Distraught with worry

[MumofDuston]

Hi everyone,

Distraught newbie here. Thank you for accepting me.

Duston is a 10.5 year old chocolate Labrador weighing 40kg (88lb), cuddly, fun, happy and extremely bouncy until 6 weeks ago......
He came to me one Friday evening presenting symptoms of discomfort - every time he laid down he had to sit up immediately. When he did manage to lay down he had to be flat out on his side, he was unhappy to curve his back. He became very clingy and wouldn't leave my side.
We got him to the vet where he was diagnosed with diabetes. Whoa, I wasn't expecting that..!! He was put on 15 units of Caninsulin twice a day and Metacam once a day.
He pretty much went into a depressive state immediately and his movements slowed right down.
I was convinced it was more than diabetes.
After 2 weeks his front paws started to drag on the ground when he walked. A week later he started knuckling and his front paws started to collapse over. Many visits to the vet showed clear blood tests, normal ultrasound scans on all his organs and multiple X-Rays showed no problems with his spine. Last Monday (8 days ago) he started collapsing - his front paws knuckling and giving way completely and his hind legs falling away from under him. When he could walk (supported) he staggered from side to side.
Our vet suspected it could be 'wobblers' syndrome and took some more X-Rays. Despite the X-Rays looking OK (conclusive proof could only be obtained with an MRI) the vet started him on steroids. Steroids started last Friday evening, 72 hours after stopping Metacam. By now Duston was, pretty much, unable to get up by himself and needed constant support whilst walking. Still perky at tea time but, other than that, very flat, depressed and lifeless. It is as though something has sucked the soul from him. He will look through me, rather than at me. By Monday evening his movement was a bit more fluid. He could get up, very wobbly, and take a few steps down the hall. I thought this was huge progress. However, this morning he was weak again. The vet has taken some blood this morning to rule out neospora and something else (that I can remember the name of) - I think it is a neuro inhibitor. He tested Duston's tendon reflexes (as he has before) and there is nothing there. Our vet has been a little baffled by the fact that Duston has shown collapse in his front paws/legs prior to his back ones. To this end our vet is now pretty sure that Duston has polyneuropathy. This has all happened so suddenly. I feel sure now that, somehow, somewhere down the line I must have overlooked the 'little' things that have brought us to where we are today. I've always had dogs, but have never experienced anything like this. Has anyone else had experience of polyneuropathy associated with diabetes..?? So sorry for long, garbled post - just offloading from my brain through my tears right now

[Eddie]

Re: Distraught with worry

Hello and welcome
I'm sorry to hear about Duston; it must be extremely worrying.
First of all forget any idea that you missed something - quite a few people feel somehow guilty that their dog has got this diabetes and think it must be because of something they did or didn't do. It's just one of those things and you have to deal with it as best you can (as you obviously are doing).

Our dog had diabetic neuropathy a bit after first being diagnosed. He is half lab and they do seem particularly inclined to get it. I don't have any experience of the front legs being weakened as well so I don't know how relevant our experience was to what you are going through, especially as your vet is still checking for other conditions. I am very wary of giving false hope based just on how our dog was affected but I'll tell you about it just in case.

Our dog also went through a stage when he could not get up, stand, pee or walk without a lot of help and support. It was only his back legs and tail that were affected though - not his front legs. He spent a lot of time just lying on his side as you describe and he slept a huge amount. The vet did endless scans xrays etc and eventually thought that there was a tumour in his spine.
That was more than two years ago and in fact it was all related to the diabetes. The people on this forum told me to give him time and to get the diabetes under control and see what happened. We did and he gradually and slowly got better so that now he is back to normal and able to run around. I really hope that your dog follows a similar pattern.

I expect you are aware that the steroids will tend to push his blood sugar higher so that may affect the insulin dose that he needs while he is on those.

If your vet hasn't already done so, one thing you could do is to give your dog a good painkiller just to check that it isn't related to pain eg in his back. They did this with Eddie and it made no difference at all but it was nice to know that his problems were not pain-related.

We gave Eddie a lot of B12 methyl tablets. There is some research suggesting that this helps diabetic neuropathy. We gave him a lot since we felt pretty desperate.

I do hope you can find some answers and I am sure others on here will be along with more specific thoughts on Duston's condition.
Antonia

[momofdecker]

Re: Distraught with worry

Hi everyone,

Distraught newbie here. Thank you for accepting me.

