Batty is our 4th dog. 12 years ago, we rescued him from the R.S.P.C.A. (as it was known at the time). He was too young for them to look after. He needed to be hand fed milk and they didn't have enough staff to handle it. But I was there when a Caucasian lady brought him in, and I took him home rather than let them put him down. He was only as big as my hand!
He's had a good life, but not a great life. Several years ago, he was diagnosed with Cauda Equina Syndrome (Horse Tail Syndrome) where the spinal canal narrows over time, pressing down on the spinal cord causing damage and chronic pain. He's been on pain killers for most of those years and has been quite well.
But (and I'm leaving out a lot of details...) in August, Batty began coming to us at night as we slept, waking me up by panting heavily into my face. I'd get up, give him a small dose of pain killer (vet's advice) and go back to sleep. That worked fairly well, but the condition worsened. Within a few weeks, the pain killers were not helping him. The condition continued to get worse until I spent whole nights; from 1am till the sun came up; calming him down and trying to make him comfortable. We thought it was all related to the Cauda Equina. We were wrong.
I despise it when a pre-existing illness/disease makes it difficult to realise that there's a separate serious problem going on.
We talked a few times to our vets and after x-raying his heart and lungs (possible causes of excessive panting...), we arranged an ultrasound to get a closer look at the inner workings of his heart. It was by chance during the ultrasound session that one of the vets noted that Batty had low blood sugar which raised suspicions about a separate illness completely unrelated to the heart. A few days later, we starved Batty for almost a day and measured as his blood sugar dropped. At the time of lowest blood sugar in the day, we took blood for an insulin test. The results came back a few days later. Sugar was low but his insulin was extremely high. Batty had Hyperinsulinism, probably Insulinoma.
In mid-September, the day after we moved house, Batty had an operation to explore his pancreas and remove any nodules found. The vet couldn't with absolute certainty observe or distinguish any nodule/s in the pancreas, so they took out half his pancreas; standard procedure. Slowly, he recovered from the major surgery (although he hated being in hospital, especially when we weren't there) and he seemed fine. Unfortunately, you can't be sure if the surgery was a success until at least 60 days after the surgery, and a couple of weeks ago, we noted that Batty's symptoms were coming back though not nearly as bad as prior to the operation.
So, after a lot of personal research and many conversations, another operation has been organised for Batty (the day after I return from Taipei). With any luck, any nodules present in the pancreas will have grown since the last operation, allowing the vets to see them. Our research also came across a blue compound (not available in Hong Kong) that will very likely allow the vets to visually identify concentrations of insulin within the pancreas. If they can't see anything, they'll just take out as much pancreas as they can, leaving enough for his normal day-to-day digestion requirements.
In the meantime, we're trying to keep Batty as comfortable as possible. One of the challenges of diagnosing and helping pets is the lack of communication. During my research, I was fortunate to come across a web forum of people suffering from chronic hypoglycaemia. It was revealing and extremely helpful to read their posts, describing the physical and emotional symptoms of acute hypoglycaemia, and the methods they used to get by. Especially revealing was the fact that many of these people suffered severe hypoglycaemia at night; the same as Batty; with some pretty depressing symptoms.
One thing vital to dealing with chronic hypoglycaemia is eating the right food at the right time, producing a constant gradualstream of glucose to the body. Gradual means no carbohydrates, especially simple carbohydrates. Here's where dogs and humans differ. Where people need a lot of carbohydrate to survive, dogs need very little and don't need grains at all! Dogs thrive better on a diet of high protein, high fat and none of the grains/carbohydrates that humans generally eat except for leafy vegetables.
So, more research later... Batty now gets multiple meals of B.A.R.F. raw meat product each day. We need to experiment to see how to interval the meals, and how much to feed him each time, but we're making progress. Especially important is a big meal before we sleep at night; another big NO in the human world of healthy eating; but the big protein meal before sleeping means that Batty doesn't experience severe hypoglycaemia at night, and that's good for all of us.
Reference note. The B.A.R.F. food is expensive. All of our kids want to eat it, but we'd have to be really wealthy people to afford B.A.R.F. for all of them; at least HK$20,000 per month! Ouch!!!
Batty in all likelihood has had Hyperinsulinism/Hypoglycaemia for a few years. Again, the pre-existing Cauda Equina influenced us to not look for another problem, but he has several physical symptoms related to long term hypoglycaemia including muscle wasting and twitching.
The next operation probably won't totally eradicate the Hyperinsulinism/Hypoglycaemia, but both should be much easier to manage, allowing him to live much more comfortably. The days that Batty spends in hospital will be hard for both Batty and myself, because I'll spend most of my time being with him in the hospital to keep him calm until he's well enough to come home; with any luck 3 days, but if the operation is successful, 3 or 4 days of suffering will absolutely be worthwhile.
This very minute, Batty is lying on the floor next to my desk, sleeping comfortably and breathing steadily without stress in his eyes. It's very good to see.