Bloodwork, and possible diabetes?

12/12/12 - I couldn't resist updating the blog on this date, could I?  :)

On Monday, I took all of the dogs in for their annual exams and bloodwork.  Having 3 senior ladies means keeping check of health on the inside, even though everyone looks healthy on the outside!

Reo got blood taken for both an EI-1 panel from NVDS, as well as regular chemistry/CBC.  Apparently, the nurses took too much blood too quickly - Reo passed out right after the blood draw!  It was super scary at first, but they gave her some oxygen and she perked right back up.  The vet likened it to standing up too quickly and getting lightheaded.  That's never happened before, so we'll have to be more careful on blood draws next time!

Though we need to wait until next week on the EI-1 panel, we already got the chemistry results back.  First of all, Reo's blood remains lipemic (fatty).  It has been this way for the past year or so, and I wasn't too surprised, but it does affect the CBC portion of the results.  Her cholesterol is normal.

She had very slight elevations in two liver enzymes, ALT and ALP.  Because they are very mild, the vet is not concerned, especially as she has been on long-term Medrol.  However, her blood glucose was very elevated (377!), and our vet is concerned that Reo could have diabetes.  :(  Though she was 7 hours post-meal, we will do a fasting blood glucose, and possibly a fructosamine test as well, to see where we stand.  At the same time, we will do a urinalysis and urine culture to see where we stand there.

The strange part is, Reo is not drinking or urinating more frequently.  She does not have accidents in the house.  She has not gained any weight (in fact, she lost a bit since our appointment in June), and is not more hungry.  We keep a close eye on her PU/PP/PD, given our experiences in the past.  Reo is also on grain-free, low-glycemic dehydrated/freeze-dried raw food.

First, cortisol is insulin's counter point.  As insulin LOWERS blood sugar, cortisol INCREASES blood sugar.  This is important to remember.  Many Cushingoid dogs (high cortisol) also have diabetes - I think about 20% of dogs who are Cushingoid also have diabetes.

I have been thinking a lot (I know my readers are surprised!) about what could have brought this on.  In the past few months, I discontinued Reo's phosphatidyl serine supplement.  Phosphatidyl serine is thought to blunt the cortisol response/spikes in cortisol.  It's possible that my giving her PS was reducing the amount of circulating cortisol in Reo's body, and when I stopped giving this supplement, she had an increase in cortisol, resulting in an increase in blood sugar (this will become apparent when we get the EI-1 panel results back - if her cortisol is high, perhaps this is the case).

For the past couple of years, I have been operating under the assumption that Reo has very, very little adrenal function (if at all).  However, perhaps her adrenals can make a bit of cortisol, and her daily dose is giving her a bit too much.  We may need to adjust the dose of her Medrol.  I plan to wait and see what the repeat blood tests say, and then I will contact Dr. Plechner and see if any adjustments need to be made.

Reo, our little problem child!  The great news is that she is happy, healthy, and not displaying any "symptoms".  I hope the glucose reading was a fluke somehow, and she is not diabetic.  I can't imagine having to stick her twice per day, although of course we are totally committed to her for life!  <3

Back to normal

11/03/12 - Reo is back to normal!  She was stressed out over having our friends' dog at home with us for a week.  As soon as the other dog went home, she seemed back to her normal routine.  Clearly, she was not impressed at sharing her house!  She ate normally this week, and is back to her spunky, playful little self.  :)

I guess I can't underestimate the effect of stress on Reo!

Also, we have finished up giving her the remaining supplements that I have.  So far, so good!

Sickie-poo

10/28/12 - Reo has had a "bug" for the past 3 days.  She's been rather lethargic, not eating, drinking quite a bit.  She has also thrown up (mostly water) a few times.  I wondered if she might have caught canine influenza (we've been watching a friend's dog for the past week, and so it made me suspicious). But, the symptoms of canine flu are supposed to be similar to kennel cough, with lots of coughing and nasal discharge.  She has none of that.  All of her functions have been normal, so I was waiting to see if something changed for the worse before I brought her to the vet (I usually am fine with waiting 3-4 days to see if something resolves itself, as long as some food/water is consumed, and there aren't any alarming symptoms).

I made her boiled chicken and sweet potato, which she ate sporadically/unenthusiastically.  I was able to hide her Medrol and L-thyroxine in the sweet potato a few times, but a couple of times I had to force them down her throat (thus making her hate me!).  Today she got to take a nice sun bath, and I think it helped to reset her - it's been rather cold the past few days, so she's been inside mostly.

Anyway, now it looks like she's coming out of it a bit, which is a relief.  I got her to eat some of the ZiwiPeak food, sprinkled with some Welactin, for dinner.  She ate less than her normal portion, but it was something!  I was planning to bring her to the vet tomorrow for a chemistry panel, but if she continues to improve, I'll just guess it was a little bug that she caught from who-knows-where!  Fingers crossed!

All is normal...

10/09/12 - Just a quick update to say that Reo has been off the lutein supplement and the Standard Process Adrenal Support for a few weeks, and we haven't noticed any changes in behavior.  Still working through the PS and Mg, but will stop those when we use up the rest of what we have.

