Jed - 13½ y/o toy poodle - addisonian crisis

[Karen & Jed]

My name is Karen. I have a 13 1/2 yr old neutered toy poodle. I joined this forum back in early 2008 when I first suspected that he had Cushings. I received a lot of comfort and help from everyone here. But, I lost track of everyone when the site closed and I think all our history is gone now. So, I will give you a recap. It was a long process to get a diagnosis and to get Jed on the right dosage of Lysodren. He's also been diagnosed with hypothyroidism. I first took him in for tests when he started drinking and drinking at the very end of 2007. I didn't start him on Lysodren until Oct 8/08 because of inconclusive tests up until then. I didn't see all the symptoms go away, we had to reload 2 more times and finally after being on an aggressive dose for quite some time, his drinking went back to normal in May of 2009. His highest weight was 6.6 kg. and recently he's down to about 4 kg. I was so aware all along, especially when we first started treatment to look out for signs of Addison's, but I'm afraid recently I screwed up pretty badly. Because of his recent weight loss, his dosage became too much for him. We didn't recognize it right away for what it was & some of the symptoms even confused the vet, who's had some experience, but not a lot, with Cushings. Too make a long story short he had been Addisonian for quite a while before he got treatment. It's been a horrible week. I thought I would lose him for sure. He was on IV in the hospital for 48 hours and I was just able to pick him up at 1 pm today. Our main concern now is that he won't eat & he doesn't have any weight to spare - he needs to gain some back. The vet force fed him 2 times. The first day, he vomited, but last night he kept it down. The vet figured that if he was at home he may eat for me. I haven't been able to interest him in anything yet. I was wondering what suggestions anyone has. He was starting to have kidney failure and we're not sure yet of the long term damage. So, the vet gave me some Medi-Cal recovery formula food to try to get him to eat and he eventually wants him to be on Hill's Prescription Diet k/d, which is supposed to be to support the kidney's. I had him on a high protein dry food called Orijen before. But, he got fussier once the Lysodren kicked in and I also added a senior soft food from the vet. The vet doesn't want him on high protien any more because it will be hard on the kidneys. Jed's also had an issue with discs in his back and some arthritis has reared it's ugly head since he no longer has all that cortisol in his system. So, I've had him on glucosimine sulfate with condroitin and MSM and also resently Ester C for his joints. He was also on Metacam for a couple of months prior to this crisis. I've had him on Milk thistle for his liver since we started Lysodren. The vet said to stop his Thyrotab temporarily and wants me to give him Pepcid AC & sulcrate suspension until he gets eating well again. Now of course there's prednisone for a while.
I think that's all the info. you need. I'd appreciate any feedback, especially how/what to get him to eat and also anything that is important in caring for him after the crisis.

Looking forward to hearing from you soon.
Karen

[Karen & Jed]

Just one more little thing so that you have all the info. The vet gave him an injection to prevent vomiting.

Thanks, Karen

[gpgscott]

Karen, I am sorry to hear about the crash.

It is getting time of evening that Alison usually checks in and she has offered lots of good advice concerning low cortisol, you have to be concerned about electrolytes as well as cortisol in some cases.

I am not a Dr. but Moria is also on thyroid supplements and I cannot think of a good reason to stop that treatment, it affects lots of internal goings on.

Boiled chicken and rice is a good meal that Jed may find interesting and it is easy to prepare. I think also plain yogurt is good and buttermilk is almost always accepted and will help rebuild the gastric flora needed for proper digestion and maybe stimulate appetiete.

Please keep us posted. Best wishes and prayers for you all.

Scott

[frijole]

Karen, Has the vet tested the thyroid since the Addisons' crisis?

You are right to focus now on the food. Sometimes you have to start with basics like chicken broth. My dog was violently ill last weekend and I took her in for an injection of electrolytes and my doc too gave the vomit injection. He also gave me the pill form to give for a couple days.

My dog went for the chicken broth first. I added pedialyte (non flavored) which I think also helped prevent diarrhea and vomiting. I just did a couple ounces at a time at first. We worked our way up slowly with me feeding her every few hours. Sometimes she ate, sometimes she didn't.

Once you get to the point where she will take solids plain old white rice and eventually cooked WHITE meat chicken. Very small to start as you probably know.

I am so sorry to hear the news but I am glad that you found us. Keep us posted! Kim

PS Please also tell us the dosage of prednisone Jed is on. Thanks.

[Karen & Jed]

Thank you so much for your prompt replies. I'm going to make a trip to the grocery store right now to get some of those things. He just took a small piece of his favorite biscuit from me, but still not the recovery formula - it smells like tuna and I don't think he would even eat it when he was feeling well.
His prednisone dose is 1/2 of a 5 mg tablet every 12 hours for 2 days, then 1/4 tablet every 12 hrs for 2 days and then 1/4 tablet daily (it doesn't say for how long).
The vet hasn't done any blood tests since the crisis. He said he wants to get him eating first and he figured the kidney values etc would be more accurate then and he wants to do an ACTH stim also. The last thyroid test he had was June 26 when it was at 32.4 nmol/L - ref range 13 to 44 nmol/L.

Thanks again for your concern. I will keep you posted.
Karen

[AlisonandMia]

How much prednisone is Jed on and how often is he getting it?

When a dog overloads really seriously it is possible for the electrolytes to be affected. This is because a really severe overload can affect the adrenals' ability to produce the hormone (aldosterone) that balances the electrolytes. If this has happened then that hormone must be replaced artificially and usually something called Florinef is used - there is another medication called Percorten which is injected and lasts for around 25 days before it needs to be repeated. Being put on an IV will fix the electrolytes short term but once the dog is off the IV the electrolytes will swing out of whack all over again unless the correct medication is given. The electrolyte imbalance is the really, really dangerous part of an addisonian crisis.

Where his electrolytes checked before they put him on the IV and would have the results of the test on hand? When did he come off the IV?

Also when did he last have a dose of Lysodren?

Alison

[Harley PoMMom]

Hi Karen,

Have you tried Nutri-cal?

http://www.1800petmeds.com/Nutri+Cal-prod1340-1340.html

Maybe he would take some of this.

Hugs.
Lori

[Squirt's Mom]

Hi Karen,

Glad you found us but am sorry to hear that Jed is having such a tough time right now. :(

As you know, we love details so if you can post the test results he has had lately, especially an ACTH and his labs. Debbie may be able to help with the labs to see if there is any indication there of kidney problems.

I am glad Alison talked about the electrolytes and the meds needed to help supply them. I have some links on Addison's that may help you a bit and will post them at the end of this message.

I'm just not that crazy about Hill's feed and my dogs really don't care for their prescription feed. I fed their kibble for years and didn't have any real complaints, but I didn't know as much then as I do now about some things like nutrition. ;) Squirt's vet has dropped Hill's and gone to Royal Canine just recently. Orijen is a good feed but it is higher in protein than some of the others. I don't know that I would be too concerned with what he ate right now as long as he is getting some dietary intake, including plenty of water. The NutriCal that Lori mentioned is a good product and will supply all the minerals and vitamins he needs until he can eat good again. Most dogs like the taste, too!

The food suggestions are all good ones and hopefully he will find some of it to his liking. If you use rice, white or brown, be sure to over cook it...almost to a paste, so they can digest it easier. Acorn or butternut squash, sweet potatoes, chicken or turkey white meat and broth, rice, and some veggies like green beans can be added as he starts to eat better. Adding a little of these things to his regular feed may get him kick-started on it, too. Since Jed is hypothyroid you want to avoid veggies in the Brasscia family - things like Brussels sprouts, broccoli, cauliflower. Here is a link about that:

http://www.whfoods.com/genpage.php?tname=george&dbid=47

It is about humans with hypothyroidism but can be applied to our babies as well.

Please keep in touch and let us know how Jed is doing.

Good to have you both home again!
Hugs,
Leslie and the girls

[Karen & Jed]

Hi Alison,
Yes, his electrolytes were checked before they put him on the IV. I was trying to remember too many things when I left the hospital today and forgot to remind him to give me a copy of the tests - I will be going in tomorrow, so I'll get a copy then. He also mentioned the Florinef today as something that we will be doing, but I don't think he said when. They took him off the IV when I went to pick him up at 1 today. it is now 6:30 here. Thanks for all the suggestions. Jed's never liked veggies so I don't have to worry about the Brasscia family (that sounds like the Mafia!). I'm going to see what other dog food options we have at the place where I was getting the Orijen to see if they have something with less protein.

Lori: That Nutri-cal looks like something I should order. Thanks for the suggestion.

Talk to you soon,
Karen

[Karen & Jed]

P.S.
Yes Leslie, that's exactly what I was thinking - I feel like I'm home again and I know that if I had stayed in contact that you guys would have told me to stop the Lysodren and get his furry little but in for a test a lot sooner.

[AlisonandMia]

If the vet said that he would need Florinef it sounds like the electrolytes where out of balance before he went on the IV. If that is the case then he should be on the Florinef now - it isn't something that can wait. This could very well why poor old Jed is still feeling very poorly despite being on prednisone.

When the electrolytes are seriously out of balance the biggest risk is that this affects the heart beat and can even lead to cardiac arrest. This is very often the cause of death in an addisonian crisis rather than the low cortisol.

When the electrolytes are affected by a Lysodren overdose it is very often a permanent thing and the dog needs to be treated as an Addison's dog for the rest of it's life which will include medication to replace the hormone that balances the electrolytes (aldosterone). The medication to do this is either Florinef (given as a daily pill) or Percorten which is a once-every-twenty-five-days injection. The dog may or may not need daily prednisone as well - just depends on the dog and on which medication (Florinef or Percorten) is used.

I am really worried about Jed.

Alison

[Karen & Jed]

If I can get him some Pedialyte tonight, can I wait until tomorrow morning to get the Florinef?

[AlisonandMia]

Offering him salt (normal table salt - not any of the fancy "lite" salts) would probably be better than Pedialyte. Pedialyte has some potassium in it and if his electrolytes out of balance because of Addison's then he won't be needing any more potassium - what he will need is sodium as lack of aldosterone means that he cannot keep sodium in his body which will mean that he is losing sodium (and this will dehydrate him as it will take water with it) and this loss of sodium and water leads to too high a potassium level which affects how the heart works. Is he peeing and drinking a lot?

You could try offering him some salt on your hand or you could try sprinkling a pinch of salt on some food. If he really is addisonian (has a serious electrolyte imbalance)then he very likely has a salt craving and it may even persuade him to eat some too. Some dogs will go for salty crackers.

Ideally he should have Florinef and even go back on an IV to be stabilized tonight but if that is really not possible then offering him salt should help. When did he come off the last IV?

The prednisone will be helping with the electrolytes a little bit but not a lot. (Prednisone has some very weak aldosterone-like action, apparently.)

Alison

[StarDeb55]

Karen, I'm so sorry that Jed is having such a tough time. I will be more than happy to look at the labs when you can post them. I use Nutrical with Harley frequently as he has had several periods of severe anorexia & weight loss where the Nutrical would be the only thing he would eat. I'm now supplementing his regular food with the Nutrical for the extra calories it provides as he is underweight by about a pound, should be about 14 lbs., he's at 12.7.

With Harley's weight issues, I have been seriously watching his lysodren dosage & have notified my vet more than once that the dosage was out of whack because of weight loss. On the first round of weight loss, it took me about a week to realize that we might be headed for a problem, & notified the vet. The vet had not even realized it, until I called, so don't feel bad.

Debbie

[Karen & Jed]

I just got back from the store. I picked up a few things for feeding Jed. I thought I would stop by the vet's on the way just to see if he happened to be there. He was, so I asked him about the Florinef. He said that he had said we will use it if we need to, once we do tests. It sounds like he didn't check the electrolytes but that they realized he was addisonian by a urinalysis. I'm not sure if that makes sense. It does seem weird that he wouldn't be worried about the electrolytes. He seems confident.
Jed just drank some chicken broth. I'm going to see if he keeps it down and I'll try a little more soon - maybe some yogurt or rice. I offered him some salt on my hand, but he wasn't interested.

Hi Deb. Thanks for the reassurance.

[StarDeb55]

Karen, I'm sorry, but there is no way that your vet can determine what the electrolytes are by a UA. Electrolytes are specifically the sodium & Potassium which can only be determined by a blood draw. As Alison has already explained how critical it is to monitor the electrolytes, I won't repeat that. If Jed has not had a blood draw done, if I were in your position, I would insist with the vet that Jed's electrolytes be checked ASAP in the morning. I do strongly encourage you that if Jed gets to feeling any worse overnight, please get him to an emergency clinic ASAP. A serious electrolyte imbalance due to Addison's is nothing to fool around with.

Debbie

[Karen & Jed]

Sorry, I didn't explain it well. I don't think he did a blood draw at all. I think he knew he was addisonian by something in the urinalysis. But, I see that he needs to have the electrolytes tested and I will take him for that tomorrow. It doesn't make sense to me that he wouldn't have checked those unless there's is something that I'm not understanding.
Jed just drank a little butter milk also. I'm pleased to see him eating a little and keeping it down. He's looking pretty good. He seems much more himself.

Thanks,
Karen

[AlisonandMia]

It's a good sign that he wasn't interested in the salt on your hand. Have you tried adding a little pinch to the chicken broth? If he doesn't actually need it a little bit won't hurt (as long as he has free access to water) whereas if he does need it it will really help him.

I am puzzled by the urinalysis. The only two conclusive tests for an addisonian crisis are an ACTH stim test and an electrolyte test which are both blood tests. The usual procedure when Addison's (naturally-occurring or through overdose of Cushing's meds) is suspected is that they first draw blood for an electrolyte test, then put the dog on a saline IV (they put the dog on the IV before they have the results of the electrolyte test) give a dexamethasone injection (to replace possibly-low cortisol) and then, when the dog is somewhat stable on that emergency treatment, do an ACTH stim test. The ACTH stim is probably more important when naturally-occurring Addison's is suspected as making that diagnosis as rapidly as possible would be quite important.

There are two types of Addison's - one where only cortisol is low but aldosterone (the electrolyte-controlling hormone) is ok and the other, far more serious type, where both the cortisol and the aldosterone levels are too low. You can get either with a Lysodren overload but the just-low-cortisol (normal electrolytes) version is far more common. When just the cortisol is low usually (but not always) the cortisol comes back up again and the dog needs to resume Cushing's treatment at some point. When both cortisol and aldosterone affected it is almost always a permanent thing and the dog is now an Addison's dog. With the correct hormone replacement meds an Addison's dog can live a normal healthy life.

It would be possible for a dog with just low cortisol to have an abnormality with its electrolytes from vomiting and diarrhea - just as can happen with an infection. When that happens the dog would be put on an IV just as they would with any other type of vomiting and diarrhea.

In your position I think I'd be in there first thing in the morning insisting that Jed's electrolytes are checked. This is a quick test that is usually done in house so you don't have to wait for results.

Alison

[Karen & Jed]

I will do that. He seems pretty good, I must say. He's cleaning himself and scratching and even getting grumpy with me when I bug him when he's sleeping - which he started in his old age. He's eaten 2Old Mother Hubbard biscuits, a few licks of yogurt and buttermilk about a 1/2 c. of chicken broth and even some turkey which he really seemed to enjoy. He's sleeping peacefully in bed with my hubbie right now. I put him in front of his water dish, but he didn't want any, so it seems the chicken broth was giving him enough water.
I'll keep you posted.
Thanks for all your help today.
Karen

[Karen & Jed]

P.S.
The vet does think that we will have to eventually get Jed on to Lysodren again, so maybe it is only the low cortisol type. I'm sorry I'm not more clear on all this. There's just been so much going on.
Good night.

[Squirt's Mom]

Hi Karen,

Here are some links on Addison's that may help you understand this condition a bit better. I sincerely hope Jed is just experiencing a low period and is not truly Addison's.

Your description of Jed last nite sounds good, but I would still want to have his electrolytes checked and an ACTH done so I would know where he was in regards to his cortisol levels. You and Jed have too well for too long to let it get out of hand now, IMHO anyway. :) Electrolytes are so incredibly important for proper functioning of the body it just doesn't make sense to me not to check them.

I am glad that Jed ate for you some last nite and hope his appetite is much better this morning. Let us know how things are today!

Hugs,
Leslie and the girls

Addison’s*

http://canineaddisonsinfo.com/
http://k9addisons.com/faqs/
http://pet-diseases.suite101.com/article.cfm/addisons_disease_in_dog
http://www.inmetrodetroit.com/pets/dachshund/frederick/addisons.htm
http://www.vetinfo.com/dencyclopedia/deaddisons.html
http://www.addisondogs.com/support/group.html
http://pets.groups.yahoo.com/group/AddisonDogs_/
http://canineaddisonsinfo.com/Support.html

[lulusmom]

Hi Karen,

I'm so happy to see you again and we are all delighted that you found us. Don't beat yourself up over stuff you can't change. Us cushparents have to take it one day at a time. We've all been where you are and most of our experiences bring to mind that old saying "hindsight is 20/20".

