eyelostit]

I imagine it was the insulin, being the little guys use less and the bottle may have lost some potency.

Glad all is well, and you feel relieved, i hate when things go wiry or I get a curve ball out of no where.

Take care :)

[Squirt's Mom]

Hi Debbie!

How are you and Apollo doing?

Hugs,
Leslie and the girls

[Debbie & Apollo]

Hi everyone!

We are still here --
Apollo is doing well - right now he is chasing Atlas for a toy.
His insulin has gone up to 6.5 units twice a day.

His eye sight is failing - especially at night. I noticed it last week -- It was time to head to bed and I turned off the lights and headed to the bedroom ... after a few minutes I realized Apollo had not followed me... I went back into the family room and he was standing there looking lost.

Debbie & Apollo

[k9diabetes]

Debbie!! :)

I'm so glad that Leslie asked about you and to see you here! Especially nice to see that Apollo is doing well.

It's weird how their vision seems to fail overnight. Hope he will adjust quickly sohe can get back to chasing Atlas.

I think we need to request an update from everyone. I've kind of opted at least for now not to do a regular monthly update but once in a while we should do one just to catch up. It was great to see Apollo's face on the forum.

Natalie

[eyelostit]

Hi Debbie,:)

I'm glad Apollo is doing good, chasing his toys !!

I think Niki can see shadows or some light, I think Apollo will be ok they adapt pretty well, its amazing how they are, of course Niki can get disoriented when we are playing in the yard and she gets off her own radar sense a bit when we do something different.

[Debbie & Apollo]

Good morning - it's been awhile since we posted... Apollo had been doing very well... not too sure what's goin on now. About every 3 or 4 days he is throwing up his breakfast... about an hour after he eats and gets his shot. The rest of the day he seems fine and back to normal. I am concerend with the frequency. If it was pancreatitis I would think it would be an all day event with his other feedings. Today he got me up before breakfast/and shot... wants to eat grass, he threw up a small amount of liquid... today he is not interestered in his food (dry or canned). He is drinking some water. Ah! he's ringing his Apple to go out again - sometimes I think if eating the grass makes hime feel better... can there be harm in that? Most likey we'll be at the vet office today... I'll let ya know.. THANKS guys for being here!

[Patty]

Debbie,
Sometimes dogs will eat grass when their tummy is upset. Anxious to hear what the vet says.
Patty

[eyelostit]

Hi Debbie :)

No doubt thats why Apollo was eating the grass, Niki did this the other day.

Let us know what the vet says, maybe just a tummy upset from something Apollo got into, I know we watch them like hawks but sometimes they will get over on us. ;)

[k9diabetes]

It's really nice to see you and Apollo here, though I'm sorry it's because he has been throwing up.

I'm anxious to hear what the vet had to say. Possibly some simmering, chronic type pancreatitis? or a little IBD?

No poop problems?

Natalie

[Debbie & Apollo]

Hi everyone
Got to the vet. Looks like Apollo may have intermitten Pancreatitis.
For now we are just using Pepcid AC and I am going to add any 'episodes' to his journal.
I only give him 1/2 a Pepcid tablet - about 1 hour before he eats.
Since he has hyperlipidemia - a blood test may not give a positive answer for pancreatitis. There were other tests that can be done but for right now (given Apollos history) we'll wait and see for about 2 weeks.

As for his poo -- for the most part that's been regular and 'solid' :)
Ah - the grass -- the recommendation was not to let him graze - especially since he has an upset stomach and upchucking messes up his sytem.

So far today is good -- he ate fine and is resting.
Thanks guys!
Yesterday when Apollo started in my hubby said: - "go to the k9 forum" :D

[Patty]

Smart man that hubby ;)

I hope the Pepcid helps Debbie. Keep us posted on how he does.
Patty

[Debbie & Apollo]

Good morning. Apollo seems to be wanting to throw up again. (so far he has not and I've kept him away from the grass:)
We have been giving him the pepcid. His appetite is good.

A thought -- his glucose, by the urine test strips is HIGH. I just took it and it was 1000 on the strip. Sorry I can't get the blood meter to work -- I am a failure there, even though he is very cooperative.

could these episodes be caused by the fact his insulin needs to be increased??

