Monthly Archives: May 2013

Hepatocutaneous syndrome AND diabetes: look ma’ still NO lesions!

April 11, 2013

Life’s been really busy! We’ve gradually increased her insulin, so she was now on 14 units twice a day. Her appetite was definitely improved and now she would eat by herself without being hand fed! We continued on the liver cleansing diet, with Ezekiel bread with cottage cheese and sour cream.

Had labs repeated and they actually were coming down nicely, except for CK, which might be related to muscle wasting, not so much liver issues.

Alk phos: 381, down from 1326!
ALT: 248, down from 436
AST: 146, down from 211
CK: 812, up from 452
Glucose: 214, down from 396
T4: 3.7, up 2.2 (interestingly, we had NOT changed her thyroid medication, yet her thyroid seemed to be improving with the improved nutrition!

We weaned her off the thyroid medication over the next week and will just continue to monitor her labs, as well as her clinical symptoms

Hepatocutaneous syndrome: got busy……oh NOOOO! The lesions are back!

April 24, 2013

Life continued to get busy! Since the real estate market was going absolutely crazy, I was doing good to get home in time to get Zoe’s insulin in her at night. Then….

Zoe is licking on her paws!! This is how this started in September!!! Auburn from our veterinarian clinic remote treatment service had called her resolution of the lesions “remission”. Did this mean we were going to go through everything all over again?! Initially, I thought it was just an infection between “her toes” and restarted her on an antibiotic. Within a week, unfortunately the lesions came back on her lip margins and her paw pads began to get crusty on the back margins and look “weepy”. I cried and prayed and prayed and cried. We didn’t have any other options for venous access and it just meant that our time with her was up.
During the next several nights, I was awakened to the realization that in the midst of being SO BUSY, I had stopped making her chicken stock! Now, God knows i am both TOO stubborn and TOO dumb to put this all together, so HE has to awaken me to speak to me! I went to Whole Foods the next day and got 2 “naked” rotisserie chickens, pulled the meat off and put the bones in the crockpot, covered the bones with water and cooked for 24 hours. (another Divine intervention, as I opened the rotisserie chicken containers, they were filled with liquid and as some spilled, I poured it into a cup to give our Weimaraner a nice liquid to pour over his dry dog food.) Within 5 minutes it had cooled and turned to gel!!! So, she actually got a “quick start” with the “free gelatin” that I didn’t even know was there!!

Fast forward to May 16th….her lip lesions are now GONE!! Her feet are not completely resolved, but they are no longer weepy and necrotic!

So, back at the end of 2012, I had started giving her Procell, after reading a case study from a vet in New York, Dr. Jason Berg who had some success treating a German Shepard with it. Within 5 days, I started the chicken stock and within 2 weeks, her lesions were resolved! I had accidentally just done an experiment on poor Zoe, but now I had been able to re-create what had happened in January!

I would have NEVER experimented on her, but now that I have, I just want to get information to other dog owners whose sweet dogs have been diagnosed with this disease. I Truly don’t know if it will work for other dogs, but it’s chicken stock!!! It can’t hurt!!!

Managing hepatocutaneous syndrome, canine diabetes

Zoe at front doorFebruary 18, 2013

Recheck on her labs and still difficult to get her to eat, but vet had great idea! When I discussed the stringy vaginal discharge and how she was licking her bottom, she suggested sour cream and cottage cheese to help with yeast infection.

Zoe LOVES cottage cheese and sour cream!! Hallelujah!! A real break through!! Sour cream and cottage cheese on anything and she would eat it!!! We increased her insulin to 10 units and started only measuring her urine dip sticks. She was spilling 1/2-1+ on glucose and either negative or trace on ketones. As she would spill more glucose over several days, we would increase her insulin by 0.5 units and leave her there for a few days and if she continued to spill 1-2+, we would increase her insulin, only increasing by 0.5 units per 2-3 days period.

Gradually her appetite began to increase with the aide of sour cream and cottage cheese! Still no return of her lesions and she really seemed to feel better and have more energy!

Alk phos: 1326, down from 1841
ALT: 436, down from 512
AST: 211, down from 268
CK: 452, up from 240
BUN: 44, probably related to feeding her so much protein, as that’s about all she would eat!
Glucose: 396, down from 487

Hepatocutaneous syndrome and diabetes: the worst labs yet

January 24, 2012

Our last trip to Auburn, this time to get help with controlling her diabetes. Her labs were the worst yet! It seemed that the moment her pancreas stopped making insulin, her liver also seemed to freak out! Actually, some of the increased lab results were from the diabetes, not the liver disease.