Just for fun, here's a list of phrases, in no particular order, that we've all either said to ourselves or heard from others. I'm sure that I've missed more than a few and I have no doubt that other members will share their own "beat myself up" and/or "emotional hissy fit" favorites.

1. I could just kick my self for not......
2. If only I had........
3. If I could get my hands on my vet right now, I'd......
4. If only I had found k9cushings.com sooner.
5. What the????
6. Why is this happening to me and my baby?
7. My head is about to explode.
8. My heart is breaking for my baby.
9. HELP!!!
10. I am so depressed
11. I'm really scared
12. I need to win the lottery
13. I need a money tree
14. I want my mommy (I never shared this one with anybody but I said that more than a few times. :D)

Keep your chin up and remember that we're here to support you through the rough times and help smooth out the hills and valleys so that if Jed has any more rough times, they are few and far between.

Hugs,
Glynda

[sunimist]

Hi Karen,

Have been checking to see if you have returned from the vet, and very anxious to find out what was determined to be wrong with Jed.

If it turns out he is having an Addison's crisis, it usually can be controlled with IV fluids and rest. The main thing, if his electrolytes are out of whack, is to get them back in line with specific medications, usually, (but not always) by IV, designed for this treatment. However, sometimes the electrolytes are not affected (such as Misty's) and all he would need would be prednisone for a while. That's the importance of getting the lytes checked at this time and then a little later to be sure they are returning to normal.

Since the vet mentioned Florinef, he must believe the lytes are out of whack, but the only way you will know for sure is to have them do a blood draw to check them. A urinalysis, as far as I know, will not give you this information.

Please don't despair if Jed has Addison's. It is treatable and can be controlled very well if diagnosed and managed by a knowledgeable vet who is up to date on the disease.
Diet plays an important role in keeping it under control also, because too much phosphorus in the diet could be a problem. It's a balancing act to keep the lytes on track. But..we may be getting the cart before the horse here since we don't know what the diagnosis is.
Could be something entirely different.

Please let us know as soon as you can.

(((HUGS)))

Shelba and Suni

[Squirt's Mom]

Hi Karen,

Just being a worry wart here....but hoping all is better today with Jed.

Let us hear from you when you can,
Hugs,
Leslie and the girls

[Karen & Jed]

Hi everyone:

I just got back from work. We had to leave Jed by himself for a short time today because my husband phoned me at work and said that he was taking my stepson into emergency. He should be fine. He had his large intestine removed and once in a while has problems with blockages and he hadn't been feeling well for the last couple of days. It's been a crazy time. My own appetite is not great either with everything that's going on. Anyway, Jed was fine when I got home. He was sleeping peacefully. He seems to be much better today. He's just being fussy about what he eats, but he is eating. He turns his nose up at some things, takes a few licks of others and almost gobbles down some things - like the poached chicken I just made him.
I stopped by the vet's. It's very close to our place. He wasn't in, but I asked for a copy of any tests that were done on Jed this weekend and the girl said, "The blood test?" So, it was a blood test, not urine. The Dr. had Jed's file with him though, because he's doing up a report, so I can't give you the numbers yet. If his electrolytes were low right now, would I be seeing any symptoms?
Thanks so much for all your encouragement and help.
I loved the list Glynda. It's good to know that others have had the very same thoughts.
Karen

[Karen & Jed]

I just spoke to one of the assistants at the hospital and she said that she can check Jed's electrolytes first thing tomorrow morning. It's hard because the vet is so swamped right now. They've had staff move out and can't get any new ones to move in. He'd like to be working only a five day week now since he's getting to retirement age, but he just can't. I'll feel better when the test is done any way.
Karen

[Harley PoMMom]

Hi Karen,

OMGosh, It seems everything is hitting you at once...you poor dear. I will pray that your stepson will be feeling better soon and I hope that things start to calm down a bit for you.

Another thing Jed might eat is baby food, the kind that comes in the jars...like stage 1 for babies. It's pureed, no preservatives and usually pups will eat them...just a thought.


If his electrolytes were low right now, would I be seeing any symptoms?I'm not sure how low they have to be before symptoms would show, I would think symptoms would be like the same in humans?? lethargy, show signs of dizziness, weakness...but I'm not sure...hopefully "others" more knowledgeable will chime in soon.

Hugs.
Lori

[Karen & Jed]

Lori - I think the baby food is a very good idea and it would be easy to keep on hand. He just ate a little brown toast with butter. He sure grabbed that out of my hand. He used to only get dog food, pumpkin and the odd chunk of fruit. I'm probably going to have a hard time getting him to eat dog food again after toast and chicken. But, it's so good to see him hungry and eating.

Take care
Karen

[sunimist]

Hi Karen! What a relief to hear Jed is doing better! So sorry for all your other problems though.

As Lori said, baby food is a good option, but be sure it doesn't have onions in it. Some of the flavors do. I always fed just the plain meats, in moderation, that are available in chicken, lamb, turkey and maybe more, because they don't have any other ingredients (especially onions) in them.

Here's hoping you have a peaceful and restful night and thanks for the update.

More ((HUGS))

Shelba and Suni

[Harley PoMMom]

Shelba, thanks for catching the fact about onion, I should of mentioned that...bad me. :mad: Well, that's one for Glynda's list :)...I should of, and a couple more...I wish I'd...:D And the one I use alot...I'm so confused! :confused::eek::D


Here's hoping you have a peaceful and restful night and thanks for the update.Me too.

Hugs.
Lori

[sunimist]

Lori,

How bout "I'm at the end of my rope!" :D Been there several times.

Karen,


I'm probably going to have a hard time getting him to eat dog food again after toast and chicken. But, it's so good to see him hungry and eating. When a baby reaches the age of Jed and my Misty, the important thing is to get them to eat...period. It's always good if we can keep them on a good dog food, but sometimes that is not an option, so we just do what we have to do to keep them as healthy as possible. I found that Misty ate much better if I mixed boiled chicken or lean ground beef (80/20) with her kibble.
Might not work for Jed though, and he just may decide he likes his dog food afterall when he is feeling better.

Have a good night.

Shelba and Suni

[Karen & Jed]

Okay guys - we're in trouble. I took Jed to the vet today for a blood test and the Dr. just called me back. Apparently his red blood cell count was at 38% when they did the test when he went in in crisis and now it's at 20%. He gave it some long name with anemia in it and said that it is idiopathic - the cause is not known, but it is the immune system destroying their red blood cells. He's on 1/2 tablet 2 times a day, but he told me to give him 3 whole tablets right now as an emergency treatment. The worst thing was he said he's not going to lie - it's a bad thing that only 50% of dogs that get it survive! I'm supposed to call him in the morning, but he won't be here for treatment, since he's going to a near by city. He said if Jed needs help, I'll have to take him to his son's clinic in a town about a half an hour drive from here. Has anyone ever heard of this? I'd appreciate any help I can get.

Thanks,
Karen

[Karen & Jed]

Forgot a couple of details. He sent some slides to pathology & is going to do some research tonight as to what the best thing is to do next. Found this on a web site:
"Immune- mediated hemolytic anemia (IMHA), formerly known as autoimmune hemolytic anemia or AIHA, is a "secondary" disease that occurs when the body's own immune system attacks it's red blood cells. IMHA refers to all anemias that occur when the immune system inadvertently destroys its own blood cells. IMHA is secondary to an immune attack directed against an underlying condition. The red blood cells become quickly coated with tiny antibody proteins, essentially marking these red blood cells for destruction. "

That's what it was. I'm going to continue to do some research too. One of the symptoms is loss of appetite and I haven't seen that yet.

[Karen & Jed]

It was likely caused by the trauma of the crisis.
Karen

[StarDeb55]

Karen, I'm not going to sugar coat this, AIHA is a life-threatening condition. (Hematology is my speciality in the lab, so this is really the stuff I know). I'm not sure that prednisone is going to be enough to get this under control. You have to use major immune system suppressants to get Jed's immune system slowed down enough to where it will quit attacking his RBC's a foreign. There are stronger immune suppressant drugs such as cyclosporin which may have to be used. Right now, I would think that Jed would need a hemoglobin/hematocrit done every 48 hours if not daily, to see if the pred is doing the job. If the RBC destruction continues, the only thing that is really going to help until any medicine kicks in is a blood transfusion. Here's one link to a website about AIHA that has some good information in the treatment section. I'm going to continue looking & will probably be back.

Right now, you need to put the Cushing's way on the back burner.

http://www.cloudnet.com/~jdickson/treatment.htm

Debbie

[StarDeb55]

http://www.marvistavet.com/html/imha.html

After reading the marvistavet info, there are a couple of other tests that I would strongly suggest you talk to your vet about which will absolutely confirm IMHA, & these are mentioned on the above link. I should have remembered them on my first post. First one, a reticulocyte count which is a measure of how well the bone marrow is working to make new RBC. Retics are basically baby RBC that when a mammalian system is under stress like this, these baby RBC will be release early into the circulating blood. In Jed's situation, you would want to see an elevated retic count which will show that his bone marrow is trying to do it's job.

Next test, which should be done as part of a full CBC is a peripheral smear exam. This is where a thin smear of blood is made on a glass slide, then stained, so a vet, or lab tech can examine what the RBC actually look like. In Jed's situation, there are 2 things that would confirm IMHA, the presence of 2 specific types of RBC, schistocytes & spherocytes. Schistocytes are basically RBC fragments. When the RBC has become coated with antibody, the liver or spleen will "bite out" that area of the RBC, leaving a fragment of the RBC. Sometimes when the spleen or liver is trying to remove these RBC's, not a large piece of the cell is removed, so the remainder of the cell will round up to form a sphere, thus spherocyte.

Last test, is a direct antiglobulin test which will actually detect the presence of the antibody coated RBC. IMHO, the first 2 tests are really more important than the direct antiglobulin test (DAT). I would discuss this information with your vet ASAP. Do you know if your vet has the capability of doing a blood transfusion because it could be the one thing that may have to be done to save Jed's life?

Debbie

[Karen & Jed]

On the vet bill, it says he did 4 test slides and he told me he was sending them to pathology, so I'm not sure about the first test, but I would guess that they are going to do the peripheral smear that you mentioned.
He mentioned that he will have more prednisone ready for me tomorrow and another prescription. I was in some shock when I spoke to him, so I'm not sure what he said it was. Now, I'm thinking it was probably one of the immune system suppressing ones.
I guess it's going to be a wait and see thing. It's going to be another long night.
I appreciate your knowledge and response. It makes me feel not quite so alone.
Karen

[Karen & Jed]

Sorry for all the posts. But, my thinking is a little disjointed right now. Just wondering if you have any suggestions as to how to care for him in the mean time. Rest, food etc. I had noticed last night at about 10 pm (it's almost 8 pm now) that his breathing got quicker. Now I realize that it's probably to make up for the lack of oxygen in his blood stream.

[Karen & Jed]

Can someone tell me if the fact that he is off of his thyroid meds since his crisis would make any difference. Would it help or hurt him if I start giving it to him again?

[StarDeb55]

Karen, Jed needs to be one a minimum of 1 mg. of pred per lb. of body weight, split into 2 daily doses It sounds like he probably is based on the 3 tablets you were to give him. I making an educated guess here that you have 5 mg tablets, & Jed probably weighs around 7-8 lbs.? If I'm close on this, 1/2 tablet twice a day is a very low dose based on everything I've read. IMHO, if you have 5 mg. tablets, the dosage probably needs to be 1 tab twice per day. As usual , check with the vet.

When it comes to care. I think the best thing is try to keep Jed as quiet as you can. If you notice that his breathing becomes very labored, this may need to be checked ASAP because if you'll read on the links I've posted a blood clot in the lung is one of things that can happen with IMHA. I don't want to scare you, but I want to make you aware of the possibilities.

Debbie

[Karen & Jed]

Don't worry about scaring me. I'm already there. I'd rather have all the information I can get. Jed weighs 8 1/4 lbs now. Are you saying that the dose he was on for after the crisis was not enough, but that the 3 tablets is enough now? About the clots. I was just reading that small doses of aspirin has made a big difference in preventing clots in many with this problem. I think now that I've done some research, I will phone the vet and ask about that and also about what the drug is that he's giving us tomorrow.

[StarDeb55]

If you have 5 mg tablets, 1/2 tab twice per day is not enough. All of the reading I've done says a minimum of 1 mg /lb of body weight which means Jed needs about 9 mg. at a minimum. You could consider the 3 tabs that you have given a loading dose for the pred, but the dosage needs to be maintained at the 1 mg. per pound level. Aspirin might be ok, but run it by the vet, & I would think a baby aspirin. Unfortunately. the use of aspirin only affects the platelets which are the first step in forming a blood clot. The type of clotting that is associated with IMHA is much more seriouos, & would probably require the use of heparin, an anticoagulant which is given by IV. This type of blood clotting is termed disseminated intravascular coagulation. The immune system problem triggers this which leads to micro clots forming through out the body. Normally, one of the main ways to try to treat DIC for short is by IV heparin.

I just wanted to make you aware of this as the labored breathing is definitely due to the very low RBC count not being able to carry enough oxygen to Jed's body. If the labored breathing that you have already noticed, gets worse, I think you may have to go to your closest ER clinic.

Debbie

[Karen & Jed]

I just spoke to the Doc. He said that he wouldn't recommend aspirin as it's not supposed to be used with corticosteroids. I'm going to go and sit with Jed and watch TV for awhile to try to keep my mind occupied for a bit and keep Jed resting. It's time to hurry up & wait.
Thanks so much Debbie, again, for being there for us.

Take care
Karen

[AlisonandMia]

Hi - it's me.

Deb has had to go to bed but will be looking on your thread as soon as she gets up.

She's asked me to ask you a couple of questions:

Has Jed been on any other medications other than his Lysodren and thyroid meds? She was wondering particularly about any sulfa drugs (most of them are antibiotics) especially trimethoprim sulfate (Bactrim).

She also asked if there is any possibility that may have contracted Ehrlichia (a tick-borne disease)? Is it a problem in your part of the country? She says it may be worth getting an Ehrlichia titer done as this disease can cause blood problems that can be quite similar to IMHA.

Neither she nor I can answer your thyroid-med question although I do know that it is regarded as a non-urgent medication so waiting until you can ask the vet about this will be fine.

I agree with Debbie that watching him for serious breathlessness is important.

Alison

[Karen & Jed]

Hi Alison,

Thanks for helping.
Other than the supplements, he took maybe one Pecid AC altogether and 2 ml of Sulcrate suspension when the doc thought he may have an irritated stomache from the metacam, just before we figured out it was addison's. During his stay at the hospital, the invoice says IV fluids, soludeltacortef & baytril. Since he came back on Sunday, it's been 1/2 tab pepcid AC when it seemed last night like he may have overdone it with eating - his tummy was gurgling and he seemed a little uncomfortable, the prednisone, 1 tablet of milk thistle & that's it. I did give him Pedialyte a few times but stopped that now.
I was wrong about the immune system suppressant. I thought the doc said he was going to give him some, but he's not planning on that yet.
The tick or bacteria this is not likely at all in our area. Especially as Jed spends almost all his time indoors lately. Only in our yard otherwise. The vet didn't suggest giving his tyroid meds since we don't want to give him energy or speed up his metabolism, requiring more oxygen.

Thanks,
Karen

[StarDeb55]

Karen, I really can't think of anything else. It does sound like your vet is having blood smears reviewed for the RBC types that I talked about earlier. You really need to talk to the vet about having the retic count done. It's very important to see if the bone marrow is responding appropriately because the hemolytic anemia when serious enough can also affect the bone marrow where it is not able to provide those new RBC to try to fight the anemia.

I will be at work until this afternoon. The hospital's server blocks my access to the site, so I can't post until I get home. Believe me, I will be here as soon as I can.

Debbie

[Squirt's Mom]

Hi Karen,

I am so sorry for the new troubles you and Jed are facing. :( I have done a little reading on IMHA, just enough to know I, too, would be scared to pieces! :eek: BUT, you are in good hands with Debbie; I don't know what we would do without her expertise in matters of the blood values and their meanings. She is a real blessing to us.

I certainly have nothing to offer on IMHA other than my support. Anytime you need a place to fall, I have broad shoulders and can hold you up until you can stand on your own, so please don't hesitate holler if things get too much. I am not the only one here with broad shoulders who cares for you and Jed...you will not be alone now, either.

I hope you and Jed have a good day today.

Hugs and healing thoughts for you and Jed,
Leslie and the girls

[Karen & Jed]

Thank you so much for your support Leslie.
Jed's breathing doesn't look any worse this morning. His gums are very pale though. I just phoned in to work and asked if it was okay if I stay home with him. I'm able to access my desktop at work from my computer at home and they can forward the phone to me if they want.
I'm really trying to prepare myself for the worst. The mortality rate for this is very high and that includes dogs that were otherwise healthy before it started. I know his poor little body has been through so much already and he's not young anymore. He has so many other things to deal with - especially worsening arthritis that can't be treated with prednisone if he starts back on Lysodren. I'm steeling myself to the idea that if the prednisone does not do it's job and he's suffering, I'm not going to put him through much more. That hurts so bad to think about not having him, but I know it would hurt more to watch him suffer needlessly. He's been a wonderful friend. My heart is physically hurting.
But, for now I will concentrate on doing what I can to keep him eating, quiet and not doing anything to cause bleeding.
Thanks for listening.
Karen

[gpgscott]

Karen,

I am just reading about the emergency and like Leslie I cannot offer any advice but want to let you know I will be thinking about you and Jed both and praying the treatment will stop this disorder.