Duston is a 10.5 year old chocolate Labrador weighing 40kg (88lb), cuddly, fun, happy and extremely bouncy until 6 weeks ago......

He came to me one Friday evening presenting symptoms of discomfort - every time he laid down he had to sit up immediately. When he did manage to lay down he had to be flat out on his side, he was unhappy to curve his back. He became very clingy and wouldn't leave my side.

Did the vet check for pancreatitis via the SPEC cPL blood test?
Here is a link to symptoms of pancreatitis:
http://www.vetmedclinic.com/?p=92


We got him to the vet where he was diagnosed with diabetes. Whoa, I wasn't expecting that..!! He was put on 15 units of Caninsulin twice a day and Metacam once a day.
[COLOR="rgb(65, 105, 225)"]Do you have a copy of the vet records? I'm wondering what his blood sugar was at diagnosis and if any curves (testing blood sugar before giving insulin and every two hours afterwards, for a 12 hour period) was done. [/COLOR]

He pretty much went into a depressive state immediately and his movements slowed right down.
I was convinced it was more than diabetes.

[COLOR="rgb(65, 105, 225)"]Did the vet test for ketones? Did the vet tell you that you can purchase ketone strips at most local pharmacies (just ask the pharmacist to point you in the right direction) and test your pup's urine at home for ketones. Anything more than trace ketones is an emergency situation as it can become life threatening. [/COLOR]


After 2 weeks his front paws started to drag on the ground when he walked. A week later he started knuckling and his front paws started to collapse over. Many visits to the vet showed clear blood tests, normal ultrasound scans on all his organs and multiple X-Rays showed no problems with his spine.

[COLOR="rgb(65, 105, 225)"]Do you have a copy of the blood test results? Are there any abnormal values? I only ask because at one point in time I was told my dog was a healthy diabetic dog because the vet had assumed the abnormal values on his blood work were the result of the diabetes. In reality, he had many other things going on and I only started to figure it out after I asked for a copy of his blood work and started doing my own research (and with lots and lots of help from folks on here). [/COLOR]

Last Monday (8 days ago) he started collapsing - his front paws knuckling and giving way completely and his hind legs falling away from under him. When he could walk (supported) he staggered from side to side.

[COLOR="rgb(65, 105, 225)"]Has his bark changed at all? How is his vision? Does he carry his head low when walking or seem to have pain in the neck area at all? Is 88 pounds a healthy weight for him?
[/COLOR]

Our vet suspected it could be 'wobblers' syndrome and took some more X-Rays. Despite the X-Rays looking OK (conclusive proof could only be obtained with an MRI) the vet started him on steroids. Steroids started last Friday evening, 72 hours after stopping Metacam.

[COLOR="rgb(65, 105, 225)"]What is his current insulin dose? Some diabetic dogs do need to be put on steroids, however, steroids are known to cause insulin resistance and typically require a higher dose of insulin to combat the steroid use. What is the dosing and frequency of the steroids?
[/COLOR]

By now Duston was, pretty much, unable to get up by himself and needed constant support whilst walking. Still perky at tea time but, other than that, very flat, depressed and lifeless. It is as though something has sucked the soul from him. He will look through me, rather than at me. By Monday evening his movement was a bit more fluid. He could get up, very wobbly, and take a few steps down the hall. I thought this was huge progress.

However, this morning he was weak again. The vet has taken some blood this morning to rule out neospora and something else (that I can remember the name of) - I think it is a neuro inhibitor. He tested Duston's tendon reflexes (as he has before) and there is nothing there. Our vet has been a little baffled by the fact that Duston has shown collapse in his front paws/legs prior to his back ones. To this end our vet is now pretty sure that Duston has polyneuropathy. This has all happened so suddenly. I feel sure now that, somehow, somewhere down the line I must have overlooked the 'little' things that have brought us to where we are today. I've always had dogs, but have never experienced anything like this. Has anyone else had experience of polyneuropathy associated with diabetes..?? So sorry for long, garbled post - just offloading from my brain through my tears right now

I replied in blue above. I'm so sorry you are going through this. My recommendation at this point is to find a good neurologist and have them evaluate your pup. I too had a dog who became extremely weak, off balance, had rear legs issues and front legs that started simply giving out. A neurologist was able to help pin point the area which was causing my boy's problems, however, I did not have the funds to run the MRI & other tests to determine the cause within the identified area.