Alk phos: 1841, up from 828
ALT: 512, up from 189
AST: 268, up from 168
Glucose: 487, up from 384

We got to see Dr. Gimmler’s face as she saw that all Zoe’s lesions were gone! Zoe was so excited to get to see everyone, she was jumping and running around–quite a different dog than when we first were seen at Auburn! Even though she had lost 5 pounds since we were last seen, she certainly seemed to feel better!

When we got home, after all the excitement, Zoe was completely worn out. She would NOT eat and we had to get an appetite stimulant: Mirtazapine 7.5 mg to be given as needed to help stimulate her appetite. It did help, but I still had to hand feed her just to get her to eat much of anything! It was really frustrating to watch her continue to lose weight, when previously one of her favorite things to do was to eat!!

Hepatocutaneous syndrome: symptoms resolved, but now new diagnosis–diabetes

January 15, 2013

Blood sugar of 664!!!! Oh my!! We started her on 5 units of NPH insulin after discussing her blood sugar with our local vet. We decided to do a “curve” at home to try to see how she was responding to the insulin.

Over the next several days, we did several glucose curves and got ranges from 388 to 620. We increased to 6 units after 4 days at 5 units. She didn’t seem to have any somogyi effect (where blood sugar drops too low and rebounds to hyperglycemia)

Even though I have a background as a nurse practioner, it was just plan awful to have to stick her to get enough blood to test her blood glucose.

Hepatocutaneous syndrome, now symptoms resolved….but different diagnosis!

December 28, 2012

Made Zoe her first chicken stock by cooking the bones in the crockpot for 24 hours after the chicken meat was removed! Within 7 days her lip lesions actually seemed less visible, by January 7th, I KNEW they were improved!! By January 11th, her lip lesions were gone!! Her paws still looked raw and had a long way to go, but we had hope!!

Now, for the next wrinkle: she was having hind leg weakness and I worried that her anti-seizure medication was needing to be adjusted. We took her to our local vet to have labs drawn and it was VERY stressful for her! She’s never liked going, but this time it seemed to really put her over the edge!

By the next morning, she was sick—really sick!! She was vomiting, drinking like crazy and I knew the signs—she was now diabetic. We had the labs results back that am from the day before–glucose was 384 and her fructosamine was 476, both high. Equally bad, her liver function tests were elevated (more than at the beginning of her symptoms!)

Alk Phos: 828, up from 228
ALT: 189, up from 53
AST: 168, up from 28

Her potassium was 6.0, which was above the reference range and I became concerned that one of her seizure medications (potassium bromide) was part of the problem with her leg weakness and could be causing the high potassium levels. The only bright spot was her hematocrit was finally within normal range at 38.3. (Finally had enough poly-vi-sol with iron to make a difference!)

We called our local vet and ordered a home blood sugar meter and by January 15th, when the meter arrived and we checked her blood sugar, it was 664!! No wonder she was so sick!!

Hepatocutaneous syndrome: no hope, just keep her comfortable

December 26, 2012

The day after Christmas and we almost cancelled the visit since Dr. Gimmler wasn’t going to be there, as she was on vacation. We decided that I might be good to get insight from another vet with more experience, so we kept the appointment.

The history part went well, but his approach was FAR different than Dr. Gimmler–he wanted me to understand that the disease is fatal and we just needed to make Zoe comfortable.

It was funny, on the trip down, my husband and I had carried on a similar conversation–we were at the end–no venous access and the fresh frozen hadn’t helped her symptoms at all. We wanted to make sure it was clear we didn’t want them doing a lot of extra measures, but mainly just wanted to make sure there was no “stone unturned”. Evidently, he had similar concerns that I was pressing this just too far and needed to let the disease run its course.

He also wanted to really examine her paws to see if there was anything we could do to help with the infections. After a good conversation, we left Zoe for the exam and went to get some lunch. We were told they would call us when they were ready for us to come back.

We still hadn’t received “the call”, so we drove back to Auburn to the parking lot and just parked and waited for the call. As we waited, we discussed how GREAT the gravy was that I made for Thanksgiving–but it had turned to “gel” in the frige. My husband was telling me how he just did not like eating anything with that much FAT in it!! I argued that it wasn’t fat, but I thought something in the bone marrow and since we were sitting in the car and had time to kill, I googled “what makes gravy turn to gel”. One thing led to the other and shortly I was reading Dr. Ray Peat’s experience with gelatin and how it is made up of amino acids! Just the thing hepatocutaneous syndrome patients are missing!!!! I learned the difference (from another site) between chicken broth and chicken stock! Chicken stock turns to gel when cooled and is made when the bones release their collagen (amino acids). I decided right then and there I was making chicken stock when we got home! Ok, so really!!!!!?…God divinely showed me about chicken stock while waiting in the parking lot to pick up my dog?? Would it make a difference?