Scott

[Squirt's Mom]

Thanks for listening.

Any time, Karen, any time.

I know your heart is heavy with all the possibilities that may come about, but your love for Jed will carry both of you through this. I have no doubt you will always do what is best for Jed, no matter the cost to you. Just as any good mom would, and you are a great mom, Karen. Jed is so very lucky to have you on his side.

Hugs,
Leslie and the girls

[Roxee's Dad]

Hi Karen,
Didn't want to clog up your thread as you and Jed have some important issues, but did want to let you know we are thinking about you and your baby boy too. We will be keeping you and Jed in our thoughts and prayers.

[Karen & Jed]

Thank you all for your encouragement.
Just looking for opionions on whether starting him back on milk thistle would help or hurt.

Karen

[SaxLady]

Dear Karen,
Sending much comfort and healing for you and your sweet boy.
Candy

[lulusmom]

Hi Karen,

I am so sorry to hear about this latest turn of events. AIHA is another condition like cushing's that really requires the attention of an internal medicine specialist so if Jed is treating with a gp, I would highly recommend that you get him in to see a specialist asap. If Jed's problem is truly IMHA and his gums are pale, he needs emergency care asap, preferrably by someone that is familiar with the condition. It certainly sounds as though Jed is in crisis and I am really confused as to why your vet has not hospitalized him to try to get him stabilized. :confused::confused:

I found a very informative site on the condition that should answer a number of questions you have have, including the thyroid med question. According to what I read, you should not give thyroid meds as the body lowering the thyroid levels is its way of conserving energy.

http://www.geocities.com/aihadogs/faq.htm#I%20CAN’T%20GET%20MY%20DOG%20TO%20EAT

Prayers and positive thoughts are being sent your way.

Glynda

[Karen & Jed]

Hi Glynda:

That was a very well written & informative site. Thank you.
I especially appreciated the answer saying that he's just tired, not in pain. It was also reassuring to know that we're doing the right thing by not giving him his thyroid meds. I did give him a 250 mg milk thistle capsule today & the 3 prednisone tablets.
I guess the reason, he's not in the hospital is that I don't know of anything that they could do for him right now. If there is, I can take him to another GP vet that's about 30 miles away, because the only vet here is out of town today. My vet said that taking him to the specialist in Saskatoon would be the most ideal thing. It's 800 miles away.
From what I've read about what they can do about this within the next few days, I feel like he's less stressed and maybe that gives his body a fighting chance, if he's here beside me. I think it was very stressful for him to be away from me & all by himself in the hospital lately. If he was a younger and otherwise healthy dog, I may see it differently. I really am trying to see it unselfishly. As of now, with the information I have, that's how I see it.

Thanks again for your responses & concern.
Karen

[labblab]

Dear Karen,

I'm sorry I've not had the chance to post to you before now, but I'm just catching up on Jed's situation, and I'm REALLY sorry to hear about his possible diagnosis. With a specialist so far away and the only available vet today a stranger, Jed's care surely does present a dilemma. I feel certain that Debbie will be by before long, and I know she will be a great help in continuing to make sense of what may be happening. I know nothing about AIHA, so I am just learning more today alongside you. It occurs to me that a possible need/benefit from a vet visit would be a transfusion? But once again, I'll bet that Debbie can give you more help in this regard.

But at his age and with the possible outcome of this condition, I do understand that you are reluctant to stress Jed, and that you are wanting to keep him peacefully at his home and by your side right now. I surely hope that perhaps you've seen some improvement in him during the course of the day. We will be so anxious to see your next update.

With many (((healing))) hugs to you both,
Marianne

[StarDeb55]

Karen I'm finally home. I know you are in a pretty despairing frame of mind right now but here are some things to consider that may still give Jed a fighting chance. First of all, Pred is a good start, but if his retic count is not elevated or below normal, this means his bone marrow has been affected as I stated in an earlier post. IMHO, you are going to need a stronger immune suppressant medication than pred. Now, we're talking cyclosporin. The good thing about this is that it is now available a little more widely than it used to be under the brand name Atopica, I believe. When I had to use it with Barkley, I could only get it compounded. I don't want to nag about what testing has been done, but it's extremely important that the reticulocyte count be done ASAP. Jed's Hgb & Hct should be checked at least every 48 hours, if not daily for the next few days. This is going to be the only way to get an idea as to whether or not the pred is working. As Glynda has already said, pale gums are a sign of severe anemia. Do you know how pale they have looked previously, do they look any worse? If they look worse, I think you may need to take immediate steps to get Jed medical care. If the available vets don't have the capability of a blood transfusion, I'm pretty sure there is a canine blood substitute that can be used until a transfusion could be done.

I know you don't want Jed to suffer, but I want to try to show you all of your available options. 13 1/2 is a senior, there's no denying that, but toy poodles can have very long lives. If you can get this under control, it's very possible that you might have Jed for several more years. One of the links I posted for you last night is in memory of a pup that survived something like 8 or 9 years after her IMHA diagnosis. The other thing I learned last night when I was looking for more info for you & me is that poodles are one of the breeds that have a predisposition for IMHA. I'm not a vet, but from what I know about autoimmune hemolytic anemia in humans, I have serious doubts about the Addisonian issues being the trigger for this, so please don't beat yourself up about that. This is a pretty rare medical problem, & there would have been no way to determine that this was going to happen.

I just remembered a couple of other things which could be very important. Please keep an eye out for things like unexplained bruising, maybe check Jed's tummy. Keep an out for any bleeding from the nose, gums, or mouth, too. I'm not talking about gushing blood, just sort of oozing. If you see any of these types of symptoms, you need to get Jed to the vet IMMEDIATELY. These are symptoms of the blood clotting problem that I mentioned last night, DIC. DIC is an immediate life threatening condition, compared to IMHA taking several days or possibly weeks.

I will be home the rest of the evening. Thurs. & Fri. are my days off, so I will check to see if you have posted as frequently as I can.

Debbie

[Karen & Jed]

Hi Debbie:

Thanks for all your time & research. I will bring some of these things up with the vet tomorrow.
Jed in some ways seems better - only I think, as a result of the prednisone. He's not in pain from any of his arthritis & his appetite is good. He's having better bowel movements than he's ever had and I've been watching to make sure they aren't black or tarry. I know those aren't the important things right now, but it is nice to see. He's much more alert than he has been for a while too. His fast breathing & his gums seem about the same. But from what I've read it takes a few days for the Pred to do it's work. I'm trying not to give him any hard food, just to make sure he doesn't get a cut or something. He walks around a bit, but I try to keep him resting as much as I can. The vet switched him to 2 tablets every 12 hrs of Prednisone starting tonight. I know that the transfusion alternatives have to be ordered from a city across Canada and the vet said that they are ridiculously expensive. I'm a little apprehensive about even doing blood tests - taking more out of him.
I will see what I can find out tomorrow.
Thanks again for your info and care. I have to work tomorrow, but I'll let you know what I find out.

[StarDeb55]

Actually, Karen, you do need to be on the lookout for black, tarry stools, too. All of this type of bleeding is bleeding from mucous membranes which is an indication that the platelet count has dropped critically low which is one of the hallmark symptoms of DIC. The other thing I would check with the vet about is possibly putting Jed on some type of supplementation that might help his bone marrow to do it's job, perhaps something as simple as some type of vitamin. I know your worry about the blood tests, but it's the only way you are going to know if the pred is working. I would think that your vet could get a full blood count + retic on no more than 1 ml. of sample, probably a lot less.

Deb

[Karen & Jed]

Good to know about the 1 ml blood test.
As far as supplementation, I've read on the internet about BAC (bio-algae concentrates) for IMHA. It's hard to know what to trust on the internet. Have you heard of it?
I'm going to be at work today, back for lunch and then to work for a couple more hours in the afternoon, but my stepson will be with Jed.

Talk to you soon.
Karen

[StarDeb55]

Sorry don't know anything about that. I was thinking more along the lines of a multi-vitamin that had iron, B12, & folate. All 3 of these are important in the production of new RBC's.

Debbie

[Squirt's Mom]

Mornin' Karen,

I'm so glad that Jed seems to ok and has gotten no worse. That is good to hear! :D

Bio-algae concentrates...this is the first I've heard of those so I did a tiny bit of research this morning. What I found most interesting in the web searches were the folks who are using them for Autism - with amazing improvement...if one can believe the testimonials and videos. Our Gary has Asperger's, so this intrigues me for him. However, when I search my other dog forums, including the nutrition sites, I could find no reference to their use. I will post to these forums and ask if anyone has heard of their use in IMHA and let you know what responses I get. I will also ask if IMHA is a nutritionally responsive condition, as I don't know. The nutrition groups I use are the following, in case you wish to check them out yourself:

Catherine Lane's discussion group
http://pets.groups.yahoo.com/group/ThePossibleCanine-Nutrition/

Monica Segal's discussion group
http://pets.groups.yahoo.com/group/K9Kitchen/

Lew Olson's discussion group
http://pets.groups.yahoo.com/group/K9Nutrition/

You will have to join the Yahoo! groups but they are free.

Personally, I would be a bit leery of these concentrates right now. For one thing, I would want to know where the algae is coming from, how it was gathered and processed, exactly what is it and to what proportions, are the formulas consistent across the products (ie can you count on the next bottle you get being exactly the same as the previous one), and if any of the ingredients could have a negative effect on his condition. And, most important of all, discuss this with your vet in depth before trying it.

I know you are in a tough spot concerning vet options where you are and want to do something to help Jed, but be very careful of trying to "self"-medicate, especially with products touted on the web. IMHA is a very, very serious condition that can go terribly wrong in the blink of an eye so I encourage you to thoroughly research and discuss everything with your vet first.

Keep your chin up, sweetie.
Hugs,
Leslie and the girls

PS.
This is a group of vets where members can discuss their pets problems, illnesses, etc: (you might find some really good info here on IMHA)

PetVet Cafe
http://pets.groups.yahoo.com/group/petvetcafe/

[Squirt's Mom]

Hi Karen,

I have asked on my nutrition groups if IMHA is nutritionally responsive, if they have ever heard of bio-algae concentrates and if they would help in cases of IMHA. I have gotten one response so far and it is a negative on the concentrates. Lew Olson had a pup with IMHA and they treated conventionally til the pup was in better shape then started to work on the diet aspect.

Will pass on more as it comes in...
Hugs,
Leslie and the girls

[Squirt's Mom]

Another message from Lew on diet: (http://pets.groups.yahoo.com/group/K9Nutrition/)

"Generally, I recommend going to a homemade or raw diet, that seems to help the most. I also add EPA fish oil capsules, the Bertes Immune Blend (vitamins E, C and B complex, plus enzymes and probiotics). I feed frequent, small meals to start (especially while on the prednisone, it can affect digestion). I have had two dogs get IMHA, and both recovered, but it is a slow process as the immune system evens out."

Hugs,
Leslie and the girls

[Karen & Jed]

I just spoke to the vet. He got the pathology report back saying that the anemia was non-regenerative. They suggest a bone marrow sample. I don't want to put him through that right now, since even if it is cancer, there would be nothing to do except make him comfortable as long as possible.

Thank you for all the leg work you've done for me Leslie.
Can you find out or let me know how I can find out what conventional treatment was used for Lew's 2 dogs? I'm interested in what has worked for others.

Karen

[Squirt's Mom]

Hi Karen,

I know part of it was the pred but not sure what else they used. It would be to yours and Jed's best interest to talk to Lew herself, but I don't feel comfortable giving out her address. Best thing would be to go to her site and join, then you can not only talk with Lew but with others who have faced this situation. There was another person who responded to my post mainly to let us know they can survive but it takes time.

When you register, there should be a section to say why you want to join...mention my name and that you are the one I was speaking of. Hopefully that will get you approved quickly since they know you are in a crisis at the moment.

Hugs,
Leslie and the girls

[StarDeb55]

Karen, I'm posting 2 very good links about canine anemia. The first one deals with making the diagnosis, & how to differentiate between regenerative vs. non-regenerative. I'm not a vet nor a pathologist, but if Jed's blood smears were the only thing the pathologist saw, I don't understand how they can make a diagnosis of non-regenerative. In all of my experience in hematology, regenerative vs. non-regenerative are going to have pretty much the same morphologic features on a blood smear. A retic count is about the only way to tell the 2 apart, that's why it's so important. The importance of a retic count is discussed on the diagnostic link. On the 2nd link, the information about non-regenerative is on the 2nd half of the abstract.

Debbie

http://www.vin.com/proceedings/Proceedings.plx?CID=WSAVA2003&PID=6508&O=Generic

http://www.vin.com/proceedings/Proceedings.plx?CID=WSAVA2005&PID=11014&O=Generic

[StarDeb55]

Karen, did your vet do a complete blood count (CBC) on Jed which is how he discovered the anemia? If he did, I would really, really like to see all of the CBC results. The CBC may give an indication of something else going on besides the severe anemia.

Debbie

[Karen & Jed]

I just got back with copies of all the blood work finally! The vet had them with him for quite a while because he was doing research etc.
Just wondering if there's any way that I can scan it and send it to you as files? It would be a lot better for you to actually see them.
Karen

[StarDeb55]

Karen, let me see if I can track John (Roxee's Dad), as I know he has experience doing this, & I think he can help.

Debbie

[Karen & Jed]

Hi Deb:

I just e-mailed them to Alison.

[Roxee's Dad]

Hi Karen,
You can scan the document and place it in google docs. You can start your own at:

https://www.google.com/accounts/ServiceLogin?service=writely&passive=true&nui=1&continue=http%3A%2F%2Fdocs.google.com%2F&followup=http%3A%2F%2Fdocs.google.com%2F&ltmpl=homepage&rm=false

Remember to share it with the world.

Or you can e-mail it to my account:
johninsana-14024749535667315446-B2fckrsr@prod.writely.com

Let us know if you have any problems or when you have completed the upload. If you start your own account, please copy and paste the link info they will give you and post it in your thread.

[Karen & Jed]

Sorry Alison, I forgot to attach the scan - duh!
Anyway I sent them to John's account now.
Thanks guys

I'm going to be away from the computer for a bit. I'll be back when I can.
Karen

[Roxee's Dad]

Recvd an error from google docs. File/s are too big


This is an automated message from Google Docs. There was a problem importing some of the documents that you emailed in:
Scan_5.pdf: The file is too big, max allowed size is: 500000 bytes
Scan2.pdf: The file is too big, max allowed size is: 500000 bytes
Scan_1.pdf: The file is too big, max allowed size is: 500000 bytes
Scan_2.pdf: The file is too big, max allowed size is: 500000 bytes
Scan_3.pdf: The file is too big, max allowed size is: 500000 bytes
Scan_4.pdf: The file is too big, max allowed size is: 500000 bytes
These documents could not be imported.
FYI,
The Google Docs Team

Maybe try sending them one at a time or just e-mail it to Alison and she will post them as an attachement.

[Karen & Jed]

Okay - Jed is freaking me out right now. He's running like he's scared and turning and looking at his back end. I can't tell if it's something physical or neuralogical. Has anyone seen this before? I gave him a 1/4 tab Pepcid AC in case it's gas in his intestine. I don't like it when he's stressed and moving too much because he needs to conserve his oxygen.

Karen

[AlisonandMia]

OK - here are the test results:

[StarDeb55]

Karen, I've just done a quick scan of the labs. On 8/21, Jed's Hgb/Hct was low normal, by 8/25, his CBC is showing nearly a 5 gm drop in the Hgb, down to 7.8, today's Hgb is down to 7.3. The other thing is there was a retic done today & it's <1.0% which means this is, indeed, non-regenerative anemia. Do you know of any medicine or anything unusual that happened between the 21st-25th that Jed may have been given or could he have gotten into anything he shouldn't have. During that 4 day period which is a very rapid onset for this, did Jed show any symptoms such as severe lethargy, nausea, vomiting, just anything out of the ordinary? I still think that the pred has given you a good start, but IMHO, I think you need to talk to the vet about the stronger immune system suppressant that I mentioned, Atopica. He can probably get a consult with the specialist to see if they think this is the way to go. This is not going to be a quick fix. The first step is to get the immune system destruction of the RBC under control. It's then going to take time for the bone marrow to recover. Also, check about the supplementation I talked about earlier today. I did think of one other thing, but I'm not sure it's available for canines. There is a medication, brand name EPO, erythropoeitin which is the hormone that stimulates the bone marrow to basically go into overdrive producing RBC's. It's used in humans when they become severely anemia from dialysis or during chemotherapy.