So far these episodes are happening in the morning - once before his morning meal and shot and 4 times after his morning meal and shot.

any thoughts? would glucose being too high cause the upset stomach etc??

thanks
Debbie & Apollo

as of 9:30 AM - yes he has thrown up his morning meal. seems to feel better and is resting.

[We Hope]

Debbie,

The high bg's can be from the possible pancreatitis and also possible because of the hyperlipidemia. The hyperlipidemia could be the cause of pancreatitis.

Sometimes part of the treatment for pancreatitis is not to give anything by mouth for a time period set by your vet--nil per os (nothing via mouth). This allows the pancreas to "rest" a bit and try to recover.

http://petdiabetes.wikia.com/wiki/Pancreatitis

Part of this treatment can be giving sub-Q fluids because they "bypass" the oral route.

I'd tell your vet about Apollo's high bg's on the urine strips and get his/her advice about increasing his insulin and by how much. My worry is that he's throwing up the morning meal and that doesn't leave anything for the morning insulin to work on.

Kathy

[Debbie & Apollo]

I'm beginning to feel like a juggler!

Apollo has had the 'IV' treatment twice.
This was at the very beginning of our journey. pancreatitis then diabetes.

I have called and we'll be at the Vet at 2 PM. I wish there was a pill to make him all better... how much to put him through ???
OK -- one step at a time -- we can do this!

I'll touch base this evening - thanks for listening.

Debbie & Apollo

[k9diabetes]

Anxious to hear what the vet says... did they put him on a bland diet?

Natalie

[Debbie & Apollo]

Back from the vet -- after another bill -- but who's counting:)

We are doing a blood workup that will be back tomorrow - at the vet his glucose was 151 --at 2:30 PM - not too bad for Apollo -- I was beginning to think maybe he was high and that's what was causing the symptoms.
Kathy, no change in his insulin dose.

The vet feels he may be at the beginnings of an infection... possibly UT, or an infection of bladder lining (Apollo has a history of bladder stones).
So far when I've tested his urine nothing alarming has shown up.
But as the vet said -- something isn't right so....

We came home with an antiobiodic - Enroflovacin -- ah and something for his eyes (Neo-Poly-Gram) -- both eyes were very bloodshot (I am sorry to admit I didn't catch that).
I am going to continue giving the Pepcid - more for prevention than anything else.

As for a bland diet Natalie -- he is on W/D dry and canned -- the vet suggested we not change at the moment.

He is resting at the moment - ate dinner fine and got his PM insulin dose. In a bit I need to wake him for his pill --

We made an outing to Pet Smart after the vet as we needed food - plus, he likes to go and check out the other dogs -- we meet a cute 2 yr old female yorkie that looked just Apollo. The little yorkie came from a breeder that turns them over to the SPCA after they are used up as breeding machines.... poor thing -- she was so scared, but really perked up when Apollo came over to her.

thanks again everyone -- I'll keep you posted -- we hope to get on the road to Florida at the end of the week, we planned to go down and help pack up our sons house -- if all goes OK with Apollo I'll be going -- if we have another rough morning, just my hubby will go.

thanks
Debbie & Apollo

[We Hope]

Debbie,

Glad to hear that Apollo's on the way to getting better with the meds! :)

Right now, I don't even want to think "bladder stones". About a month ago, my guy here had 120+ very small ones removed. He was giving us no real signals they were there, either.

Good to hear Apollo's bg's weren't as high as you thought they were. I think your guy's gonna start walking on the road to recovery from this one! ;)

Kathy

[Debbie & Apollo]

Today we took both of the dogs for grooming.
Our grommers great and is very sensitive about Apollo - so Apollo goes in while I wait and the groomer brings him right back to me -- our grommer is located at the vets office. The groomer also noticed that Apollo tummy is a bit extended.

The vet had the test results back from the blood and we went over the numbers while we were there.
Apollo's glucose was just about the only thing that looked good. :cool:
His cholesterol and triglycerides were both higher than when we ran the last blood work.

