My Baby Bonnie

[Sahara]

Hi, Baby Bonnie is my rescue dog. We found each other at the end of August after my mother passed away (I lived with her & was her caretaker). Bonnie will be ten in March. She is a poodle and shih-tzu mix. She immediately became the light of my life.

I knew when I adopted her that she was diabetic. Giving her insulin is no problem, as I gave Mom insulin for years. Her eating habits are very picky (we think she was fed junk food). She is a wonderful dog and has a sweet and funny personality. She attached herself to me the first evening I had her, and I don't know what I ever did without her. But from the beginning, we could not get her blood sugar under control. It was almost always over 600 when I took her to the vet, sometimes so high it wouldn't register on the meter. She has bouts of pancreatitis. We increased her insulin (N) from 5 units twice a day to 8 units.

Finally, the vet decided to test her for Cushing's. It was in the middle of January. I looked up the symptoms and was sure she had it. And yes, she does have pituitary dependent Cushing's. The vet said her cortisol levels were sky-high. He immediately started her on Lysodren, 5 mg. twice daily. After 3 or 4 days, we had to stop the loading because she was not doing well. I've only given her one dose since, and she has had to have the emergency Prednisone several times. She swings between constant ravenous hunger and not eating at all. We have had several scary hypoglycemic incidents. When she does eat, I give her 3 units.

Bonnie once again had very bloody diarrhea and vomiting over the weekend. I am very thankful for my vet. He talks to me on the phone almost daily. We go there at least once a week. I'm sure he charges me as little as he can get by with. Yet, my finances are almost depleted. Today he gave her a B-12 shot along with something else, but I'm not sure what. If she's not better tomorrow, she will spend the day at the clinic tomorrow. Thank goodness it is very close. We are holding off on insulin and I am giving her Pepcid. She did eat and keep down a little bit of food this afternoon. She is so lethargic I have to carry her out to potty.

I am very discouraged and scared. I love Bonnie so very much and I don't know how I could handle losing her. She is so precious to me. Every time we think we are making progress, something else happens. My vet is doing his best and worries about her constantly. Does anyone have any suggestions? I appreciate any advice.

[lulusmom]

Hi and welcome to you and Baby Bonnie.

I'm sorry to hear that Bonnie is doing so poorly right now. Can you reconfirm what dose of Lysodren you were giving Bonnie? Lysodren comes in 500mg tablets and you mentioned 5mg. That would be a minute amount of the drug and not enough to do much of anything. Also how much does she weigh? Did your vet do an acth stimulation test after Bonnie became ill? If so, what were the results? Did he also check electrolytes?

We are always concerned when we hear that a dog is diagnosed with cushing's while diabetes is uncontrolled. High bg's can affect the tests and cause false positive results. Both Poodles and Shih Tzus are breeds that seem to be over represented with respect to cushing's but there is still reason to be concerned about the diagnosis as most symptoms of both diseases overlap. Besides weight loss and excessive drinking and peeing, what other symptoms does or did Bonnie have that are associated with cushing's? Which tests were done to confirm the cushing's diagnosis and can you please post the results? I have included a link below to a blog on Dr. Mark Peterson's site regarding the difficulty in diagnosing cushing's in an uncontrolled diabetic dog. Dr. Peterson is a renown internal medicine specialist who lectures worldwide on diabetes, cushings and many other topics.
You will note that Dr. Peterson defines insulin resistance as doses greater than 2.2 U/kg/injection to control hyperglycemia. If Bonnie weighs more than 8 pounds, I don't think she can be deemed insulin resistant.
http://endocrinevet.blogspot.com/2012/01/q-diagnosing-cushings-disease-in-dogs.html

We have a sister site, www.k9diabetes.com, and I heartily recommend that you join there so that you will have the best of both worlds. They are amazing in their knowledge and ability to help members through really tough times. You will note on Dr. Peterson's blog that user k9diabetes made a comment on that blog about the number of dogs their forum sees that are tagged with both diseases. That user's name is Natalie and she is the owner of k9diabetes.com. Please, please join there.