Here are a couple of videos I took of my boy's struggles:
https://www.youtube.com/watch?v=3HXYp_rocWc
https://www.youtube.com/watch?v=77fHhd5RLDY

And the results from my boy's neuro visit:
https://inmemoryofdecker.shutterfly.com/31

[parje1]

Re: Distraught with worry

I'm so sorry to hear about your pup.

I have an 11.5 year old Yellow Lab with diabetes and GI issues. She became quite weak and had trouble with balance and mostly loss of function in one of her back legs. She would drag her back leg and curl her toe under and drag it. She was falling down stairs and I had to carry her to go out to go potty for awhile. We suspect it was neuropathy.

We're one year into her diagnosis and she's much better now.

The B-12 injections really helped my pup perk up. That was something I had to fight to get her on with the vet. She gets an injection once a month at home. Definitely worth asking your vet about.

Acupuncture has also helped my dog when she was losing mobility. It gets the nerves all fired up again.

As suggested, ask about his vision. My pup has now lost her vision due to cataracts. It was a rough 6 weeks while she got used to the loss of vision. Now, you couldn't even tell she can't see. She gets around very well.

We're all here for you. This group is a lifesaver.

Jen & Mia

[Monsters Momma]

Re: Distraught with worry

Oh my goodness! I would be distraught too if we had gone through what you have! Having not gone through this, I just wanted to add my welcome and tell you, you have found a great place for information and support. I hope you'll find the answers you need!
Mel and Vinny

[MumofDuston]

Re: Distraught with worry

Thank you all so much for your welcome and kind words. Despite the support of a wonderful husband and a dedicated vet, it has been a very lonely and confusing time. Duston's symptoms could fit so many diagnosis and I seem to have found ALL of them whilst endless trawling on the internet. Our vet favours polyneuropathy over wobblers syndrome, but it has been a close call. Only an MRI would be conclusive but, having spent £1,500 over the past few weeks, another £1,800 is just a stretch too far right now. Gutted that we chose to ditch our pet insurance..!!

Eddie:-
Duston was originally on 13 units twice a day. When his BG shot up this weekend on the steroids, it was increased to 15 units twice a day.
All through the investigations Duston has shown no signs of pain (one reason why our vet isn't convinced he has VDD/wobblers). His mood is very low though, which makes me think he could be in some degree of discomfort somewhere. I will be asking the vet for some pain relief to see if it makes a difference.
I'll also be asking for B12. The vet doesn't seem to think it will be beneficial but, in all honesty, I can see it doing no harm even if it is no help.
Did the B12 help Eddie..??

Momofdecker:-
I do believe Duston was tested for pancreatitis as our vet told us his pancreas was OK.
I don't have any of his records but I do know that his BG at the time of diagnosis was 28.4 and no curve was done at that time. All curves have been done by me at home.
The vet did test for ketones and everything was fine. I have ordered some home test strips today and already have a pee catching pot allocated
I don't have a copy of his bloods either (I really must get my hands on all this info) but we were told that all the blood tests came back within the normal levels.
His bark hasn't changed nor, I believe, has his vision. He has cataracts as a result of the diabetes and the vet checks them at every visit to the surgery. They haven't changed.
Yes, he does carry his head low when he walks. He always has done. There are lots of things he has 'always' done that I now seem to be questioning
88lb is a good weight for him now. Due to diet and treat restrictions, he has lost about 8lb over the last 6 weeks.
He is on 15 units of Caninsulin twice a day - that was increased this weekend due to his BG rocketing whilst on the steroids. Originally he was on 13 units twice a day.
His steroids are Prednicare 5mg tablets. Fri, Sat, Sun, Mon he was on 4 tablets TWICE a day. Tues, Wed, Thur, Fri, Sat he will decrease to 4 tablets ONCE a day. Sun, Mon, Tues, Wed, Thur he will decrease to 2 tablets ONCE a day. Sat, Mon, Wed he will have 2 tablets ONCE a day and then that will be the end of them. I do believe they have made a difference but increased BG is going to bring its own problems.
Like you, we cannot financial stretch to an MRI to confirm a diagnosis of VDD/wobblers. We could have a tissue biopsy done to determine exactly what type of neuropathy Duston has but I don't feel that he can take such an invasive test that wouldn't achieve much in the long run.
My gut feeling tells me there is an underlying injury. Being a bouncy Labrador he would (even at 10.5 years old) jump to head height to greet his humans and go racing and skidding across the kitchen floor in order to get to his food bowl (just in case his dinner was going to run away)..!! One wrong jump or one slip could have caused some damage. The day he 'told' me there was something wrong, he did appear to be in a degree of discomfort.
I have watched your videos of Decker. The knuckling, turning under and collapse of his front paws is exactly what Duston has been doing, even the staggering from side to side. I haven't been able to find footage that I could relate to in such a way.
Duston, however, has no withdrawal reflexes on any of his limbs. This is what leads our vet to believe that Duston has polyneuropathy.

