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  #11  
Old 03-03-2010, 09:05 PM
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ozzi ozzi is offline
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Default Re: Insulin Frustrations!

Thanks Natalie! It's funny because when Ozzi initially started insulin, he dramatically improved, to about the level he was at prior to diagnosis. Then he deteriorated until we switched him to Humulin in the am and Novolin in the pm. He has been doing awesome regarding the weakness, until the past few days. He has a great deal of trouble getting up, and when he's up he's pretty good, although most recently if he stands for more than a couple of minutes, his back legs start to gradually "fall" until he cannot seem to hold his weight, and actually "collapses" to the floor. Being a typical male, he absolutely refuses help from us (lol) and prefers to get up on his own, which makes me crazy, yet, as a male myself, I do understand! Our vet talked about changing his insulin from NPH to a different type of insulin if this continues. She also mentioned testing him for Cushings, but felt this was probably not the underlying issue because his blood sugar does respond to the insulin, and some of his readings 6 hours after insulin have been as low as 70, which she said she has never seen in a Cushing's dog. So, I'll keep having his blood monitored until I start it myself, and see what's next. I just wish I could ask him how he's feeling!!!!!!
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Ozzi, Dalmatian/Australian Cattle Dog mix, 12/03/1996 - 08/15/2010. Diabetes, blind from cataracts, cauda equina syndrome, and arthritis of the spine and knees. Daddy loves you Ozzi
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  #12  
Old 03-03-2010, 10:56 PM
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Default Re: Insulin Frustrations!

Do you know how to do a quick nerve test?

You support their weight and then turn over a back paw so the top of the paw is resting on the floor.

If the communication via the nerves is good, they should right it quickly to a normal position.

If the communication via the nerves is not good, as in neuropathy or things like degenerative myelopathy, they can't feel that the paw is turned under and they will leave it that way for a long time or even indefinitely.

It's a quick way to test it that you can do at home.

That might help sort out whether this is a pain/arthritis type problem or a nerve/communication problem.

From http://neuro.vetmed.ufl.edu/neuro/NExam.htm

Quote:
Conscious proprioception is one of the first tests to perform. This reflex is partially responsible for many of the other postural reflex responses and is a good indicator of spinal cord dysfunction. The test in performed by the turning over of each paw, one at a time, so that the animal is standing upon the dorsum of the foot. This is not a normal position for the foot and the normal animal will almost immediately reposition the foot to the normal position, so that it is once again standing upon the plantar surface.
Natalie
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  #13  
Old 03-04-2010, 11:40 AM
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Default Re: Insulin Frustrations!

Natalie,
I didn't know the fancy name for that test (lol), but the vet has done it a few times when she examines him. His response is very slow, but he does return his back paws to the plantar surface eventually. This was part of the work up that lead her to conclude that he has a neuropathy.
Kevin
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Ozzi, Dalmatian/Australian Cattle Dog mix, 12/03/1996 - 08/15/2010. Diabetes, blind from cataracts, cauda equina syndrome, and arthritis of the spine and knees. Daddy loves you Ozzi
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  #14  
Old 03-04-2010, 02:35 PM
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Default Re: Insulin Frustrations!

I didn't know it had such an impressive name either! Just looked it up last night looking for a better description of it than mine.

Natalie
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  #15  
Old 03-05-2010, 11:53 AM
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Default Re: Insulin Frustrations!