I really don't see anything else too much out of whack. I strongly recommend that you talk to the vet about the Hgb/Hct being done at least every 48 hours. If Jed's Hgb goes below 7, you really need to talk to the vet about going on the stronger immune suppressant ASAP. It sounds like you want to give Jed a chance, but I also understand that at 13 1/2 you don't want him to suffer.

How much pred are you giving daily. Is it at least 1 mg./lb? If it's not, please, please talk to your vet about bumping up the dose.

Debbie

[StarDeb55]

Karen, Cushy has brought it to my attention, thank goodness, that EPO will not be an option for Jed. Honestly, I was grasping at straws for you, & did not really know if the drug was suitable for use in canines. I'm posting the information that Cushy looked up for both of us. The following is a quote from the marvistavet website.


EPOGEN/ERYTHROPOEITIN: In older times, anabolic steroids were used to address the anemia (low red cell count) of chronic kidney disease. With the advent of genetic engineering, the actual hormone the kidney has stopped producing can be given by injection. This is done usually at home 2-3 times a week along with an oral iron supplement. This treatment has helped many patients dramatically as the anemia that goes with kidney disease can be very debilitating. The downside to this treatment is that the product commercially available for use is of human origin and pets will ultimately produce antibodies against it (and worse still against their own remaining hormone). For this reason, this hormone is not used until anemia is more advanced and the patient really needs this treatment.

http://marvistavet.com/html/body_chronic_renal_failure.html


While human recombinant erythopoietin works reliably in dogs and cats, it is not quite the same protein as what a dog or cat would make for itself and in some patients the immune system of the pet can recognize the human protein as foreign. Antibodies may develop in response to its exposure which not only destroy the human erythropoietin but the pet's natural erythropoietin as well.

http://marvistavet.com/html/erythropoietin.html

I wish I could think of something else, My brain is sort of working in overdrive, so if I come up with something, I'll be back.

Debbie

[Karen & Jed]

Good morning everyone:

Whew that was a long night. At about 7 pm Jed experienced what I now know was a steroid psychosis. He was having hallucinations and it was making him run and be afraid - which he doesn't need since he's supposed to stay calm. I put him in a crate, which he isn't used to so doesn't do very well. He finally calmed down and slept around 3 am or so. He seems fine now.
Thanks so much for helping me with the lab reports and all your efforts.
Just to clear one thing up - the report with the retic on it was not done yesterday, it was done on the 25th.
As for what happened to him over the 4 days between tests. The first test was done when I took him in to the hospital because he was weak and vomiting and hyperventillating & not eating at all. The vet deduced mostly from his history and weight loss but still being on the same dosage of Lysodren, that he was in Addisonian crisis. So for 48 hours they had him in intensive care and on IV fluids. I took him in on Friday the 21st and picked him up Sunday 23rd in the afternoon. He mostly rested and continued on prednisone for the next day and a half and then I took him in on the 25th mostly because I was concerned about his electrolytes. That's when the 2nd blood test and pathology samples were taken. The first test showed signs of kidney failure, so maybe that or the stress & crisis brought on the IMHA. That's all I can think of.
I'm off to work. I'll check in when I get back.
Have a good day.

Karen

[Squirt's Mom]

Hi Karen,

I read your post last nite about Jed's behavior but had no clue as to what could be happening so had nothing to offer except to worry with you in silence. I am so glad to read this morning that he is better and that you figured out what was wrong. WAY TO GO!!! Now if it happens again, you will at least have a good starting place. :) I saw my poor little daddy experience that psychosis and it was terrifying and confusing the first time. After the first time, I just sat and swatted bugs and anything else he feared until it passed. Of course, the staff began to wonder if I needed medicating...or a straight jacket! :p

I hope you have a good day and come home to find sweet Jed having one as well!

Hugs,
Leslie and the girls

[Karen & Jed]

Hi,

I just got home from work and my step son said that Jed was sleeping most of the day. He's probably tired after last night. Shortly after I got home & fed him a little bit, he started with the phycosis again. This time I put him in the crate right away. Last night I tried to hold him and soothe him for hours, but he would just try to get away most of the time. It was the vet that was on call that told me to put him in a crate and he would eventually settle down.
The one thing I thought of that maybe Jed ate that he shouldn't have was he was almost living on chicken broth that I had bought at the store. I read something about toxicity from onions and looked on the ingredients and there was onion juice in it. I don't know if there was enough to trigger the IMHA in his state or not. I haven't given him any more.
...My writing was just interrupted for about 15 minutes for a phone call and Jed's been very quiet in his crate. He must have calmed down now.

Take care everyone.
Karen

[gpgscott]

Hi Karen,

Do be aware of onions, garlic also. I think I would not give him anything right now that I did not cook myself, and chicken and rice, and buttermilk would sustain him for a long time.

I have not had one with this issue but I am concerned that he is not hospitalized.

Very best to you all. Scott

[Roxee's Dad]

Hi Karen,
I haven't reviewed your (Jed's) Bloodtest results as I have no expertise in that field. I do rember reading about biting at flies. I have also been reading and trying to learn more about canine seizures and epilepsy and found this. Maybe Deb knows if Jed was tested for Hypothyroid.


Clinical Signs of Canine Hypothyroidism
Behavioral Problems
aggression / fearful / shyness / hyperactivity / lack of consentration / fly catching (biting at imaginary flies) / star gazing (staring in space) / inappropriate elimination (urine, feces)

There are other signs but this one reminded me I saw this on the Epi-angels site.

[Karen & Jed]

That's very interesting John. Jed is hypothyroid and he's off his medication right now because of recommendations for IMHA. He's more likely to run away from something than snap at it, so maybe it has more to do with that then the prednisone. I guess we won't know for sure until we start to taper the pred.

Scott - thanks for the tips about food. Even the chicken I had made him I poached in some of the chicken broth. I won't be doing that any more. As far as hospitalization, I'm going by what my vet says and some of my research. Such as:
"The decision to hospitalize a patient with IMHA depends largely on the severity of clinical signs. If the disease is caught early and the patient is stable, close outpatient management can be a reasonable option. More often, patients presenting with IMHA are already quite sick and need hospitalization for monitoring, supportive care, and treatment."
In a small town like I'm in, he doesn't get around the clock care. There left in a cage by themselves all night wondering where there family is. He's pretty stable right now too. So, I feel more comfortable and I think he is for now too, having him sleep beside me and I can feel his breathing, carry him out go to the bathroom and see if he's wobbly, check his poop color etc. Right now I just don't see what they can do for him in hospital. He's a dog that really gets seperation anxiety too. He won't even lay on the couch unless someone is with him.

I'm very touched by all of your concern and efforts for us.
Thank you so much

[StarDeb55]

Karen, I understand totally about you wanting to keep Jed at home in light of the situation with your vet. My GP vet does the same thing, once the office closes at 6PM, there is no one there to monitor any pups that are kept overnight. It makes me very uncomfortable.

Debbie

[Squirt's Mom]

Hi Karen,

Wanted to pass this on to you before hitting the hay tonite. This is from Moncia Segal's site, K9Kitchen:

There have been studies which have shown that bio-algae concentrates can be helpful for many species of animals with different forms of cancer and blood diseases. Antioxidants and porphyrins ( found in dark green leafy vegetables) have also been shown to be helpful in blood diseases in animals and humans.

If it were my dog, I would want to hedge my bets as best I could. I
would first and foremost verify with the vet that he has ruled out
causes of this that are potentially treatable.... for example, eating
pennies (can cause an overdose of zinc), infection with ehrlichiosis,
and allergic/unusual reactions to some antibiotics can also cause IMHA.

If your dog has any food sensitivities at all, you need to be
meticulous. Adding bio-algae concentrates is definitely worth a try.
Can't hurt, might help, and if it does, what a gift. Ditto for dark
green veggies like spinach. I would enhance his diet with spinach and
other colorful veggies for the phytonutrients.

With any immune mediated illness, stress can be a big trigger. Although you want to feed a healthy diet, I would weigh the decision to make a major change in the diet carefully. It might be better to alter his existing diet - enhance it with nutritious foods - than to change it suddenly and dramatically. I don't know that a "cancer" diet would be of any benefit since this is not a true cancer. But since IMHA can be rapidly lethal in many dogs, I would definitely try some BAC and add vegetables rich in phytonutrients.

Again, so sorry about the diagnosis. Hope you can keep ahead of it for a while.

Cathy (moderatorui)


I haven't explained to this group that it isn't my pup I am asking about as this is the first response from them. I have had more dealings with Monica than I have Lew and trust her completely as a result. Not to say that Lew is any less qualified or trustworthy - she isn't. Each of the groups I belong to have a different view and approach, but they are all good. It just takes some looking, reading, and talking to see who is the better fit for you and Jed.

Hope he is doing better with his fear attacks, whatever the cause, and that you both have a good nites rest.

Hugs,
Leslie and the girls

[AlisonandMia]

Hi,

The one thing I thought of that maybe Jed ate that he shouldn't have was he was almost living on chicken broth that I had bought at the store. I read something about toxicity from onions and looked on the ingredients and there was onion juice in it. I don't know if there was enough to trigger the IMHA in his state or not. I haven't given him any more.

Karen

I think there is a good chance that the onion juice in the chicken broth could be the cause of Jed's anemia. The timing looks like it could be right for this to be the cause.

You need to let your vet know ASAP that Jed has been having it and that it lists onion juice as an ingredient.

If it was the onion that has caused this then it won't be Immune Mediated HA but a different sort of HA caused by onion toxicity which shouldn't be an ongoing problem. I believe a special test (looking for something called Heinz bodies in the blood) can confirm that it is caused by onion.

Here's a link to some info on IMHA which mentions onion toxicity as being a possible cause of hemolytic anemia: (http://www.marvistavet.com/html/body_imha.html) It says:


Remember, not all causes of hemolysis (red blood cell destruction) are immune-mediated. Onions in large amounts (and possibly garlic as well) will cause a toxic hemolysis.

Alison

[Squirt's Mom]

Hey Karen,


Remember, not all causes of hemolysis (red blood cell destruction) are immune-mediated. Onions in large amounts (and possibly garlic as well) will cause a toxic hemolysis.

Oh, this would be wonderful!!! Scott and Alison have made an excellent point and one certainly worth looking into. I've had tunnel vision...ain't it great that so many can work on your situation and give various thoughts? What a group we have here! :cool::cool::cool:

Keeping you and Jed in my thoughts and prayers,
Hugs,
Leslie and the girls

[Karen & Jed]

I'm sorry everyone. I didn't get any e-mail message for some reason, so I didn't know there were any posts for me. I just came to post something to you because I've been thinking about some of these same things. Thanks for all your great input. Here's something that my desperate mind has been thinking: Since it was nonregenerative does that mean that it may not be the immune system destroying them at all, but only a problem in the production of new red blood cells and does that mean it may not be IMHA.
In the Merke Veterinary Manual on line it listed these reasons for nonregenerative anemia: Nutritional Deficiencies, Anemia of Chronic Disease, Renal Disease. Then under Anemia of Chronic Disease it said, "Primary Bone Marrow Diseases - Anemia of chronic disease can be characterized as mild to moderate, nonregenerative, normochromic, and normocytic. It is the most common form of anemia seen in animals. The anemia can be secondary to chronic inflammation or infection, neoplasia, liver disease, hyper- or hypoadrenocorticism, or hypothyroidism. The anemia is mediated by cytokines produced by inflammatory cells, which lead to decreases in iron availability, RBC survival, and the marrow’s ability to regenerate. Treatment of the underlying disease results in resolution of the anemia."
Does that not sound like it's saying that hyperadrenocorticism (that's addison's isn't it?), could cause it and that if it indeed was an Addison's crisis and the addison's is treated, that it could solve the problem? And if he hadn't been eating for quite a few days - maybe nutrition could have been a factor and then the onion wouldn't have helped.
I know his hrt was at 38% when he went in and 20% 4 days later, but it may have been starting to deplete and I read also that it takes a few days to start regenerating and maybe for the prednisone to start working.
Can anyone tell me if this makes sense?
Karen

[Karen & Jed]

I just spoke to my vet with all our thoughts. He said yes, it does mean that it may not be IMHA or that it's not absolutely for sure that it's not nonregenerative just from the one test. He didn't think that the addison's would likely cause it, as it wasn't chronic, just temporary. He said one thing that contributed to the hrt count decreasing so quickly was that on the first test he was dehydrated and on the 2nd he was hydrated, dilluting the blood. Which I think is bad because it may mean that it probably was lower already and maybe it is cancer. He said in that case they would have treated with Prednisone anyway to buy some time. I mentioned the onion toxicity and we figured that the lab would probably have mentioned seeing heinz bodies in the blood, but he's not ruling it out. He said he's going to do some more reading and tell me if there's anything he thinks we can do effectively.
I am more concerned now that it could be cancer, since I had noticed even before the addison's crisis, I thought his gums seemed a little pale. I can tell that the vet thinks it is cancer too.
This sure is a roller coaster ride. It's really wearing me out.

Karen

[AlisonandMia]

When I asked Deb whether the Heinz bodies would show up on the tests run so far she said most likely they wouldn't have - it seems a special test needs to be done to find them, ie you have to specifically go looking for them.

Alison

[Squirt's Mom]

Hi Karen,

In reading the Merck manual, I would have to say that the Addisonian crisis could be behind his anemia, and getting that treated and under control could bring his RBC count back up. But, renal or a primary bone disease as well as nutrition deficiency's/toxicities, could also be the cause of non-regenerative anemia.

Another thing I read is that giving fluids can help prevent renal failure in patients with IMHA. I wonder if giving sub-q fluids at home is something you vet would recommend or do they not thing it is a factor in Jed's case?

What worries me most about your situation is the lack of medical attention from specialists. I know that has to be of concern to you as well. There are so many possibilities and you are left to figure them out on your own...with a little help from us, of course. ;) I know it would be costly, but not as much as an 800 mi trip to the specialist, but I think it is important that Jed's RBC count be checked at least every 48 hours as Debbie has suggested. This will give you a better idea of how much improvement, if any, since getting the Addison's crisis under control.

I'm sure Debbie will along to give you much more info on the possibility of the crisis as the cause...this is her bailiwick! And, thank goodness we have her here! :cool:

Hang in there, you are doing a superb job!
Hugs,
Leslie and the girls

[Karen & Jed]

Another question for Debbie: Also the high white cell count and the nucleated, dysplastic, binucleated red cells and inflammatory leukon all sound like cancer too, don't they?

Karen

[Squirt's Mom]

Hi Karen,

Just read your last post so I went back to the manual and looked under anemia. This is what I found:

Anemias that are caused by decreased erythropoietin or an abnormality in the bone marrow are nonregenerative.

If no evidence of external bleeding is found, a source of internal or occult blood loss must be sought, eg, a ruptured splenic tumor, coagulopathy, GI ulceration or parasites, or other neoplasia. If hemolysis is present, the patient may be icteric. Patients with chronic anemia have had time to adjust, and their clinical presentation is usually more indolent with vague signs of lethargy, weakness, and anorexia. These patients will have similar physical examination findings, pale mucous membranes, tachycardia, and possibly splenomegaly or a new heart murmur, or both.

Bone marrow evaluation by aspiration and/or biopsy is indicated in any animal with an unexplained, nonregenerative anemia. If the CBC reveals a decrease in more than one cell line, possibly indicating a hypoplastic marrow, a biopsy would be indicated along with an aspirate. Biopsies and aspirates are complementary: biopsies are better for evaluating the architecture and degree of cellularity of the marrow, and aspirates allow for better evaluation of cellular morphology. Aspirates also allow for an evaluation of orderly maturation of the red and white blood cell lines, the ratio of red to white blood cell precursors (M:E ratio), and the number of platelet precursors. Iron store can also be evaluated by Prussian blue staining. An M:E ratio of <1 indicates that red cell production is greater than white cell production; with an M:E ratio >1 the opposite is likely. The M:E ratio is always interpreted in light of a recent CBC, because changes in the ratio could also be due to suppression of one cell line compared to the other.

His assessment of the crisis as a cause makes perfect sense - chronic VS acute - and Jed's crisis was NOT chronic. I hope you and your vet are so wrong about the possibility of cancer but it is something that needs to be checked out. :(

Hugs,
Leslie and the girls

[Karen & Jed]

Another thing is that I don't think his blood work really supported that he had addison's when he went in. Maybe it was all because of cancer and the Prednisone and the rehydration has helped temporarily with the symptoms.

Karen

[StarDeb55]

Not necessarily, the bone marrow is so stressed right now, it's releasing nucleated RBC's to try to compensate for the profound anemia, & basically dumping all cell types into the circulating blood trying to cope with the stress of the anemia. Karen, all I can tell you is when Barkley got sick before his lymphoma was diagnosed his CBC results showed what is termed pancytopenia meaning low WBC, low RBC, Hgb & hematocrit, & low platelet count. Jed's CBC does not show that at all

Even though I wasn't able to post at work today, I was doing further research on the onion toxicity issue, & I think that this is the largest part of Jed's problem. When it comes to detecting Heinz bodies, unless the vet lab stained a blood smear with what is called a "supravital" stain, the lab would not have picked them up. Routine hematology stains which is usually either a Wright's or Wright's-Giemsa will not pick Heinz bodies up. I would think the vet lab should still have enough sample from the 25th or whatever date it was that initially showed the profound drop that your vet could request the sample be pulled & tested for Heinz bodies.

