a diabetic setback...

Buzz is in the animal hospital. Or the doggie prison if you'd ask him. Pancreatitis: the return of the vomiting. Sometimes I feel like my life would make a great movie.

In his mind, he's done his time. 36 long, hard hours. I will (hopefully) get to pick him up tonight, but that could change if he starts throwing up again. I visited him last night and the poor guy couldn't stop throwing up long enough to cuddle with me. But the only thing that seemed to be on his mind was the door and getting through it to go home. It broke my heart to leave him there.

Please don't leave me.

Before the pancreatitis set in, Buzz had his first hypoglycemic event at home. He started shaking and acting really strange and he even threw up, so I checked his sugar. 30! As in, T-H-I-R-T-Y (the normal low is about 80). He (of course) had no interest in eating, but I was SO FREAKING LUCKY that we had karo syrup. I dipped my finger in it and spread it over his gums (as I had read to do in other blogs and websites). Buzz was not happy about that, he really hated the taste - but I can't blame him. Everything returned to normal within an hour.

Then it happened again in the middle of the night. The vomiting, shaking, and totally weird behavior had me absolutely freaked out. I got him to the emergency vet, which is also the same place as our diabetic/internal specialist vet, and he's been there since.

I think the pancreatitis caused the hypoglycemia - everything just got so messed up. Having an autoimmune dog sucks.


Does anyone else have any experience with pancreatitis and diabetes?

Buzz is tired of being sick.

Buzz was back at the emergency vet last Saturday (Feb 11). He ended up staying the night there because he couldn't stop vomiting.

We found out that he had low albumin via a blood chem panel. Albumin is a protein that keeps blood in the vessels, so when it's low, there can be swelling. His face was swollen and he was a bright shade of red, so that seemed to fit the symptoms pretty well. They started him on cerenia and metronidazole (as always) and gave fluids through IV (though he wasn't too dehydrated thank goodness, as that seems to be the trigger for really going downhill). He improved on Sunday, but was still swollen and red. On Sunday night's blood test, his albumin was higher, but still too low. We took him home because there wasn't much else that could be done.

On Monday morning, I woke up to Buzz being incredibly red and swollen - so back to our normal vet he went. He stayed there all day (no fluids), and they rechecked his albumin Monday evening - which was higher than Sunday night, but still lower than normal. His swelling had gone down, but the redness was still very much there.

With all of this (plus his vet visit a mere 2 weeks ago), he was diagnosed with PLE - protein-losing enteropathy. PLE occurs when the dog loses albumin, probably via Buzz's intestines, which leads us to the 2nd diagnosis:

Buzz was unofficially diagnosed with IBD - irritable bowel disease. I say unofficial, because to officially diagnose IBD, an endoscopy is done with a biopsy taken from the intestines to confirm. We opted against this for several reasons. First, Buzz is a diabetic and anesthesia is definitely going to mess with his system (plus, right now, he's an unregulated diabetic, the worst kind). Second, he was recovering. A biopsy is usually going to show abnormal pathology when the bowel is inflammed, and it's likely that at that point in time, the inflammation was decreasing. Third, the only course of treatment is steroids - which Buzz cannot have - and a switch to hypoallergenic food, which we have made. Steroids can be used on Buzz in only extreme circumstances, like if his life is in danger, as they make diabetes worse.

So now Buzz is on a new food (Hills Prescription z/d) and he's recovering. He's off antibiotics and the cerenia, but is still getting sucralfate for a few more days (to coat and protect his stomach).

We're back on the path to getting his diabetes regulated (again!) and he seems happier and happier every day.

Buzz Update

Buzz started vomiting early Tuesday morning and had diarrhea start later that day. He wasn't interested in any food or water, so we took him to the emergency vet clinic Tuesday night. They pumped him full of fluids and gave some anti-nausea meds to help with the vomiting and we brought him home.

Wednesday morning, Buzz vomited bloody water, so back to the vet he went. Our internal specialist vet did blood work, an ultrasound on his pancreas, and numerous other tests and concluded that he couldn't conclude what was wrong with Buzz. Ultimately, he decided to treat for pancreatitis and an upper urinary tract infection.

I visited Buzz Wednesday evening and he was looking a little better, but still pretty weak (he hadn't eated for almost 48 hours at this point). The vet tech informed me that Buzz was now known as the 'explosive diarrhea-er' since whoever took him out could hear it from 10 yards away. Ha. Poor guy. He stayed overnight to keep his IV fluids and antibiotics going.

The Buzz update as of this morning was that he hadn't vomited or had diarrhea all morning. And they fed him and he gobbled it all down in 5 seconds flat.

I just talked to our diabetes vet, and he said that Buzz is doing a lot better and we can take him home tonight. He wants to keep him on fluids for a few more hours but otherwise, Buzz is stable enough for home. He wants to increase his insulin (almost forgot about the diabetes, didn't you? I didn't mention it previously because his glucose was so messed up these past few days, I wouldn't even know where to begin) by a few units in both the morning and at night, which is a lot for a dog Buzz's size.

