Seeing But Not Believing

Our day didn’t quite go as planned. No, Bennie didn’t have her first spa day… I actually was about to publish a blog earlier when the doorbell rang. Turned back around and noticed Beignet’s right inner lower lid was bulging/ballooning out. Her eyes had been just fine an hour before when I did midday drops. Pictures were sent to her eye doctor (I won’t post since I know not everyone will want to see). The wonderful, Dr. Tori Torres, was able to squeeze Bennie in since Dr. Brad was out at our regular vet. I was totally freaked out!

Say some prayers this was an allergic reaction and will respond to the antihistamines she got and some extra doses of her steroid eye drops for the next few days. Worst case scenario she has a cyst in her tear duct (which maybe common in dachshunds😬). That will be the suspicion if it doesn’t start to improve. Veterinary Eye Institute said she would need to see Dr. Warren early next week if it doesn’t go down. After a long weekend of call and another doctor already on vacation I really, really don’t want to have to take off work to take her to Dallas. Plus I’m a little nervous about all that would need to be done since she doesn’t tolerate sedation well at all. Wish us luck!

On a side note, only Beignet would actually enjoy wearing the recommended cold compresses! Ironically the cold pack pictured was the smallest I found at either CVS or Walgreens. They totally need child sized cold packs! So came up with a hack for all that Karo syrup diabetic dog parents have via a Google search! Apparently corn syrup freezes and is still very moldable. Our Karo packs seem to be freezing great and will be ready to use in no time!

Hope everyone has a night less eventful than ours!

-Devoted Doxie Mom

Just have to add this pic of Bennie searching for Dr. Brad. She always manages to get to his personal office to look for him when he’s out.

DNA OF A DIABETIC DACHSHUND

Having a human medical background might not always be the best thing when caring for a special needs pet… My medical side is always wanting to know each and every detail on why Beignet is going through everything she’s been through. When she was so sick a month ago, I was on Chewy.com ordering some things for her when an ad for the Embark Dog DNA test came up. From what I read, it was created at a vet school and tests for over 170 different medical conditions. At the time before her pentoxyfilline had kicked in, I wasn’t sure she would survive. I’m also almost certain she could help the future of veterinary medicine in some way. The thought that she could get a genetic diagnosis that could either explain some of what we’ve been through and/or help treat her was too much to resist.

Her kit arrived and I swabbed her mouth and sent it back in several weeks ago. I was embarrassed to tell my vet that I did it. However, he was actually excited that I had done it! We received her results last week which I’m going to attach below. Testing can not only help you determine a genetic predisposition to many conditions, but also can help you discover exactly what breed your Rescue pup is! If you decide you want to test your dog, PLEASE PLEASE use Beignet’s referral code by clicking this link – https://www.talkable.com/x/3mHvwl. You will get $25 off!

First, Embark confirmed she is 100.0% DACHSHUND!!! I guess it might be embarrassing if she wasn’t being that our site is all about being a diabetic dachshund! The test shows that she has a low normal ALT (liver enzyme) so even increases within normal range could indicate liver damage… I, of course, have gone back through some of her labs to look at her previous ALT’s more closely. This gene in no way causes liver damage though. Essentially the rest of her test was unremarkable. Scientists from Embark have emailed me and will use her history to help with future dog DNA discoveries. All in all, I’m really glad I did it! I think knowing the ALT part alone was worth the cost of the test. It kind of made me giggle when it said you could reunite your dog with his/her relatives. Can you imagine if I contacted Beignet’s relatives to request a meet up so that she could meet her biological family?? I also discovered that Beignet’s “WOLFINESS SCORE” is higher than most dog… Most dogs are <1% wolfy and my Bennie is 4.3%. Here’s a link to her profile for anyone interested: http://embk.me/beignet12 and to her vet report:

Hope you enjoyed! And don’t forget to use our link for $25 off if you decide to do DNA testing on your dog!

http://www.talkable.com/x/3mHvwl.

Sincerely,

Devoted Doxie Mom

Holidays & Hypoglycemia

When you have a diabetic dog, you definitely have to be flexible with your schedule. This afternoon, I missed out on Memorial Day with my family because Beignet’s blood sugar was too low.