Parje1:-
Thank you for the information on B12. Is it injected in the same manner as the insulin..??
Our vet suggested that accupuncture could be beneficial for wobblers but would not be helpful for polyneuropathy.

Symptoms that could be one thing or another that require totally different treatments. I've never been blessed with patience but I must learn to take it one day at a time. However, it would be nice to get through a day with no tears..!!

Thank you all.

[Riliey and Mo]

Re: Distraught with worry

Hello and welcome

can you post a recent curve that youve done?

How much did the vet increase his insulin from 15 iu twice a day?

are you injecting right after food every 12 hours?

where are you injecting?

what food is he eating and how much?

Just a few questions for more data on Duston thanks

mo

[k9diabetes]

Re: Distraught with worry

So sorry to hear about Duston's problems... It very much sounds like his diabetes is a relatively small problem compared to what sounds like significant neurological problems.

The weakness and knuckling in the forelimbs suggests that there is some kind of disease somewhere from the brain to the base of the neck. Unfortunately, a brain tumor is one possibility along with some kind of disease of the spinal cord above the front shoulder level.

Steroids are one of the treatments for brain / spinal tumors.

Do you have access to a veterinary neurologist?

A consult with a neurologist is critical in a case like this, as soon as possible. There are many noninvasive tests they can use to help determine where the problem is coming from.

The difference between even an internal medicine specialist and a neurologist is huge. The neurologist's special training can make a huge difference in the ability to accurately diagnose.

Wish there was better news...

Natalie

[MumofDuston]

Re: Distraught with worry

Thank you Riliey and Mo.

Between 23/12/14 an 30/12/14 I took 'random' tests on the vet's advice. The lowest BG reading we got was 336.6 (18.7), the highest was 511.2 (28.4). Out of 20 tests, only 3 were lower than 360 (20).

I did the first curve on 01/01/15:-
07:30 - 457.2 (25.4)
Breakfast followed by 13 units Caninsulin
09:30 - 457.2 (25.4)
11:30 - 480.6 (26.7)
13:30 - 349.2 (19.4)
15:30 - 273.6 (15.2)
17:30 - 322.2 (17.9)
19:30 - 261.0 (14.5)
Tea followed by 13 units Caninsulin

Curve of 11/01/15:-
07:30 - 298.8 (16.6)
Breakfast followed by 13 units Caninsulin
09:30 - 264.6 (14.7)
11:30 - 421.2 (23.4)
13:30 - 331.2 (18.4)
15:30 - 293.4 (16.3)
17:30 - 270.0 (15.0)
19:30 - 253.8 (14.1)
Tea followed by 13 units Caninsulin

Curve of 16/01/15:-
07:30 - 423.0 (23.5)
Breakfast followed by 13 units Caninsulin
09:30 - 370.8 (20.6)
11:30 - 489.6 (27.2)
13:30 - 311.4 (17.3)
15:30 - 496.8 (27.6)
17:30 - 457.2 (25.4)
19:30 - 477.0 (26.5)
Tea followed by 13 units Caninsulin - Start of Steroids, 20mg

Curve of 18/01/15:-
07:30 - 505.8 (28.1)
Breakfast followed by 13 units Caninsulin - Steroids, 20mg
09:30 - 662.4 (36.8)
11:30 - 581.4 (32.3)
12:30 - 549.0 (30.5) - I check this one an hour early as others so high.
14:30 - 558.0 (31.0)
17:30 - 612.0 (34.0)
19:30 - 469.8 (26.1)
Tea followed by 15 units Caninsulin (upon vet's advice)- Steroids, 20mg

Duston remains on 15 units twice a day.

I am injecting around 15 minutes after food at 12 hour intervals.

