A lot has happened in the two years since I've posted to this. Well, really it's only been the last 13 months that things have happened. Catcher was neutered in February 2008. Despite his nice structure and beautiful markings I knew that given his temperament he would never be a breeding option. Shortly after the surgery he developed Keratoconjunctivitis Sicca (KCS or Dry Eye). While treating him for the KCS he became very ill. We rushed him to the vets where after a battery of tests he was diagnosed with Exocrine Pancreatic Insufficiency (EPI) which had led him to develop Diabetes. This was all 6 days before he turned 2 years old.
The last year has been a trying one. It has taken that long for Catcher to become healthy again. However, I feel that the treatment protocol laid out for us is only masking the issue and not addressing it. Under the advisement of a trusted colleague I took Catcher to see a holistic vet. She has changed his life, and in my opinion enabled him to lead a better one.
We are in the beginning stages of his new treatments. I intend to document everything that happens from this point forward, as well as what has happened in the last year. I will back date all entries so they will appear as in real time.
Thank you for your support reading Catcher's story.
~Casey~
Tuesday, June 16, 2009
Tuesday, March 10, 2009
ACTH results
Catcher was a total trooper while getting his injection for the stim test and his blood drawn. He was happy to just sit with me, twitching his tail while they took the blood.
Observation I've discovered: In reactive classes we always talk about mat exercises. You spend an enormous amount of time building a relationship between your dog and their mat. Their mat is their safety zone, where no one enters it, and only happy things happen. It's used for calming, settling, and a great shaping exercise. Here is what I've now noticed: Catcher has generalized that the benches and scale at the vet clinic are "mats". When we walk into the lobby he runs to a specific spot on the benches. He jumps up on them, and sits there, happy and looking for treats. Then he makes a break for the scale, and will do a sliding stop onto it, sitting there twitching his tail and smiling at me, because again it's a highly reinforced space. It's nice to see him calm at the vets.
Firstly: Weight: 45.0 pounds!!!!! We've successfully gained back the 6 pounds he lost while he was sick, and have gained an additional 2 pounds!
Results:
Pre-ACTH Cortisol: 6.5
Post-ACTH Cortisol: 2.5
Comments: (as best I can understand them)
Reference Range:
Pre-ACTH: 2-6
Post-ACTH: 6-18
Equivocal: 18-22
Post-ACTH w/ hyperadrenocorticism: >22
Post-ACTH w/ hypoadrenocorticism: <2
According the vet clinic he shows no signs of Cushing's or Addison's. Yay! That is one big boost of confidence for me. Now back to the roller coaster that is regulating his blood sugar.
Observation I've discovered: In reactive classes we always talk about mat exercises. You spend an enormous amount of time building a relationship between your dog and their mat. Their mat is their safety zone, where no one enters it, and only happy things happen. It's used for calming, settling, and a great shaping exercise. Here is what I've now noticed: Catcher has generalized that the benches and scale at the vet clinic are "mats". When we walk into the lobby he runs to a specific spot on the benches. He jumps up on them, and sits there, happy and looking for treats. Then he makes a break for the scale, and will do a sliding stop onto it, sitting there twitching his tail and smiling at me, because again it's a highly reinforced space. It's nice to see him calm at the vets.
Firstly: Weight: 45.0 pounds!!!!! We've successfully gained back the 6 pounds he lost while he was sick, and have gained an additional 2 pounds!
Results:
Pre-ACTH Cortisol: 6.5
Post-ACTH Cortisol: 2.5
Comments: (as best I can understand them)
Reference Range:
Pre-ACTH: 2-6
Post-ACTH: 6-18
Equivocal: 18-22
Post-ACTH w/ hyperadrenocorticism: >22
Post-ACTH w/ hypoadrenocorticism: <2
According the vet clinic he shows no signs of Cushing's or Addison's. Yay! That is one big boost of confidence for me. Now back to the roller coaster that is regulating his blood sugar.
Thursday, February 19, 2009
More Trouble
Catcher went to the vet for his yearly 4DX test. I decided to do a full work up on him since we were drawing blood anyways, and he hadn't had a complete set done since last June.
The good news is he was negative all around for Heartworm/Lyme/Ehrlichia/Anaplasmosis!
Results of the bloodwork:
CBC Comprehensive:
HGB: 18.1 (12-18)
MCHC: 36.8 (32-36)
Basophil: 0 (0-1)
Chem 21:
ALK Phos: 229 (10-150)
BUN: 29 (7-27)
Cholesterol: 477 (112-328)
Glucose: 440 (60-125) (this was to be expected)
Chloride: 102 (105-115)
NA/K ratio: 26 (27-40)
My vet called and asked about running a T4 panel. I said that we'd done one in July '07 and it was normal. It was also suggested that we do an ACTH stim test for Addison's and Cushing's.