LOL Natalie! I forgot to mention that Ozzi also has a "foot drag" at times. Sometimes when he's walking, particularly when navigating stairs or even going over a threshold, his hind leg paws will "catch" and the dorsal surface ends up under him causing him to fall. At first we thought it was his vision, but now realize that its most likely the neuropathy causing that, so we are very careful with him on stairs and hold his collar. He does well with this in general. The other thing we have noticed is that if we don't immediately clean up after he poops (which can be a challenge on some wintry New England days!) he will unknowingly walk in it, and he seems to have no idea about it. He doesn't try to get it off because I think he doesn't realize it's there. Also, over the past year, he has had episodes (about once/week) of fecal incontinence, and has no idea whatsoever that he is doing so. I think the neuropathy is causing a fairly great loss of sensation in the lower part of his body. He never has urinary incontinence. As I previously mentioned, his neuropathy work-up with our vet showed no tumors or abnormalities on Xray, ultrasound, etc. The year or two previous to these more dramatic symptoms, Ozzi experienced "episodes" about every 3 or 4 months where he would "collapse" and then walked with a limp, which resolved spontaneously within a day or so. He has been on deramaxx for that for the past 3 years. I think somehow that was the beginning of the neuropathy issue. I'm wondering if there is anything that can be done for him or if taking him to a neurologist would be anything more than academic. Does anyone have any thoughts?? Thanks, I appreciate the advice, and I LOVE the forum!! I don't feel all alone anymore!!
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Ozzi, Dalmatian/Australian Cattle Dog mix, 12/03/1996 - 08/15/2010. Diabetes, blind from cataracts, cauda equina syndrome, and arthritis of the spine and knees. Daddy loves you Ozzi
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  #16  
Old 03-06-2010, 07:13 AM
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Default Ozzi's Glucose Curve

Ok, so yesterday I got Ozzi's blood from his elbow callous without a problem. This morning I did his fasting at 6am which was 555..ugh! I was unable to get blood at 8am despite 5 sticks because the fur absorbed it and I couldn't get it on the strip. I stopped, fed him and give him insulin. I'm thinking that I will do some shaving to get better access to the blood droplet. Should I forget about the curve today since I couldn't get an 8am reading and do it tomorrow? Or is there value in continuing today? Thanks for your thoughts.
Kevin
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Ozzi, Dalmatian/Australian Cattle Dog mix, 12/03/1996 - 08/15/2010. Diabetes, blind from cataracts, cauda equina syndrome, and arthritis of the spine and knees. Daddy loves you Ozzi
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  #17  
Old 03-06-2010, 09:16 AM
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Default Re: Ozzi's Glucose Curve

Shaving the spot will , of course, help. Have you heard about smearing a VERY LIGHT dab of Vaseline (petroleum jelly) around the spot you intend to "stick"? It causes the blood droplet to remain in a ball shape (usually).

Craig & Annie
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  #18  
Old 03-06-2010, 09:48 AM
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Default Re: Ozzi's Glucose Curve

Thanks Craig! I have NOT heard of that, and I will definitely try it. I'm not convinced Ozzi is going to love the shaving bit, but I'll give it a try as well...I think it's the Dalmatian in him that prevents his Australian Cattle Dog part to be fully expressed....LOL!! I did opt to scrap the curve for today since I was missing the 8am glucose (when I give him insulin and food), and will attempt it again tomorrow. I also figured shaving him will cause him stress that might throw off the true glucose values.
Fingers crossed for tomorrow,
Kevin
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Ozzi, Dalmatian/Australian Cattle Dog mix, 12/03/1996 - 08/15/2010. Diabetes, blind from cataracts, cauda equina syndrome, and arthritis of the spine and knees. Daddy loves you Ozzi

Last edited by ozzi; 03-06-2010 at 09:51 AM.
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  #19  
Old 03-06-2010, 11:31 AM
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Default Starting Over With Ozzi...Need Advice

I love Ozzi's vet, but she told us not to change anything in his diet, including treats, and we would adjust the insulin to his diet. I don't think this is the best way to approach his diabetes management. Ozzi's glucose yesterday two hours after insulin was 298. This morning, his fasting blood glucose was 555. He has been having increasing hind leg weakness over the past week. I need to make some changes. I called the vet, she's not in until Tuesday! In the past, I've spoken with the on-call vets about various issues, and they are reluctant to say anything beyond "keep things the same and check in with Dr. XXX on XXX when she's in."

