Early Morning Surgery Advice

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Patty	Early Morning Surgery Advice	Lead	[-]
Registered User Posts: 297 (07/02/09 07:36:38) Reply Quote More My Recent Posts Message Me Connection Blocking Invite Ignore User's Posts Report Post	Tags : None Hi all, Ali has been doing really well with a few adjustments I made the last couple of weeks. Problem is she has a growth on the top of her tail that we've been watching. It has continued to ulcerate and grow. I took her into the vet yesterday and she feels it needs to come off as it will continue to grow and bleed over time - especially if there's a larger blood vessel feeding it. So, we're going to be messing things up again for a while. The vet can get her in on Monday the 6th. She recommends a first thing a.m. surgery (7:30am) with fasting and 1/2 insulin dose. I really hate to do this, especially now that I just got her figured out! But, I feel like we just need to get it over with. I scheduled the appointment. They will do pre-op bloodwork on her and put in a saline lock to administer a glucose drip if needed. She's recommending an oral antibiotic to follow as a precaution for infection and Previcox for pain for a couple of days. Those of you who've been through surgeries with your diabetic, any advice is welcome. What insulin dose did your dog get that day for a morning surgery? And how did your dog do with that? Ali's shot is usually at 6:30am and she'll need to fast. I've never given her 1/2 her insulin dose without food, so don't know where that will land her bg-wise. The vet did comment that she knows some vets like to do no insulin but she felt it was better to have some insulin working so her bg isn't sky high. Someone else I talked to prefers to do 1/3 of the usual dose. What do you all think? Ali is on Humulin N. Thanks! Patty Patty and Ali 9 years 48 pounds diagnosed May '08 Primal's Pheasant formula plus probiotic and vitamins - fed 4x a day Humulin N 8 1/2 units twice a day
LouieTX		#1	[-]
Registered User Posts: 113 (07/02/09 09:09:53) Reply Quote More My Recent Posts Message Me Connection Blocking Invite Ignore User's Posts Report Post	If Ali was on a basal insulin, like Levemir or Lantus, I would say that she would still need some to tide her over through the day. But with Humulin N, I'm not so sure. Actually I'm a little surprised that your vet is suggesting giving some of the N, since Ali will most likely be fasting much of the day. When Louie had his radiation therapy treatments for his osteosarcoma, the oncology vets told us not to give any insulin the morning of each treatment. Yes, his sugars were somewhat higher for the day, but they didn't have to worry about him crashing with a low blood sugar. Even my human patients don't get any insulin on the day of surgery when they are fasting (unless it's Lantus or Levemir). I am assuming your vet will be closely monitoring Ali's blood sugar, so hopefully they would catch any precipitous drops. If it were me, though, I would probably just give 1/3 dose and then let the vet know about it. Good luck with the surgery--let us know how everything went! --Beth in Houston, TX "Big Lou"--black lab mix, 106 lbs, diagnosed with diabetes in 3/07. Gets 38 units of NPH twice daily. Also twice a day--3/4 cup Fit 'n Trim kibble, 1 can Pro Plan Chicken Entree canned food, 1 cup of broccoli, 1 heaping tablespoon pureed pumpkin and supplements of C-Caps and flax seed oil. Treat--1/2 milk bone biscuit after insulin. Diagnosed in 3/09 with osteosarcoma, had radiation therapy for palliative pain management, also takes Deramaxx, Tramadol, sam-E and Pepcid twice a day, and just started him on Artemisinin, a chinese herb that helps fight cancer. Last Edited By: LouieTX 07/02/09 09:14:03. Edited 1 times.
dmarie		#2	[-]
Registered User Posts: 144 (07/02/09 11:22:53) Reply Quote More My Recent Posts Message Me Connection Blocking Invite Ignore User's Posts Report Post	When Moki had to have surgery last fall for dental problems, his doctor also said to fast him and give half the amount on insulin. he was monitered during and did excellent. Moki was home by noon the same day. Bg's stayed around 180 through surgery. He was also on Humulin N. D'marie Salt Lake City UT Precious Angel Moki - Born November 24, 1994 (dx 12/07) Entered Heaven April 5, 2009 Forever may you run little boy!! Priscilla (Cillie) 11 yrs Perfect Health - Chablis (Beanie) 14 yrs Healthy (controlled Addisons disease) Sami 10 yrs Perfect Health & Sweet Angel Jassi Born 03/19/1995 Entered Heaven Sept 14, 2007 Forever we love you little girl!