I have brought a copy of my lab's Heinz bodies procedure home which includes some of the clinical information which might be of interest.

CLINICAL SIGNIFICANCE:


Heinz bodies are found in the presence of unstable hemoglobin, in certain red cell enzyme deficiencies, & following ingestion of oxidative drugs. Drugs commonly associated with the presence of Heinz bodies are sulfonamide, nitrofuran, antimalrial, dilantin, streptomycin, & fava beans. (No cracks about Hannibal Lecter, please!:rolleyes::D).

This is why I asked whether or not Jed had been given Bactrim or any other sulfa based antibiotics. After the reading I did today, the culprit in onions is a sulfa containing compound.

In our procedure, we actually have some information about how cats are affected including the % of Heinz bodies present to be clinically significant. In my reading today, cats are more severely affected than dogs but my educated guess would be that the information in the procedure would be pretty close to what the consequences are with canines.

In this situation, I'm pretty much in agreement that this is probably not IMHA. I do think it would be worthwhile to see if your vet can get the Heinz body test added on to the blood the vet lab should still have. Most labs, human or vet, should be keeping samples for a minimum of 5 days, this is why I think the test can be added.

I didn't want to bore you with the technical details about cats but will post them if you want. I do hope this helps. It's my gut feeling that if this is simply hemolytic anemia due to onion toxicity, it should be self-limiting, but how long it will take for the bone marrow to kick in, I just don't know.

Debbie

[gpgscott]

Maybe a course of Procrit would be in order. It is not that costly and can kickstart the marrow.

Scott

[StarDeb55]

Umm, Scott, I posted about the possibility of using EPO (Procrit is one of the brand names) on Thursday, I think. Cushy alerted me to the fact that EPO is not used in canines unless it's a last resort. To sum up the info she passed on to me which I posted for Karen earlier, since EPO is a human product, a pup's system can build antibodies against & make the anemia much worse.

Believe me, when I posted I was grabbing at straws trying to find something that might help.

Debbie

[gpgscott]

Umm, Scott, I posted about the possibility of using EPO (Procrit is one of the brand names) on Thursday, I think. Cushy alerted me to the fact that EPO is not used in canines unless it's a last resort. To sum up the info she passed on to me which I posted for Karen earlier, since EPO is a human product, a pup's system can build antibodies against & make the anemia much worse.

Believe me, when I posted I was grabbing at straws trying to find something that might help.

Debbie

Thanks Debbie,

I am aware that if it is used for an extended period of time the body builds resistance to it and I have no experience in cannine adminstration but I do have experience with a feline and it was a very good experience. I just wanted to put it out there and still think I would discuss it with the Dr. in this case.

Scott

[Squirt's Mom]

Hi Karen,

More links for you:

IMMUNE-MEDIATED HEMATOLOGIC DISEASE AND BONE MARROW FAILURE
http://www.hemopet.org/files/Immune%20mediated%20hematologic%20disease.pdf

VetNet
http://www.vetnet.co.uk

*look for AIHA forum* - there is quite a bit of discussion/info on this forum!

Hugs,
Leslie and the girls

[Karen & Jed]

Hi everyone,

I really would love if this onion thing were it. Unfortunately what's stuck in my mind is that I told the Dr. that I had noticed that Jed's gums looked kind of pale to me before. I can't remember when it was for sure - maybe within the last couple weeks before he went in the hospital. But the vet had previously said that the hrt count wouldn't have been low enough to make him pale if he was 38% as the first test said. But obviously since, he has thought about the fact that he was dehydrated when he went in and had that test done and his count was probably actually lower than that and it probably was never a drastic drop as we first thought. I was glad to hear about the difference between Jed's blood count and one showing lymphoma, but what about leukemia or bone cancer? I don't know what blood counts would look like with them.
I guess part of me is so afraid to hope right now. This has been such a painful time for me as I know many of you can relate to. I'm sure you've all been through your share and more. I really can't say how much I appreciate your continued support.

[Karen & Jed]

I just spoke with the vet. I guess he had tried to call when I was out. He does think the onion is possibly a culprit. He did say there is a treatment, but we would have had to do it right away and if it was the onion and he' s survived this long, he'd probably get better on his own. I think it's a long shot. As far as the counts indicating cancer, he said it's not that specific. That's why they recommended a biopsy. Here's hoping for a miracle.

Karen

[SaxLady]

Karen,
I am trying to keep up with the posts. However, it's been difficult because I just lost my little Katrina. I do want you to know that I am saying prayers that Jed will be fine. Saying prayers for you as well.
Hugs and comfort,
Candy

[Karen & Jed]

Dear Candy,
Thank you for reaching out to encourage me in a time that must be so difficult for you. I'm so sorry for the loss of your dear friend. She looks like a sweetheart.

Take care,
Hugs back.
Karen

[AlisonandMia]

I just spoke with the vet. I guess he had tried to call when I was out. He does think the onion is possibly a culprit. He did say there is a treatment, but we would have had to do it right away and if it was the onion and he' s survived this long, he'd probably get better on his own. I think it's a long shot. As far as the counts indicating cancer, he said it's not that specific. That's why they recommended a biopsy. Here's hoping for a miracle.

Karen

I think I'd go for the Heinz body testing before doing something as invasive as a biopsy of some kind. If they do find Heinz bodies in quantities to explain the red-cell count then onion is likely the culprit and then at least waiting and seeing if Jed recovers before going any further with more invasive tests would make sense.

From what I've read, one of the cancers associated with hemolytic anemia is hemangiosarcoma which would probably be best looked for with a high-resolution ultrasound.

Alison

[StarDeb55]

Karen, I've been mulling things over while I've been at work today, but didn't want to post until I could look at Jed's labs, again. I am convinced you are not dealing with anything that might cause bone marrow failure, because Jed's marrow HAS NOT failed. On his results from the 27th, he has a very elevated WBC count that if this result were on a human, we would consider it critical. His platelet count is perfectly normal. If he were in bone marrow failure, you would see quite the opposite, a low normal or low WBC, with a low platelet count. Now, the WBC may be elevated simply because of stress. Both WBC & Platelets are stress reactants in the body & will go up with no real serious reason for it. For example, most patients post-operatively will show an increase in both of these values due to the stress of surgery.

IMHO, your vet is correct about Jed's hemaglobin/hematocrit were probably much lower on the initial set of labs that showed these values to be low normal. Dehydration will cause the RBC to concentrate because there is less liquid (plasma) in the blood, causing the Hgb/Hct to falsely elevate. Once the pup or human patient has been rehydrated, then these values will fall like a stone. I have seen human patients with a GI bleed who were actively bleeding copious amounts of blood come into the ER with a normal Hgb/Hct, but they are dehydrated. Once the IV's have rehydrated the patient, then BOOM, the patient has a critical low value on these 2 results.

Not to be a nag, but I really think it would be worthwhile to see if the Heinz body test can be added on to any of the blood that has already been drawn which the lab should still have. Ideally, it should be the sample that showed the profound drop on the Hgb/Hct. As Alison has already said, this would not involve another blood draw, & it would probably go along way to ruling in or out the onion toxicity question.

How are both of you doing today? As you can tell, I've been thinking about both of you.

Debbie

[Karen & Jed]

Thank you for thinking about us so much. It really touches my heart.
I'm glad to hear that bone marrow failure is not indicated.
I understand what you're saying about the heinz body test. It's just that I want to put my time & resources only into things that will make a difference in how we proceed. If some treatment would depend on it then I would do it. I'd love for it to be the broth that did it, but it just seems like things are pointing towards some type of cancer. One of those things we know now is that his rbc's were low and his gums were pale when he went in the first time and that was before the broth.
I'd rather put our money into nutrition and things that will help his overall health and keep him going as well and as long as he can. (I'd appreciate any input on that too.) Then, when & if the time comes, more meds to keep him comfortable until he lets me know it's time. In the mean time I want us both to enjoy our time together as much as is possible. I don't know if that makes any sense to you.
Please keep talking to me when you get a chance. Your knowlege and compassion are very reassuring.

Take care,
Karen

[StarDeb55]

The one thing I can tell you about nutrition with a possibility of cancer is what Barkley's oncologist wanted me doing for him. To quote,
Carbs feed cancer. She wanted Barkley on a high protein, low carb diet. I don't remember right off the top of my head, if Jed's kidney function is ok or not, but you want to be careful with a high protein diet for a pup who does have compromised kidney function. The one dry kibble I can recommend that I used with Barkley & I still use it is EVO, high protein & absolutely no grain. I don't know if it's available where you are, though.

Debbie

PS- Have you considered having an abdominal ultrasound done to check for any masses, especially a hemangiosarcoma? It's the lab tech in me that even if I wasn't going to treat, I would want to know what I was dealing with so I would have some idea what to expect.

[StarDeb55]

Karen, it's been a couple of days since we have heard how things are going for both of you. How is Jed doing & how are you? I sincerely hope that this finds Jed making some progress.

Debbie

[Karen & Jed]

Hi,

Sorry I haven't written for a bit. I was so out of my routine for the last couple of weeks, that I've had so much to do and catch up on. Jed's demeanor is better now that he's not on quite so much Prednisone. He's having 2 tablets every morning now. As far as his breathing & his pale gums, they haven't gotten any worse. He sleeps a lot and is very hungry. I think he's gained some weight back. He's also still scared quite a bit. I'm pretty sure that John was right and it's not being on his thyroid meds that's causing that. On Monday we will be going in for blood tests and I will talk to the vet about whether he can go back on those. I'm having a bit of a hard time with knowing what to feed him as the vet said he wants him on a diet to support his kidneys & as you brought out, carbs feed cancer. I've been giving him cooked chicken or hamburger, Hill's k/d (it's one of the only dog foods I've been able to get him to eat), some buttermilk, pumpkin (he'll only eat if it I mix it with the meat) and a few Old Mother Hubbard biscuits - which I soak a little so they aren't hard. I don't want to give him anything that may cut his gums. His poop had been getting softer and a little slimey again - maybe because the higher doses of prednisone had been making things more solid - and adding the pumpkin has made it better.
As for me, I'm trying to get back into my routine as much as I can, but I try to get back home as quickly as I can. I don't like being away from him much.

Take care
Karen

[Harley PoMMom]

Hi Karen,


I'm having a bit of a hard time with knowing what to feed him as the vet said he wants him on a diet to support his kidneys & as you brought out, carbs feed cancer.


This site has some good info on phosphorus levels in foods.

http://www.dogaware.com/kidney.html

(scroll down a bit and there are charts)

Quacks from

Carol, Atty Cat & always Winnie & McGill

Hope this helps.

Love and hugs.
Lori

[StarDeb55]

Karen, I'm very happy to hear that both of you are hanging in there & Jed at least seems to be stable. Did you ever ask the vet about some type of supplement that might help with the anemia? The supplement probably should contain iron, B12, & folate, all of which are important in the production of red blood cells.

I can't offer much more help with the food issue as I have never had to deal with renal problems. Barkley had enough issues, but at least he didn't have any renal problems.

Debbie

[Squirt's Mom]

Hi Karen,

So glad to know that Jed is no worse and seems to be holding his own.

It's hard when we have to continue with our daily routines which take us away from our babies when they are in need, but I know you are doing everything you can to be with Jed once your other obligations have been met.

Take care and let us hear from you.
Hugs,
Leslie and the girls

[Karen & Jed]

Thanks for the link Lori. I had read that site and gotten some ideas from it, but am glad to know that you are endorsing it. Have you had any experience/sucess with it? That's another thing I've given him a couple of times is egg whites with a little yolk. I think I'll go make him some.
I'll ask the vet about supplements when we go in after the weekend also Debbie.

Thanks
Karen

[Squirt's Mom]

Hi Karen,

I have some kidney diets I had gathered for another friend here from Drs. Messonnier and Pitcairn if you are interested. Of course, you would need to run them by your vet for approval first.

Here is another link on managing kidney diets:

Dietary Management of Dogs With Renal Disease
http://www.vetprof.com/clientinfo/KidneyDiseaseInDogs/diet.htm

I urge to you also keep in mind Jed's liver as you work on the kidney diet. The supplements Debbie recommended will help.

If you want to try to address his problems nutritionally, there are several good folks online you can contact and work with who are trained specifically in canine nutrition. Most vets have very little knowledge of nutrition. I firmly believe a nutritional approach can do wonders for many, many conditions. For Jed, I would strongly recommend Monica Segal. You can find her at:

http://www.monicasegal.com/

Hugs,
Leslie and the girls

[StarDeb55]

Karen, just to clarify, the 3 things I mentioned to look for in any supplement will help the bone marrow produce RBC. Any deficiency in these 3 nutrients/vitamins will hinder the bone marrow in the production of RBC. Of course, right now, you want to do everything you can to "jump start" Jed's bone marrow, & get cranking out as many RBC's as possible.

Debbie

[Karen & Jed]

So, can I just get iron, B12 & folate meant for humans and if so, what dosage. I'm pretty sure as Leslie said about most vets, my vet won't know a lot about this type of approach.

Karen

[StarDeb55]

Karen, I'm sorry, but most human based medication & supplements are frequently not appropriate for our pups. What I would suggest, if your vet is not familiar with this, that he contact the IMS, & ask for their input.

Debbie

[Karen & Jed]

Good to know.
Thanks
Karen

[MiniSchnauzerMom]

Karen,

Just wanted to give you a word of caution about the Canine Restricted Protein diet from http://www.vetprof.com/clientinfo/KidneyDiseaseInDogs/diet.htm

This is a very old diet from Hills from the late 1970's. Not only has it shown up in print, it has circulated around the internet forever. I was given the diet sheet (which contained this very same diet along with several others) for a dog I owned in the 80's and called Hills about it then. I also called them about it in 2007 when a vet gave it to me for Munchie and spoke to yet another representative about it last year.

To make a long story short each and every time I called, I was advised that this diet is outdated, it is unhealthy and I should throw the printed sheet away as well as tell the veterinarian who gave it to me to dispose of it.

Louise

[acushdogsmom]

I would strongly recommend Monica Segal. She is a Nutritionist, which means she has a vet degree in nutrition. and with Jed's situation that is the type of assistance you will need.Actually no ... to my knowledge, Monica Segal is not a Vet and she is also not board certified in Veterinary Nutrition (ACVN).

Her bio on her website says
Monica Segal is certified in Animal Health Care through the University of Guelph with studies in animal nutrition, physiology, diseases and parasites, as well as pet care.Note that it says through the University of Guelph, not at the University of Guelph. So she may have taken a course in animal health care (which included some studies in animal nutrition) at a community college or school which is in some way affiliated with the University of Guelph, but she did not graduate from Guelph, or it would surely say on her website that she did. Guelph is a prestigious University in Canada and if she actually had a degree from Guelph, in Veterinary Medicine or otherwise, she'd be saying so, I'm sure.

And if she had a "vet degree in nutrition", after her name it would say "DVM, Diplomate ACVN", indicating that she is a vet and also a boarded specialist in veterinary nutrition instead of the letters "AHCW" (I have no idea what that stands for, by the way).

That said, Monica Segal may still be very good at what she does - and she charges for her services, so I sure hope that she's good at it - but she really isn't very clear or forthcoming on her website about her qualifications and educational background.

[acushdogsmom]

Karen,

Just another idea I thought you might like to know about. I don't know if you'd be interested in this, but if you are looking for help with formulating a good homemade diet for Jed, maybe you and your Vet can work with Dr. Rebecca Remillard, who works at the Angell Memorial Vet Hospital in Boston.

Here's a little blurb about her on the Angell Memorial website:
http://www.mspca.org/site/PageServer?pagename=nutrition_Team (http://www.mspca.org/site/PageServer?pagename=nutrition_Team)

She is a Board Certified Veterinary Nutritionist (DVM, Diplomate ACVN) and in addition to her job at Angell Memorial, she also has a website http://www.petdiets.com (http://www.petdiets.com/) where she does offer consultations and formulation of diets for pets with medical conditions.

I've never used her service, but I did know someone (online at another e-group) who consulted with Dr. Remillard in person at Angell Memorial in Boston, and she was very happy with the homemade diet that Dr. Remillard created for her dog.

Here's some info about Dr. Remillard's services from her website:

https://www.petdiets.com/Consult/default.asp (https://www.petdiets.com/Consult/default.asp)


Our Expertise:
We specialize in making sound dietary and nutritional recommendations for dogs and cats with medical conditions. Your pet may be sick and not eating the recommended diet well. Your pet may have more than one medical condition for which there is no single best commercial pet food. We make recommendations and formulate diets based on current principles of dietary management and the pets' food preferences. We offer choices based on the known current scientific literature and our clinical experience.

