Blood Sugar Monitoring

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Got an email the other day about monitoring a dog's blood sugar.  I've mentioned before that my brother Eric monitored his dog's blood sugar, while I didn't.  Tony had regular blood sugar curves done, and they were always consistent after the first couple of months.  Eric's dog Lucky (always a bad choice for a dog name), however, was almost always out of control in that area.  Eric had several things going for him that I didn't:  at the time, he himself was diabetic (he isn't anymore, thanks to some pretty serious lifestyle changes), so he was hyperaware of everything connected with that; Lucky was a BIG Labrador retriever, which made it easier to draw the tiny bit of blood needed for the test (trying to do this without help to a Pomeranian ain't easy; you can't ever get the right grip); and, Eric is a behavioral psychologist with tons of experience with animals and many medical procedures.
At any rate, if it had been necessary to test Tony's sugar, I would have found a method of getting the blood, and it would have become routine in a hurry-- that's just the way it is.  If your vet tells you to do this, DO IT.  Like giving the insulin injections, you'll get better with practice over time, and you'll definitely get better control over your dog's diabetes.  There's a veterinarian's discussion of this at Pet Place; it's a basic explanation that should give you enough information to ask your vet the right questions.

Incidentally, there's something new and exciting in the monitoring pipeline for humans, which should eventually work itself into veterinary applications.  See the article below.

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Dogs acting weird

It's been a week since Tony started getting the new food, Royal Canin Urinary SO. I was not impressed when I opened the can. SO (I don't want to keep typing "Urinary"-- kind of a gross name for something edible, isn't it?) is very dense and dry, which surprised me. The Lamaderm Tony usually eats is much looser and wetter, and I guess I expected the SO to be about the same, but it's so dry and solid that you really have to work to break it up. I started by mixing about 2 teaspoons worth into a slightly smaller than usual amount of Lamaderm, added the usual teaspoonful of cooked chopped broccoli (Tony loves this, and it does not produce oxalic acid, thank goodness), and set it in front of him. I'd like to say that he was intrigued by the new addition, but no, he was in one of his moods, and refused to look at the bowl. He does this once or twice a week, just to keep me on my toes, I guess, but I was in a kind of anticipatory frenzy over this, so, instead of ignoring his behavior, I followed him around for a bit, tapping my fingernail on the bowl and chanting, "Eat! Eat! Eat!"
After a few minutes of this, he went into his favorite corner, yawned, and -- very ostentatiously -- went to sleep. My family started drifting into the room, each asking about dinner. I'm now thinking about adding a sock-puppet component to my coaxing ritual.

As usual, after an hour or so of concentrated spurning, Tony deigned to stroll over for a taste, and apparently found it to be acceptable. What a relief! I'm sure I've mentioned that he (like all dogs) refuses to eat at all every so often, and I was really keyed up over the potential effects of the SO. I was so hyped about it, in fact, that on my way back from picking up the food at the vet's, I stopped at a Petco and bought a "Male Incontinence Wrap." It cost $22, which is an outrageous price for what is basically a strip of denim and vinyl with a Velcro closure. I did not buy any liner pads, because they were priced even more outrageously-- $17 for a pack of 12! My sister has been using one of these on the older of her two Great Pyrenees, and she uses Serenity pads (for humans), which are much cheaper, so I'm going that route. For the next couple of hours everyone was watching Tony, but there wasn't much of a payoff. He didn't start drinking copious amounts of water, didn't scratch at the door, no blood-sugar crash, nothing. In a way, it was encouraging, but it was too early to tell anything.

Then, a couple of days ago (he was up to a tablespoon of SO by then), he seemed to stop drinking altogether. I came home from work (I'm teaching an evening class this summer), and my mother told me that she hadn't seen him take a drink in the four hours I was gone, and he hadn't wanted to go outside either. Now we were all watching him, and she was right, he didn't seem to drink, and we had to take him outside, rather against his will. He was, however, sleeping a lot more than usual. What did that mean? Who the heck knows?! Dogs sometimes act weirdly. You try and try to figure them out, but in the end, you're just guessing, and you know it. My best guess is that he was drinking when we weren't looking, ditto for urinating-- it's a big yard, and you can't watch him every second. If he really wasn't drinking, he may have only been adjusting to the reverse-osmosis water that's now in the bowl. Or he may have been registering a complaint about that change. Whatever. Yesterday he was acting "normally" again.