It looks like the possibility of Cushings maybe be the next thing to re-test for.
I used to go on the Cushings forum before I found this forum... can't seem to get on it right now so I'll have to take some time and hunt down the problem.

Debbie and Apollo

[acushdogsmom]

It looks like the possibility of Cushings maybe be the next thing to re-test for.
I used to go on the Cushings forum before I found this forum... can't seem to get on it right now so I'll have to take some time and hunt down the problem.

Debbie and ApolloI think you've figured out that the Cushing's forum has moved because I just noticed that you have registered there (at the new site) and your membership has now been approved. The previous owner closed the old site without any warning (which is why you couldn't get on there). We had a temporary "home" here for a while (thanks to Natalie!) while a group of Moderators from the old cushings board got together and built a new forum/message board at http://www.k9cushings.com/forum.

Hoping you are not also dealing with Cushing's, but if you are, successfully treating both Cushing's and Diabetes together can definitely be done. :)

[k9diabetes]

With good blood sugar control, I'm doubtful about a Cushings diagnosis. Have them run the ACTH instead of the LDDS as that is a better test for dogs with other health problems.

It doesn't hurt to check but usually you can't get the kind of good blood sugar Apollo has when Cushings is present.

Natalie

[ladysmom06]

Hi Debbie,

Sorry to hear that Apollo is having problems.

It looks like the possibility of Cushings maybe be the next thing to re-test for.
Hoping it's not cushings but like Cushy said if it is both diseases can be treated successfully.

Good luck with the testing and keep us posted. Hugs to you and Apollo.

[Debbie & Apollo]

Natalie thanks for the insight -- there are SO many things to consider.
Apollo had a rough afternoon & evening - he did throw up around 2:30 PM yesterday and then he had no interest in any food. Around 5 PM (his usual insulin time) I got him to eat some canned food (Sci Diet Lite - which is the can food we give Atlas)
I figured in order to give the shot that was better than nothing.
The food stayed down but the "runs" were full force -- he usually has a hard time with antibiodics.

We were out 'going -or trying to go' about every 1 1/2 hrs last night. This morning I cooked up a chicken breast - gave him about 2 tablespoons of it with some of his regular can food -- he did eat and so far it's stayed down.
I reduced his insulin to be on the safe side - only gave him 5 units.

I have a call into the vet-- today is her day off -- I am beginning to think the ultrasound will be the next step.

I am going to go back and read for some of the home meals other feed their babies.

thanks for listening.

Debbie & Apollo

[Debbie & Apollo]

Hi

We have an appt at Univ TN on July 27th.
Going over to PU records just in case we get a call to come for an earlier appt.
I'll keep you posted.

thanks
Debbie & Apollo

[k9diabetes]

A Cushings test wouldn't be high on my list of things to do. Seems like it's the pancreatitis or maybe IBD type problem that's more pressing so I'd do an ultrasound before I'd do an ACTH test.

Natalie

[Debbie & Apollo]

Natalie you must be a mind reader!
I was just going to propose the ? of which to do first:)
girl - you're good!

Apollo is doing ok right now - actually he has been playful....
he just loves to tease me!
Last week we were discussing 'arrangments' and crying --
today he's making us laugh!

I am going to ask about anything that can help lower his chl. and trig.
Also, let them know he is VERY sensitive to antibiodics... are there other options if we need them again.

I have an overnight bagged in case we need to stay overnight.
more stuff for Apollo than me:)

thanks guys!
Debbie & Apollo

[Debbie & Apollo]

