Update on Timon

[tymbaa29]

Re: Update on Timon

Hi, well Timon did well during his ACTH test today. He was very relaxed and the staff just love him so he did not seem stressed which I was trying to avoid. He had a nice 2 hour nap while we waited for the post test. Won't know the results of the ACTH test till tomorrow but after the IM reviewed Timon's BGs over the last 5 days he decided to move him to 7 units for 3 days and wants me to call with results. He feels that we are on our way to getting the Cushings under control and with Timon's blood glucose levels not having the large dips that they did when he first came home, he is comfortable with moving him to a higher unit dosage...

His eye is also doing ok....Opthamologist was great with explaining what I was seeing with his cornea and I understand that better now. I hope the ACTH test results come back good.....I would just love to see him get to levels that stay in the 200-300's.

Barb

[Patty]

Re: Update on Timon

Barb,
Sounds like a very positive day!
Patty

[k9diabetes]

Re: Update on Timon

Our Chris had corneal dystrophy, which meant that his corneal cells tended not to cement properly. When he got corneal ulcers, they were extremely slow to heal and tended to spread rather than get filled in.

The thing that worked for him was punctate keratotomies. It's weird to me in concept but they use either a grid or small punctures to kind of break up the surface of the cornea that needs to fill in and that actually makes it heal better. Chris had an ulcer for months and months before we finally did a punctate keratotomy and then his cornea healed up quickly. So we vowed never again to wait - just go straight to the keratotomy if the ulcer didn't heal immediately.

I haven't read the following in detail but it seems to cover some of the basics of this issue: http://en.wikipedia.org/wiki/Corneal_ulcers_in_animals

Refractory corneal ulcers can take a long time to heal, sometimes months. Topical antibiotics are used continually to prevent infection. Pain medications are given as needed. Loose epithelium is removed with a dry cotton swab under topical anesthesia. This is in order to allow production of normal basement membrane and division of normal epithelium. Often further treatment is necessary, such as a keratotomy, which is superficial cutting or piercing of the cornea. There are two main types used in dogs: multiple punctate keratotomy (MPK) and grid keratotomy (GK). MPK involves making small superficial punctures into the cornea with a needle.

We found that debridement did not resolve ulcers when corneal dystrophy is present.

Chances are good something like this is going on if he has had the ulcer for any length of time.

Chris didn't need any general anesthesia for the keratotomy - he was a very mellow dog - and was in and out in about 15 minutes.

Hope that helps,

Natalie

[tymbaa29]

Re: Update on Timon

Hi, Timon originally had an ulcer that they indicated had healed. He had been dealing with glaucoma in his right eye and after treating it for about 4 weeks, his pressure was getting higher. While he was in the hospital the Op discussed going with an intavitreal ciofovir injection. Timon was not able to see out of his right eye for some time and for that reason I decided to consent to the injection. His pressure has been great since; however, about a week after the injection he developed a corneal infection which they said was secondary to his enlaged globe from the glaucoma.

Op has discharged the ointment I was applying and is continuing with Ofloxin drops 1 drop 2x/day for 2 weeks. He still has a white clouded ring area around the center of his eye, but his complete eye is not as buldging and red.

Gave 7 units last pm and at 12:30 am Timon's BG was 150. His reading this am at 6 was 296. I gave him the 1/2 dose as IM instructed if BG is under 300 I know you mentioned that BGs may run higher after ACTH and my first thought is that his cortisol level may have been too low which contributed to resistance to the 6 units he was getting.

I will get the results of the ACTH today. I will ask for the pre & post results.

Barb

[tymbaa29]

Re: Update on Timon

Hi, just heard from IM, Timon's ACTH results are as follows:

Pre test: 1.2
Post test: 12

IM wants to see post test result between 5 & 8 so he decided to have me give Timon 1/4 tablet Lysodren two times a week instead of one time a week.

I am not really familiar or comfortable yet with this issue so I am interested to see what others think about his plan of action.

Barb

[ladysmom06]

Re: Update on Timon

Hi Barb,

I don't know about lysodren - Lady was on trilostane. I think you joined the cushing's board - I'm sure they'll be able to help you with your question. Lots of people there using lyso.

