Ollie's Over the Rainbow Bridge

[oliversparents]

Re: Ollie's journey

Thanks so much all of you for the thyroid med info. We will, thankfully, be here throughout the few weeks following the introduction of his thyroid meds. It's very reassuring to hear it might make a big difference with getting him regulated.

We won't actually have the prescription in hand until Wednesday or later, since it's being mailed. In the meantime, I guess we should continue to monitor his glucose levels, but perhaps keep the insulin where it's at (30 units now). His last curve was on between 291 and 438.

He now weighs 62 lbs, and seems to be gaining back some of the weight he lost (he was too heavy, so this is not great). Although it should mean that his body isn't digesting fat in response to being starved of glucose, is that right? Do I reduce his food a little to compensate?

My country vet also told me that the keytones in a urine test are reflective of the keytones the dog produced in the previous 2 weeks. And that any keytones are really not good. Is that everyone's understanding here, too?

He's not acting sick. In fact he's doing great. He's had a few falls due to the blindness, but no injuries. He's probably a bit overconfident and that's why he's not cautious enough. I took him for a short walk off leash down our dirt road and he did fantastic...he even went off road to investigate a freshly killed deer carcass. He's so happy to be out of the hospital and back in dog paradise!

Mary

[jesse girl]

Re: Ollie's journey

glad ollie is doing ok and back home enjoying his dogs life

Yes its maybe a good idea to put the regulation process on hold if gaining weight and feeling pretty good shows he is probably ok

Some dogs have remained higher there whole diabetic life and did well so at least for the short term he should be ok

Its amazing how much other members had to reduce the dose . Its possible ollie could be at 15 to 20 units before its all set and done so something to ponder

[momofdecker]

Re: Ollie's journey

I wouldn't worry about the weight until after he's started the thyroid meds. Looking back at Decker's history - his bg ran 400-600+ for about six months. His weight held pretty steady during that time on a minimal amount of food for a dog his size. It was probably one of the earliest clues (which was overlooked) that he might have been suffering from something more than diabetes. Decker lost 10 pounds in 8 weeks after starting thryoid meds (which was probably why after initially stabilizing his insulin dose he needed another adjustment a few weeks later). One of the symptoms of hypothyroidism in dogs is unexplained weight gain.

Just as an FYI - hypothyroid dogs can also have problems with their eyes - which may clear up once treatment is initiated. Cataracts won't go away - but inflammation or other irritations might clear up.

Hypothyroidism symptoms can manifest in many ways and varies from dog to dog. Here is a comprehensive list of symptoms that have been observed with the disease.

http://siriusdog.com/hypothyroid-dog-signs.htm

[oliversparents]

Re: Ollie's journey

I just wanted to update you all on Ollie and ask some more advice.

He's doing great. He's got the cone of shame off, he's off his pain meds, and is coping with his blindness well. Here is his curve from yesterday (the best since diagnosis):

5:45 am: 187
8:10 am: 234
10:15 am: 281
12:05pm: 281
2:20 pm: 241
4:10 pm: 228
5:45 pm: 214

He gets fed at 6 am and pm, and is on 30 units Novolin.

So, we are ready to start the thyroid medication, Thyrovet (Levothyroxine) at 0.6 mg 2x daily.

I know this can make the insulin more effective, so we are thinking we should lower his insulin at the same time, but by how much? My initial thought was to cut it in half (15 units insulin) and do close monitoring for a while.

Any advice?

Thanks,

Mary

[jesse girl]

Re: Ollie's journey

Now i dont have any personal experience on the matter but from looking at the results of others you plan sounds prudent

Most had to scramble and play catch up reducing the dose keeping their pups from going to low

I think you would be one of the few that would make a preemptive reduction in response to starting the thyroid medication

Now its not starting over you have plenty of information but it may be a bit of a rollercoaster ride until the medication settles in

glad ollie is doing good . You have done well with him .

[stylynjm]

Re: Ollie's journey

Sissy is on levothyroxine. When she started it,I just tested
A few times a day and watched her. Her insulin needs didnt change much the first few months.they have changed a little now, but just keep an eye on Ollie..
Sissy has always been very slow to adjust to any change.
Good luck,it does help with overall feeling good.

[oliversparents]

Re: Ollie's journey

So, I just did a little more research, and I am glad I didn't just go ahead and give him the dose of thyroid med recommended by the vet (0.6 mg 2x daily). That is the recommended beginning dose in most cases.

In complicated cases, such as diabetic dogs, the dose should be 25% of the normal beginning dose, and gradually increased over 3 months. Insulin dose should be reduced at the same time.

It doesn't say how much to reduce the insulin by. This is from a long article in Whole Dog Journal 2012:

http://dogaware.com/articles/wdjhypothyroid.html

Now I have a call in to my vet to (once again) educate him. I know he's not a specialist, but geez. I may have to get a lower dosage.

Needless to say, with Ollie's good numbers yesterday, we are hesitant to mess with it! We also do not know if Ollie has heart or blood pressure problems, which the thyroid med can adversely affect.

Luckily, we are going to a different vet next week to have his stitches removed. We'll try to get a 2nd opinion on the thyroid dose at that time. We may have to wait until then to even try it.