I feel like hypoglycemia is one of the biggest fears of a diabetic dog owner. The best advice I can give is to stay calm. I always double check a low reading to ensure it wasn’t just a faulty reading. If your dog is symptomatic, quickly rub ~1tsp of Karo Syrup (or honey) directly on his/her gums to get the sugar quickly absorbed in their system. Know this will quickly wear off, so try to get the dog to eat right after. If you have to go to the vet, be sure and bring Karo with you for the drive in case they drop again. Continue to check blood sugars every 10-15 minutes to ensure it’s coming back up.

Beignet has only been symptomatically hypoglycemic one time – at the time I was rushing her to the ER Vet in hypovolemic shock. Needless to say she truly needed Karo Syrup that time (and more than once). Usually if her sugar is low she is not symptomatic. With her other health conditions, she doesn’t do well with sharp rises/drops in sugar. She can’t eat any of the recommended treats for hypoglycemia either which is frustrating to treat hypoglycemia with protein. I’ve had to learn how she reacts so now I feel very comfortable when she does have a low. My vet and I have discussed at length how I should respond.

If your dog does get low & your vets office isn’t open, an absolutely phenomenal resource is the Facebook group Canine Diabetes Support & Information. Someone will jump on your post and help you right away. CDSI is the largest online group and definitely the most helpful. Had some odd experiences trying out other groups and would only trust info from the CDSI group. In fact, I’m not sure I would be able to check Bennie’s blood sugar at all were it not for a member in CDSI that insisted I try checking her inner lip. Total game changer! The other benefit is you get to find support from other pet owners experiencing your same highs and lows. They have great resources available. Plus they will help you handle hypoglycemia step by step if needed.

Know with hypoglycemia a dose change in your dog’s insulin could be needed. Be sure and make a hypoglycemia plan with your vet and if that’s not possible, use the CDSI resources.

Well I better run and get Beignet fed. Hopefully she will eat after all of her treats earlier… Hope everyone had a wonderful Memorial Day! We are so thankful all who have served our great Nation!

Sincerely,

Devoted Doxie Mom

Click on products below to start testing your dog’s blood sugar today!

An Eye For An Eye….

Pictured above is our 3rd vet specialist selfie of 2018. Beignet and I just made our first 6 hour round trip visit to see Dr. John Warren at Veterinary Eye Institute in Plano, Texas (http://www.veterinaryeyeinstitute.com/meet-our-doctors/john-r-warren/ ). When Beignet got diagnosed with diabetes, all I could focus on was that she was only 7 years old and could soon be blind due to this diagnosis. Was she going to be able to beat diabetes? Of course I just assumed as a physician she would be the best controlled diabetic my vet has ever seen (and yes Bennie decided that wasn’t going to be the case…). Was her perfect control going to be soon enough to prevent diabetic cataracts? I sure hoped so.

The doctor in me immediately thought I needed to do all the preventative precautions for a diabetic. However we had a few obstacles. First there are very few vet specialists in our area. Secondly, Beignet threw me a major ball when she became extremely ill just weeks after her diagnosis. Worries over her eyes after a 6 week struggle for her life were just a distant memory.

Dr. Warren said it is always best to see a vet ophtho as soon as possible after a diabetes diagnosis. They can guide you through what to expect. Work with you on preventative care options. And also diagnose cataracts and other eye conditions that may already be present. Depending on the source, 50-70% of dogs diagnosed with diabetes develop cataracts during the first year after their diagnosis. Beignet has 4 more months until her 1 year anniversary so we hope that we beat those odds. However all diabetics will eventually get cataracts. My almost 12yo nondiabetic has early lenticular cataracts from old age now. My understanding is that diabetic cataracts respond better to surgery than nondiabetic cataracts, so at least there’s that if I can afford surgery when our time comes.

What I didn’t realize with my focus on cataracts was the next most common eye disorder in diabetics, Keratoconjunctivitis Sicca (aka dry eye). After a bout with corneal ulcers, Beignet received this new diagnosis weeks ago. Having the same diagnosis, I have some idea of what she’s been going through. However my dry eye doesn’t involved nasty snot pouring from my eyes all the time (thankfully). Beignet can at times not open her eyes. She blinks repetitively. I’m constantly having to clean her eyes and apply drops. If your diabetic dog has mucus discharge of any color from his/her eyes, please have your dog tested for dry eyes or better yet, see a vet eye doctor if you haven’t already. When Beignet saw Dr. Warren, she still had ZERO tear production in either eye. She has to do a month of once daily steroid drops along with a compounded 3 time a day immmunosuppressant drop that will hopefully stimulate tear production. If dogs fail therapy they can transplant a saliva gland from the mouth to the eye which causes nonstop tearing. We hope we don’t have to resort to this….