IamMomtoMissy		#3	[-]
Registered User Posts: 13195 (07/02/09 13:05:28) Moderator Reply Quote More My Recent Posts Message Me Connection Blocking Invite Ignore User's Posts Report Post	When my little Missy had to have a portion of her bladder removed ( cancer tumor) she was scheduled for 9AM surgery...I was to bring her in at 8. Missy was on an 8 AM/PM schedule. What we did was start a few days ahead of surgery I WAS to make her shot a bit later each day so the night before she got food/shot about 9:45 I believe it was. I recall we wanted to go as late as possible but no later than 10 PM as that was when she was to start her fast. She got no food or shot the morning of surgery. ( She still had some duration from her later than norm shot night before) At 11 AM I got the call Missy was out of surgery and already awake.... and I was told her BG was then at mid 90s. Of course it was going to continue to rise thru the day. I picked her up somewhere around 4 oclock-ish. The vet wanted me to give food and shot that evening earlier than usual... about 5;30 or so and to call her just before I was to do the shot to tell her what the BG and it was low-mid 300s. I was advised to give 1/2 extra unit and then in AM to do food/shot about 6-6:30 AM with again the extra 1/2 unit. That night food/shot was abt 7:30 .. and I "think" we did a bit extra insulin then as well....but each shot time the BG was better and better. ( exact times are a bit fuzzy... but know we did gradual time adjustment and also added 1/2 unit for at least the 2 and think 3 shots after she came home.) By second full day at home she was back on regular time schedule and reg insulin dose. Within just a few days she was totally back to her normal BGs and we never got traumatically high reading. That low-mid 300 when she came home was already down into the 200s by the next AMs shot so she was never real high for any long period of time. I know there was concern as to extent and duration of surgery which wouldn't be known till they got in there. I know the vet said they'd use the gas as she wanted her to go under quickly and come out quickly afterward. I will say this protocol worked very well for Missy.... even with a 'traumatic' type surgery she never got thrown off very much at all and she bounced back beautifully. Terry ( Angel Missy- was diabetic) ,and my rescues, Naddie and Quincy ( non-diabetic)
debbuna		#4	[-]
Registered User Posts: 1782 (07/02/09 14:05:35) Reply Quote More My Recent Posts Message Me Connection Blocking Invite Ignore User's Posts Report Post	Lucy just had surgery recently with a vet I trust very much. He told me he does not do early am surgeries on diabetics. His instructions were to feed her normally in the morning, give no insulin, and bring her in immediately after eating. They immediately started an IV and a glucose/antibiotic drip. They scheduled her surgery at 1pm, so from early morning until surgery she was monitored and her bgs were carefully controlled. He wanted to keep her between 70-100 prior to surgery, apparently because his experience shows the diabetics rise quickly during surgery. She was kept on the iv's until 4 pm, came home with a beautiful bg. reading, and did great. They also used the anesthesia cocktail on her. A mild sedative that puts them asleep (not unconcious- just asleep), then used the ISO gas which knocks them out but only for short bursts I think. The intent is to be able to wake them up at will and quickly should something go wrong. It's supposed to be safer for our babies with other problems and is used for tiny animals (birds, snakes, rodents, etc) as the anesthesia of choice. Of course, you have your vet and will need to follow his advice as he is the one doing the surgery. It's ok to ask questions though, so don't be afraid to do that and be clear about his answers. and my Lucy, American Pugsley, age 12 -born 6/26/1996, DX. diabetic Nov. 07, blind 2/08, Weight 14 lbs., Novelin N 7U , Homecooked chicken/white rice/ broccoli with canned Hills W/D
Patty		#5	[-]
Registered User Posts: 298 (07/02/09 16:57:26) Reply Quote More My Recent Posts Message Me Connection Blocking Invite Ignore User's Posts Report Post	Thank you all so much for the feedback! It is very helpful! I have also had someone bring up the fact that the vet wants to use Previcox which carries some risks as an NSAID and that Tramadol may be a safer alternative. It doesn't have the anti-inflammatory properties but works as well on pain. I definitely want to ask the vet about this as well. Patty Patty and Ali 9 years 48 pounds diagnosed May '08 Primal's Pheasant formula plus probiotic and vitamins - fed 4x a day Humulin N 8 1/2 units twice a day
mommytoNash		#6	[-]
Registered User Posts: 922 (07/03/09 10:54:05) Reply Quote More My Recent Posts Message Me Connection Blocking Invite Ignore User's Posts Report Post	Patty, My experience with Nash was exactly the same as Dee and Lucy. Mild sedative and then gas that can be taken off and he could be brought out if needed. He was on an IV and they could/did administer 5% sugar solution as needed. Nash was feed and given insulin at 6:30.......and we took him in at 8 AM. Surgery started around 9:30-10 AM. He was low when he arrived (I had tested him at home)......and they also found out that he was still low when he arrived.....so they started him out with the solution. He did really really well, and they kept him around 180 the whole surgery. We picked him up around 4:30 and he was feed and given his insulin at his normal 6:30 PM time. Hope that helps. Cindy and Nash Nash was born 9/2/1998, and is my sweet 1/2 breed Cocker Spaniel/English Springer Spaniel. He was dx'd with diabetes in November 2007 and is currently on 12units of Novelin N twice a day. Nash went blind approximately 6 months after his dx.