Little Miss Reo has been extra spunky lately - I think due to the fall weather.  The chillier temperatures mean more active squirrels, which keeps Reo on her toes!

Decision for Reo

09/16/12 - Finally, Sean and I have decided how we are going to proceed with Reo.  You may recall that I've been struggling with whether or not to continue to give Reo the retinal protection supplements, as it seems she has very little vision remaining these days.  I have not been sure whether the small amount of remaining vision is worth preserving - she might get around better if she were completely blind.  And, I don't want to continue to give her things that her body doesn't need/can't use.

We have decided not to give most of her supplements any longer.  We will be suspending the following:
- Lutein (her last capsule was given yesterday)
- Phosphatidyl Serine (have about a month left, will suspend when we use the last of it)
- Magnesium Taurate (have about 2 months left, will suspend when we use the last of it)
- Standard Process Adrenal Support (have about 1 week left; just not sure she needs this any more)
- Sardines (these were given as a source of adenosine, which works in conjunction with the Magnesium Taurate)

We will continue to give Reo the Cell Advance 440, Nutramin, and Prozyme, and keep the rest of her diet the same (Welactin, Dasuquin) as we like the benefits of those supplements for older dogs (and Leigh gets these three supplements as well).

I do have a huge amount of guilt for not being more pro-active for Reo surrounding the time of our big move in March of this year.  I really thought that we were "in the clear" since her vision had returned, and I severely underestimated the effects of stress on Reo's vision.  Literally, when we started packing up our house, her vision started to decline.  She then got a toe infection, and allergens in the air were high.  A lot of stress for our little girl (plus lots of stress on the humans, too!), really affected her.  I'm working on letting my guilt go, and taking comfort in the fact that Reo is as healthy as she has been in years.  She is still such a happy dog, and her health truly is the most important part.

We will continue to get blood chemistry and thyroid tests every 6 months, to make sure that we are on the right track with her care.  I envision getting and EI-1 panel from NVDS every year or so, again, to make sure that we are staying on track.  If there are any issues that make me think she may be unbalanced, I may test more frequently - we will just have to play it by ear!

I will likely update this blog less frequently, as I hope (?) Reo will be quite stable.  But, of course I will share any new things that I learn about SARDS, relevant articles, and updates on Reo's condition.  I am also very happy to hear from readers whose dogs have been diagnosed with SARDS, and help in any way that I can.

Fall is around the corner!

09/05/12 - It is hard to believe it's September already - everyone in our household is looking forward to the cooler temperatures of fall!  The past few mornings have been quite chilly, and the dogs love it!  It's a great opportunity for them to lounge around in the warm morning sun, while the air is still chilly.  We're hoping to sneak in one last camping trip this year - we'll see how it goes!

For the past 10 days, we've been watching two of our friends' dogs.  I anticipated that this would be stressful on Reo, so I pulsed her Medrol for a week.  She seemed to do fine, well, other than one of the dogs not understanding Reo's mostly-blindness.  If Reo walked into her, the other dog would snap and growl.  Fortunately, I was home all the time and could correct the other dog before things got out of hand.  Overall, everything went relatively smoothly, but all of us were pretty happy to get down to our normal routine with just three dogs!

Sean and I will be making our final decision in the next week or so, concerning what to do regarding Reo's supplements.  I will post an update once we decide!

Reo's updated obstacle course videos

08/17/12 - Wow, I've been so bad about updating lately!  We've been having a lot of summer fun.  We went camping, and had my parents out to visit, so we've been busy.

So, we've passed about a year since Reo was confirmed to have her vision return.  Here is one of last August's videos for reference (many more videos archived on my blog!):

August 2011 course

Since this time, her vision improved in the fall/winter, but then took a huge backslide as her stress kicked up due to our family's cross-country move. My thought was that when we moved, she had no vision whatsoever. She received another series of DepoMedrol injections, hopefully to help reset her system, and she did improve.

Lately, I've been wondering if she has any vision at all, or if she's just mapped things out. I do find it curious that she bumps into things a lot. I would have thought if she were totally blind, she would have mapped things out better. I spoke with Caroline Levin about this, and she said it's been commonly
reported in humans that low-vision is more difficult to navigate than no-vision. So, I don't know what is going on. Certainly sometimes, it seems like she can't see anything - she can't track a cotton ball like she used to.

But, recently, I took some new obstacle course videos for curiosity's sake - now I don't know what to think! I think she could still have a little vision left.

August 2012 #1

August 2012 #2

August 2012 #3

She seemed to have the most problem in the last video, getting caught between the gutter downspout and the strawberry flat! But because I've never had a blind dog before, I'm not sure if dogs can do exercises like this obstacle course based on their other senses?

Reo appears to have the most trouble in the shade/light transition, which I think is worthy of note (she always seems to do better in full sun).  There is no doubt that she does not get around as well as she was one year ago, but I don't think that she is completely blind, as she can get around some of the obstacles and not crash into them like a fully blind dog would.  I feel certain that she is completely blind in her right eye, and she has some minimal vision in her left.

I'm not any closer to making a decision about whether to continue all of the retinal protection supplements, or to just suspend the and let her become fully blind over time.  I need to do some more thinking about that.