We'll be looking forward to hearing more about your precious girl.

Glynda

[Sahara]

I'm sorry, I was confused on the Lysodren. It was 125 twice daily. Since I have had her, her weight started at 9.5 lbs., then 10, then 10.5, then in one week down to 9.5, then 9.2, yesterday (less than a week) 8.2, today 8.9. The other Cushing's symptoms she shows are a lot of hair loss along her trunk, very pot-bellied, and hind leg weakness. I don't know of any specifics of her testing, but I am asking them to put some copies together for me.

Today we went back for blood work. She is very anemic and her protein is low, but everything else they checked was in normal range. She is a little dehydrated. We got home and she vomited dark brown. If she does that again, she goes back for the afternoon. They aren't sure what has caused this, but they suspect Hemmorhagic Gastroenteritis. I am more worried than ever. They put her on flagyl and sucralfate.

I will post results when I receive them. Thank you, Glynda!

[lulusmom]

I am very concerned about Bonnie. She's a diabetic off of insulin, showing signs of possible ketoacidosis and/or addison's and now suspected of having HGE. All three of these conditions can be fatal if not addressed so I am completely confused as to why your vet doesn't think Bonnie is in serious trouble and simply sent you home with Flagyl and Sucralfate. Was an acth stimulation test done when Bonnie crashed after Lysodren and did your vet tell you what Bonnie's blood glucose level was today?

[Sahara]

I was really surprised they did not keep her today. I don't think they did another ACTH test. Her glucose today was around 400. I am surprised she is not more dehydrated than she is, but she does drink water. Then she lies down next to her water dish so she doesn't have to move. My vet is very young and new, but I did overhear him discussing everything with the vet who is the owner. I couldn't really make out the conversation, but I was glad he was getting his input. I do know that I am not taking my eye off this girl for one second, and I will do whatever I possibly can for her. Right now, that seems to be holding her, loving her, and praying over her. I keep checking her skin for dehydration. I can tell it is more sticky than it was, so I may call back soon. I am definitely frightened.

[k9diabetes]

Glynda asked me to look in on your thread... so sorry to hear that Bonnie is not feeling well. I brought up the post you made at the K9 Diabetes forum back in October.

I too am very worried about Bonnie. Given the low blood sugar she had, it sounds like she may now be lacking adequate amounts of cortisol, and a dog in an Addisonian (lack of cortisol) crisis is very sick. Low cortisol is a life-threatening condition.

If her cortisol levels are still quite low, it could be that she can't tolerate any insulin right now since low cortisol causes low blood sugar.

Can you ask the vet ASAP for the results of all of her tests and post them here immediately?

What was the suspected cause of the anemia? Bleeding in the GI tract?

If the vet is really knowledgeable, hospitalization might be best, at least for a day to be able to really sort out what is and isn't going on with her.

But if there is any question that the vet might be in over his head - which is not a criticism at all in a complicated case like Bonnie's - then even a single consult with a specialist could make a big difference in her ability to recover.

Natalie

[Sahara]

Yes, the suspected cause is GI tract bleeding. She was taking prednisone daily until she became so ill on Sunday. What kind of specialist would it be? I live near Wichita, KS.

Thank you for your input! I will see if I can get the results today.

[lulusmom]

Here is a link to the ACVIM listing of internal medicine specialists in the State of Kansas. There is a one listed in Wichita:

http://www.acvim.org/PetOwners/FindaSpecialist/Results.aspx?LASTNAME_field=&ORGNAME_field=&INTERESTCDLST_field=SAIM&STATECD=KS&ISMEMBERFLG=Y&CUSTOMERTYPE=Diplomate&LASTNAME=&INTERESTCDLST=%7ESAIM%7E&ORGNAME=&WBP=specCust_List.htm&WHP=specCust_Header.htm&RANGE=1%2F25&HASPETSFLG=N&SORT=LASTNAME

[Sahara]

I took Bonnie back to the vet. I called about the dehydration & they said to try gatorade with a syringe, & she couldn't keep it down. So I took her back, & her condition had worsened. They are giving her fluids & anti-nausea medication. I am going to get her before they close because no one is there at night & we don't want her unattended. In the morning I will take her back & they will do another CBC. We are hoping she won't need a blood transfusion. I got copies of test results & will post them in a few minutes.