All of this behavioral observation seems to feed my anxiety, so I'm trying to cut back a bit, but at the same time, I have to watch for problems. His latest appears to be stiffness in his right hind leg, which he gets now and then (he is pushing thirteen years old, after all), but it seems to be coming and going throughout the day. Meanwhile, the other dogs have their own problems. Gus's incontinence has expanded to include defecation accidents (this started at my brother-in-law's birthday party, oddly enough). He's always been a bit strange in that area anyway; he prefers to do it on concrete as a rule, on the patio or the deck around the pool. In a way, it makes it easier to clean up, but it's also kind of annoying. Doc is not a patio-pooper, but he does have a problem leg himself (hey, maybe Tony's just imitating him for the attention. Hmm.); he's had surgery on it, without much success. Lately he's been flopping down at odd intervals, but Steve, my sister's husband, says that he's just as lively as ever at the dog park.

We'll see.

Things that make you go, "Huh?"

I don't think I'll ever be surprised again by the odd things that turn out to be important to anybody's health, be they human or not. On Wednesday, while I was at work, my vet called about the report on the stones they removed from Tony's bladder. His stones were oxalate, not struvite. Struvite stones can be dissolved; oxalate stones must be removed surgically. I already knew that whichever it was, I was going to have to change food, but I was hoping that we were not looking at more surgeries in the future to remove stones.

I spent yesterday morning researching the situation. I wanted to know the right questions to ask Dr. Kroll when I returned her call. She had told my mother that she wanted to switch Tony to Royal Canin Urinary SO food, so I read up on that, and I realized that there were going to be problems. This food has meat by-products and corn, both of which I have scrupulously avoided since they are linked to various health issues, and this remains a concern. As Tony eats around half a can of food a day, the $1+ increase in the price per can was not as bad as it would be for a larger dog; I checked around online for suppliers who might have a better price than the vet, but that didn't work out, thanks to shipping charges. The food is supposed to adjust the ph and dilute his urine so that stones don't form, but I was still worried about the diabetic aspect. Tony's diabetes has been under good control, and I have no idea how the Royal Canin food would work in that regard. However, the bottom line was, and is still, that more stones are almost inevitable, at least according to my research, so I'm going to switch.

When I spoke with her, Dr. Kroll expressed some of the same concerns I had about the potential for more stones and about the effect the new food would have on Tony's blood sugar. I asked her about alternatives (she guessed that I wouldn't be thrilled with the idea of the Hill's brand of anti-stone food; she was right), and she said that if I wanted to try it, we (she and I) could consult with a nutritionist to develop a diet that specifically addressed both problems. While I wouldn't mind cooking for Tony, I decided to try the Royal Canin first, to see how that worked before going the homemade route. But there are still a few details that I expect will be hard to deal with because of the food. For one thing, Urinary SO is supposed to increase thirst and frequency of urination, which in itself can affect blood sugar, and we've already had a few incidences of Tony having accidents in the house during his recovery from the surgery and the bladder infection. I'm going to look into "doggy diapers," but he still has the mysterious irritation on his skin, and the diapers might exacerbate that condition. He's also lost some fur recently, and I wonder how the new food will affect that. She is still looking into the skin problem, so I should have more about that later, but for now, she recommends continuing the antibacterial shampoo. In regard to the urinary situation, she wants him to drink only the reverse-osmosis water (we have a household filter system for that because our water comes from a well) that we drink, which means all three dogs will have to switch to that. The only problem I can see with giving them the r/o water is that they seem to prefer their water straight from the well, even though it is extremely hard water with lots of iron and a horrible phosphorus smell. We'll see how that goes.

I'll be picking up the new food this afternoon. Based on Dr. Kroll's instructions, Tony will switch over slowly, over a two to three week period. He'll also have some new restrictions on his diet to eliminate oxalic-acid-producing foods, like spinach and peanut butter, which are particular favorites of his. I sure hope this works!

What a Dog!

Tony is doing well! He came through the surgery just fine. Luckily, they were able to flush the stones back up the urethra into his bladder, where they could remove all of the stones without too much trouble (cutting into the urethra itself would have caused a lot of problems, not least of which is that diabetics don't heal easily and that incision couldn't be sutured lest scar tissue develop and screw up his ability to urinate!). His vet warned me that there might be blood in his urine for the next 3-5 days (and there was some last night), but otherwise he should just take it easy for the next few days.

So, things will probably get back to normal now (I hope), and that's the way it is with this disease: days of routine interspersed with emergencies of varying degrees of seriousness. We've been lucky that Tony hasn't had any major blood sugar crashes, a problem that plagues my diabetic mother. In fact, when he has his blood sugar curve tracked, which necessitates him spending the whole day at the vet's, he has always shown the best possible reactions to food and his insulin. Obviously, this isn't always the case, and I'd love to hear how other people have handled problems with their diabetic dogs.