Ask a vet 24/7: Lab with Blood Blister & Rat Terrier on Multiple Meds

Have you ever gotten home after a vet visit and realized you forget to ask them something important? Of course, this scenario typically happens after the vet hospital is closed and lines of communication are severed.

Embrace is proud to partner with VetLIVE.com to offer policy holders access to a team of licensed and accredited vets. Whether your need to double-check with a veterinarian on a medication, have a question about a potential toxicity, or you have more detailed pet health concerns, VetLIVE’s veterinarians are available to provide guidance when you need it most.

Below are real questions asked of VetLIVE veterinarians! Hopefully, the answers could help you in an emergency.

blood blisterLab with Blood Blister

Question: “Bella, 1 year old, was spayed at 5 months. She rejected some of her internal stitches. I think the vet used pretty thick\big ones because she is a rambunctious Lab. I just noticed a sizable blood blister in the same location, about the size of my thumb. I was going to wait till tomorrow to take her to the vet.

If it pops I have some Vetericyn wound & infection treatment spray, but it has an expiration date of 11-1-2012. Think I can wait till tomorrow? Can I use the spray if it pops? ”

Answer:

Some medications actually become harmful after their expiration and I don't believe Bella to be in danger of a serious systemic infection so I would hold off on using the spray.

You can clean it with a basic dish soap and water. Do make sure to rinse it well and try to keep her from licking the area.

I think you should be fine to wait until tomorrow for the vet visit. I have seen much worse and am glad it looks as good as it does. Please let me know if you need anything else!

Rat Terrier on Multiple Meds

Question: "My Rat Terrier has been diagnosed with Meningitis and is on 25mg of Cyclosporine daily and 1/2 Prednisone every other day. Due to the medications she has also developed Diabetes. She is now taking 6 units of insulin twice a day and her blood sugar curve remains at 519. Is there another medication that I should mention to reduce the blood sugar and glucose in her urine? Is it possible for the diabetes to be cured if we are ever able to get her off the Pred and Cyclosporine? She is also on a medication to protect her liver called Denosyl. Thank you for your help!"

Answer:

Wow, what a number of complicated disease processes Isabella is struggling with!

I first want to try to explain diabetes and prednisone in dogs. Prednisone doesn't cause DM in dogs, although the prednisone could have absolutely unmasked it sooner rather than later. Diabetes in dogs is Type1 Diabetes. We don't know what causes it in most dogs (in general, could be stuff like smoldering subclinical pancreatitis in about 30% of the cases and who knows for the rest of them).

When a dog becomes diabetic, it has had a problem in the beta cells of the pancreas for a long time and finally, when there is NO MORE insulin, the BG's go up. If you come along with an insulin antagonist (like prednisone), that can antagonize the last little shred of insulin the dog has, then you could unmask the problem...but the dog was going to become diabetic in a short while anyway...there's just no way around it.

As far as getting this DM under control, I'd have some conversations with you vet first. Are you doing the curves in the vet hospital? If so, it would save a lot of money for you if could learn how to generate them at home, although I am not sure if this is a concern of yours. Also, testing at home, IF YOU ARE COMFORTABLE WITH THIS, is probably more accurate because the pet is less stressed. Blood glucose rises when pets are stressed. How much this affects the results is dependent upon each individual pet.

Ask you vet to see if they recommend getting a glucometer, that tends to work well (in my hands that's either an AlphaTrak or a One Touch Ultra). Then, I prefer to do the FIRST curve in the hospital, so your vet can compare the numbers (not just once but over the course of the day) to the owner's machine vs those on a machine that we know to be accurate in-house.

Once you know the glucometer is working accurately, you need to learn some basic know-how (and your vet must show you these in person):

  • how to get the BG samples: for big dogs, use a lancet in the accessory carpal pad or buccal mucosa or even an elbow callus
  • how often to do a curve: must wait 1 week after a dose change before the next curve
  • how many BGs to get during a curve (every 2 hours throughout the day, changing to once an hour if the BG's are <150 mg/dl at any time)
  • most importantly, to let the VET decide on the insulin dose (some people want to decide this themselves when you give them independence to do the tests at home, but this is NOT RECOMMENDED; your vet knows best).

Other things are important to make sure the management of things is going well:

  • you can accurately measure and then inject the insulin
  • you are moving the injections around on the dog's body every day
  • you are neither OVER- nor UNDER-shaking the insulin (sometimes we scare pet parents so much  about not over-shaking it that they fail to reconstitute it well and inject diluent)
  • you are ONLY feeding the prescribed diet at mealtimes, when the insulin is given, using a MEASURING CUP and the amount is REASONABLE for a dog her size (sometimes when the weight is falling off of them pet parents panic and start really over-feeding the dog---which means we have to chase after them with an ever-increasing amount of insulin)

Changing to different insulin sounds like another good option to me after you exhaust these options.

I also want to add that the glucose toxicity from the hyperglycemia is toxic to the beta cells of the pancreas and impairs their ability to function, so the sooner you get the hyperglycemia under control, the sooner the beta cells recover. It is unlikely that her diabetes will resolve if the prednisone can be stopped, but the sooner this happens, the better shot she has.

The denosyl should not be a problem.

I hope this is helpful to you and Isabella!

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