We will be traveling back to see Dr. Warren in a month. Please pray that her eyes are responding to treatment. We are feeling a little defeated at the moment. I keep thinking – what next?? Before 2018, we had minimal issues. So far, it’s been diabetes followed by chronic pancreatitis followed by suspected jejunal inflammatory bowel disease followed by a new heart murmur and now this. You can see with all that, why we aren’t the perfectly controlled diabetic I initially thought she would be (although is there even such a thing???). Her eye issues require more time than anything else. And for the record her heart issue was insignificant. Despite it all except for the 6 weeks in February/March and this past month this sweet baby has been nothing but happy no matter what she had to deal with. I’m hoping we get back to that fun loving, tummy rub obsessed, tail wagging, loves everyone happy girl again!

To end, my advice is even if you have to drive, get your dogs eyes checked! Even if you can’t afford cataract surgery, getting established might improve you dog’s long term outcomes. And what if your dog has treatable dry eye, like Bennie or another easily treatable condition? Not treating can lead to vision loss. I definitely don’t think a $125 visit was at all unreasonable especially in that it was the nicest vet office I’ve ever visited. Just wish he was a little closer!!!

~Devoted Doxie Mom

Addendum : A lot of diabetic dog owners go ahead and start lubricant eye drops when their dog is diagnosed to hopefully prevent their dog from getting dry and becoming more susceptible to corneal ulcers. Here is the type many use pictured above. Click on the pic to purchase.

Although it was recommended that Beignet not use just drops.   Instead, Dr. Warren insisted she use the GenTeal Tears Severe Gel (not to be confused with the version for nighttime that’s a step up from this which we were told not to use). You can purchase the gel by clicking on the pic ABOVE

There is no set brand of eye wash you have to use. It’s best to use a dog version of an eye rinse though or sterile water whereas the GenTeal brand of dry eye products are actually made for humans but okay to use on pets. I’ve posted a link to our favorite sterile eye wash below. Click on the pic to purchase.

The Panic of Pancreatitis

Is there anyone who’s heard ‘pancreatitis’ and not freaked out a little? And if you didn’t freak out, maybe its because you truly just didn’t know much about it. I will review what pancreatitis is, how its diagnosed, how its treated, the prognosis, how to prevent pancreatitis and our personal pancreatitis journey with not 1 but 2 doxies.

First you might be wondering what your dog’s pancreas has to do with diabetes. The pancreas is an organ that has both endocrine (think insulin production) and exocrine (think digestive enzymes for fat and protein breakdown) functions. So since the pancreas has endocrine functions it is most definitely involved in diabetes. Pancreatitis can be acute or chronic. It can be mild or subclinical, it can also be severe. Pancreatitis can cause diabetes. Its also said that diabetes can cause pancreatitis.

Here’s a little breakdown of how pancreatitis happens: Pancreatic ‘juices’ get secreted ➡️ Other enzymes get activated ➡️ Damage to the exocrine pancreas occurs (Ex. Bleeding, swelling, inflammation, breakdown including fat breakdown, etc) ➡️ The body mounts an inflammatory response ➡️ Enzymes and inflammatory substances spread throughout the body ➡️ General inflammation spreads throughout the body affecting multiple organs. So with all this potentially going on, you can see how even just one episode of pancreatitis could cause permanent changes to your dog’s pancreas.

SYMPTOMS of pancreatitis can be vomiting, anorexia/hyporexia (not eating at all versus decreased appetite), dehydration, fatigue, weakness, pain, depression, diarrhea, fever, high heart rate, breathing difficulties, shock, etc. My non-diabetic dachshund was diagnosed with pancreatitis years ago and her only symptom was that she wasn’t sleeping well. She was constantly up and down, because she was unable to get comfortable due to pain.