This is a Nutritional Consultation through your primary care Veterinarian:
Your primary care veterinarian as a vital partner in the care of your pet. Legally, we must work through your veterinarian because we do not have a primary doctor/patient/client relationship with you. We work as a specialty consultant to your veterinarian. Our recommendations will be sent directly to your veterinarian for review and you will be notified when the information has been sent to his or her office.

Client Education:
We also consider client education an important part of our mission and service. We provide you with the most current information specific to your pets’ medical condition(s) in an understandable prose written specifically for pet owners. Pets only need one nutritional formulation (one recipe) however, food substitutions are offered when appropriate.

Recommendations:
We fax our written recommendations to your veterinarian for review. You will be asked to provide this contact information. We will complete our recommendations generally within 10-14 business days of receiving confirming medical information from your veterinarian. Our charge for a personalized Nutritional Consultation is $250 for your first pet, but then discounted ($100) for your second pet or discounted further ($50) for the third pet in the same household IF different diet formulations are required. Most times, we can design a diet that accommodates more than one dog or cat in the household.

This fee covers product research, review of medical information and a diet formulation. It also covers all questions you may have about our diet recommendations. Food substitutions are always offered if appropriate. Please understand there is an additional charge of $100 to reformulate another homemade diet if you should later request a change in ingredients, foods or supplements that were not previously specified or if the pet should develop another medical condition.

Note that she provides different kinds of dietary advice (commercial diets, homemade diets, or a mix of the two) depending on what you ask for:

https://www.petdiets.com/popup/popup.asp?url=body.asp&sT=Types of Nutritional Recommendations (https://www.petdiets.com/popup/popup.asp?url=body.asp&sT=Types of Nutritional Recommendations)


You may only want specific commercial product recommendations for the pet. Each letter of recommendation will include specific product names, our reason(s) for suggesting those products, our order of preference (if there is one) and the recommended amount to feed the pet.

You may only want a homemade diet formulated specifically for a pet or you are feeding a homemade diet and want to know if it is complete and balanced, and appropriate for the pet's condition. Each letter of recommendation will include a recipe using both metric and common measurements on the amount of each food ingredient to feed the pet per day. The recommendations also include specific and easily obtained nutritional supplement(s). We also provide information on the preparation and storage of the food, monitoring of the pet and veterinary instructions. All diet recipes are guaranteed to be nutritionally complete and balanced according to current scientific information and our clinical experience.

You may want recommendations that consider both commercial and a homemade diet formulation.
As you can see, Dr. Remillard's service is not exactly cheap, and the client's Vet has to also agree to work with Dr. Remillard as a consulting Specialist, but if you are interested, I don't think it matters that you are in Canada and Dr. Remillard is in the States. You and your Vet can communicate with Dr. R. via e-mail and/or fax, I'm sure, or via long distance phone calls if necessary.

[Squirt's Mom]

Thanks for the info on Monica, Cushy. I have obviously either misunderstood what I was told, or mislead altogether. In hindsight, the lack of "Dr." should have been a clue?

:o :o :o :o :o :o :o :o :o :o :o :o :o :o :o :o :o :o :o :o :o :o :o :o

[Karen & Jed]

Put on your dancing shoes everyone! I have some promising news. Jeds HCT count was up today from 20% to 25.7 and his hemoglobin was up to 7.9 g/dl from 7. His retics were at 2.8%. It seems that he's regenerating. I hope everything continues to improve. His tongue has gotten pretty white looking underneath about a week and 1/2 ago and started getting pinker since then, so I was getting my hopes up. I really had a feeling that it was from being on the lysodren at a dose that was too high for too long. So I've been doing more research lately and found these three comments from different sites:

Lysodren side effects:
Anorexia, vomiting, diarrhea (blood)
Lethargy, weakness, ataxia
Idiosyncratic hepatotoxicity
CNS toxicity
Transient or permanent hypoadrenocorticism
Bone marrow necrosis

Adverse effects of mitotane include GI upset, idiosyncratic
hepatotoxicity, central nervous system (CNS) toxicity,
and development of transient or permanent
hypocortisolism.6 Two dogs treated with mitotane
reportedly developed bone marrow necrosis when
receiving appropriate doses of the drug. (this was a study of 200 dogs on mitotane)

Conclusions and Clinical Relevance—Results suggest that bone marrow necrosis may be common in dogs with hematologic disorders. In most dogs, bone marrow necrosis was associated with an underlying disease condition or drug exposure, but idiopathic bone marrow necrosis was also identified. Disease conditions that should increase suspicion of possible bone marrow necrosis include sepsis, lymphosarcoma, and systemic lupus erythematosus; drug exposures that should increase suspicion of possible bone marrow necrosis include chemotherapeutic agents, phenobarbital, carprofen, metronidazole, and mitotane. (J Am Vet Med Assoc 2005;227:263–267)

Anyway, I was crying again on the way home from the vets today - this time out of some relief & hope.

Karen

[gpgscott]

Hi Karen,

I hope it is just an over administration of Lysodren and that little Jed is recovering.

The labs you are reporting are BIG improvments and serious prayers here for more improvement to come.

Please keep us up to date and many well wishes and prayers for you, Jed and your whole family.

Scott

[StarDeb55]

YAHOOOOOO!!!!

Way to go Jed!! I was going to post to you in a little bit, Karen, to see how things were going, but you beat me to it with terrific news. With a retic count of 2.8 %, Jed's marrow is most definitely regenerating, working hard to combat that anemia. You may be on to something about the bone marrow necrosis. I'm wondering what your vet would say about it, & would he/she be willing to get the IMS's thoughts on the possibility. My concern is that if there is a distinct possibility that the lyso is the cause, could this happen again with further treatment with lyso???

Karen, this has really made my day, I'm tickled all different shade of pink for both of you.

Debbie

[Karen & Jed]

Thanks for sharing in my excitement and for all your warm wishes.
I had wondered myself how the vet would take my suggestion and I was surprised. He said it is a possibility.
I also am concerned about Jed reacting to Lysodren again. I was hoping that if it is that, it was because of an overdose. Whatever the case, we would have to monitor it closely. He does so much better as far as his pain & weakness when he's on the prednisone. I'm wondering if he may be one of those dogs that does better leaving his cortisol a little higher than the usual goal for Cushings treatment.
Another piece of good news from our visit was that his weight is perfect now. He's up from 3.9 kg to 4.6. The only problem now will be preventing him from going higher. He's back to being ravenous and waking me up a couple of times during the night for food.
We're cutting back the prednisone to 1/2 tablet a day & he's restarting his thyrotabs at a low dose.

Take care,
Karen

[Karen & Jed]

Oh - one question Debbie. Jed's platelets are very high. Is that something to worry about and what could be the cause? His white count is up slightly from last time too, although down from what the pathology lab said compared to the vets office on the same date.

Karen

[Squirt's Mom]

YIPEE!!!!

What good news, Karen!! :D:D I am so glad to read this post tonite! Along with many others here, I hope this trend continues and this dreadful time will be behind you before long with no lasting adverse effects. This is just great! :D:D

Big hugs,
Leslie and the girls

[StarDeb55]

Karen, keep in mind that when the bone marrow is regenerating & hyperactive, this is not only going to affect RBC production, but also WBC & platelet production, since all of these cell types are made in the bone marrow. These 2 cell types are also a stress reactant in the body & will elevate when the body is under stress. Goodness knows, Jed has been under stress.

Debbie

[gpgscott]

Karen, based on your report and Debbie's take it does seem there is much reason to believe that Jed is on the mend.

Continued well wishes and prayers for you all.

Scott

[MiniSchnauzerMom]

Karen,

I was so glad to read that Jed has taken a "turn for the best". Poor little guy has really been through the mill, as well as you. I hope he continues to improve and that restarting his thyrotabs will help Jed to feel even better!!

Louise

[Squirt's Mom]

Hi Karen,

It's been way too long since we heard about Jed....how are things going for ya'll? Drop a line when you get a chance, ok? Set an old worry wart's mind at ease. :p

Hugs,
Leslie and the girls

[Karen & Jed]

Hi everyone,

I hope this finds everyone doing well. I keep thinking about you all and wanting to send you a note, but everything has been so busy since it was put on hold for quite a while. I can't tell you how grateful I am for your support through our crisis.
Jed continues to do pretty well. Our biggest challenge has been his appetite. His weight is back up to 5.3 kg. It was perfect at 4.6. He gets me up once or twice during the night for food which really affects how I function during the day. He's been on 1/2 tablet a day of prednisone for about a month now.
We're at a scary part for me now. We just got a blood test and acth response. His hct count was 38% - great news. His kidney values are now a concern. I was hoping they would be better, but they've gotten worse. His ura was at 27.7 nmol/L (ref 2.5 to 9.2). Not sure how far along the scale of renal failure that is. I'm wondering if that's from the high doses of pred and/or damage from the crisis. I've been trying to feed him a low phosphorus homemade diet mostly, with the Hill's prescription k/d canned sometimes. We're going to start him on an ACE inhibitor. Any recommendations for supplements etc would be appreciated. His pre and post cortisol were <25. Here's the scary part to me. The vet said it's time to wean him off of the pred and start today to load him on Lysodren. He's been drinking more again lately and I assumed by the doc's wanting him on Lysodren that his cortisol must be up again, but then I got a copy of the test results and see that it's not. I haven't started the Lysodren yet, but sent an e-mail to the vet to say he needs to explain to me why we're putting him on Lysodren at this point. Isn't it possible that he's still Addison's and the drinking is from the kidney problem and the appetite is from the prednisone? I'm waiting for his reply.

Karen

[Roxee's Dad]

Hi Karen,
Very glad that Jed is doing pretty well.


He's been drinking more again lately and I assumed by the doc's wanting him on Lysodren that his cortisol must be up again, but then I got a copy of the test results and see that it's not. I haven't started the Lysodren yet, but sent an e-mail to the vet to say he needs to explain to me why we're putting him on Lysodren at this point. Isn't it possible that he's still Addison's and the drinking is from the kidney problem and the appetite is from the prednisone? I'm waiting for his reply.

Yes, I would be scared too. Very good heads up on your part to want to know why. Good for you!:)

Please let us know what he has to say.

[StarDeb55]

Karen, I'm so happy to hear that the hemolytic anemia has successfully resolved. I would absolutely question the vet about putting Jed back on lysodren as when you convert your results to ug/dl, both Jed's pre & post are <1 ug/dl. In fact, with numbers like that, IMHO, Jed still needs to be on pred. If your vet is insistent, I think I would ask that he consult with the IMS.

Sorry can't help with the kidney issues as I have never had a pup who had kidney problems. I would like to see what the creatinine value is. Creat is the more important of the 2 tests to monitor kidney function. BUN can be affected by level of hydration, diet, & several other things, whereas the creat normally is not.

Deebie

[acushdogsmom]

His pre and post cortisol were <25. Here's the scary part to me. The vet said it's time to wean him off of the pred and start today to load him on Lysodren. He's been drinking more again lately and I assumed by the doc's wanting him on Lysodren that his cortisol must be up again, but then I got a copy of the test results and see that it's not. I haven't started the Lysodren yet, but sent an e-mail to the vet to say he needs to explain to me why we're putting him on Lysodren at this point. Isn't it possible that he's still Addison's and the drinking is from the kidney problem and the appetite is from the prednisone? I'm waiting for his reply.

KarenMy dog's cortisol production dipped to too-low levels (pre and post ACTH stim values at less than 10 nmol/L) several times over the years that he was being treated with Lysodren. He was in the care of an Internal Med Specialist, and she never put him back onto the Lysodren until his post-ACTH stim test number came back up to around 100 nmol/L (3.6 ug/dl) or even a bit higher than that.

And when we did start him back on the Lysodren, there was no need for a loading dose, since we were not trying to lower his cortisol production - just keep it where it was. So we just started him back on a weekly Lysodren maintenance dose when we did start him back on the Lysodren.

For sure, we would not have been putting him back onto the Lysodren with a post-ACTH stim test number of <25 nmol/L (less than 25 nmol/L, which "translates" to less than 1 ug/dl) especially after an Addisonian-type reaction.

I'm not a Vet and not a medical professional of any kind, but I would think that it is indeed possible that the increased drinking could have something to do with a kidney issue and an increase in appetite can definitely be caused by the pred. Pred can actually cause increased water consumption, too. Those symptoms are certainly not due to overproduction of cortisol if his post-ACTH stim test result is at less than 25 nmol/L, so I can't understand why your vet would want to start back on the Lysodren at this point in time.

I haven't been able to read through your whole thread, but if you have a Specialist who can be consulted, I think I'd vote for doing that.

P.S. Not sure if you know this, but it's possible that Jed's cortisol production may never get high enough again to warrant being on Lysodren. We've had several members whose dogs' cortisol got too low several times, and each time climbing back up eventually to levels where the Lysodren maintenance could be restarted - until the time when the numbers went too low and the cortsiol production never did get high enough again for the dog to need Lysodren.

So you need to wait and see if the cortisol production continues to rise or not, and at least to where it gets to levels of around or over 100 nmol/L (post-ACTH) before re-starting the Lysodren. And I'm sure you also can see why you can't always know by symptoms alone if the cortisol is too high or too low - you always need to do an ACTH stim test (ACTH response test) to see by the post-ACTH number where the cortisol reserves really are.

[gpgscott]

Karen,

I am very glad that Cushy has given you her view of this and it seems you two are thinking the same way.

Please let us know as soon as you have a response from the treating Dr.

Scott

[Karen & Jed]

Thank you for that info from your experience Cushy. That makes total sense to me. That's why I was so surprised to see the test results. On the phone when he was telling me how we were going to proceed with the Lysodren. He said the results were "what you'd expect in a case like this" and asked if he was drinking more again. I said I had noticed an increase just recently and assumed that he meant the results showed his cortisol was getting higher again. Am I ever glad I always get a print out and have you guys to reassure me that I'm not crazy for questioning things!
Debbie:
The creatinine value is within the reference range. It's at 128 umol/L (ref range 68 to 141). Bun/Cr ration 54.3. Chloride was a little low - 103 mnol/L (ref 108 to 118) not sure if that means anything. The biochem notes that came back from the lab says, "Mild increase in urea - could be renal, pre renal or non renal. Recommend checking urine sg" (must be specific gravity) "to assess if increase is a reflection of volume contraction or dehydration. Mild low chloride any diarrhea?"
I just cleaned up the yard today - not really much diarrhea, it seems to depend on what he's eating, but it's mostly very solid.

Karen

[acushdogsmom]

You're not crazy. :D

And please note that I edited my post above a few times, so I hope you saw everything I said, including the PS and a few other thoughts I added in there. :)

[Karen & Jed]

Thanks for pointing out your edits. I hadn't seen it all.
It wouldn't surprise me if Jed is permanently addison's just because it took us a while to figure out that it was an addison's crisis. It was quite awhile before he got the proper treatment.
I wish I did have access to a specialist. :( I would have gone that route a long time ago for sure.

Karen

[sunimist]

Hi Karen,

Are you referring to the BUN here?
His ura was at 27.7 nmol/L (ref 2.5 to 9.2).

Check out this link
http://www.vet.uga.edu/VPP/clerk/mckee/index.php


BUN concentration is most often measured to assess kidney function. It is important to realize that many different disease conditions alter BUN concentration but may or may not alter renal function. Therefore, BUN concentration should be compared with creatinine concentration and urine specific gravity to properly evaluate kidney function.


And some causes of high BUN:

Increased protein intake
Upper gastrointestinal hemorrhage
Increased catabolism of protein
Starvation
Infection
Fever
Prolonged exercise
Drug administration
Glucocorticoids
Azothioprine
Hypovolemia
Shock

I am in a bit of rush right now, but will be back later. I personally think it would be tragic for Jed to start him back on Lysodren with a post reading of below 1. After much testing and ruling out, it was determined that Misty's strange kidney levels were affected by her addison's, and not so much kidney related.
I'm hoping your vet will take a little time and rule out other possible causes before restarting Lysodren on an addison's dog.

Be back later

Shelba and Suni

[acushdogsmom]

Hi Karen,

Are you referring to the BUN here? I think that Labs in the States tend to refer to "BUN" and Labs in Canada (and some other countries, as well) refer to "urea" - but I think that it's the same thing:

http://www.igan.ca/id83.htm


BUN or Urea

BUN stands for blood urea nitrogen. It measures the amount of a waste product called urea in the blood. Urea is formed by the liver in the process of ridding the body of ammonia which is built up as protein you eat is broken down. It is normally excreted in the urine. If kidney function is impaired, the urea builds up in the blood. In general, the higher the urea the worse the kidneys are functioning. However, the BUN can also rise because of other reasons, even if the kidney function is still good.

People in Canada, Europe and other parts of the world may not actually find BUN or the term "blood urea nitrogen" printed anywhere on their lab reports. In this case, the test is simply called "urea", and the lab results are given in SI units

[AlisonandMia]

Hi Karen,

When was that stim test run - the one that gave the low figure?

I would think that before starting him on Lysodren again (if you do) he should be off the pred and have another stim. It is quite likely that the Cushing's symptoms you are seeing now are simply caused by the pred. How much pred is he on, how often? (Sorry if you've already said.:o:))

You are doing a really good job!