Hi!
Well we made the trip to UT and found out lots of things about Apollo, along with waiting for some test results to come back. All in all the UT experience was very well worth the time and effort.
It’s hard to know where to start.
It has been determined that Apollos diabetes is NOT under good control, using a fructosamine test he was 473 which is high (normal is between 250 – 350). There appears to be underlining conditions which are throwing things off and will continue to hinder good diabetic control.
1) Apollo has bladder stones and also kidney stones in both kidneys. Two years ago he underwent surgery for this same condition (calcium oxalate stones – which cannot be dissolved). At the moment Apollo shows no outward signs of unariry tract infection or difficulty going potty. We are keeping a super close watch on him … what goes in and what comes out. Also I am starting to test urine samples at least once a day.
2) Apollo triglycerides were 1870, even after fasting… he is going to start a drug for this (not sure how to spell it) …gemfibrozil.
3) There appears, from the ultrasound and radiology tests, to be a spot on his pancreases and also a thickening of the walls of his intestines. Not sure about the spot on the pancreases but the intestines could mean an IBS…since he has diabetes yes there are a few drugs to help this that are not steroid based.
4) They drew a small amount of fluid from his gall bladder – tests results won’t be in for 5 days.
5) They did a urine culture – tests results in 3 days.
6) We are waiting on suggestions on diet from the nutritionists. I am going to start reading back in these threads for ideas on home food prep. I need to watch out for fat, and protein…right now I don’t remember if protein is a concern. I know it has to be low fat.
7) Recommendation to stop the Potassium Citrate, stop the Denosyl, and stop the Milk Thistle since there appears to be no advantage to him to continue these supplements.
8) Recommendation to do surgery to remove the stones in the bladder… the ones in the kidney can not be removed safely. During this time also take biopsies samples.

The situation is complex – one attempt to help Apollo tends to mess things up for something else.
He is like a scale that seems we cannot get a balance. Right now he is on W/D as it is low fat. He could use being on U/D for the help with the stones… however the fat is way too high for him.

It seems surgery will eventually be necessary to remove the stones… but if the stones are only going to RETURN… we can’t cut open this poor guy every year!
They would like to do biopsies on the two areas (the spot on the pancreases and the area in the intestines)
All of this would require him to be in the hospital for about 3 – 4 days. As you can imagine the cost is up there.

Right now we are unsure on how to proceed. 1) We are going to start the meds to try and lower the triglycerides. 2) And keep an eye on the pee:) 3) PLAY AND LOVE ON HIM!

Thanks for all you input, care and support!! There is a great deal to absorb.

Debbie and Apollo

[pgcor]

Oh boy Debbie...you're right that is a lot to absorb. I just wanted to say how sorry I am about Apollo not doing as well as we'd hoped. But, on the plus side, it looks like everything can be corrected. It could be years in between stones?

Anyway, I admire your fortitude! Apollo is a lucky boy and I know you feel the same way too!

Pam

[We Hope]

Debbie,

I think you have a great plan for dealing with Apollo's medical problems! ;)

Having high triglycerides can be the reason for insulin resistance and I think starting Apollo on a drug to deal with that will help.

Quite a few years before diabetes, Lucky also had a large bladder stone which we removed. We kept watch on the bladder for any possible signs of more--thankfully, there never were. When diabetes came along, we put him onto the W/D canned without any recurrence of the stones.

My present dog who does not have diabetes is about half the age Lucky was when he developed the bladder stones. Toodles had 120+ small ones removed about 6 weeks ago.

We're monitoring the pH levels of his urine, hoping that it won't be necessary to put him on U/D. So far, he's stayed away from acid pH quite well.

I know exactly how you feel regarding Apollo and the bladder stones! Keep your chin up and take things a step at a time--(yes, I'm taking my own advice re: Toodles!) :)

Kathy

[Debbie & Apollo]

Kathy:

what ph # do you strive for,
how do you measeure and
what do you do to reach it?

They asked us to take Apollo off the potassium citrate... here we thought it was a good thing.

[We Hope]

Debbie,

We've been trying to keep him in the pH neutral range. What I'm using to measure are strips from pHion:

http://www.ph-ion.com/index.asp?PageAction=VIEWCATS&Category=205

Right now I'm using an 80 count pack of their test strips. Bought them right here on eBay:

http://cgi.ebay.com/80-pH-TEST-STRIP-FOR-URINE-SALIVA-BALANCE-FREE-SHIP_W0QQitemZ290329352764QQcategoryZ11776QQcmdZVi ewItemQQ_trksidZm263QQ_trkparmsZalgo%3DSIC%26its%3 DI%252BC%26itu%3DFICS%252BUFI%252BUA%252BIA%252BUC I%26otn%3D19%26ps%3D50

(This seller offers free shipping for the strips; if I bought directly from pHion, there would be a shipping charge.)