You may never know the CAUSE of your dog’s pancreatitis. Many cases are idiopathic, or cause unknown. Here are some potential causes:

    Diet and nutrition are important triggers. Generally this is a high fat/low protein diet. There are typically an increase in cases around the holidays when dogs tend to get into table food they shouldn’t. Always ensure your dog can’t get to food or your trash! It can happen with just one ‘meal’ of fatty table scraps. Also certain prescription diets such as those that help dissolve bladder stones.
    Hypertriglyceridemia is when there is excess fats circulating in the dog’s blood (typically >500mg/dL).
    Trauma
    Hyperadrenocorticism
    Obesity
    Surgery – although this is now thought to be caused by decreased perfusion to the pancreas during anesthesia
    Drugs/Toxins
    Infections
    Hypercalcemia
    Associated illnesses

Any dog can be affected by pancreatitis. It is more common in middle aged to elderly dogs. It is more common in females. Research from necropsies are beginning to show far more dogs are affected than anyone originally thought. Certain breeds are known to be more predisposed to pancreatitis. Those include: Schnauzers, Poodles, Cocker Spaniels, Yorkshire Terriers, Dachshunds, etc.

DIAGNOSING pancreatitis whether acute or chronic can be very tricky! I was shocked to discover Beignet had chronic pancreatitis. How could I have not known she had it??? In humans, lipase and amylase elevations typically give you your diagnosis but do not determine severity of disease. Amylase shows elevations within 5-8 hours of symptom onset and returns to normal by day 3-4 and reaches a maximum 12-72 hours after symptom onset. Some research supports only checking lipase in humans due to it being elevated both in the early and late stage. Lipase elevates within 4-8 hours of symptom onset, peaks at 24 hours and returns to normal within 8-14 hours. In humans, both amylase and lipase can also increase with other disorders. I feel its important to understand a little about human diagnosis to help us understand dog diagnosis. Below I will go through each diagnostic option in dogs:

  • CBC & Chemistry Profile: These are extremely important to evaluate the dog for systemic complications, but are NOT useful to diagnose pancreatitis. In a dog with pancreatitis, you may commonly find signs suggestive of nonspecific inflammation, a decrease in platelet count, an increase in neutrophils with a left shift, increased BUN and creatinine, increased liver enzymes, increased bilirubin, etc. Although amylase and lipase are on the Chem profile, they are described below.
  • Amylase: Has very poor sensitivity and specificity. Very limited as a measure of pancreatitis diagnosis. Possibly given the human info above, its already potentially normalized by the time the dog presents to their vet.
  • Lipase: This is generally on most in-office metabolic panels. Lipases are something released from multiple organs including the pancreas, liver, stomach, endothelium etc). A serum total lipase is NOT specific for pancreatitis. An article online from Texas A&M Vet School said it could miss up to 86.4% of pancreatitis patients. Lipase can be increased by steroids, cancer as well as diseases of the kidney, GI tract, and liver. Also there is an increase in false negatives in pancreatitis patients due to hemolysis, lipemia and icterus (jaundice). Beignet has never had an elevated amylase or lipase.
  • Serum Pancreatic Lipase Immunoreactivity (PLI): The Spec cPL®️ specifically tests for pancreatic lipase and has rare false positives. In office rapid cPL tests are available, but generally cPL tests are send out tests for most vets. This test is how we got Beignet’s diagnosis of chronic pancreatitis. http://vetmed.tamu.edu/gilab/service/assays/pli. Be aware that many GI conditions can cause mild pancreatic inflammation. This in turn can increase your cPL test. Sometimes a repeat cPL maybe needed to help determine if the dog has a primary or secondary pancreatitis.
  • Trypsin-like Immunoreactivity (TLI): This is the diagnostic test of choice for EPI as it tests exocrine pancreas function. It is not very sensitive for pancreatitis though.
  • Abdominal X-ray: This is more important to help excluse other diagnoses in your vet’s differential diagnosis (the diagnoses your vet is ruling in or out including pancreatitis). Findings in pancreatitis will be nonspecific.
  • Abdominal CT or MRI: Very insensitive in cats and never truly evaluated in dogs. Probably not worth what this would cost you.
  • Abdominal Ultrasound: Highly specific for pancreatitis, but just seeing an enlarged pancreas with fluid accumulation around it is not enough to give you the diagnosis. With newer high resolution ultrasounds, occasionally pancreatic nodular hyperplasia could be misinterpreted as pancreatitis. When it comes to an ultrasound, consider the expertise of the ultrasonographer (who maybe your vet), quality of the machine, and the level of suspicion of your ultrasonographer. When Beignet was sick, my vet told me his ultrasound machine was older and if we wanted to do one locally, he would send us to do one on a better machine. We were going to a vet school, and chose to wait to do one there done by their radiologist. I was able to see chronic changes quite easily on the entire left side of Bennie’s pancreas on her ultrasound😢. Contrast enhanced ultrasounds have improved diagnostic evaluations but aren’t routinely done.
  • Pancreatic Cytology or Histopathology: This can give you a definitive diagnosis. FNA (fine needle aspiration) of the pancreas has been reported to be safe. But sometimes the disease is very localized, so a normal FNA does not exclude pancreatitis. Biopsy on the other hand can increase a dog’s risk of pancreatitis as compared to FNA. If pancreatitis is severe, a dog’s anesthesia risk is much greater. An exploratory lap or FNA may be too risky in severe pancreatitis.

