June, 2021: Coco is gone. Her gentle beautiful spirit left her battered body yesterday morning. My husband was with her. She had gone over 24 hours without eating, and it was clear that she was in distress. She didn’t wag her tail, she didn’t bark, she could barely make it outside to urinate. Her body trembled and shook, and she didn’t lift her head. And her eyes—her beautiful, soft, sweet brown eyes—were red-rimmed and sorrowful. Jack looked at her Sunday night and said, “it’s time.” I still gave her her diazoxide, the medicine which might have caused some of her distress, to stop her from having a seizure from low blood sugar, and just in case she’d make it through. Here’s the story of Coco’s all-too-short time with us.
Coco was left at Waukegan Animal Control when she was 13 years old. I saw her on a Facebook post by Susan Elliott, the person in charge of Animal Control. I contacted the rescue I foster for, Placing Paws, to ask if I could foster a senior dog and they immediately agreed. I actually went to look at another senior dog, but that dog was one I was worried could easily jump my three-foot fence. When Susan mentioned Coco, and I saw her trembling in her kennel, my heart broke. Susan took her out and she immediately came to stand by me. I was hooked. I brought two of my dogs, Chloe and Lexi, to Waukegan the next day to make sure they’d all get along. Coco had lived with two cats, so I wasn’t worried about her getting along with them.
Three days later, on March 22nd, I brought Coco home. She got along with everyone, and at first seemed to like the huge crate I set up in the living room. That would quickly change. She then decided her favorite place was the comfy dog bed under the table in the living room. But within a few weeks, she decided the couch was just right and that remained her favorite place to lie. She sleeps there at night, and during the day she lies next to Jack when he practices his trumpet, nudging him to pet her constantly.
Coco saw the vet immediately and was vaccinated and had her horribly long nails cut. She also had a double ear infection which was treated. She loved walking in the backyard, exploring, and rolling in the grass. I’m guessing that living in an apartment and getting walked on a leash didn’t offer those kinds of opportunities. After a few weeks, I began to notice strange episodes where Coco would seem confused and disoriented. She would walk around, stumbling, and stand in the corner for a few minutes, her whole body twitching at intervals. She was restless and couldn’t sit or lie down. I posted that on Facebook. (After all, don’t we all get our pets’ first diagnosis on social media?) I was told it seemed like symptoms of low blood sugar, and we took her to the vet to see if that was the case.
They saw that her blood sugar was a bit low, and they were going to begin more testing when a few nights later Coco had a full-blown seizure. That event, a month after she came to live with us, was horrifying—Jack actually thought she was dying. I had never seen anyone—human or animal—having a seizure. I called Christie, one of the founders of Placing Paws, and she told me that during a seizure, it’s not painful, and Coco wasn’t suffering. She said to keep her safe and after to take her to the emergency hospital. We covered her with a blanket and made sure a rug was under her head so it didn’t bang against the floor.
The drive to the hospital was dreadful. Coco was in the backseat and I drove down the expressway at 90 miles an hour when it was safe (it was late and there wasn’t much traffic). I kept looking back at her worrying that she was going to have another seizure. At the emergency clinic, they admitted her, and I went home. They would keep her for three days, performing all kinds of tests, and finally diagnosing her with a tumor on her pancreas that caused her pancreas to make too much insulin, which caused her extremely low blood sugar, and that ended up causing the seizure. It’s called insulinoma, and the medication they put her on to treat the overproduction of insulin, diazoxide, is unbelievably expensive. For the next day or two, they monitored how she was doing with the diazoxide, making sure that her blood sugar was at good levels before they sent her home. She came home with the diazoxide and prednisone, but almost immediately she stopped eating. They did say that both medications might cause nausea, and to cut back on the diazoxide. I went from 1ml they wanted her on twice a day to .2. She seemed to tolerate that so I went up to .3 for four days. When that went well, with her eating, I increased her dose again. During this time, she was getting us up several times during the night for extra feedings. We’d keep a can of dog food on the stove and shove a few spoonfuls in her mouth at midnight, 2:00 am, and 4:00 am.
I had been told I would have to test Coco’s glucose levels, and so I ordered a glucometer from Chewy’s. I had been told to just check her glucose levels every two weeks to make sure she was doing well, but I would end up checking her levels daily, and often twice a day. Finally the testing strips arrived with the monitor and I could check her blood sugar levels. Learning how to test her glucose levels was a process. At first, I wasn’t sure where to prick her to get the blood. Finally, I realized that the bare patch of skin on her tail, about the size of a quarter, was perfect. Sometimes it took pricking it twice to get enough blood, but she didn’t seem to notice or she didn’t mind. The tricky part, for me, was that if you put the testing strip in the glucometer before you pricked her, and then it took too long to get enough blood, the meter would give an error reading. Two minutes was the max. So I started pricking her first, and then once
I made a chart that showed the dates, the amount of medication she was getting, and how she was doing. I added in her glucose levels and color coded them. Yellow highlighter meant that the level was above 60, purple meant that she was low. Sometimes, she was so low that the monitor just read “LO” and that’s what I had to record. When she was low, I’d give her some Karo syrup to bring it up. Sometimes, we didn’t need to actually check the levels, as we could tell that she wasn’t doing well and needed the syrup. We actually were giving her the diazoxide in coffee cake, which hid the horrible taste. Coco was gaining a lot of weight from all the food!