Mary

[momofdecker]

Re: Ollie's journey

If you are home testing it might be worth considering giving the full thyroid dose. My suspicion is that the reduced dosage (or gradual introduction to the full dose) is based on the assumption that most pet owners are not testing a dog's bg at home. Knowing that low thyroid levels can cause insulin resistance, and increasing them may eliminate the resistance, it does make sense that there would be concern of overdosing for dogs not being monitored at home.

We had enough curves on Decker to understand his patterns/trends, and that's how we knew how to adjust his insulin needs. If he continued to drop beyond 2p, we knew he would go too low. That knowledge allowed us to be able to intervene before he ever hit the low - and then reduce his next insulin dose. It was a hard line to walk because when you give karo/food and reduce a dosage, you may see elevated bg because of karo and extra food. Practicing that patience was difficult at times but did pay off in the end.

Added:
ps - that is a great article - one of few articles I've read that gives a much broader view of how hypothyroidism can manifest in dogs.

[MikeMurphy]

Re: Ollie's journey

Hi Mary,

Prior to my Lily being diagnosed with hypothyroidism, she was in really bad shape with severe hair loss, uncontrolled diabetes, high triglycerides, high cholesterol.

Once diagnosed, her Internal Medicine Specialist started her on .6mg of thyroxine twice a day and reduced her insulin from 30 to 16 units of Novolin N. I did her weekly curves at home, called them in to the IMS and she settled in at 18 units after a few weeks. Everything else also got back to normal.

Lily weighed 57 lbs at the time and is now right where she should be at 62 lbs.

Her vet runs a T4 test on her every 6 months and adjusts her thyroxine dose accordingly. She is currently on .3 mg of thyroxine twice a day.

Best of luck with Ollie!

[oliversparents]

Re: Ollie's journey

Thanks for the helpful comments. Good point, momofdecker, about the possible assumption of the article about home testing.

And Mike, so glad to hear your story. We tried to get Ollie into an internal specialist but could not get an appt and had to go back home (5 hrs from any specialist). Lily is such a similar weight and was on a similar dose of Novolin, so that's really useful.

Here's what vet #1 said this morning, after I related the cautionary stance of the Whole Dog Journal article: reduce Novolin to 25-15 units and give 1/2 (0.3 mg) of the thyroid med 2x daily.

He admitted he had no experience with hypothyroidism in combination with diabetes. I think he has good intentions and skills, but he's very young. He also lives in a fairly poor rural area. Perhaps diabetes with hypothyroid goes untreated/undiagnosed more often, and so he doesn't see it. Seems pretty common on this site.

In any case, we are seeing vet #2 on Tues for stitch removal (because his location is more convenient) and he is an older semi-retired experienced vet. We plan to ask him about all this, but in the meantime, looks like we can feel safe to start Ollie on the thyroid with less insulin.

[stylynjm]

Re: Ollie's journey

It's my thought,that the normal starting thyroid dose is
.1mg for every 10 lbs...sissy gets .1 morning and night

[oliversparents]

Re: Ollie's journey

We have decided to go with a reduction of insulin from 30 to 15 units, and a 0.6 mg Thyrovet pill 2x daily, starting today. We'll be monitoring his blood regularly and adjusting the insulin accordingly.

Thanks to everyone for helping us with this decision. I'll keep you posted.

Mary

[oliversparents]

Re: Ollie's journey

Just an update on Ollie:

Last Monday, Ollie bumped his remaining eye on a chair pretty good, and was in pain. We had some tramadol left over, so gave him some and he felt better. We were taking him to the vet next day anyway to have his stitches removed.

So, the vet (country vet #2 this time) said he thought the lens had burst. His eye did look cloudier. Since Ollie seemed to be feeling fine on the pain meds, he recommended we give him extra eye drops (4x daily) and continue the pain meds. We will return in 5 days to do a blood test for thyroid anyway. Hopefully Ollie will not have to have his other eye removed. The vet said he's seen eyes like this go either way: either had to be removed or resolved on their own.

So far Ollie seems perky and not needing as much pain med, so we'll be reducing that today. So, interestingly, this eye's lens could have ruptured due to impact (trauma) and glaucoma may not be involved. As I understand it, glaucoma is increased pressure due to the eye's ineffective draining. Also, this vet said not to over-worry about his glucose levels until we get the thyroid dose adjusted correctly. The other country vet wasn't going to see Ollie for a thyroid blood test until after a month on Thyrovet, this doctor wants to see him after 10 days on it.

So, we're opting for the sooner blood test. Hoping that can get us dialed in quicker. His levels were pretty good until he bumped his eye, and then they went really high (600's). We've got them back down into the 300's now. He's up to 22 units.

We also got an Optivisor for him:

http://www.provizorinternational.com...izortrade.html

I had to modify it a little, but he went on an off-leash, off-road jaunt with us yesterday, and loved it. I do have to say I wouldn't leave it on a dog all day long, since it's fairly heavy and not as ergonomic as you'd wish. But that's OK, I was only planning to use it on off leash walks anyway.

Mary

[Judi]

Re: Ollie's journey

poor Ollie! That optivizor is very cool. I'd forget that Jenny was blind sometimes when I was walking both dogs and the poor girl would bonk into things.

glad vet #2 seems to have some common sense. hang in there!

[k9diabetes]

Re: Ollie's journey

Aw, poor pup! Hope he is able to mend it on how own.

Natalie