Alison

[Karen & Jed]

Thanks for your replies girls,

Sorry. That was just a typo on my part. It was supposed to be urea, not ura. Yes. I would think that that is the same as BUN.
I can see some of the causes of high BUN could apply to Jed besides kidney failure:
Increased protein intake (could be since I started a homemade diet)
Upper gastrointestinal hemorrhage (no black tarry poop)
Increased catabolism of protein (?)
Starvation (definitely not!)
Infection (his wbc is good)
Fever (don't think so)
Prolonged exercise (ha ha!)
Drug administration (yes)
Glucocorticoids (yes!)
Azothioprine (?)
Hypovolemia (he's slightly anemic - don't know if that's connected)
Shock (doubt it)

Misty's situation encourages me too - maybe it is because of the addison's.

Alison: The stim test was done last Friday Oct 9 and it was sent away to a lab and with it being a holiday weekend, we didn't get the results back until yesterday, Oct 15th. He was on very high doses of pred at first when they thought he had IMHA, that was decreased and for a little over a month he's been on 2.5 mg every a.m. He weighs about 11 1/2 lbs. right now.

[lulusmom]

Hi Karen,

I noticed that your vet uses IDEXX Labs so it is possible that the reference units on the acth stim test result may be in ug/dl? If so, then your vet may be right in thinking that Jed's cortisol could be too high. However, I do agree with Alison that any stim done while being dosed with prednisone could skew the results and if you confirm that the reference unit is ug/dl, Jed should probably be tapered off the prednisone and new acth stim test done.

A post stim of 6 ug/dl or greater for a cushdog is interpreted as too high, plus the prednisone can definitely push that number higher. A combination of both can certainly cause elevations in the urea (BUN). If that is the case, then Jed's kidney functions are probably fine. My Lulu's IM explained that elevations in BUN, plus the protein in her urine are both secondary to the cushing's disease. She was not concerned with Lulu's labwork as her creatinine, urine specific gravity and I believe she mentioned bilirubin (?), were all normal which is a good indication that kidney disease is not involved. Debbie may be able to confirm if it is the bilirubin or albumin that is usually abnormal with kidney disease.

Can you get back to us with your confirmation on the acth stim test reference units?

Glynda

P.S. Cushing's disease absolutely increases protein catabolism. This is what causes the severe muscle wasting.

[acushdogsmom]

Hi Karen,

I noticed that your vet uses IDEXX Labs so it is possible that the reference units on the acth stim test result may be in ug/dl? If so, then your vet may be right in thinking that Jed's cortisol could be too high.I know that Karen will tell us the units of measurement that are on her actual Lab test report, and that's a good point, Glynda - ie are the cortisol numbers in nmol/L or in ug/dl ? - but I'm in Canada and I can tell you that even though we have IDEXX Labs here (a Canadian Veterinary Lab was bought out by IDEXX a couple of years ago), the reporting units on my lab test reports are still in nmol/L for cortisol (not ug/dl)

[Karen & Jed]

Hi Glynda:

Yes. The pre & post coritsol levels were less than 25 nmol/L, which is less than 1 ug/dl. So, he's definitely low.

Karen

[StarDeb55]

Karen, I'm slightly less concerned with a normal creatinine. There is a possibility that the elevated BUN may be a warning sign of developing renal issues since it is on the increase. I think you & the vet need to formulate a plan to address this which it looks like you are. I would also ask the vet about regularly checking Jed's BUN & creatinine to try to catch a problem before it get out of hand.

Debbie

PS- I just got home, so didn't actually read what everyone has posted to you this afternoon until just now. Anyway to answer Glynda's question about bilirubin to monitor kidney function, OOPs, bilirubin is a liver function test, albumin & total protein are the other tests to look at along with BUN & creatinine.

[Karen & Jed]

Thanks Debbie.

[AlisonandMia]

If he was on pred when that stim was done (Oct 9) then what the test probably measured was actually the pred - especially as the pre and post were the same. The results would suggest that he is not producing any cortisol for himself and is therefore still Addisonian. The only other explanation for that stim test result is that there was something wrong with the stimulating agent or he didn't actually get the stimulating agent. I do recall one case at cc.net where an IV stim agent didn't actually make it into the vein (tech error) which caused a false low result on a test. (Anyone else remember that one?)

If he tested so low while on the pred then I'd think he needs the pred just to replace normal cortisol productions and most certainly doesn't need Lysodren at all at the moment and most certainly doesn't need to be loaded. A low dose of pred like this combined with such a low stim test result would be most unlikely to be the source of his drinking and increased appetite. I'm so glad you are questioning your vet on this!

Do you think it is possible that his weight gain and increased appetite could be that you are now feeding a home cooked diet and he just likes it a lot more? Personally, I wouldn't feed him at night as he doesn't really need it and, as you said, it isn't doing you any good! If you do decide to not feed overnight then you will likely find he stops asking as he no longer gets a reward for waking you up. If do decide on a no-food-at-night policy I'd think the "asking" will get worse before it gets better though so if you do do that, starting it over a weekend might be a good idea so you can catch up on your sleep.

Another thing - increased appetite and urination and thirst are symptoms of diabetes (to which poodles do seem to be rather prone) so getting that ruled out might be a good idea too.

Alison

[Karen & Jed]

I just got back from picking up some food at the vet's and the receptionist told me that the doc is going to phone the lab about what to do. I feel very relieved about that.

Debbie: I started Jed this morning on the ACE inhibitor that the doc gave me and we're doing a low phosphorus diet to slow down progression of kidney disease. Albumin was 35g/L (ref 27-36) if that matters.

Alison: Jed has always been very food oriented. He drove me nuts when he was Cushingoid. The only time he wasn't hungry was when he was on the right dose of Lysodren. It is possible that the home cooked diet has made it worse - he didn't get any people food for a long time before that. Also, it's harder for me to keep track of calories now. When he was on dry dog food I knew how many calories were in it and just measured out the amount he was allowed for the day and split it into 3 or 4 servings. He's also hypothyroid, but is on only 1/2 the dose that he used to be on to keep it under control. The vet wants to keep the meds down because of the kidney problem. That won't be helping his appetite and thirst either will it, along with the pred and kidney issues? When he first came home after the crisis he wouldn't eat and he was way too thin, so I just wanted him to eat whenever and whatever he would. That probably made a bad habit for him too. For some reason, he doesn't bother me much during the day if I'm home. He mostly sleeps. It's the evenings that are the worst. I usually have to give him a little spray with the water bottle to get him to quit bugging me. I think you're right about feeding him during the night. I'm going to try to feed him before bed and then only put him out to go to the washroom, if he wants off the bed and I'll have to give him a little spray to disuade him after that. Hopefully my husband can be patient enough.
His blood glucose level on this last test was 6.3 mnol/L (ref 3 to 6.6).

[acushdogsmom]

Here's something you can print out to show your Vet that may be helpful.

The quote below is from the Cushing's therapy recommendations from the Auburn University Veterinary Lab protocols posted on the Auburn University site and it says:


During maintenance therapy:

1. Cortisols are between 30-110 nmol/L; continue as is.

*2. Cortisols are below 30 nmol/L; stop lysodren, retest with ACTH at 3-4 week intervals until cortisols increase to 30-110 nmol/L range, then resume maintenance.

*Dog may require glucocorticoid supplement, especially if stressed. Also, monitor Na/K to see if Addison’s has occurred


They are saying that it would be okay to restart after the dog's post-ACTH stim result is AT LEAST 30 nmol/L - but preferably higher than 30 and less than 110 nmol/L would be the time to restart Lysodren maintenance therapy. As I said previously, my dog's Internal Med Specialist Vet liked to see his cortisol back up to around 100 or so before restarting the Lysodren.

The entire post is in our Resources Forum, here:
http://www.k9cushings.com/forum/showthread.php?t=207

And here's a direct link to the entire one-page pdf file that you can print out:

http://www.vetmed.auburn.edu/uploads/81/83/81830a52bfaaf4c1b889e5e3d20db2a9/Cushings-Therapy-Recommendations.pdf

(or print out the pdf file that is attached to the post)

Hopefully, the person at the Lab with whom your Vet is planning to consult will also know the correct way to proceed when a dog treated with Lysodren has an ACTH stim test (ACTH response test) with results as low as Jed's are after being off the Lysodren entirely for as long as he has been off it. After almost 2 months off of the Lysodren his adrenals are still only capable of producing less than 25 nmol/L of cortisol when stimulated to release all of the cortisol reserves into the bloodstream, and the stim test numbers probably also included some pred that was read by the lab equipment as cortisol. The way I learned it from the Specialist who treated my dog with Lysodren for more than 6 years, that's just not enough to restart on Lysodren.

Your Vet could maybe also contact any Internal Med Specialist, maybe one at a Specialty Clinic in Calgary, for an opinion, by phone and/or fax.

I am sure that any Boarded ACVIM Specialist would know that you don't restart Lysodren with cortisol values that low, especially when the dog is coming off of an Addisonian reaction and is still on pred and has values that low on a stim test.

[sunimist]

Karen,

How long has Jed been on just the 1/2 dose of thyroid meds? Do you have the last free T-4 results? And when was that test done?
What time of the day do you give the meds?
I'm just noodling here, but wonder if his thyroid level is too high. You may have already addressed this, but please post those results again if you have them. An imbalanced thyroid level can cause some of the symptoms Jed has, so just grasping at straws, I guess.

[Karen & Jed]

That post from the Auburn University is perfect. I printed it out and will show it to my vet. Thank you.

I don't think you're just grasping at straws with the thyroid question. I think you're right on. Before the crisis Jed was on 2.5 mg thyrotab 2 x day for about 6 months. He was tested in June (2 months before the crisis) and his Tetraiodothyronine was 32.4 nmol/L (ref 13 to 44). The lab comments were, "T4 indicates fairly good control of thyroid disease - there is room to increase dosage if clinical signs warrant it." He was off the thyrotabs for 3 weeks during and after the crisis and the vet let me put him back on about a month ago, but only at 1/2 the dose that was keeping fairly good control previously, because he doesn't want to overload his kidneys since he's worried they are showing signs of disease. So that certainly won't be helping his thirst and appetite.

[Karen & Jed]

Oops! I must have accidentally pressed the thumbs down icon. Please ignore it. It doesn't apply.

[AlisonandMia]

I've got rid of the thumbs down icon for you and selected "no icon". Actually, I think you can edit it yourself by clicking on edit post and then, click "go advanced" and that will allow you to edit smilies and the post icons.

Looks like another thyroid test might be in order. I don't know how long the dog has to be on a dose for the test to be accurate though. Someone else should be able to help with that though.

Alison

[Karen & Jed]

Thanks Alison.:D

[lulusmom]

Hi Glynda:

Yes. The pre & post coritsol levels were less than 25 nmol/L, which is less than 1 ug/dl. So, he's definitely low.

Karen

Thanks for confirming for me. Wow, I was certain that you were mistaken about the reporting units because quite frankly, I wanted to give your vet the benefit of the doubt as I found it difficult to believe that he would suggest anything as outrageous as weaning Jed off of prednisone and recommencing Lysodren treatment with a pre and post number of less than 1 ug/dl. As I recall, the nearest IM is 800 miles away for you but are there other vets within a reasonable distance that may have at least some experience with cushing's? If so, I'd seriously consider changing vets like yesterday. If you don't have that option, then Jed is incredibly lucky that he has such an informed mom. Can you imagine what would have happened had you had blindly followed your vet's recommendation? This is a perfect example of why it is so incredibly important for us cushparents to educate ourselves. Good job, mom.

Glynda

P.S. If Jed restarted thyroid meds a month ago, you can retest now.

[sunimist]

Karen,

It appears Jed hasn't had a thyroid panel done since June when tests showed he was controlled, right? He was on a fairly large dose of thyrotabs (2.5 mgs twice daily). Completely off medication for three weeks and then restart at 1/2 dose? Correct me if I'm wrong.
If this is correct, he definitely needs a thyroid panel done, at least a T-4.

FWIW, thyroid meds cause prednisone to exit the system at a faster rate resulting in less control. I had the same problem with Misty and we had to adjust her dose and schedule to keep things on a more even plane. Something you might want to check on with your vet.

[Karen & Jed]

I totally agree about the thyroid panel needing to be done and I'm sure that it would be high, but I don't think it would make any difference to the vet at this point, since I brought it to his attention and he doesn't want to increase his meds anyway because he doesn't want to over load the kidneys. Yesterday I e-mailed a hospital in a city that is about a 5 hour drive there and back to ask them if anyone there has much experience with Cushings & Addison's and am waiting for an answer. Maybe there's a vet there that will understand the blood chemistry & treatment better. Otherwise, I will ask this vet to check with specialists about what the kidney values meand and how to proceed with thyroid meds. Frustrating.

Karen

[sunimist]

Karen, I know how frustrating this is for you and if you can take Jed for a second opinion, I think that would be the thing to do at this point. Hope you get some positive feedback from the call you are waiting for.

He may very well have kidney problems, and that might be the primry issue, but he definitely needs a vet with experience in dealing with kidney disease if that's the main issue. It is a complicated and delicate disease and has to be treated correctly.

However, I will tell you from my experience that when Misty was suffering from what we thought was kidney disease a few years ago, a very savvy lady told me that from the bloodwork and symptoms it didn't sound or look like kidney disease to her. She said it looked more like Addison's to her and that was often the case with the two diseases. Guess what! She was right. We started concentrating on treating the Addison's and before long Misty did a complete turnaround. She did have early kidney disease, but that was not her primary problem, just mostly age related, and the kidney issues did not ever become a problem. I'm not indicating that's what Jed's problem is, just another possibility you might want to pursue if you see another vet. Just my opinion. :)

((Hugs))

Shelba and Suni

[Karen & Jed]

Shelba - I really think you are probably right about that; especially because his kidney values were fine until the Addison's crisis. I appreciate you sharing your experience with me. It's very reassuring. All of you are really an invaluable resource to someone in a situation like mine, where we have inexperienced & overworked vets trying to help us.

Thanks,
Karen

[sunimist]

Hi Karen,

Haven't heard from you in a while and was just wondering how Jed is doing. Have you heard anything from your email or has your vet consulted with a specialist yet?
Hope no news means he is doing well. Please let us know. :)

Love and hugs,

Shelba and Suni

[Karen & Jed]

Hi Shelba:

Thanks for checking in on us. Sorry I haven't filled you all in for a while. I got an answer back from that clinic that I had e-mailed that's a ways away from here and here was his reply:

"Hi Karen,

Cushings disease is a bit of a bugbear to treat I have to admit. It is a disease that we see, however I would not say we see a terribly high number of them.

Honestly, to give you much information about the case, I would have to see the whole record including the previous labwork and we'd likely need to set him up for a full exam. To be brief on the information you've given me, we usually wouldn't put a dog back on Lysodren unless his cortisol values were high after an ACTH stim - you probably need to get a full rundown from your vet on where he is at.

We would be happy to help you out on this if you wish, or if your vet wishes to refer him, that would be fine."

I got sick for a good week, so I didn't bother phoning the vet, I just waited for him to get back to me. When I got better, I phoned him, since he never did get back to me. Now I don't know for sure if he spoke to a specialist, but he did change his tactics. He now wants us to wean Jed off of the prednisone, keeping an eye out for any addison's symptoms, get it out of his system for about a week or 10 days and then do a stim test here in the clinic. No Lysodren for now. Jed's getting a 1/2 tablet every 2nd day now. His appetite hasn't gotten any less that I can tell, but he did have one night where he actually slept all the way through!

Karen

[acushdogsmom]

Now I don't know for sure if he spoke to a specialist, but he did change his tactics. He now wants us to wean Jed off of the prednisone, keeping an eye out for any addison's symptoms, get it out of his system for about a week or 10 days and then do a stim test here in the clinic. No Lysodren for now. Jed's getting a 1/2 tablet every 2nd day now. His appetite hasn't gotten any less that I can tell, but he did have one night where he actually slept all the way through!

KarenHi Karen,

I am really glad that you haven't been giving Jed any more Lysodren and I am also glad to hear you are watching for Addisons type symptoms while carefully weaning off the pred and also glad you'll be doing another ACTH stim test after the pred is out of his system.

You really don't want to start back on the Lysodren until those post-stim numbers come back up. So I'm really glad to hear that your Vet has changed the treatment plan.

Every dog is different in the way they react after an overdose - some may start overproducing cortisol again very quickly, others may take a long time before starting to really produce measurable amounts of cortisol, while others may never again have the ability to produce large amounts of cortisol.

You need to find out what Jed's adrenals are going to do by observing him and by doing periodic stim tests etc - and no more Lysodren until and unless his cortisol production increases to a level where it's safe and appropriate to re-start the Lysodren.

Please keep us posted! :)

[Sabre's Mum]

Hi Karen

I have been following Jed's thread but just wanted to pop in and say hi and maybe give you a little insight into what has happened to my Hungarian Vizsla - Sabre.

As "acushdogsmom" has said ... every dog is different in the way the react to Lysodren.