Less than two weeks later, we noticed that she had many times when we had to give her Karo syrup. The wonderful internal medicine veterinarian said to increase the amount of diazoxide to 2ml twice a day. I slowly, very slowly increased her dose, a few mls at a time, so she wouldn’t stop eating. She did well, but even at 2ml twice a day, she she showed signs of and had low blood sugar. So we increased the diazoxide to 2 ml three times a day. for five whole days her blood sugar was good. No Karo syrup. But on the sixth day, she began showing low blood sugar again. We gradually increased it to 3ml three times a day.
At that point,I knew I had about 8 of the glucose testing strips. I needed more. One pack of 50 testing strips is $50. They cost a dollar a strip! I placed an order with Chewy.com, sure that those eight would last the three days until my order arrived. I also ordered more of my dogs’ kibble. And when I placed the order on a Wednesday night, I saw that the order was expected to arrive on Saturday. That was great. I was testing her once or twice a day, but sometimes the strips would give an error message. But when Saturday arrived, Coco seemed off and I was now out of testing strips. She had also thrown up a huge amount of food at 6:00 that evening, and had also thrown up the afternoon before. That worried me because I couldn’t be sure she was digesting the diazoxide she needed.
We saw her trembling, and then she threw up. She slept on the couch with her head pushed into the pillows, a tell that meant she was feeling nauseated. I called the rescue and asked what they thought. They urged me to take her to the emergency hospital, which relieved me. I am hesitant to incur additional bills for them on Coco’s behalf, but they are all about getting their charges the medical care they need—the cost be damned. So we bundled her into the car and I drove to the Veterinary Speciality Clinic in Buffalo Grove. I called when I was leaving to let them know I was on my way. But when I got there, I was told by the receptionist (you don’t go inside, you call from the parking lot), that Coco was going to be the last dog admitted because they were so full. Then she called me back five minutes later and gave me the bad news. They were diverting all new arrivals, us included, to other emergency hospitals. We went to Premier, which in Grayslake is only ten minutes from my house. I called them and they were wonderful. Once we arrived, they came out and took Coco inside so they could monitor her until the veterinarian could see her. Her glucose was not low.
Their vet called me four times to talk about Coco’s condition. He carefully read the notes from the VSC (Veterinary Speciality Clinic) and started Coco on anti-nausea medication. They did x-rays to see if there was any obstruction causing her to vomit. In the end, she came home at midnight after getting subcutaneous fluids, an anti-nausea injection, and a steriod injection. Apparently steriods can cause nausea. They gave her cerenia there for the nausea, and her glucose levels were low. They were hesitant to give her IV glucose because they didn’t want to make things worse.
Poor Coco. The diazoxide can also cause nausea. And now she hates the stuff. It’s a nasty white liquid that is flavored with marshmallow, and while at first I could put it on bread and she would eat it, now, even if it’s in pound cake, she smells the stuff and turns her head away. So I have to put the whole 3ml (which is a lot!) in her mouth and hold it closed so she can’t spit it out. Then I quickly give her the Logic beef dog food to take away the taste. She still likes that, so it’s working. For how long, I don’t know. She is now so picky that she won’t eat the Canidae chicken and rice canned dog food. The veterinarian at Premier suggested that I give her canned chicken (which I hadn’t known was a thing) and rice for a few days and she loves that. He also gave me 15 testing strips to last until the Chewy order arrived.
Because prednisone can also cause nausea, they gave her a shot so she wouldn’t have to take it orally. They also said to start her on omeprazole, for stomach acid. So now she was getting diazoxide at 6:00 am, 2:00 pm, and 10:00 pm. And prednisone, cerenia, and omeprazole at breakfast and dinner. While her glucose levels were great, her appetite got worse and worse. The the ER, she had refused all food except for canned chicken. I bought canned chicken (I hadn’t even known it was something you could buy). I mixed it with rice. Within two days, she wouldn’t eat the chicken, or any of the canned dog foods I had bought for her. She wouldn’t eat the fresh dog food I got for the dogs. She would eat the Friskies I feed the cats. A day later, I made her ground beef and mixed it with rice. She ate that for two days, and then would turn her head away when I offered it to her. Her tail wagged less, and she seemed less happy. Two days later, she ate a can of Friskies at 5:00 am but then wouldn’t eat all day. She lay quietly, although once she had enough energy to jump on the couch and sleep there. Her eyes looked incredibly sad and red-rimmed.