We decided to go through with the ACTH stim test but hold off on the thyroid panel for a little while.
The thought of Catcher having another autoimmune disorder scared me. I felt like this was a never ending battle and that he was never going to get better. I spent a lot of time thinking about the outcome. What kind of life was he going to have given all of his issues? He hated his shots, even with treats. He runs when he sees the needles for blood draws, even though he gets treats galore. I didn't think that I could put him through another treatment plan.
After thinking long and hard I decided that if either one came back positive that I would let him go. It was not fair to keep him going because I wanted him with me. I didn't see that he was going to have a great quality of life if he was simply going to continue to develop autoimmune issues and not be able to regulate his blood glucose levels.
The good news is he was negative all around for Heartworm/Lyme/Ehrlichia/Anaplasmosis!
Results of the bloodwork:
CBC Comprehensive:
HGB: 18.1 (12-18)
MCHC: 36.8 (32-36)
Basophil: 0 (0-1)
Chem 21:
ALK Phos: 229 (10-150)
BUN: 29 (7-27)
Cholesterol: 477 (112-328)
Glucose: 440 (60-125) (this was to be expected)
Chloride: 102 (105-115)
NA/K ratio: 26 (27-40)
My vet called and asked about running a T4 panel. I said that we'd done one in July '07 and it was normal. It was also suggested that we do an ACTH stim test for Addison's and Cushing's.
We decided to go through with the ACTH stim test but hold off on the thyroid panel for a little while.
The thought of Catcher having another autoimmune disorder scared me. I felt like this was a never ending battle and that he was never going to get better. I spent a lot of time thinking about the outcome. What kind of life was he going to have given all of his issues? He hated his shots, even with treats. He runs when he sees the needles for blood draws, even though he gets treats galore. I didn't think that I could put him through another treatment plan.
After thinking long and hard I decided that if either one came back positive that I would let him go. It was not fair to keep him going because I wanted him with me. I didn't see that he was going to have a great quality of life if he was simply going to continue to develop autoimmune issues and not be able to regulate his blood glucose levels.
Wednesday, January 07, 2009
New Year's
New Year's day I brought the dogs in from playing outside. They were with me in the living room when I noticed Catcher acting weird. He became very anxious. He was suddenly eating every speck of dirt off the carpet. He was trying to get to Stewie's food. His nose was warm to the touch. I was concerned and made sure to keep a close eye on him. A few minutes later he curled up on the couch to go to sleep. I watched him and noticed him shiver. Then he shivered again. I found this to be odd since he had been inside for an hour at this point.
I called Mom to help me do a blood draw, suspecting his blood sugar was too low. I was correct. It read 40. He was teetering on the edge of seizures and coma. What I had initially suspected was shivering was really tremors. I quickly gave him some Karo syrup and called the Emergency vet. They said to recheck his BG in 30 minutes. At which point it was in the 130's.
I did not give him insulin that night. The next day I called my vet. They said to not give him any insulin in order for the body to recuperate. Without any insulin his BG went straight back to off the charts. The next day we gave him 8 units in the morning. At 2:00 I noticed the same scavenging behavior and warm nose. I checked and he was in the 50's. Again we gave him Karo syrup and he bounced back.
We decreased him to 5 units as he was keeping in the 250's range, which isn't quite normal, but is better than 500.
I called Mom to help me do a blood draw, suspecting his blood sugar was too low. I was correct. It read 40. He was teetering on the edge of seizures and coma. What I had initially suspected was shivering was really tremors. I quickly gave him some Karo syrup and called the Emergency vet. They said to recheck his BG in 30 minutes. At which point it was in the 130's.
I did not give him insulin that night. The next day I called my vet. They said to not give him any insulin in order for the body to recuperate. Without any insulin his BG went straight back to off the charts. The next day we gave him 8 units in the morning. At 2:00 I noticed the same scavenging behavior and warm nose. I checked and he was in the 50's. Again we gave him Karo syrup and he bounced back.
We decreased him to 5 units as he was keeping in the 250's range, which isn't quite normal, but is better than 500.
Monday, November 24, 2008
So begins the roller coaster
I will skip ahead now, but summarize the last few months...
Catcher's insulin dose was increased to 7 units in July. At his one week recheck his BG was 83 so we decreased the insulin back to 6 units twice daily. His weight was up to 41.4 pounds.
Catcher seemed to do well for the next few months. I ordered a glucometer so I could test him at home, though I was still uneducated and did not test him as regularly as I should have been.