[Sahara]

I can't figure out how to post the results. I scanned them to Microsoft Word. Going to pick up my doggie....

[molly muffin]

oh dear, sweetie. Do they give her an IV for fluids?

Sharlene and molly muffin

[Harley PoMMom]

We'll be right here waiting.

As far as posting the test results, just type them in a post on your thread, as an example....ALT 150U/L (5-50)

[molly muffin]

Only the ones that are abnormal high or low.

Sharlene

[Sahara]

I got my Baby back! The fluids and meds did wonders for her. He fed her and she was ravenous, and he gave her insulin. She's kept it down for an hour now. He said she was barking and bouncing around. She's not right now, but she is better. We'll see what happens. I'll type in results as I can this evening.

[Harley PoMMom]

So glad to hear Bonnie is feeling better!! YAAA!!

[Sahara]

Since she came home, she has just slept. I think the activity at the clinic wore her out. There were bunnies in her room. lol

So, I will try to do these test results. I didn't put in the results that were in range. If you wonder about any, please ask.

It is so wonderful to feel I have support. It helps me so much! Thank you all!

1/17/14 Dexamethasone Suppression-3 samples (low dose)
Cortisol(pre) 8.1 (1.0-6.5)
Cortisol(4hr) 0.5
Cortisol(8hr) 3.0

Interpreted as PDH.

10/07/13 HMII test

GRA 12.62 (3.00-12.00)
GR% 93.9 (62.0-87.0)
LYM .18 (1.00-4.80)
LY% 1.3 (12.0-30.0)
MO% 4.8 (2.0-4.0)
RDWc 15.3 (0.0-0.0)
PLT 698 (200-500)
PCT 0.64 (0.00-0.00)
PDWc 35.8 (0.0-0.0)

1/31/14 VetScanII test

ALP 1231 (20-150)
TBIL 0.7 (0.1-0.6)
GLU 609 (60-110)
NA+ 136 (138-160)

2/25/14 HMII test

GRA 20.19 (3.00-12.00)
GR% 93.4 (62.0-87.0)
WBC 21.62 (6.00-17.00)
LYM 0.16 (1.00-4.80)
MO% 5.9 (2.0-4.0)
RBC 2.78 (5.50-8.50)
HGB 5.8 (12.0-18.0)
HCT 19.32 (37.00-55.00)
MCHC 29.8 (31.0-34.0)
RDWc 16.3 (0.0-0.0)
PLT 589 (200-500)
PCT 0.64 (0.00-0.00)
PDWc 38.4 (0.00-0.00)

2/25/14 VetScanII test

ALP 772 (20-150)
AMY 1290 (200-1200)
BUN 29 (7-25)
CA 7.6 (8.6-11.8)
GLU 572 (60-110)
NA+ 128 (138-160)
TP 5.2 (5.4-8.2)

[Sahara]

oh dear, sweetie. Do they give her an IV for fluids?

Sharlene and molly muffin

He did it under the skin due to time limitations.

[lulusmom]

We have a member, Debbie, who is a seasoned lab technician and knows her stuff. She tries to check in whenever she can and luckily she saw your thread. She took a look at Bonnie's blood values and she is also greatly concerned for Bonnie. I've posted her comments below and suggest that you contact your vet today to ask about this. It's beyond my ability to understand but your vet should.


I noticed that you & Nat were pretty worried about this one. I did a fast scan of the labs that have been posted. This little one has a 5.8 gm. hemoglobin which is life threatening, no matter how you look at it. The diabetes & everything else needs to go to the back burner. This needs to be addressed immediately. The 2 things that probably need to be done is a retic count to check to see if the bone marrow is making an adequate number of RBC, along with a peripheral blood smear to look for RBC fragments (schistocytes). The presence of fragments may indicate a clotting problem termed DIC which may explain the GI bleed.