All her numbers were in yellow – we didn’t have to give her any Karo syrup. She was eating fine. She was even sleeping better — only waking us up once a night for food.
So now she’s home, although she’s still lethargic. On Sunday, she wasn’t wagging her tail much and she lay on the couch with her head shoved into the pillows, which is a sign she isn’t feeling well. I was worried that she was really feeling bad, and hoped that it was just a hump that she had to get through to be back to her happy self. Strangely, her blood glucose levels were high on Saturday, over 100 two of the three times I took it.
It’s now almost a week since our journey to the emergency clinic (June 3rd). Her blood glucose levels have been consistently above 70, and she doesn’t show any signs of low blood sugar. She’s on four medications: Cirenia for nausea, Omeprazole for reflux, Prednisone, and the diazoxide. She gets the pills twice a day, and the diazoxide three times.The problem is that she’s refusing food. Upon her return from the ER, she was on a bland diet of rice and chicken. She seemed to like it. But when I tried to give her the canned beef that she adored, she turned her nose away from it. She did eat the chicken and rice for a few days, but now she’s refusing that. So I’m down to giving her rice and Friskies cat food. She won’t eat the expensive fresh food I give the other dogs, she won’t eat the expensive canned beef dog food I ordered two cases of, and she won’t eat the canned chicken I got at the grocery store for her. Just cheap canned Friskies.
Otherwise, she seems to be fairly happy. Her tail wags. She goes outside and sniffs around. She’s getting pickier and pickier about what she’ll eat. Now, a few days later, she’s only eating ground beef and rice. And she doesn’t finish her bowl, which is fine because the other dogs are happy to clean up the stray rice bits and beef left over. Sweet Coco doesn’t mind when they come close, she has absolutely no food aggression. In fact, when Chloe snapped at her because—while I was feeding Coco, mind you!—and Chloe wanted it, Coco didn’t respond at all. She tolerated the cats’ kneading her, crowding her on the couch, and Chloe’s irritated snapping, all with equanimity and grace. She still nudged Jack’s arm when they shared the couch together so that he would pet her. She barked when she wanted to go out or get a bit more attention. She made us laugh.
One night I was in the living room reading and I heard a commotion in the kitchen. I looked for my naughty dog, Lexi, but she was in a dog bed next to me. I went into the kitchen and saw the cat chasing a mouse. Well, Coco saw that and pushed the cat aside. She went after the mouse, and I thought I saw her open her mouth and make a gulping motion. But then she kept looking for the mouse, so I assumed it had gotten away. I looked by their water, in the laundry room, in an empty bag. No mouse anywhere. Until ten minutes later, in the living room, when Coco threw up an intact, soaking wet, dead mouse. I moved her away before she could eat it again. Ewww! Coco, really?
I’d been carefully keeping track of her glucose levels on a table I created. When Coco arrived, I noticed that she had a bare patch of skin on her tail. That spot became the perfect place to prick her to take her glucose levels. She barely noticed and I was able to pet her and keep her distracted while doing it. It wasn’t easy getting used to doing it and in the beginning I had to have Jack or Abbie come and help, but I’ve gotten adept at balancing the pen with the needle and the monitor with the test strip. I highlighted the normal glucose readings in yellow and the low ones in purple. That made it easy to see the days she was doing well and when she wasn’t. I also noted the medications she was getting, and the diazoxide levels, as well as how she was eating and feeling. That table helped a lot at the end.
One thing I remember about Coco is that as much as we tried to get her to sleep in the bedroom with us and with the other three dogs, she wouldn’t. She would venture in the room, look around, but she always left. I got her to lie in one of the dog beds in our room, but after a minute she got up and left. At night, when Jack and I would lie in bed and read, she could come to the doorway and put her head just inside the door, laying it over the threshold. But after their last trip outside, she knew we were going to close the door, and she didn’t want to be shut in the room with us. She choose to sleep in the living room, on the couch, with the cats to keep her company. But in the morning, more often than not, she was waiting when I opened the door, just outside the door.
I know that we should be happy that we got to be with Coco at the end of her life and make that ending as happy and comfortable as we could. And we are. But I wish I could have spent more time with her. I wish she had felt secure enough to sleep in the bedroom with us. I wish there hadn’t been so much time when she felt sick. I also wish that the man who raised her and had her for thirteen years could have been with her at the end. He obviously loved her and treated her fairly well. Although she had really long nails and a double ear infection, he cried when he left her at Animal Control.
I wish what we all wish for those we love—human and animal—that our ending is peaceful and surrounded by loved ones. And because Jack was there with her, petting her and telling her she was loved, Coco got that.
PamelaKramer.com 