Patty		#7	[-]
Registered User Posts: 299 (07/03/09 14:52:14) Reply Quote More My Recent Posts Message Me Connection Blocking Invite Ignore User's Posts Report Post	Well, I got a call from the vet's office tonight for pre-op instructions. It was a receptionist that called and she transferred me to a tech to answer a few questions as the doc wasn't there and with the holiday, won't be in until Monday morning. I asked again about the 1/2 insulin dose as Ali can drop pretty quickly early in her curve with excitement/stress, even with food. The tech of course just said to follow the vet's instructions. I asked what time the vet would be in on Monday morning and she said 8am. They'd like us to get there between 7:30 and 8. So I'll need to make the decision on what dose to give her earlier than that. She'll get insulin at 6:30a. They'll do a pre-op blood panel and put in the saline lock, in case they need an IV. When I asked how they monitor blood sugar during surgery, she said they don't. But they may check it after surgery. I dearly hope she didn't know what she was talking about... This doesn't sound typical to me from your experiences. How were your pups monitored? With periodic blood draws? I'll tell you, that made me very nervous... Patty Patty and Ali 9 years 48 pounds diagnosed May '08 Primal's Pheasant formula plus probiotic and vitamins - fed 4x a day Humulin N 8 1/2 units twice a day
IamMomtoMissy		#8	[-]
Registered User Posts: 13198 (07/03/09 15:36:16) Moderator Reply Quote More My Recent Posts Message Me Connection Blocking Invite Ignore User's Posts Report Post	Patty, since the way our vet planned her surgery and the proticol as I described above, Missy was still within her 12 hour cycle ( though toward the end) when she went into the vets for the surgery ... and since no food/insulin pre AM surgery I can't help you. Seems our vet used a different approach than most ... but it worked fine for Missy... excellent in fact ...went so much better than I had expected. I guess you just have to trust your vet and I'm sure the same will go for Ali . Since they'll be doing a pre-op blood panel it likely will include the glucose testing. ( though I'd be sure to request it just in case) Did they say how long the surgery should take? Missy's was a couple of hours. Terry ( Angel Missy- was diabetic) ,and my rescues, Naddie and Quincy ( non-diabetic)
Patty		#9	[-]
Registered User Posts: 300 (07/03/09 18:15:38) Reply Quote More My Recent Posts Message Me Connection Blocking Invite Ignore User's Posts Report Post	Terry, I do like the theory behind what your vet did. And it seemed to work beautifully! With Ali's eating schedule of 4xs a day to offset her peak, a 10pm shot for her would mean eating her 2nd and largest evening meal at 1am though. I have gotten reports from other places as well that many have done well with 1/2 insulin. I know Margo recommends 1/3 insulin if the dog is home resting and not stressed vs. at the vet. But all were monitored during surgery. I really do have a hard time trusting vets due to too many bad experiences. Many were unconcerned or lacked the diabetic knowledge to help. Hopefully her surgery won't be long. I can check her when we get there and compare with their lab draw. The vet also said last Wed I could wait for her if I wanted. Thanks, Patty Patty and Ali 9 years 48 pounds diagnosed May '08 Primal's Pheasant formula plus probiotic and vitamins - fed 4x a day Humulin N 8 1/2 units twice a day
Brandy mom		#10	[-]
Registered User Posts: 3191 (07/04/09 04:38:11) Moderator Reply Quote More My Recent Posts Message Me Connection Blocking Invite Ignore User's Posts Report Post	I am just reading this and want to say good luck with the surgery. I will be thinking of you and Ali. Brandy had several surgery after DX with diabetes. Her first surgery we did half the insulin with no food. During the surgery she dropped to low. We found out that the stress will lower her BG. She had an IV and was given glucose. So now we do surgery with out any insulin or food. The last surgery she had a lump removed from her next to her eye. He BG stayed below 180 with any insulin. So each vet will do it different. I would find out if the vet plans on using an IV some vets don't use them for surgery. She was given a pain shot just before she was sent home. I was given Trandol for the next three days. Antibiotic for 10 days after the surgery. Hope this helps. Dawn and the girls, Brandy is the diabetic and hypothyroid. Doberman 70 pounds. Born 06/04/2000 DX 06/04/2006. She is on a combination of regular insulin and N insulin and Soloxine. She eat California Natural Herring and Sweet Potato. Penny Non diabetic and hypothyroid. Doberman Lab mix 57 pounds. Born 07/04/1996. Is on Soloxine and eats Fromm Salamon Ala Vegetable.