[tymbaa29]

Re: Update on Timon

Hi, I have posted my test results on Cushings sites..I am glad to also have their support.

With Timon being moved to 7 units NPH N am & pm, looks like we are back to the large dips in his sugar levels. He experienced the same thing through his 1st two weeks home from hospital. He did level out in the 400's just before his recheck ACTH on 2/4/10 and as I mentioned, decision was made to up him to 7.

His rates since starting 7 units are as follows:

2/3/10:
6pm: 565
10pm: 260
12:30 am: 150

2/4/10:
6am: 296 (only gave 3.5 units as per IM instruction if between 250-299)
12pm: 369
6pm: 458
10pm: 260
12:30am: 183

2/5/10:
6am: 549
12N: 194
6pm: 438
9pm: 307
12:30 am: 102 (yikes!) gave him some food
3:30 am: 256

2/6/10:
6am: 521

I am wondering if moving to 7, a full unit was too much?

Barb

[peggy0]

Re: Update on Timon

i believe it was. Those 500's in the morning indicate a low at night. I would go back to 6 for a few days and then go up to 61/2

[k9diabetes]

Re: Update on Timon

I do think 7 units is too much for his low points.

If someone is home with him all the time, you could add a snack around 4 hours after each meal and perhaps level things out nicely, in which case 7 units might be okay.

If not, then I'd go back to 6.5 and consider possibly working with his diet after things have been settled in for a while. With those steep drops in blood sugar, better regulation would require either more meals per day or attempting to tweak the diet to be digested more slowly.

Natalie

[tymbaa29]

Re: Update on Timon

Hi,moved Timon to 6.5 units two nights ago and the dips have not been so low. He is dropping alittle lower each day in his am levels which is good because he was in 500's. IMS is on vacation and will not be back until tomorrow to check out the rates I sent him...I am starting the Lysodren 2x/wk this week..I am alittle nervous but I did receive some great feedback from the Cushings site regarding Lysodren and the treatment of atypical cushings..

Barb

[k9diabetes]

Re: Update on Timon

I haven't had a chance to read your thread at the Cushing's forum in detail but I do see that atypical Cushings has been confirmed and that you have been in contact with Dr. Oliver, who approves of the current treatment plan.

Glad Timon had the UTK panel - that's definitely the way to go.

Natalie

[tymbaa29]

Re: Update on Timon

Hi, it looks like 6.5 units is working better than the 7 units for Timon. Here are a few day's results:

2/7/10:
6pm: 418
9pm: 248
12:50 am: 222

2/8/10:
6am: 256 (Held insulin as per IM)
12N: 506
6pm: 469
80pm: 367
11:30pm: 271

2/9/10:
6am: 335
12N: 210
6pm: 459
12M: 208

9/10/10:
6am: 339
(could not make it home from work for noon testing)
6pm: 415
9:30pm: 235

Timon gets his 2nd dose of Lysodren tomorrow am.

I posted a picture that I hope appears correctly. He is younger in the picture but it is one of my favorites.

Barb

[k9diabetes]

Re: Update on Timon

You can put his picture as an Avatar so it shows up on all of your posts if you'd like. Go to UserCP and then you would upload it similar to the way you did for your profile picture.

So does he have a really long tongue!? (sometimes those little pictures can be deceiving!)

There is also an album available to you where you can upload the pictures where they can be seen in larger size.

Natalie

[tymbaa29]

Re: Update on Timon

Looks like I got the picture to upload correctly. Yes, Timon does have a very long tongue. The picture I have posted was taken during the summer so his tongue is hanging out alittle extra.

His BGs seemed really good today:
5:30 am 335
12N 278
5:30 pm 322
9pm 228

At least I do not have the really low dips like I was seeing through last week. I am working a snack in at 4 hours post am dose as much as I can.

Barb

[k9diabetes]

Re: Update on Timon

Very nice!

With numbers like that, if you could do a full curve on the weekend just to be sure it doesn't go any lower at some other point... then you could increase the insulin a tiny bit and see if all of those levels come down.

If there are days when you can't give the 4-hour snack, you could drop back to the previous level of insulin if need be to keep him in a safe range.

Natalie