Before I bought these, we did some price comparisons with the litmus paper John could order and what I turned up by searching the internet for this type of strip. The price for these pHion strips was less than the price quoted by the vet supply house. I tried asking at 2 local "chain" pharmacies for something like this and neither one had anything in the stores.

These are easy to use and easy to read.

Toodles tests neutral most of the time. He had a couple of days where he went to alkaline, followed by a day where he went slightly toward acid. That was followed by a return to the pH neutral zone.

I asked John whether his going back and forth at times was anything to worry about and he told me no. Asked him if it was the same principle as blood glucose--that having some "off" readings at times weren't a problem as long as they don't become the norm and he told me yes.

Right now, we're not doing anything to get Toodles into neutral pH. We've left the food unchanged. We're trying to see if he can stay "in balance" without the need to go to something like U/D.

John suggested that I get something like low/no fat, low salt chicken broth to try to get him to drink more fluids as taking in more fluids can be helpful with keeping stones away.

HTH!

Kathy

[k9diabetes]

Hi Debbie,

It is a lot to absorb but finally now you have some real answers about what is going on with Apollo. So you have a place to start and a plan, which is great.

Pretty much everything going on with Apollo could be raising his blood sugar - that's one of the stinky things about diabetes. Ann has had many many different issues to deal with for her dachsund Andy and has felt a lot of the same frustration.

A friend of mine has a poodle who has gall bladder sludge and feels crummy off and on. So far as I can tell, veterinary medicine does not deal with gall bladder sludge other than to identify it on the ultrasound. Surgery can be done but it is risky... although I think that's at least partly because the disease is often quite advanced and the dog older when it is done.

In my friend's case, I think they will continue to just manage symptoms as best they can.

There used to be a food list for what is good and bad for crystals but the site is no longer available at the address I had. There is a section of the Merck manual regarding them. http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/130616.htm

I haven't reviewed it so don't know if it's helpful.

As you may have seen, our cat, Gus, has IBD. In his case he's taking a very small dose of steroid for the inflammation and we changed the protein source of his food, first to turkey and then to lamb. Any possibility that the IBD is related to food?

I'm glad you had a good visit to UT and that you have some plans and lots of tests to guide you. I am looking forward to seeing the rest of the results.

Natalie

[Debbie & Apollo]

Good morning all!
man I am tired
.... Apollo is having a good morning and we are having fun bending over to make sure the flow goes:)
He started the triglyceride meds this morning... it is actually what people can use... in fact my husband had some (and he threw them out about 2 months ago as he didn't react well to them) man! I could have saved some $$$ they were over $1 a piece! Maybe we can get my hubbys doc to give us another script if they work:) we have script insurance - HA!

I saw about the ph strips Kathy-- thanks -- the strips we are using are about the same so I guess we are ok --- I am making another list of questions.... I want to get a handle on why we have taken him off the potasium citrate, (the Merck site you sent Natalie does recommend) and more about understanding the ph.... Apollo has been almost 90% of time at 5 on our stirps -- which is the lowest reading on the strip.
They Merck site also talks about B6, Thiazide Diuretics and Chlorothiazide diuretics...I'll look them up later and see what that's about.

I am also going to ask about the low fat'low salt chicken brooth. We have tried to get him to take sugar free cranberry juice... he'll get a lick, but that's it...but we'll keep plugging.

As soon as I get info about a diet from the nutritionist I will post for sure....
The UT vet is conferring with Dr.Bartges (also at UT) - he's running a study on dogs with Calcium Oxalate stones. I have conveyed I have no problem home cooking. Apollo would love a good home cooked meal I'm sure :D

bye for now...
Debbie & Apollo

[We Hope]

Debbie,

I think I'd try to stay away from things like cranberry juice as they tend to keep the urine toward acid.

http://www.organicfacts.net/health-benefits/fruit/health-benefits-of-cranberry-juice.html