In conclusion, Buzz got sick. Really sick. 3 days later and we still don't really know what caused it, but we are going with pancreatitis and an upper urinary tract infection. His diabetes is all messed up, but once we get him home and back on a routine, it will be easier to deal with. Obviously the diabetes played a role in him getting sick (he's got a sucky immune system that likes to attack itself), but wasn't the major problem this time.


PS. I find it rather curious that Buzz always seems to get sick right before February, which is National Pet Dental Health month and our regular vet offers 20% off expensive dental services. Buzz has nasty periodontal disease (from years as a stray and throw-away dog) and desperately needs extensive work done, but our diabetes vet won't approve of him going under anesthesia when he's sick and unregulated. Hmm... maybe he's much smarter than we take him for? :)

Diagnosis definitions...

This post is meant to familiarize everyone with what pancreatitis, colitis and diabetes really mean.

Pancreatitis
(from http://www.mayoclinic.com/health/pancreatitis/DS00371 and http://www.petdiabetes.com/pdorg/pancreatitis.htm)


Pancreatitis means inflammation of the pancreas. The pancreas produces enzymes that help digestion and hormones that help regulate the way your body processes sugar (or glucose). The inflammation can become severe, and the digestive enzymes that are normally inactive can become active and these enzymes then can cause damage to the pancreas. This causes a cycle of increasing inflammation. The vet thinks Buzz has chronic pancreatitis, or essentially scar tissue has formed in his pancreas, which in turn decreases the ability of his pancreas to function properly, and therefore diabetes can (and did) result.




Colitis
(from http://en.wikipedia.org/wiki/Colitis and http://www.mayoclinic.com/health/ulcerative-colitis/DS00598/DSECTION=symptoms)


Colitis refers to an inflammation of the colon and is often used to describe an inflammation of the large intestine (colon, caecum, and rectum). We think this is a separate medical condition than the pancreatitis/diabetes. This may be one of the causes that his diabetes got so out of control, though.




Diabetes Mellitus
(from the American Heart Association, http://www.americanheart.org/presenter.jhtml?identifier=4546)


Diabetes is a disease in which the body doesn't produce or properly use insulin. Insulin is a hormone produced in the pancreas. Insulin is needed to turn sugar and other food into energy. Buzz doesn’t make enough insulin because of the scarring of his pancreas. This causes sugars to build up too high in his blood. Diabetes mellitus is defined as a fasting blood glucose (or the blood glucose when Buzz isn't eating) of 126 milligrams per deciliter (mg/dL) or more.


To give you an idea of how bad Buzz's diabetes is/was, these are his glucose readings since we picked him up on Thursday night, December 9, 2010. Please keep in mind that after each reading, we administered the proper amount of insulin - usually after texting the internal specialist to get his thought on how much insulin to give (humulin-r initially, then switched to humulin-n after the second reading on Sunday, each was measured in mg/dL)


Friday: 485 at 12:30pm, 260 at 5:00pm, 574 at 10:50pm
Saturday: 484 at 9:40am, 430 at 3:00pm, 541 at 10:10pm, 458 at 12:10am
Sunday: 556 at 8:40am, 599 at 3:00pm, 178 at 7:30pm
Monday: 517 at 8:30am, 452 at 8:30pm
Tuesday: 248 at 8:00am, 610 at 10:00pm
Wednesday: 417 at 9:45am, 413 at 7:45pm
Thursday: 720 at 9:45am, 377 at 8:00pm
Friday: 307 at 7:45am, 695 at 8:40pm
Saturday (today): 203 at 8:15am

My best friend has diabetes - now what?!

Buzz was diagnosed with diabetes 1 week and 4 days ago, and this has been the most stressful 1 week and 4 days of my life.


Buzz came into our lives in March of 2010. We found him on petfinder.com and drove through 3 states to pick him up from a rescue organization. He wasn't the picture of health, but he wasn't rolling over dead anytime soon, either. They thought he was 3 years old, but they also thought he had been with them for only 6 months. When they got all of his paperwork together, they realized he had been there for over a year and a half. I guess that was a sign of the type of care, or should I say lack of care, that he received there.


We had our first big health problems in June when Buzz started vomiting blood. After spending $500 for essentially a babysitter and saline, he got better and we went on with our lives.


At the end of October, we realized he was drinking/peeing A LOT, but we chalked it up to him eating our other dog's food (she's on a special food for bladder stones that she had surgically removed at the beginning of 2010. It makes her drink/pee a lot to flush out her bladder).


At the end of November, he was acting very lethargic and losing his appetite. These were huge red signs because this dog LOVES to eat and play. We thought he was losing some weight as well, but just figured whatever had happened back in June was rearing it's ugly head again. There's no way I'm paying $500 for saline again, I thought.


Then came Monday, December 6th, 2010. The morning started off with Buzz vomiting all over our comforter. Then all over the couch. Then the carpet. Then outside on the patio. Then the carpet again, and eventually in his crate. We made a vet appointment for that afternoon.