We got The Call and went back inside to get Zoe. We were told they gave her a different sedative this time that would be short acting. (Butorphanol instead of the usual methadone). Zoe came out very “drugged” and was really unsteady as she tried to walk. We got her in the car and headed back to Birmingham. By the time we got home, she was vomiting bile (not a good sign when your dog has liver disease!!) They had suggested we change her pain medication to Codeine, rather than tramadol and gabapentin. This wasn’t exactly the outcome I had hoped for!

Hepatocutaneous syndrome: the good news and the bad…

December 17, 2012

Let’s start with the good news!!

Zoe’s labs were incredible! After being on Dr. Dodds liver cleansing diet less than 2 months, her labs were practically normal!! Dr. Dodds had suggested that I could HOPE to get her Alk Phos to around 250, since she is geriatric!

Alk phos: 228–down from 297
ALT: 53–down from 84
AST: 28–down from 35

Hct: still anemic at 32.6. Valuable lesson here: check the expiration date on supplements! I had been giving her Poly-vi-sol with iron to supplement the liver cleaning diet, but just realized that it had expired about Six months ago!

Ok, now for the BAD news, after giving the aminosyn in a central catheter, they could no longer thread the catheter far enough to administer the Aminosyn, due to scarring from all the infusions. So, for now, we tried plan B. Dr. Dodds said that she has had some success with giving fresh frozen plasma, which didn’t require a central line, so we opted to administer that instead of the Aminosyn.

For the moment, hepatocutaneous syndrome seems to be winning, we will see how the FFP helps!

Well, no luck with the fresh frozen, now we were out of options! I prayed, Jesus, I know she is just a dog, but she is my sweet girl and I love her. I need YOU to either show me it is time to just let her go or i need YOU to heal her. I honestly don’t know how people whose children die get through it. I just imagine that by God’s grace HIS hand is the one that holds them.

Hepatocutaneous syndrome. What other treatment options are there?

December 6, 2012

After our last infusion of trophamine, Zoe had little improvement in her lesions. I learned that one of the vets at Auburn had had a dog have his lesions resolve a few years ago. I asked Dr. Gimmler to see if the other veterinarian would be willing to review the chart to see what was different with the treatment plan of that dog and Zoe’s treatment. There was one difference: they had used Aminosyn 8.5%, which WAS available (unlike the Aminosyn 10%, which continued to be on manufacturer back-order) Yaaay!! We had options!!

We were excited that hopefully we could see some benefit again utilizing the aminosyn. As with each visit to Auburn, Zoe loved seeing everyone! She would wait by my car to get to buycbdproducts for what we began calling her “spa treatment”. The following day, as the vet student would walk her down the hall she would want to stop and “visit” with everyone along the way! I loved watching her interact with everyone–they seemed to always make her feel “special”! Crazy, I know!!

Unfortunately, her paws continued to have fungal and bacterial infections–she continued on oral antibiotics and now on oral anti-fungal medication, as well. We also started her on ResiKetoChlor, which really seemed to help soothe her paws! Zoe seemed to have a chance to beat Hepatocutaneous syndrome!

Hepatocutaneous syndrome: is there anything I can do for her?

November 26th

After having lots of family stay with us for Thanksgiving, we were all very tired, Zoe tolerated all the activity well, but her appetite was waning. i had to hand feed her and she decided she really didn’t care for fish! I made her the liver cleansing diet using chicken instead and she would eat (as long as I hand fed her)
we took Zoe back to Auburn for her Aminosyn 10% infusion. (Only to determine that there was a manufacturer back-order and since our results with Trophamine weren’t as good as we had with the Aminosyn, we were concerned that we might not get the same benefit from from it, but we had to try again without any other options) so, she got the trophamine instead of aminosyn

Since she had been on the liver cleansing diet from Dr. Jean Dodds for about a month, I wanted to see IF there could have been any improvement. WOW! It was working!

Her labs were:
Alk Phos: 297 down from 516
ALT: 84, down from 117
AST: 35, down from 41
GGT: 8, down from 22 on Oct 6th (wasn’t checked originally at Auburn, but Dr. Dodds suggested we check it to determine how hard her liver was working)

Amazing! The liver cleansing diet was actually bringing her liver enzymes down!! Maybe hepatocutaneous syndrome wouldn’t win this one–now IF if the skin would follow!