"Cranberry juice is very effective against urinary tract infections. 100 percentage cranberry juices produce hippuric acid in the urine. Hippuric acid acidifies the urine and prevents bacteria from sticking to the walls of the bladder."

http://marvistavet.net/html/body_canine_oxalate_bladder_stones.html

"Potassium citrate also helps create an alkaline urine (in which calcium oxalate stones have difficulty forming). "

With the struvite type of stones which neither of us are dealing with, they want to stay away for alkaline urine, because that's what can make this type of stone form:

http://marvistavet.net/html/body_canine_struvite_bladder_stones.html

"The reaction takes place only in an alkaline pH but the presence of ammonia creates just the alkaline pH needed for stone formation."

Toodles is wild about orange juice--that's now off the list because it tends to make for acid pH urine.

You might want to sign up for this prescription card for Apollo's meds:

http://k9diabetes.com/forum/showthread.php?t=504&highlight=prescription+card

Too bad we can't go back to the days when talking about The Stones meant the band! :D

Kathy

[Patty]

Hey Debbie,
I don't have much to add. Wanted to let you know I've been following your thread and thinking of you.

I have the opposite pH problem with Ali. Her urine tends to be too alkaline and at one point showed struvite crystals. I would say the same as Kathy and steer clear of the cranberry as it can create a more acidic environment for Apollo.

I like the pHion brand strips too. They read in .25 increments and are very sensitive. I did a test on Ali back in April to see how she was fluctuating during the day. She varied between 7.5 and 6.5.

I read the most acidic time is around 2-3am and most alkaline is around 2-3pm. So you can see some variation.

Sounds like you have a lot of great people working on Apollo's case!
Take care,
Patty

[Debbie & Apollo]

Your comments about the cranberry juice really make sense to me, I don't know why the UT vet said to go ahead and use it. I am not going to risk it. He wasn't too willing to drink it anyhow:) -- Guess I'll finish that bottle.

I am getting a better handle on understanding the ph and I am going to see about getting the strips you are suggesting... just as a back up and in addition to what I am using to measure glucose, blood, ketones, and protein.
Also I am going to 'gently' ask about stopping the potassium citrate... so much leans to using it... I'd like to understand better why not to use it.
Kathy, thanks for the info in the script cards! every little bit helps.
Patty, I'll trade you for those struvite stones:)

Debbie & Apollo

[Debbie & Apollo]

Hi everyone!

Our computer got switched and all my links and favorite information was locked up in that little 'black box'. I went digging for passwords ....I'm Back! lol

Anyhow, I wanted to check in to say hello! Apollo is WELL! He is on chlorestoral meds now (along with all the other stuff:) and it has made a HUGE change in regulating his numbers. He is also much more playful and has a beautiful healthy coat. Issues with his eyes are still there. We can tell that his vision is getting worse.

We had been stock piling vetsulin and it appears we will have to take the plunge and switch. With Apollo and all of his issues we were avoiding the change, but ..... I need to get very busy and read these threads and see how all of you are doing.

Debbie & Apollo

[Patty]

Hi Debbie,
Good to see you back :) What cholesterol med is Apollo on now?
There are a lot of people that have made the switch here so you'll have lots of help when you're ready.
Take care,
Patty

[Debbie & Apollo]

Hi, and thanks!

Apollo is on Gemfibrozil. I have to cut the pills into four pieces :)
It is actually a med people use:) I get it at Wal Mart and they accept the pet discount card:) I am hoping they will also accept the pet discount card for the insulin and needles:)

I have been studying the different posts. I was planning on using up all the Vetsulin and then do the switch, but I may try and keep a few weeks just in case he has a bad reaction. The vet would like us to come in and get his weight and then we will get us a script.

His food is Royal Canine 'Digestive Low Fat'. We use some dry and also the canned food. On the dry food I add water and let it soak, the canned is given after his shot. Apollo still has the bladder stones so we try and get in as much water as possible.

The only health issue we had was during the winter was his nails; he developed a build up around the nail bed. I am very careful to dry his feet and nails now....and I am considering finding some sort of foot covering :) My children will surely laugh at him now.....as if the coat and stoller were not enough :D

Debbie & Apollo

[ladysmom06]

Hi Debbie,

Good to hear from you. Happy :D:D to hear that Apollo is doing well. Good luck with the change of insulin - like Patty said many here have made the switch so your in good hands. Hugs to you and Apollo.