[maria]

Do you have an internal medicine specialist with whom you could get a second opinion? Bonnie has so many abnormal labs. As good as your vet may be, I would be on the phone with an IMS getting an appointment today. You could ask your vet for a referral or find one yourself. If you are close to a teaching hospital, that would be another resource for a veterinary specialist. Make sure to take all lab reports.

[Squirt's Mom]

How is Bonnie today?

[Sahara]

She is a little better. She cared enough to shake in the vet's office, so that's a good sign. She hasn't vomited since yesterday afternoon. He said she was more hydrated and her gums were a little pinker. I'm going to try to feed her something after a bit. This afternoon I teach kids at church after school, so she'll stay at the clinic then.

I am going to show the doc what Debbie said this afternoon when I take Bonnie in. I'll also see how he reacts if I ask about a specialist. I think I will go ahead and call the specialist in Wichita that is on that list and ask about the cost, etc. If it weren't for finances, I would be on their doorstep right now.

[maria]

I really hate the finances can keep us from helping our kids. I wish there were free or low cost clinics at the teaching hospitals based on need. I live in CA and I think my IMS charged 90.00 for a consultation. Will be keeping you both in my prayers. Please let us know how she is doing.

[Tina]

I just have a second to post but wanted to say that in addition to the concerns that Debbie mentioned regarding Bonnie’s labwork, the sodium is critically low also. The potassium level is not listed so I am assuming that it must have been in the normal range. But even so, with the sodium at a critically low level, the sodium: potassium ratio could likely be low, which is a strong indicator of Addisons. Anemia, the low protein and increased BUN are also abnormalities that can be indicative of Addisons. I scanned your thread and did not see a current cortisol level, do we know what that is? And has Bonnie had any further bloody diarrhea?

As Glynda and Debbie have said, the anemia as well as Addisons can be life threatening. And so can HGE. I am very concerned about Bonnie also. Please ask your vet about all of these things. I am wondering if a transfusion is needed to stabilize the anemia. Addisons can become life threatening very quickly, even without diabetes in the mix. IV fluids and medication are needed if she is heading toward a crisis. Please keep us posted as to how she is doing and what your vet says.

[Sahara]

I am posting the results of Bonnie's test from yesterday that are in normal range in case that could be helpful to someone. I do not have a current cortisol level.

ALB 2.7 (2.5-4.4)
ALT 37 (10-118)
TBIL 0.5 (0.1-0.6)
CRE 0.5 (0.3-1.4)
K+ 4.2 (3.7-5.8)
GLOB 2.6 (2.3-5.2)
MON 1.27 (0.29-1.50)
MCV 69 (60-77)
MCH 20.7 (19.5-24.5)
MPV 10.9 (3.9-11.1)

[Sahara]

I am excited. She is bathing me in kisses and wagging her tail. She also ate a bit. I wouldn't let her have too much, because she is not known for having the sense to stop ( like mother, like daughter).

[Sahara]

I've got my Bonnie again. I got to the vet's and she was asleep on his lap. She is such a little charmer. She ate and drank too fast and regurgitated a couple of times, but she is better. I wanted to talk to him about the comments, but they had just lost their power and were in a mess. I'll talk to him tomorrow. I called the internal medicine doc, and they must have a referral. The first visit is $100.

[Sahara]

Well, she just puked all over me...

[k9diabetes]

Does she have any ketones?

The blood sugar you listed is terribly high and ketones could be a problem at this point if it is remaining high. They are potentially fatal.

Do you have test strips at home you can test with for ketones?

Natalie

[Sahara]

No, I don't. I've never tested her for ketones.

[Sahara]

Are they something I can get at the store? Do they require a prescription?

[lulusmom]

I believe you can get them at Walmart but the folks on k9diabetes will have much more information for you. Please visit www.k9diabetes.com and let them help you learn how to do home testing so that you know what is going on in Bonnie's little body and what the red flags are so you can be proactive rather than reactive when she crashes. When it comes to diabetes and cushing's, you need an experienced vet and an educated pet owner. When either or both are missing, that's when dogs get into trouble so please, please let Natalie's group help you. We'll be here for you on the cushing's front but cushing's needs to go on the back burner until you have the diabetes, anemia and HGE under control. I am truly concerned about Bonnie. :(:(

[Sahara]

All right. Thank you for your help.