So here's what I'm doing:

(1) After researching dog foods, I found Wilderness made by Blue Buffalo. It is a high protein, low carbohydrate, grain-free dog food. I'm on my way up to tax-free NH (due to cost) to purchase it in both the kibble and canned forms.

(2) NO MORE REGULAR TREATS. He will get chicken, green beans and reduced fat cheese (which he loves and has minimal carb).

(3) I plan to do spot checks prior to insulin and 5 hours after to make sure his sugar remains okay.

My Question: He is currently on 23 u of NPH twice/day. The vet started him initially on 15 u and he has been adjusted up since. Should I return to the 15 u or somewhere in between? I feel that changing his diet and continuing on 23u will be too much.

I appreciate your expertise and advice. I'll check back in a few hours!

Thanks,
Kevin
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Ozzi, Dalmatian/Australian Cattle Dog mix, 12/03/1996 - 08/15/2010. Diabetes, blind from cataracts, cauda equina syndrome, and arthritis of the spine and knees. Daddy loves you Ozzi
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  #20  
Old 03-06-2010, 11:54 AM
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Default Re: Starting Over With Ozzi...Need Advice

For most changes that could effect blood sugar, I like a 25% reduction in the dose. Usually a dog can have anywhere from 1/4 to 1/2 of the usual insulin dose without any food on board (like they refuse to eat or before surgery). That amount covers the basal insulin needs unrelated to food.

So typically cutting the insulin dose 25% is a pretty major change in insulin dose when you are making food changes. At 23 units, a pretty good approximation of 25% would be 6 units so I'd say go down to between 15 and 17 units.

As far as the leg problem goes... I have two thoughts that sort of contradict each other.

The darker thought is that degenerative myelopathy has come to my mind every time we have talked about Ozzie's neuropathy problem. I'm not extremely familiar with this issue so I don't know the fine points of diagnosing it. I only know that the prognosis, sooner or later, is quite poor so I hope that this is not what Ozzie is suffering from.

I will, however, pull up some links as they may be helpful.

http://neuro.vetmed.ufl.edu/neuro/DM_Web/DMofGS.htm

http://vetmedicine.about.com/cs/dogd...nmylopathy.htm

The other train of thought I had when reading your most recent post about how he would collapse and then walk with a limp for a while reminded me of something Chris experienced half a dozen times in his last two years.

Every once in a while out of the blue he would just collapse, writhing on the ground obviously in pain, and not be able to get up. If I could get him to lie still for awhile - quite a while, usually needing 15 or 20 minutes - he would then be able to get up but still seemed uncomfortable. After another four or five hours, he would be okay again.

We always assumed that he might have slipping discs or some kind of spasm in his back since it came and went so abruptly. He had x-rays and there were a handful of problem discs in his neck and over his hips with bone spurs on the end of them but no pinching of the spinal cord.

Chris' overall nerve function to his back though was mostly pretty normal. He had some arthritis and was slightly slow on one back foot but not enough to warrant a diagnosis of anything.

I have wondered about clots too blocking the signals... a dobie I know suffered a clot and completely lost function in his back half.

I do think a consult with a good neurologist would be helpful. He certainly seems to be suffering some kind of lack of nerve communication and the neurologist would have the best arsenal of tools for diagnosing exactly what it is and treating it.

Our dog saw a neurologist after he suffered a collapse that was very different from the back problem. The general vet saw him right away and saw signs of vestibular syndrome but they didn't entirely match that so he got us into the neurologist within an hour or two.

The neurologist did a lot of noninvasive tests to ferret out exactly what was and wasn't working and concluded that it was in the brain - either at TIA or a growth. We worked it as a TIA, putting him on blood thinner and doing a cardiac ultrasound to look for a clot in the heart.

Without the neurologist, I don't think we could have narrowed down the problem as much as we did.

Natalie
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