[Debbie & Apollo]

Thanks Lynne!

I have been reading and getting the gist of things.... I have to admit I was also reading to see if someone had a secret stash or a genie in a Vetsulin bottle :)

I don't mind building and maintain a boat....but I resist changing boats, especially since I finally got this boat floating soooo nicely :rolleyes:

Study, study, study:)

Debbie & Apollo

[Joan]

If you are really happy with vetsulin, caninsulin, ...same product is still available. these people ship to U.S,, if that doesn't work , I canpurchase it here, just dont know how to ship it safely. I am in the US every few wks as we live so close to the border.

http://www.77canadapharmacy.com/Caninsulin.php

[eileen]

In needing to watch the acidic levels in my cat with renal failure, yet trying to help prevent her UTI's it was recommended to use D-Mannose.

Maybe this is something that can be of help for Appolo, it is not suppose to interfere with the glucose levels of a diabetic.

http://www.healingtherapies.info/Urinary-Tract%20Health.htm

[k9diabetes]

Hi Debbie! :)

I definitely prefer keeping a reserve of Vetsulin just in case the NPH doesn't work. So far, that occurrence is really rare but it can happen.

And if it does, your vet can apply to the Critical Need program and receive Vetsulin.
______________

This announcement was made yesterday (5/5/2010) by the fda. Thought it may be of interest to some.

http://tinyurl.com/24gq3ef (http://tinyurl.com/24gq3ef)


FDA Announces Availability of Vetsulin for Critical Needs Dogs and Cats

May 5, 2010

The Food and Drug Administration (FDA) announced today a plan to address concerns regarding the supply of Intervet/Schering Plough Animal Health’s (Intervet) Vetsulin (porcine insulin zinc suspension), a product used to treat diabetes in dogs and cats. FDA is allowing Intervet to offer a limited supply of Vetsulin through their Vetsulin Critical-Need Program. The supply is only to be used for a critical-need dog or cat that, in the medical judgment of the pet’s veterinarian, cannot be effectively managed on another insulin product.

In November 2009, FDA announced its concerns about the stability of Vetsulin and recommended that diabetic dogs and cats currently receiving Vetsulin be switched to other insulin products. After publicizing this recommendation, FDA and Intervet heard from many veterinarians and pet owners who expressed significant concerns about specific diabetic dogs and cats which could only be controlled with Vetsulin.

As a result of these concerns, FDA is recommending veterinarians with qualified patients contact Intervet’s Technical Services Department at 800-224-5318, to request enrollment of the patient in the Vetsulin Critical-Need Program. The veterinarian will need to provide the medical rationale for why the patient cannot be effectively controlled using another insulin product.

Intervet continues to work with FDA to address concerns associated with the manufacture of Vetsulin. Because Vetsulin may have varying amounts of crystalline zinc insulin in the formulation, it could cause a delay in insulin action and an overall longer duration of insulin activity. Insulin products that do not remain within specification throughout the entire shelf life could potentially result in unpredictable fluctuations in the glucose levels of diabetic patients.

Use of this product under the Critical-Need Program will require close monitoring of the patient, all of which is described in an owner consent form.
_______________

But most dogs did great with the switch.

Natalie

[Debbie & Apollo]

Good morning!
Joan - thank you the information about getting the insulin from Canada. It looks like the supply they have will have expiration dates that only go up to October .... and for helping to get it to us that would be difficult over a long period of time, but thank you for the offer!

Eileen, the information on D-Mannose was interesting, I will talk to our vet.

Natalie - great to still know you are here! Thank you for the information on the vetsulin in special cases.

After all the research we have decided to make the switch, having the NPH insulin available from Wal Mart will really be sooo much easier. I will look at our current insulin supply and needles and hold back three weeks just in case there is a transition problem. Apollo is doing well at the moment and I think he is in a 'good' place currently ... the change will work! I believe the switch will be in August.