[k9diabetes]

Ketostix or Ketodiastix are urine test strips you can buy at a pharmacy. If they don't have them in stock, they should be able to order them for you.

http://www.americandiabeteswholesale.com/product/bayer-keto-diastix-reagent-strips_1641_130.htm

Ketostix test ketones only. Ketodiastix test glucose and ketones. But with his blood sugar, a sugar test will be pointless and it would be much better to test blood sugar at home.

If you can take time to go to the main website, there is a lot of information there: www.k9diabetes.com (http://www.k9diabetes.com)

Natalie

[Sahara]

Hi, I wondered if some of you may be interested in how Bonnie is doing. She is the best she has been since I got her. She healed from the HGE or whatever it was. I was really scared. She has had a few other short episodes of bloody diarrhea, but none in several weeks. She developed insulin resistance again. Her blood glucose fasting yesterday was 479, which is high, but much better than her usual over 800 reading. She is back on Lysodren. She has had 125 mg. twice daily on Wednesdays for almost three weeks (her third dose will be tomorrow). She is getting 8 units of insulin twice daily, and tomorrow I am to only give her 7 in case the Lysodren lowers her blood sugar. She sleeps a lot, but when she is awake she is pretty peppy. I feel like we are on an upward swing, and I am extremely grateful. One day at a time...

[molly muffin]

That is wonderful news!!!! I'm so pleased to hear that she is doing well. Congratulations. It's a tough journey sometimes and dealing with both is no fun, but you're doing an excellent job.

Sharlene and molly muffin

[Harley PoMMom]

Hi, I wondered if some of you may be interested in how Bonnie is doing. She is the best she has been since I got her. She healed from the HGE or whatever it was. I was really scared. She has had a few other short episodes of bloody diarrhea, but none in several weeks. She developed insulin resistance again. Her blood glucose fasting yesterday was 479, which is high, but much better than her usual over 800 reading.

Thanks for updating us and I am glad she is feeling well. In a previous post Natalie asked if Bonnie was checked for ketones, has this been checked?


She is back on Lysodren. She has had 125 mg. twice daily on Wednesdays for almost three weeks (her third dose will be tomorrow). She is getting 8 units of insulin twice daily, and tomorrow I am to only give her 7 in case the Lysodren lowers her blood sugar. She sleeps a lot, but when she is awake she is pretty peppy. I feel like we are on an upward swing, and I am extremely grateful. One day at a time...

I am a bit concerned about Bonnie though, was an ACTH stimulation test done before the Lysodren was restarted? Also, I'm assuming that Bonnie was started on a maintenance dose of Lysodren, the protocol for the maintenance dosing is for the entire weekly loading dose to be divided and given 2 or 3 times throughout the week. Another thing that concerns me is that the initial loading dose of 125mg twice a day, which was at the 50 mg/kg, was too much for Bonnie and her cortisol dropped too low. If this was me, I would have an ACTH stimulation test done and if the results show that she needs the Lysodren I would lower her maintenance dose to around 25-30mg/kg, which would be around 113 mg of Lysodren being divided and given throughout the week.

Hugs, Lori

[Sahara]

Thanks for updating us and I am glad she is feeling well. In a previous post Natalie asked if Bonnie was checked for ketones, has this been checked?

Yes, but it has been a while now. I probably should check again.


I am a bit concerned about Bonnie though, was an ACTH stimulation test done before the Lysodren was restarted? Also, I'm assuming that Bonnie was started on a maintenance dose of Lysodren, the protocol for the maintenance dosing is for the entire weekly loading dose to be divided and given 2 or 3 times throughout the week. Another thing that concerns me is that the initial loading dose of 125mg twice a day, which was at the 50 mg/kg, was too much for Bonnie and her cortisol dropped too low. If this was me, I would have an ACTH stimulation test done and if the results show that she needs the Lysodren I would lower her maintenance dose to around 25-30mg/kg, which would be around 113 mg of Lysodren being divided and given throughout the week.