At the end of October he was tanking on water again. I tested his blood and it was in the upper 300 range. I was advised to do a glucose curve on him. (Take readings every two hours post injection)
He had his insulin at 7:20.
7 am: 345
9 am: 187
11 am: 220
1 pm: 333
3 pm: High (high on the glucometer means it is over 500)
5 pm: High
Okay so the way it is supposed to work is that the insulin is metabolized at a rate that 6 hours post injection the BG will be at it's lowest point. Catcher was now metabolizing it within 2 hours of his injection. So we switched him to Vetsulin (a porcine insulin). Ideally vetsulin is metabolized slower and only needed every 24 hours, however we were giving it every 12 for Catcher.
Catcher was not responding to the vetsulin at all. I spent the first half of November with him reading over 500. I was getting cranky and worried that nothing was going to be able to help him. After doubling his dose, and still not working, we discovered that Vetsulin is a different concentration (40 units/mL rather than human insulin being 100 units/mL). (I also discovered that human pharmacies are useless). So because I was using the human syringes he was not receiving the correct dose. We promptly changed the syringes and began to see a difference. He still did not react to 6 units however, so we increased his dose to 10 units twice daily.
His peak with 10 units was 73 so we decreased to 9 units.
Catcher's insulin dose was increased to 7 units in July. At his one week recheck his BG was 83 so we decreased the insulin back to 6 units twice daily. His weight was up to 41.4 pounds.
Catcher seemed to do well for the next few months. I ordered a glucometer so I could test him at home, though I was still uneducated and did not test him as regularly as I should have been.
At the end of October he was tanking on water again. I tested his blood and it was in the upper 300 range. I was advised to do a glucose curve on him. (Take readings every two hours post injection)
He had his insulin at 7:20.
7 am: 345
9 am: 187
11 am: 220
1 pm: 333
3 pm: High (high on the glucometer means it is over 500)
5 pm: High
Okay so the way it is supposed to work is that the insulin is metabolized at a rate that 6 hours post injection the BG will be at it's lowest point. Catcher was now metabolizing it within 2 hours of his injection. So we switched him to Vetsulin (a porcine insulin). Ideally vetsulin is metabolized slower and only needed every 24 hours, however we were giving it every 12 for Catcher.
Catcher was not responding to the vetsulin at all. I spent the first half of November with him reading over 500. I was getting cranky and worried that nothing was going to be able to help him. After doubling his dose, and still not working, we discovered that Vetsulin is a different concentration (40 units/mL rather than human insulin being 100 units/mL). (I also discovered that human pharmacies are useless). So because I was using the human syringes he was not receiving the correct dose. We promptly changed the syringes and began to see a difference. He still did not react to 6 units however, so we increased his dose to 10 units twice daily.
His peak with 10 units was 73 so we decreased to 9 units.
Friday, July 11, 2008
More Blood work
I was very overwhelmed at first. We started Catcher on pancreazyme mixed in his food. It was a nightmare getting him to be hungry enough to eat it, but eventually he warmed up to the idea.
We ran another pre-anesthetic profile on him just to monitor his progress.
His BG was 351. It was recommended to increase his dose to 7 units twice a day and recheck in one week.
We ran another pre-anesthetic profile on him just to monitor his progress.
His BG was 351. It was recommended to increase his dose to 7 units twice a day and recheck in one week.
Monday, June 23, 2008
EPI - We Learn More
Over the past few weeks I have learned a lot about Catcher's issues. Simply put Exocrine Pancreatic Insufficiency means that he cannot absorb the nutrients he is digesting. Which explains his wasting over the last few weeks.
From an online article:
"The pancreas has two functional parts. The endocrine part secretes insulin and glucagon, which are essential for the metabolism of carbohydrates. The exocrine part consists of units called acini that produce and secrete enzymes essential for the digestion of protein, into the small intestine. With EPI, there is a gradual wasting away (atrophy) of the acini. Clinical signs do not develop until most of the acini are gone. As dogs lose the ability to digest protein, they progressively lose weight despite a voracious appetite.
Affected dogs lose weight despite voracious appetites, and usually pass large amounts of semi-formed feces. They often eat their own stools, or other inappropriate substances. Some dogs with this condition do not show these typical signs, and may experience intermittent watery diarrhea or vomiting.
Although this disorder cannot be cured, management is generally fairly straightforward. Powdered pancreatic enzyme extract is mixed in with each meal. Within a few days, your dog's appetite and stools should become more normal, and s/he will begin to gain weight. Enzyme supplementation of your dog's food will be necessary for life." 1998 Canine Inherited Disorders Database.