Everyone have a great day! Stay cool!

Debbie & Apollo

[Debbie & Apollo]

Hi!

Well we started the switch from Vetsulin on Sunday. He is now on Novollin.

His Vetsulin dose was 7 units 2x's a day.
the vet has him on Novolin 3 units 2 x's a day.

His numbers have been SUPER high. on day #3 we raised the insilin to 3 1/4
on day #5 we raised again to 3 1/2 units. His gl. numbers are still SUPER high 500 and up.

Is it safe to increase the insulin..... am I going too fast?

Otherwise all else seems good. I had a longer post but the server timed out... typing faster this tme:)

thanks for your input.

Debbie & Apollo

[Patty]

Hi Debbie,
There was a recommendation put out early on that indicated vets should start all over when switching insulins...meaning a very low starting dose.

That was changed later to recommend a 25% decrease in starting dose during the switch. A 25% decrease from 7u would be 5 1/4 u. So you are still quite a bit under that.

I would bump up a full unit and see if that helps. Then go a bit slower as you get closer.

Patty

I also wanted to add the shape of curve you get on Novolin N may be quite a bit different than on Vetsulin so I would be sure to do a full curve when you get the numbers down a bit too.

[Debbie & Apollo]

Thank you for your response Patty! I can't tell you how many times this site has helped us!!!!!

I gave Apollo 4 full units and will increase from there again tomorrow. He is scheduled for a blood curve at the vets on Monday and I will play that by ear...if I already know we don't have good control the tests would be waste of money.

After supper we went outside and Apollo was chasing Atlas (our Maltese) and he also ran after my hubby for a tractor ride....so I think he feels good:)

again thank you! I will keep you posted.

Debbie & Apollo

[eyelostit]

Hi Debbie,

Just stopping by to say hi :)

dolly & niki

[Debbie & Apollo]

Hi!

Just an update on Apollo.

He is currently doing well and the insulin switch has not had any adverse reactions.

His dosage is up to 6.5 - I believe in a few days we will do another slight increase. We are trying to give him a few days on each insulin increase as he seems to get excellent numbers when we make the increase and then the gl # tend to climb on the second day.

His desire to eat is still very good....he will not let us be late :) Water intake is also leveled off.

In Novemeber he will trun 11 years!
5 years as a diabetic...My where has all the money gone?? :D

Everyone have a great weekend!
Debbie & Apollo

[CarolW]

Hi Debbie,

Thanks so much for the update on Apollo. And huge congratulations on the success of all your care and attention!

AND - anticipating - may Apollo and you have a fabulous time with his 11th birthday in November!

Kumbi sends his love and congrats from the Bridge, in which Kwali joins him, and Camellia says, "What's diabetes? What's Cushings?" We're hoping those will always remain questions for Camellia!

Fri, 3 Sep 2010 07:05:50 (PDT)

[Debbie & Apollo]

Thanks Carol!
Last night a neighbor was setting off fireworks, we had to blast the TV but Apollo was still shaking.
Today is a good day. He is presently chasing Atlas for a ball! I love to see them play!

Have a great day.
Debbie & Apollo

[Debbie & Apollo]

Just an update and a question please.

Apollo has made the insulin switch. Overall he seems to be doing fine.
We have had, for the past week, an incident everyday where he will spit up one of his meals about 2 + hrs after feeding. There is really no pattern as to the time this (spit up) happens. We had him tested and discovered his gl was 48. This is low for him! We have had no other signs of low sugar and I have read through many of the posts here.

Any thoughts?? Right now we have reduced the insulin, and I am hand feeding him also to get him to slow down (he goggles!) Otherwise he is good! Still stealing socks and slippers:)

thanks

Debbie & Apollo

[Patty]

Glad you reduced the insulin with a 48 in there. How much insulin is he getting now?

[Debbie & Apollo]

Insulin dose is now 7 1/2 now.

[k9diabetes]

In Novemeber he will turn 11 years! 5 years as a diabetic...My where has all the money gone?? :D


LOL Ain't it the truth!

I'm glad he's successfully made the switch. Hope no more low blood sugar either!

Natalie