Hi everyone. I am new member but have lurked here for a few weeks now. I feel like i needed to reach out now for some forum advice. I have 8yr old labrador "Remi". She is currently about 67lbs and i have not been able to get her BG under control!
Sorry for the long post but the background info is probably important too.
Several years ago routine bloodwork showed highly elevated ALP and moderately elevated ALT enzyme levels. The first treatment was antibiotics (Clavamox). Bloodwork work was rested after a couple weeks with no change. Next we did an abdominal ultrasound. Liver was "subjectively large". Only the left adrenal gland was imaged due to gas or feces blocking the right and it appeared normal. Next was Cortisol Urine test. Cortisol/creatine ration came back High at 28 (with >13 as considered high for her). We proceeded with a Low-dose dexamethasone suppression test and results came back negative for Cushings. At that point we moved to an ultrasound guided biopsy. Microscopic findings were mild to moderate chronic active portal hepatitis and vacuolar hepatopathy. Comments said the special stain was positive for mild to moderate copper accumulation. Comments also said the heptocellular swelling/vacuolation are non-specific changes but commonly seen in Cushings syndrome. The vet diagnosed her with copper storage disease. Treatment started with a month on cyclosporine and then we spent the next 3 months treating with chelation therapy and no-copper prescription liver diet. Her bloodwork was retested after 3 months and ALP and ALT were higher than before.
She continued on the prescription low-copper diet for several years with no drop in her liver enzyme values. We never got to the root of the elevated enzymes. She has been a pretty happy dog that loves to play for hours on end.
About 2 months ago her appetite had started to drop off (she never a voracious eater to begin with) and she started getting up at night to drink lots of water. Bloodwork showed high BG level, elevated liver enzymes (no surprise), and elevated bilirubin levels. We started insulin treatment but within a couple days she had basically stopped eating. Her Urine had turned orange in color and she was hospitalized. She now had bilirubin in her urine and the vet did an ultrasound. They did not see any tumors or other major issues. She was put on ursodiol and eventually prednisolone to try and address the liver/bilirubin issues as the vet felt this was making her sick and not wanting to eat. After a couple weeks, of her eating a couple days and then shutting off and acting sick again, I decided to taper her off the steroid and try and get the BG under control. It was still out of control (500-600s) and figured the steroid was making her impossible to manage. She was extremely weak and had dropped about 15lbs by this point (we were extremely close to putting her down as I thought she was on her death bed). Ultimately after much reading, I asked them to run a spec cPL pancreatitis test and it came back positive. We changed to a restricted fat diet and I have her eating on a regular basis. We are supplementing with Biocase pancreatic enzymes. She has regained her strength and is active again. It's been huge turn around since she could barely lift her head and spent all day on her bed. Currently, she begs to go out and play ball on a daily basis. I am home monitoring her BG and stepping up her insulin on a weekly basis. She started at 15 units of Novalin N and is currently at 21. Her curves are fairly flat with lowest values in the morning and evening at insulin dosing times. I was fairly optimistic that i was making progress when i started seeing values in the 300's but got very frustrated on the last curve as her BG spiked to 700 mid-day.
Her latest curve taken every 2hrs starting at 7am
384-477-569-710(confirmed)-533-468
The curve before that was a bit flatter. I dont have it in front of me but it was more like 490-515-550-590-520-485
I figured it was worth putting this in front of the wisdom of the masses to get some advice. Also, her prednisolone dose was fairly low and she has been off that steroid for almost a month now. Her urine looks much better and i don't see any evidence of bilirubin.
Sorry for the long post but the background info is probably important too.
Several years ago routine bloodwork showed highly elevated ALP and moderately elevated ALT enzyme levels. The first treatment was antibiotics (Clavamox). Bloodwork work was rested after a couple weeks with no change. Next we did an abdominal ultrasound. Liver was "subjectively large". Only the left adrenal gland was imaged due to gas or feces blocking the right and it appeared normal. Next was Cortisol Urine test. Cortisol/creatine ration came back High at 28 (with >13 as considered high for her). We proceeded with a Low-dose dexamethasone suppression test and results came back negative for Cushings. At that point we moved to an ultrasound guided biopsy. Microscopic findings were mild to moderate chronic active portal hepatitis and vacuolar hepatopathy. Comments said the special stain was positive for mild to moderate copper accumulation. Comments also said the heptocellular swelling/vacuolation are non-specific changes but commonly seen in Cushings syndrome. The vet diagnosed her with copper storage disease. Treatment started with a month on cyclosporine and then we spent the next 3 months treating with chelation therapy and no-copper prescription liver diet. Her bloodwork was retested after 3 months and ALP and ALT were higher than before.
She continued on the prescription low-copper diet for several years with no drop in her liver enzyme values. We never got to the root of the elevated enzymes. She has been a pretty happy dog that loves to play for hours on end.
About 2 months ago her appetite had started to drop off (she never a voracious eater to begin with) and she started getting up at night to drink lots of water. Bloodwork showed high BG level, elevated liver enzymes (no surprise), and elevated bilirubin levels. We started insulin treatment but within a couple days she had basically stopped eating. Her Urine had turned orange in color and she was hospitalized. She now had bilirubin in her urine and the vet did an ultrasound. They did not see any tumors or other major issues. She was put on ursodiol and eventually prednisolone to try and address the liver/bilirubin issues as the vet felt this was making her sick and not wanting to eat. After a couple weeks, of her eating a couple days and then shutting off and acting sick again, I decided to taper her off the steroid and try and get the BG under control. It was still out of control (500-600s) and figured the steroid was making her impossible to manage. She was extremely weak and had dropped about 15lbs by this point (we were extremely close to putting her down as I thought she was on her death bed). Ultimately after much reading, I asked them to run a spec cPL pancreatitis test and it came back positive. We changed to a restricted fat diet and I have her eating on a regular basis. We are supplementing with Biocase pancreatic enzymes. She has regained her strength and is active again. It's been huge turn around since she could barely lift her head and spent all day on her bed. Currently, she begs to go out and play ball on a daily basis. I am home monitoring her BG and stepping up her insulin on a weekly basis. She started at 15 units of Novalin N and is currently at 21. Her curves are fairly flat with lowest values in the morning and evening at insulin dosing times. I was fairly optimistic that i was making progress when i started seeing values in the 300's but got very frustrated on the last curve as her BG spiked to 700 mid-day.
Her latest curve taken every 2hrs starting at 7am
384-477-569-710(confirmed)-533-468
The curve before that was a bit flatter. I dont have it in front of me but it was more like 490-515-550-590-520-485
I figured it was worth putting this in front of the wisdom of the masses to get some advice. Also, her prednisolone dose was fairly low and she has been off that steroid for almost a month now. Her urine looks much better and i don't see any evidence of bilirubin.