Patty		#11	[-]
Registered User Posts: 301 (07/04/09 12:30:10) Reply Quote More My Recent Posts Message Me Connection Blocking Invite Ignore User's Posts Report Post	Thanks Dawn! What time was Brandy's surgery that first time with 1/2 insulin? Do you remember? I'm leaning toward giving her 1/3 of her dose of insulin. I know with insulin on board the stress of greeting everyone at the vet will drop her in the morning. She's on 8 1/4 u so that'd be 2 3/4u for a 1/3 dose. The vet will put in a port for an IV to be used only if needed is my understanding. Patty Patty and Ali 9 years 48 pounds diagnosed May '08 Primal's Pheasant formula plus probiotic and vitamins - fed 4x a day Humulin N 8 1/2 units twice a day
Brandy mom		#12	[-]
Registered User Posts: 3192 (07/04/09 14:53:41) Moderator Reply Quote More My Recent Posts Message Me Connection Blocking Invite Ignore User's Posts Report Post	The one when she got 1/2 insulin was at about 8am. Brandy gets her food and insulin between 4:30-5:00. So that could of been the problem too three hours after insulin. The insulin was working with out any food. Now I remember what I wanted to ask this morning. Are they going to do a path test on the lump? Dawn and the girls, Brandy is the diabetic and hypothyroid. Doberman 70 pounds. Born 06/04/2000 DX 06/04/2006. She is on a combination of regular insulin and N insulin and Soloxine. She eat California Natural Herring and Sweet Potato. Penny Non diabetic and hypothyroid. Doberman Lab mix 57 pounds. Born 07/04/1996. Is on Soloxine and eats Fromm Salamon Ala Vegetable.
Patty		#13	[-]
Registered User Posts: 302 (07/04/09 18:29:17) Reply Quote More My Recent Posts Message Me Connection Blocking Invite Ignore User's Posts Report Post	Dawn, That's about where she'll be by the time they do the surgery I think - around 2-3 hours in. I've decided with her tendency to drop, I'm going to give her 1/3 dose. I'll let the vet know when we get there but I think it will be a non-issue, the 1/3 vs. 1/2 dose. She's not familiar with Ali's diabetes, although she's worked with others in general. She just wanted her to have some insulin and not be without. We'll see how it goes I guess. I am asking that they send it out to test. The vet doesn't think it's malignant but I want to know for sure. Thanks, Patty Patty and Ali 9 years 48 pounds diagnosed May '08 Primal's Pheasant formula plus probiotic and vitamins - fed 4x a day Humulin N 8 1/4 units twice a day
Mollyroger		#14	[-]
Posts: 12910 (07/04/09 21:50:31) Reply Quote More My Recent Posts Message Me Connection Blocking Invite Ignore User's Posts Report Post	Hi Patty and Ali, Will be saying a prayer that all goes very well and smoothly for Ali's surgery, lots of hugs and Blessings, Peggy and Miss Molly - Levemir 2x a day 12 hours apart. Basal is Humalog (Rapid) meal bolus - wt. 13.1 lbs. homecooked food/ supplements: Balance IT, C-Biotic, Milk Thistle, Denosyl, Welactin, Prozyme. Molly's story: http://petdiabetes.wikia.com/wiki/Case:Miss_Molly
Patty		#15	[-]
Registered User Posts: 303 (07/05/09 06:09:17) Reply Quote More My Recent Posts Message Me Connection Blocking Invite Ignore User's Posts Report Post	Thanks Peggy! I'll let you all know how she does Patty Patty and Ali 9 years 48 pounds diagnosed May '08 Primal's Pheasant formula plus probiotic and vitamins - fed 4x a day Humulin N 8 1/4 units twice a day
IamMomtoMissy		#16	[-]
Registered User Posts: 13203 (07/06/09 01:22:00) Moderator Reply Quote More My Recent Posts Message Me Connection Blocking Invite Ignore User's Posts Report Post	Just to say I have Ali in my thoughts this AM as she heads for her surgery. Will be looking for your update and will be praying all goes well for her. Terry ( Angel Missy- was diabetic) ,and my rescues, Naddie and Quincy ( non-diabetic)