We get to the vet and the first thing they always do is weigh him. He had lost 8 pounds. EIGHT POUNDS! This was a big deal because he was only 25 pounds to start with, now down to a low of 17. What kind of a mom am I that I let my best friend lose that much weight and not even notice?! They ran a CBC and chem panel, which came back with glucose levels through the roof. Next, they did a urine test and found that his ketone levels were life-threatening.


We were referred to an internal specialist who would be able to get his diabetes under control over the course of a few days. I knew this was going to be expensive, but it's worth it for the health of my baby. The IS assured me that he had never had a dog who's diabetes he couldn't get under control. I felt pretty good with that and left Buzz in his hands.


Tuesday. I left work at 5PM and went to visit my little friend at the pet-hospital. The IS informed me that his diabetes had been well-controlled on a very small amount of insulin my vet had given him the previous day, so he was thinking maybe it was just transient diabetes brought on by some sort of infection? I liked this idea. I liked it a lot, actually. The diabetes would go away, no pricking, no insulin, just a healthy dog again. Too bad this idea only lasted for a few hours.


I got a call Tuesday night that Buzz's sugar had spiked (roughly 24 hours after that first insulin injection). They gave him the same amount and expected it to last 24 hours again.


Wednesday. The IS calls to let me know that while Buzz's diabetes is pretty much under control now, he is just not feeling better. The IS did a mini-ultrasound and saw some abnormalities so he wanted to call in a radiologist who wasn't available til Thursday. Great, I thought, another $200 in an overnight hospital stay for something that should've been taken care of already. Oh well, he is my best friend, right?


Thursday. Buzz has been diagnosed with pancreatitis (something the IS thought was a big possibility) and colitis and pretty much inflammation of every internal organ he has. The prognosis isn't good. He isn't feeling better, he isn't eating (down to 16 pounds!!?!?), and the diabetes is still being weird. The IS decides that a steroid injection will be the only thing to help the inflammation, and he is right - however, steroids make diabetes worse. Thankfully, we got to pick Buzz up Thursday night and take him home. They were hoping he would be more comfortable there and maybe even get his appetite back.


Friday. I stay home from work to chill with Buzz (and Bella, our other dog). He's still not eating, and really all he's interested in is sleeping. We had picked up an AlphaTRAK glucometer system from the IS the day before and were testing his blood glucose every 3 hours or so, but it was always above 300 regardless if we had given him insulin or not (he was then on humulin-r, a fast-acting insulin). I headed back to the IS Friday afternoon to pick up some antibiotics for Buzz (he had a very stuffy nose). At this point, Buzz was on cerenia (anti-nausea), metoclopramide (gets everything moving through his intestines), famotidine (stops him from spitting up), and now the antibiotic (plus insulin) - all injectable because he wasn't eating anything. Friday came and went without anything too crazy happening.


Side-note: Our internal specialist was awesome. He was available through text message anytime, day or night. This was especially helpful because although I knew a lot about diabetes being in the health field, I had never actually dealt with a diabetic dog.


Saturday. Buzz still wasn't eating. I made an emergency visit to our primary care vet, where they filled him with subcutaneous fluids (and sent me home with more fluid and needles) and did an xray to rule out pneumonia. Which he didn't have - thank goodness! They also gave him another steroid injection to help increase his appetite and fight off all of that inflammation. Buzz started eating small pieces of boiled chicken later that night, but refused any other food - rice, broccoli, wet low-residue food, everything.


Sunday. The end of the weekend. We were really exhausted by this point. Buzz was making very small improvements, and we were honestly not sure he would pull through (which is still a very sad thought for me).


Monday. Buzz was finally starting to eat small amounts of wet low-residue food as long as there was plenty of boiled chicken mixed in. Still no rice or anything else, though. His diabetes had progressed to the point where we switched to humulin-n (a longer-lasting insulin) and we were injecting 4 units twice a day.


Tuesday. Recheck day at the IS. Buzz wasn't dehydrated (yay!), but they wanted to keep him to monitor his glucose since it had been so wacky since he went home on Thursday. They kept him all day, but after they gave him his morning insulin, his sugar dropped to 52. They were able to give him food, etc., but the thought that he could dip so low when we were at work really scared me.


And this leads us to where we are now. We are checking Buzz's blood glucose twice a day - trying to keep it at 8AM and 8PM - with the insulin injection being given immediately after. His eating is still strange because he will eat the wet food sometimes, but won't at other times. So he basically is eating now whenever he wants, whatever he wants. I think he is starting to gain back weight, but that's almost the last thing on our priority list right now.


He is starting to become playful again, just last night he got in a tussle with Bella over their favorite toy (they love those stuffing-less toys, we had a raccoon and a fox but the raccoon was lost at the IS - so they are now fighting over the fox). His ears perk up when he hears the treat jar open and close and he comes galloping in the kitchen to gobble down whatever food is in his bowl.


I think he is making progress. I try to not get too excited if I see some of the old Buzz (such as gobbling down all of his food!) because I know we still have a LONG road ahead of us. But I know that as long as Buzz has us and we have Buzz, everything is going to be fine.