I am injecting around his scruff and shoulder area, both left and right sides alternately.

He has 180g Arden Grange White Fish & Potato Sensitive (dry) with 100g Arden Grange Partners White Fish & Potato Sensitive (wet). He has 3 tablets of Lintbells Yumove Advanced twice a day in his food.

K9diabetes:-

Thank you.

I, too, believe that the diabetes was discovered purely by accident when the other problem flared up.

Our vet thought that there could be something from brain area down to shoulders. X-Rays showed nothing but, as I said before, perhaps only an MRI would be conclusive.

We are weaning Duston off the steroids now, as per the vet's advice. I do feel that he had improved whilst he was taking them. The next few days will tell, no doubt.

Our vet can refer us to a specialist center in Birmingham, he suggested for an MRI but I wonder if there are other options..?? To be fair, he has been consulting with the specialists at the center and they agree that it is, most likely, polyneuropathy. Yet, still, I'd like to know the cause so we know how to proceed.

I will chat with later.

Thank you.

[momofdecker]

Re: Distraught with worry

I wanted to share a bit more with you.

I'd have to go back and look but Decker was started on twice daily dosing of steroids as well. I think it was for a week or two and then we reduced to once daily dosing and then tried to go to every other day dosing. When we started the steroids within two doses we saw a marked improvement in his mobility. When we went to once daily dosing we saw a mild regression. When we went to skip a day dosing we saw too much regressions and asked his vet to go back to daily dosing. He never really got back to looking as good as he did before we did the skip a day dosing. The week we lost him we'd just started him back on twice daily dosing.

What we noticed with the steroids as we were trying to taper them is that we did have to adjust his insulin dose based on his fasting number. He was on levemir insulin, which is four times as potent as other insulins and his needs ranged from 3.5u to 5.5u while on steroids.

We also gave Decker methyl B12. Don't know if it ever helped, but know it did not hurt him. I'll let Eddie's mom give you more info about where she purchased hers as I see you are in the UK.

In addition to the Methyl B12, we gave cosequin to address joint pain, his neuro prescribed gabapentin to address pain and a few months before we lost him, his GP vet prescribed tramadol to provide additional pain relief. Decker was also hypthyroid so he got meds for that to. We had a taped med schedule in our kitchen and a calendar where we wrote in his steroid schedule.

As you noted, Decker never lost reflex response in his feet. His tail never stopped wagging. He did have a few bouts of fecal incontinence though. I remember being frustrated with the front paw knuckling as well. Our vet had initially thought it was degenerative myelopathy when he was experiencing the struggles with his rear legs, but the progression of weakness/knuckling to his front legs never seemed to fit with that theory. The other thing we'd looked at was what is known as GOLPP (http://cvm.msu.edu/hospital/clinical...pp-study-group) - but Decker had a change in bark and was hypothyroid which were reasons we looked at that.

Sending prayers you way in hopes you are able to find some answers. Folks here are great for moral support and just to bounce ideas off of.

[Eddie]

Re: Distraught with worry

In reply to your query on B12, we think it may have helped Eddie although we don't really know whether it was just getting his diabetes stabilised.
We gave him weekly B12 injections from the vet plus B12 methyl tablets and B12 with intrinsic factor, getting both tablets from Amazon.

The vet had already said that he thought Eddie only had 3 weeks left so we were pretty desperate and we just guessed at a dose which we thought would be big enough to make a difference so he had a lot! The vet wasn't really involved except for giving the injections. Apparently any excess is just peed out.

Bear in mind that Duston's insulin requirement may drop sharply as he comes off the steroids.

For what it's worth Eddie's mood was beyond low while he had the neuropathy. For several weeks he literally spent all day and night in his bed, lying on his side, apart from staggering out to toilet or lurching over to his food bowl while we propped him up. He had no interest in anything and looked awful. His behaviour coupled with the vet's grim prognosis would almost certainly have led to us having him put to sleep except for the advice I got on here that he might pull through it. One of my friends urged us to give him "time to be ill and time to get better" and that also encouraged us to wait and see. It helped to know that he didn't seem to be in any pain. His BG numbers at the time were not extravagantly high - similar to Duston's without steroids.

I hope Duston feels better soon and you can find some answers.
Antonia

[Eddie]

Re: Distraught with worry

A few thoughts on Mom of Decker's post - [I can't get the quotes to show properly]

We also gave Decker methyl B12. Don't know if it ever helped, but know it did not hurt him. I'll let Eddie's mom give you more info about where she purchased hers as I see you are in the UK.
We got Swansons brand from Amazon.