If your dog has joined us in the pancreatitis club, you maybe curious about TREATMENT options:

  • Aggressive fluid treatments with electrolyte replacements if needed.
  • Remove any potential causes.
  • +/- Gut rest. Recommendations on this vary. Definitely will be done if the dog is vomiting despite anti-nausea medications. Beignet required it.
  • Nausea medications: Cerenia and ondansetron are potential options
  • Pain medications
  • +/- Antibiotics: these have questionable value so are not routinely recommended.
  • Reglan (metoclopramide) for improving gastric motility. It can help with nausea but should not be used as the dog’s anti-nausea medication in pancreatitis. I read that it could decrease blood flow to the pancreas potentially. Bennie was put on this for gastric emptying and it was increased from twice to three times a day when she was hospitalized at a vet school.
  • Reflux medications. Many dogs are put on them but I haven’t seen them listed as parts of treatment. Bennie was put on omeprazole but advised to stop after a week due to potential issues with long term PPI use. However she may have been put on this more for her suspected IBD than her pancreatitis.
  • Food: May require a permanent food change. Generally <10% dry matter fat, but Ultra Low Fat diets are what we will see being recommended in the future. Stay tuned for an upcoming post with all my dry matter fat calculations. Do not use the fat percent on your dog food label (unless Hill’s, who often has the actual dry matter fat values on their labels) but instead put the information into a calculator like this one http://fnae.org/dmb.html. Know that these values are minimums and typically the food contains ~3% more fat than what you calculate. You can always contact the company to ask for the actual value. Early nutritional support is a key component of successful treatment in humans with pancreatitis.
  • Plasma transfusions maybe needed in severe cases of pancreatitis.
  • If a dog isn’t responding, prednisone, prednisilone, or cyclosporine maybe given. Cyclosporine for a dog with diabetes is preferred as it has less of an impact on insulin resistance. There is not a lot of data on its use in chronic cases.
  • Entyce – a newer appetite stimulant maybe needed to get your dog to eat. Since I forgot to originally add this, I will post about Entyce in an upcoming blog.

To PREVENT pancreatitis, keep your dog at their recommended, ideal weight. Avoid feeding foods high in fat. Work on a weight loss plan for your dog if they are overweight. Discuss any medications your dog is on with your vet to determine if they potentially increase your pet’s risk.

Your dog’s PROGNOSIS depends on the severity of disease. Risk factors for poor outcomes include: hypothermia, acidosis, low calcium and failure of 1 or more organs. Chronic pancreatitis typically has better outcomes, but may eventually cause diabetes (like in Bennie) and/or other diseases that affect the dog’s quality of life. There are many dog’s like Beignet that have an upset tummy here and there, but aren’t very ill. So even with a visit to the vet, no one is aware that the dog is actually having a mild pancreatitis flare. Chronic pancreatitis maybe associated with intestinal or liver inflammation.

This went a little longer than I initially intended. My information is more to give a better understanding of pancreatitis and should not replace the care and advice of your vet team. My information comes from my own personal medical knowledge and reading various articles over the past months. Texas A&M vet school has many great articles on pancreatitis. The Merck Manual online also has some great reading on dog and cat pancreatitis. Hopefully if you experience an acute flare your dog does well! I will tell Bennie’s story in a future post.

-Devoted Doxie Mom