Brandy mom		#17	[-]
Registered User Posts: 3193 (07/06/09 03:32:53) Moderator Reply Quote More My Recent Posts Message Me Connection Blocking Invite Ignore User's Posts Report Post	Just adding my prayer for Ali's surgery this morning. I will check back later for and update. Dawn and the girls, Brandy is the diabetic and hypothyroid. Doberman 70 pounds. Born 06/04/2000 DX 06/04/2006. She is on a combination of regular insulin and N insulin and Soloxine. She eat California Natural Herring and Sweet Potato. Penny Non diabetic and hypothyroid. Doberman Lab mix 57 pounds. Born 07/04/1996. Is on Soloxine and eats Fromm Salamon Ala Vegetable.
carolsue		#18	[-]
Registered User Posts: 7 (07/06/09 05:32:54) Reply Quote More My Recent Posts Message Me Connection Blocking Invite Ignore User's Posts Report Post	Sending you and Ali my thoughts and prayers also. Carol and Dusty 10 year old 15 lb female feist, dx Dec 08, Vetsulin 3 units AM, 4 units PM, Royal Canin food for Diabetics
LOVEWESTIES		#19	[-]
Registered User Posts: 423 (07/06/09 06:30:59) Reply Quote More My Recent Posts Message Me Connection Blocking Invite Ignore User's Posts Report Post	Hi Patty, I just wanted to say I hope all goes well with Ali's surgery. I will say a special prayer for your girl. Hugs, Heidi and Chloe Staunton, Virginia Chloe, West Highland White Terrier, 10 years old, Dx'ed 12/06, weight 20 lbs., Humulin N (5 1/4 units 2 X Day) Diet: BRAVO Raw Diet, Veggie Mix, and Pumpkin
Patty		#20	[-]
Registered User Posts: 304 (07/06/09 10:35:24) Reply Quote More My Recent Posts Message Me Connection Blocking Invite Ignore User's Posts Report Post	You all are so thoughtful to send us so many well wishes! Thank you! Ali did well. Last night her bg was 130 before bed. This morning was 174. I gave her 1/3 of her usual dose. She was 240 when we left the house...she'd been following me around wondering where her breakfast was! They took her blood for labwork at 8:50a and it was 235. My meter read 197 (with my adjustment) with lip stick and 240 (with adjustment) with the venous blood they'd drawn. The vet gave her a morphine injection to start sedation. Ali had a few dry heaves after that which she warned was a normal reaction. They also use an isoflurane gas in the operating room). I was able to stay with her until right before they took her for the procedure. The surgery took about an hour. She was out by about 10:15am. Her bg was 265 by my meter. We went back and sat with her as she came out of the anesthesia. She was very vocal...whining and tossing her head around. Once she got her bearings, I got a sloppy kiss on the ear, lol. She finally got her legs to work again and we were home by noon. The vet said she had to make a larger incision than she initially planned. The growth had several nodules around it. She used some webbing in addition to the sutures to close the area as she didn't want to pull the skin too tight and cut off the circulation to that area of the tail. So, we head back on Wed. for dressing change and to let the vet look at it. We have 500mg Amoxicillin as antibiotic twice a day for a week and half of a 227mg tablet of Previcox for pain once a day for 1-2 days as needed. She's still a bit wobbly. It's beautiful here and she wants to be out, so I took her pillow outside to lay on the patio and she's fairly alert watching everything but she does the "head bob" as her eyes get heavy. She's not up to drinking anything and has refused ice chips, which she loves. Hopefully she'll eat something tonight. Hugs! Patty and Ali (whose 10th B-day is in 3 days! ) Patty and Ali 9 years 48 pounds diagnosed May '08 Primal's Pheasant formula plus probiotic and vitamins - fed 4x a day Humulin N 8 1/4 units twice a day

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