As you noted, Decker never lost reflex response in his feet. His tail never stopped wagging.
Just noted this - oddly enough Eddie's tail most definitely did stop wagging. It seemed as if his tail had gone numb and he would lie on it at a funny angles, squashing it in a way that he never would normally. No idea if that's significant but thought I'd mention it. It all helped to make him look deeply depressed.

[k9diabetes]

Re: Distraught with worry

Ideally, a neurologist would personally perform the exam. They do many tests involving manipulating various body part and looking at the responses.

Even the direction of eye movements can influence their diagnosis.

Our dog, for example, had what was likely some type of vascular event. Our GP vet at the time was sharper than most. He did the basic neuro tests and found some things consistent with a temporary syndrome but others not so sent us immediately to the neurologist, who confirmed that it wasn't the minor syndrome and concluded it was something in the brain, most likely a temporary clot, like TIAs in people.

In our dog's case, the eye movements (nystagmus) did not match the syndrome.

Here's a page on polyneuropathy (peripheral neuropathy):

http://www.petmd.com/dog/conditions/...l_neuropathies

Natalie

[amydunn19]

Re: Distraught with worry

Just a note on the insulin injection - some people get poor absorption from injecting the scruff. You might try the flank area further back to improve absorption. It may not even be an issue - it is just something that is discussed a lot here and it seems Duston needs every little bit of insulin right now.

I can't be of much help with the other issues as I never had them with my little dog but I am glad we have some people very well versed in this type of issue. Best of luck to you.

[MumofDuston]

Re: Distraught with worry

Thank you all so much. I already feel a great deal of comfort knowing that Duston isn't alone, and I feel a little less lost.

Momofdecker:-

When our vet prescribed the steroids, Duston had only just started falling over. He saw him on Tuesday of last week but he couldn't start the steroids until Friday evening (he had to get Metacam out of his system). By the time we got to Fri/Sat, Duston could hardly stand by himself. His front paws knuckled as soon as they touched the ground and his rear end was out of control. It took until Monday to see signs of improvement. We saw the vet yesterday but, as far as he was concerned, he could see no improvement since he last saw him. However, in that time, we had seen a huge deterioration and we were now seeing progress..!! I know the steroids will play havoc with his diabetes but I am loathe to stop them completely (more so now I have read about Decker's experience).
Duston hasn't shown any signs of pain, just deep depression. Was Decker's pain obvious..??
Duston's tail hasn't been very waggy if late. Although this afternoon it seemed to go into overdrive
Thankfully, so far, there is no change in his bark (but he really hasn't been using it much lately) I am keeping an eye on his swallowing whilst eating and drinking. This evening his teeth were periodically 'chattering', particularly when he was anticipating his tea being dished up. I don't know how significant this is.

Eddie

Thank you for the information on Swansons B12, I will have a look on Amazon. As long as I am in no danger of overdosing him or giving him the wrong thing, I'm going to give it a try. I will ask our vet about injections too.
I am so sorry Eddie had to suffer so much, but it is reassurance to me that I must be patient and give Duston the time he needs. It's just so heartbreaking seeing him this way.
The top of Duston's tail has sometimes taken on a 'hooked' shape when he has been laying flat on his side. I'm sure he still has feeling in it, it just looks rather odd.

K9diabetes

Thank you for the information on the neurology examinations. I feel more confident that this is the way we should go as soon as possible.

Amydunn19

Thank you for the advice about the injecting site. This evening I started his injections in his flank. It will be interesting to see what results we get. If he is suffering from some ailment around his neck/shoulder area, it would also seem sensible not to be poking around there with needles every day.

-oOo-
Out of interest, Duston seemed very alert this afternoon. My husband brought him to see me at work and it really peaked his interest. For the first time in 8 days he was able to have a wander unsupported. He was a bit wobbly and fell down a couple of times but he was much improved on how he has been and I felt happy to leave him to it (like letting go of a child when they take their first steps)..!! Tonight, however, he is wrecked and in need of some support again (when he does muster the energy to get to his feet). It must have really taken it out of him.
Also, as I mentioned above, his teeth started to 'chatter' when he was anticipating the arrival of his tea this evening. Does anyone know if this is significant..??