I'm sorry, I just realized I miscalculated her Lysodren dose. She is getting 62.5 mg. twice once a week (1/8 of a tablet). I'll ask the doc if I should further split the dose. She did not have an ACTH stim. test. Are they expensive? I'll ask him about that also.

Thank you...I appreciate your help very much. I am learning more every day!

Janet

Baby Bonnie, 10 yrs. old, spayed, shih tzu/poodle mix, 10 lbs.
Diabetic (no idea when diagnosed), 7-8 units Novolin N twice daily
PDH diagnosed 1/15/14, Lysodren 62.5 mg. twice daily once a week
Diet: Came to me extremely picky with a love for junk food. Currently we begin with a dry food (whichever brand/flavor she will eat that day) which she will only eat if I feed her on my lap out of my hand like a treat, usually 1/4 c. or less; then I break out the canned food, which right now is Purina One SmartBlend, 1/4 a can which I feed to her by the spoonful or she eats it so fast she vomits; then a couple of bites of yogurt; and finally, a small amount of peanut butter as her shot treat.
Criminal activity: pilfers mints, candy, cough drops, granola bars if left where she can reach, most especially my purse; knocks over trash if left down when she is home alone, then chews and uses creative decorating abilities.

[Sahara]

That is wonderful news!!!! I'm so pleased to hear that she is doing well. Congratulations. It's a tough journey sometimes and dealing with both is no fun, but you're doing an excellent job.

Thanks so much! I feel inadequate, but then remember she most likely would not have lived if I hadn't adopted her. I'm not perfect or rich, but I do the best that I can.

Janet

[Harley PoMMom]

Yes, but it has been a while now. I probably should check again.

Since her sugar readings are fluctuating so high, I too, think that a check for the ketones is a good idea.


I'm sorry, I just realized I miscalculated her Lysodren dose. She is getting 62.5 mg. twice once a week (1/8 of a tablet). I'll ask the doc if I should further split the dose. She did not have an ACTH stim. test. Are they expensive? I'll ask him about that also.

Thank you...I appreciate your help very much. I am learning more every day!

Janet

Unfortunately ACTH stimulation tests are expensive but this is the only way to make sure Bonnie's adrenal glands are able to produce cortisol. If a dog is feeling well while on treatment a baseline or pre reading can be helpful in determining if the dose is adequate but with Bonnie's blood sugar not stabilized I am afraid that would skew a baseline/pre result.

Also, if the ACTH stimulation post number is high than a maintenance dose might not be able bring the cortisol level down to within the therapeutic ranges.



Criminal activity: pilfers mints, candy, cough drops, granola bars if left where she can reach, most especially my purse; knocks over trash if left down when she is home alone, then chews and uses creative decorating abilities.

Now that is funny, Bonnie is a feisty one!! :)

Hugs, Lori

[Sahara]

Now that is funny, Bonnie is a feisty one!! :)

Yes, she is such a sweet little girl & everyone immediately adores her. Then I find little wrappers hidden under or behind chairs, or a little candy stash, and a little adorable innocent-looking dog sits and wags her tail....she really would be a great pickpocket. I may have to put her to work to pay vet bills!

[goldengirl88]

That is sooooo cute about the candy wrappers!! Blessings
Patti

[molly muffin]

hmm, I always thought my molly put me to work. Seems we might have got that backwards.
I think Bonnie much smarter than Molly as mine wouldn't try to hide a thing, she'd be throwing it in the air and attacking for the world to see. LOL

Bonnie sounds just adorable. I'm so glad you and she found each other! She really is very cute.

hugs
Sharlene and molly muffin

[molly muffin]

Hi Janet, haven't heard from you in awhile and was wondering how Bonnie is doing? Hoping to hear from you that she is doing great and still her little pickpocket self.

Sharlene and molly muffin