From the Cornell website:
Description: EPI is characterized by inadequate production of digestive enzymes from pancreatic acinar cells. This might be a result of chronic pancreatitis, juvenile pancreatic atrophy, decreased function in severe protein-calorie malnutrition, or rarely following acute hemorrhagic pancreatitis. The lack of digestive enzymes and bicarbonate secretion results in acidification of the gut, malnutrition and weight loss, with voluminous stools containing undigested fat, muscle fibers and protein.
Signs: Abdominal distention, Abnormal behavior, aggression, changing habits, anorexia, diarrhea, dullness, flatulence, increased borborygmi, internal abdominal mass, lack of growth or weight gain, pale, pica, polydipsia, polyphagia, rough hair coat, steatorrhea (fatty stools, feces), Tachycardia, underweight (poor condition, thin, emaciated, unthriftness, ill thrift), unusual or foul odor (stools, feces), vomiting or regurgitation, weight loss
After reading several different articles, and talking with my friend Jenn whose collie is suspected to have EPI, I realized that Catcher had certainly been showing most of the symptoms. The problem was that they were intermittent, and any of those symptoms could be evidence of something else. For a long time we suspected that his off and on again diarrhea was due to a parasite problem (he had picked up whipworms at daycare as a puppy and we'd been treating with panacur regularly to break the cycle). It was only when looking at everything as a whole did the pieces of the puzzle begin to fit together.
I was still left with asking how and why. How did an adolescent dog who was perfectly healthy (as proven by multiple blood workups) develop all of these conditions (KCS, EPI, Diabetes) within 2 months of each other. What had changed? Did his neuter have any effect on this? The unfortunate problem was that no one had any answers. All 3 conditions are fairly rare in Border Collies, especially ones under the age of two. EPI and Diabetes are both pancreatic and if untreated EPI can lead to Diabetes. However, the KCS was a totally unrelated issue.
From an online article:
"The pancreas has two functional parts. The endocrine part secretes insulin and glucagon, which are essential for the metabolism of carbohydrates. The exocrine part consists of units called acini that produce and secrete enzymes essential for the digestion of protein, into the small intestine. With EPI, there is a gradual wasting away (atrophy) of the acini. Clinical signs do not develop until most of the acini are gone. As dogs lose the ability to digest protein, they progressively lose weight despite a voracious appetite.
Affected dogs lose weight despite voracious appetites, and usually pass large amounts of semi-formed feces. They often eat their own stools, or other inappropriate substances. Some dogs with this condition do not show these typical signs, and may experience intermittent watery diarrhea or vomiting.
Although this disorder cannot be cured, management is generally fairly straightforward. Powdered pancreatic enzyme extract is mixed in with each meal. Within a few days, your dog's appetite and stools should become more normal, and s/he will begin to gain weight. Enzyme supplementation of your dog's food will be necessary for life." 1998 Canine Inherited Disorders Database.
From the Cornell website:
Description: EPI is characterized by inadequate production of digestive enzymes from pancreatic acinar cells. This might be a result of chronic pancreatitis, juvenile pancreatic atrophy, decreased function in severe protein-calorie malnutrition, or rarely following acute hemorrhagic pancreatitis. The lack of digestive enzymes and bicarbonate secretion results in acidification of the gut, malnutrition and weight loss, with voluminous stools containing undigested fat, muscle fibers and protein.
Signs: Abdominal distention, Abnormal behavior, aggression, changing habits, anorexia, diarrhea, dullness, flatulence, increased borborygmi, internal abdominal mass, lack of growth or weight gain, pale, pica, polydipsia, polyphagia, rough hair coat, steatorrhea (fatty stools, feces), Tachycardia, underweight (poor condition, thin, emaciated, unthriftness, ill thrift), unusual or foul odor (stools, feces), vomiting or regurgitation, weight loss
After reading several different articles, and talking with my friend Jenn whose collie is suspected to have EPI, I realized that Catcher had certainly been showing most of the symptoms. The problem was that they were intermittent, and any of those symptoms could be evidence of something else. For a long time we suspected that his off and on again diarrhea was due to a parasite problem (he had picked up whipworms at daycare as a puppy and we'd been treating with panacur regularly to break the cycle). It was only when looking at everything as a whole did the pieces of the puzzle begin to fit together.
I was still left with asking how and why. How did an adolescent dog who was perfectly healthy (as proven by multiple blood workups) develop all of these conditions (KCS, EPI, Diabetes) within 2 months of each other. What had changed? Did his neuter have any effect on this? The unfortunate problem was that no one had any answers. All 3 conditions are fairly rare in Border Collies, especially ones under the age of two. EPI and Diabetes are both pancreatic and if untreated EPI can lead to Diabetes. However, the KCS was a totally unrelated issue.
Subscribe to:
Posts (Atom)