Sabre went low last year, went lower and was off Lysodren for 4 1/2 months. We only used pred on a two or three days at the start of being very low. When he came off pred there was very little difference so we did not give him any more. We tested him a week later (not much difference in numbers), 2 months later (within range but not much cortisol in reserve) and about 4 months after no Lysodren when we restarted him. Even though the numbers were in range on the test after 2 months of no Lysodren we did not restart him due to what the pathologist described as an "addisonian response". From my research I found a reference that if the post had an increase of less than 25% than the pre it was considered an "addisonian response".

Generally, the pre is not used in interpreting the results of the ACTH stim but I believe that it is very important in cases where the dog has gone low (and also in the case of a non-stimulatory response). You really need to see a "response" after the agent is injected. We eventually restarted Sabre on Lysdodren when his pre was 2.35 and the post was 3.73. Sabre is now more sensitive to Lysodren and it has taken a few stims and change of doses to finally get a maintenance dose sorted out. He is now on 20mg/kg and both the vet and I do have our suspicions that even this dose may have an eroding effect on his adrenals. So, hence I continue the watchful eye as usual!

Take care and all the best to you and Jed

Angela, Sabre and Flynn

[Karen & Jed]

It sounds like you and Sabre have had quite a roller coaster ride too and that you've done a great job. It's so hard sometimes, isn't it? But, our friends are worth it. :)

Thanks so much for sharing your experience with me. It all helps me very much when dealing with a vet that is inexperienced with cushings. Especially the part about the "addisonian response" . I will be sure to watch for that once we start testing him again. It's also very good that you and "acushingsmom" have made the point that each dog's situation is different. It will make me more vigilent having no preconceived ideas.

I will keep you posted.

Take care,
Karen

[Karen & Jed]

Hi

Just checking in to keep you all posted. Jed's been doing well. He's been off the pred for about a week. His appetite has definitely changed. He's still asking for food quite a bit, but he's a little fussier now. He's sleeping good. I see that his arthritis is starting to bother him again now. That was a nice thing about being on the steroids. I was going to give him Metacam again, but in all the info it says it is not for dogs with kidney problems. I have Jed on glucosomine for his joints and milk thistle for his liver. Does anyone know if there's anything that is well known to be helpful for their kidneys? He's just on the Thyrotabs and ACE inhibitor for meds right now.
I'll be taking him in soon for an acth stim to see where he's at.
Hope everyone is doing well.

Karen

[Casey's Mom]

Hi Karen, my dog Casey is taking Adequan injections from the vet for her arthritis and it really helps her - also she can't take Metacam because of her elevated liver enzymes which I believe is common in a Cushings dog.

[Karen & Jed]

Thank you Ellen, for your response. I will look into Adequan for sure.

Karen

[gpgscott]

Hi Karen, my dog Casey is taking Adequan injections from the vet for her arthritis and it really helps her - also she can't take Metacam because of her elevated liver enzymes which I believe is common in a Cushings dog.

Just to point out Adaquan is not totally benign in the area of renal load, but is much better than the oral meds and is better directed at the issue of joint pain.

I have used it now for almost 15 years for three pups, Moria included and I think it is one of the best treatments going.

Scott

[Karen & Jed]

Good to know Scott. I'm going to do a little research on it and bring it up to my vet next week when I bring Jed in for an acth stim test. I'm going away for the weekend and am a little nervous. I have to leave him at the kennel. They are a very good kennel and he seems to be doing fine. I will leave them with very specific instructions as to what to look for as far as signs of Addison's.

Take care
Karen

[AlisonandMia]

It probably wouldn't hurt to get them to give Jed a little dose of pred while he is in the kennel. Being away from home is stressful for them so if his cortisol is on the low side still it may cause problems for him there even if he is fine at home. It may give both you and the people at the kennel peace of mind. You could ask your vet about this.

Of course the stim test results may be in before you leave and may show that this won't be necessary. But some dogs that are well within the 1 - 5 range still need a little pred in stressful situations - it varies from dog to dog and it seems that as they get older sometimes they are more likely to need it.

Alison

[Karen & Jed]

Very good idea Alison.
The clinic is too busy to do a test before I leave, so I'd feel better knowing he's had some prednisone. The vet wants it out of his system for a while before he does the test, but it'll have to wait.

Thanks
Karen

[StarDeb55]

Karen, sorry I haven't posted earlier but have been out of touch due to installing a new computer. I'm so very pleased for both of you that Jed is still doing well.

Debbie

[AlisonandMia]

Very good idea Alison.
The clinic is too busy to do a test before I leave, so I'd feel better knowing he's had some prednisone. The vet wants it out of his system for a while before he does the test, but it'll have to wait.

Thanks
Karen

You only need to wait 24 hours after a dose of pred before doing the stim test - maybe 48 hours if it was a really big dose. You shouldn't have to wait any longer than that because pred doesn't last long in the system.

Alison

[Karen & Jed]

Hi Debbie. Nice to have you back. I hope you're enjoying your new computer.
Alison - I'm very happy to hear I don't have to wait long to test after the pred.
Once again, you've really helped me. Now I will be able to enjoy the weekend without too much worry.

Thanks again

[Karen & Jed]

Hi everyone,

Just giving you an update on Jed. He had an acth stim test on Wed and they phoned with the results today. His pre was 2.28ug/dl and his post was 4.39. So, the vet said to continue with no pred or Lysodren and watch for signs of addisons or cushings. The poor little guy has had some stressful things lately. We had to go away 2 weekends in a row, so he went to the kennel from the 13th to the 16th, and the 21st to the 23rd. Then Wed was his vet appt and Thurs was his grooming. He seems much more stressed being kept in a crate now, since his addisons crisis. I don't know if it's his cortisol level being lower that makes him not able to deal with it as well or if it is trauma from being alone in the vets office for 3 days and all the IV's and needles etc. I noticed when I picked him up from the kennel and the vet, he was whining, barking and panting. He seemed panicky and he used to be so good. He had a1/2 tablet of pred every 2nd day while at the kennel, since I wasn't able to watch him and it was a stressful situation. Also, twice in the last couple of weeks he started having softer bowel movements and didn't seem well, so I gave him a 1/2 tablet and it picked him right up. When I picked him up from the kennel last time, he had been dragging his bum on the ground so much it was pretty red & raw. I got some corticoid cream from the vet and it's much better now. So his last pred before the test was on Sunday. He had the test Wed and it was Wed night I had to give him another 1/2 tablet. He would start trembling and all of a sudden have to go out and he'd be out there squatting all over the yard for about 10 or 15 minutes. It seemed like he would still have the urge even though not much was coming out. The pred settled him down right away. He went right back to normal and didn't go out for the rest of the night. Anyway, yesterday and today he seems really good and he looks good too after his grooming yesterday. We noticed a definite thinning of his coat lately. I think that's a result of all the pred he's been on. I'm glad we're not going anywhere for a while now.
I have to see if I can get his weight to go back down some again now. He's at 5.7 kg and his ideal is about 4.5.

I hope you're all doing well.
Karen

[Squirt's Mom]

Hi Karen,

So good to hear from you and Jed! Poor little fellow, he really has had some stressors lately, huh? I know it was hard on him being in strange places without his mom close at hand so it isn't surprising that you are seeing some reactions to that ordeal. Our cush pups don't handle stress too well and Addisonian pups even less so he's kinda between a hard spot and a rock. :( I am glad to hear that the pred is helping him, tho! :D I wonder if it was stress that made him scoot his butt so much at the kennel? OUCH! Glad the cream helped!

Hugs,
Leslie and the girls

[Karen & Jed]

Hi friends,

I hope everyone enjoyed their holidays. Jed's been doing pretty well. I'm guessing that his cortisol is going up all the time, since his appetite and weight sure are. He's back to being overweight. He's only taking 1/2 the thyroid meds he was taking before as the vet was concerned about his kidneys. For about a week now, he's been taking a swim in the tub every night for some exersise and to hopefully strengthen his legs. He sleeps good at night and hasn't started drinking too much yet. My vet thinks it's best to wait for him to start drinking lots before we start treatment again. His last acth stim test was Nov 25th - pre was 2.28ug/dl and post was 4.39, which was good. Does it seem wise to wait for him to start having symptoms again before we treat? My thinking was that by that time he has all the complications of Cushings that are hard on his system, that we were trying to prevent in the first place. The other issue I'm having is that the last urinalysis he had was done Oct 14th, his urea was high, but his Creatinine was within normal. At the time, he was addison's and on prednisone. The vet has him on a phosporus binder and prescription kd diet to slow kidney problems. Also, his thyroid is probably not as under control as it could be, since he's only taking 1/2of what he was taking before and it was keeping it at a good level and between that and maybe his cortisol being up, his extra weight isn't good for him either. From my reading and from what others have said here, if I remember correctly, the high urea could have been because of the addison's and especially since the creatinine is good, maybe he doesn't have any kidney issues. If that is the case, he may be taking unnesessary medication and be on a diet that is not the best for him and not having his thyroid as controlled unnesessarily. The last time I went in to get his acth stim, between the cost of keeping him there for the test, the consultation (which you now have to have in order to have any test or procedure) and the lab work and the medication, it cost $285! I went to get more food today and asked how much to get a urinalysis. They said it would be another consultation, they would have to do an ultrasound (she said they don't do a urine test without that now), and with the lab fees it would all cost another $150 or so. It's just getting to be so ridiculous. The food is very expensive too.
Anyway, I was wondering if anyone has used the at home urine tests that you can buy on the internet. I was seriously thinking about going that route, if it would be beneficial.

Take care everyone
Karen

[lulusmom]

Hi Karen,

Nice to hear from you and it's great to get a status on Jed. It would be great if you could get your hands on the last labwork that was done and post the abnormal values to include the unit of measurement and the reference ranges. You have some questions about kidney issues and we can offer more meaningful feedback if we have more information.

If the bloodwork was done while Jed was on Prednisone, then it is possible that it was the Pred that caused the elevation in Urea (BUN), especially since the creatinine was normal. If Jed's drinking and peeing has been normal, then chances are his urine specific gravity is probably normal as well, which would be further evidence that Prednisone may be the culprit. However, it is my experience that when a vet puts a dog on a phosphorus binder, there is some pretty convincing evidence that kidney function is impaired enough to cause an accumulation of phosphorus in the intestinal tract. Having you post the test results will help us follow your vet's rationale.

Is your vet an internal medicine specialist? If so, that might explain the higher than normal fees. My dogs treat with an IM and if they are going in for a stim test only, I am not charged for a consult but I pay more for just the stim test than what you pay for a stim and a consult. If only the dang stimulating agent wasn't so expensive.

I am not familiar with an at home urinalysis kit; however, it seems logical that you would have to obtain a free catch specimen. This is an acceptable method of collection for a urine cortisol:creatinine ratio test but I don't believe it is an acceptable method for most other analyses. I personally think you need to have the urinalysis done inhouse. IMO, I think charging a consult fee for doing a urine draw is a bit much.

I agree with your vet's approach to restarting treatment when symptoms return. When I switched both of my dogs from Trilostane to Lysodren, we were ultra conservative and waited until they were symptomatic as well as having an acth post stim greater than 22 ug/dl.

Glynda

P.S. Was your vets decision to reduce the thyroid meds a result of a new thyroid panel or test that showed that Jed's original dose was too high?

[BestBuddy]

I do know when urine is collected by cystocentesis that our vet also likes to use an ultrasound to locate the bladder so that he is not poking around my little dogs abdomen with a needle. He doesn't charge for the ultrasound just for the urine analysis costs.

I also know nothing about the home urine tests.

Jen

[Karen & Jed]

Thank you for your replies Glynda & Jen.
The last complete blood work Jed had done was Oct 9th. His pre and post cortisol were both <25 mnol/L at the time, so he was still addison's and was on prednisone - had been since Aug 25th. He was tapered down to 1/2 tablet per day and was almost 11.5 lbs. His red blood cells were still low 5.3 x10E12/L (Ref 5.5 to 8.0), but were on the way back up after having gone dangerously low during the addisons crisis.
Biochemistry Results & ref
Urea 27.7 mnol/L (2.5 - 9.2) High
Creatinine 128 (68 - 141)
Chloride 103 (108 - 118) Low
Phosphorus 1.95 g/L (.72 - 2.08)
protein 67 (54 - 71)
ALP 157 IU/L (4 - 113) High
ALT 207 (0 - 113) High
Calc Osmolality 307 nmol/kg (278 to 306) High

I've recorded only the things I thought were of interest, but if you need another figure, let me know.
Prior to that - Jun 26th, his acth was perfect and his urea was 7
The day he went into the hospital in addisons crisis & dehydrated, but he'd been started on IV corticosteroids (Aug 21st) his urea was 26.4 & his crea 163 umol/L (ref 44-159)
When they let him out on the 25th he was rehydrated and his urea was 14.4 & his phos .85

What do you make of all this?

I probably need to get another test done soon, don't I?

Thanks,
Karen

[Karen & Jed]

Hi Everyone,

Jed started throwing up recently - the only symptom I've seen. Blood tests indicated pancreatitis. Anyone with experience with this? What I've read on the internet isn't encouraging when it is combined with cushing's. The vet started him on antibiotics last night since his wbc count was high. I am waiting for a phone call this morning to touch base with the vet again. My regular vet is on holidays and this is a sub. He's very nice & helpful.
On the bright side, his kidney values are fine. The vet had been concerned about that and had him on kd food and benazipril. I think it was, as others here have said, because of the pred he'd been on for the addison crisis.
I had recently put him on Omega 3,6,9 fish oils since I read that they were good for the kidneys, now I'm wondering if that either brought on or exaserbated the pancreatitis since it's added fat. He doesn't get much fat otherwise. I think the kd is fairly low fat and he gets Old Mother Hubbard biscuits - low fat 'just veggin' variety. Also, since he hasn't been being treated for cushings and he's only been on 1/2 the usual dose of thyrotabs because of kidney concerns, he's gained weight again and obesity, hypothyroidism, cushings and prednisone are all things mentioned as contributing to pancreatitis.
Any input on this would be appreciated.
Thanks so much.
Karen

[gpgscott]

Hi Karen,

It becomes a real balancing act when you have one on in years and with multiple issues.

I do think the fish oil could contribute to panreatitus. I do know that ground flax seed is a good source of omega III and it might be a better alternative.

If I am reading right it is now 3 months since the most recent stim and with the symptoms you are reporting I think I would be wanting one.

Best wishes. Scott

[Karen & Jed]

Thanks for your reply Scott.
Actually his last acth stim test was Nov 25th - pre was 2.28ug/dl and post was 4.39. So that was almost 2 months ago. His last complete blood work showing the kidney values had been 3 months ago, that's probably what you were reading. But I agree, when my regular vet is back from holidays I think I will have to schedule another acth stim test, although he had said that he wanted to wait until he was drinking lots before he put him back on Lysodren again. I'm no vet, but I feel uncomfortable with the other problems that can come with the cushings not being treated. Does that make sense or is it not severe enough unless he's drinking lots?

Take care.
Karen

[gpgscott]

Karen,

He is oldish.

Poodles are notorious for carrying on, but he is still old. Treasure him, as I know you do.

I really am mixed on this.

Any med you admin is going to both help and hurt.

Me, I think I would stay away from cortisols and fats.

Wish I knew more.

Very best.

Scott

[Karen & Jed]

Yes. He is old and I try to remember that. He's going to be fourteen in a couple of months! The vet said yesterday that he looks good for his age and he still seems comfortable. He often runs around the house all excited like he's still young, gets lots of enjoyment out of eating, gets very excited to see us and loves to just sit with us on the couch. I put him in the bathtub in warm water for a little hydro therapy every night. So, there's still quality of life there and I just want to make the best decisions for him to keep it that way for as long as possible.
Thanks for your reminder to treasure him. I think I'll go give him a hug.
I appreciate all your input. It helps me to sort things out.

Karen

[sunimist]

Hi Karen,
Sorry poor little Jeb is having yet another problem. Did the vet mention IV fluids for the pancreatitis? Not sure how severe it is, but it can really turn nasty quickly and if it does, Jed will need to be hospitalized as it can be life threatening. Do you happen to know what his Amylase and Lipase values were? Also his electrolytes?

Yes, from my experience the fish oils can contribute to too much fat and that in turn can cause pancreatitis. Sometime after Misty suffered her acute pancreatitis attack, I began giving her Welactin salmon oil and it quickly let us know it was too fatty for her.

Sure do hope Jed is feeling better, and keep us posted.

Shelba and Suni

[Karen & Jed]

I don't have the numbers, as I just spoke to the Dr. after hours. The girls weren't there to give me a copy. But, I should go before it closes. The vet did say that it seems mild. He hasn't vomitted yesterday or today and doesn't seem dehydrated.
Thanks for your concern and I will post the numbers when I get them.

Karen

[Franklin'sMum]

I feel uncomfortable with the other problems that can come with the cushings not being treated. Does that make sense or is it not severe enough unless he's drinking lots?

Take care.
Karen
Hi Karen,
I'm so sorry Jed hasn't been feeling well. About the Cushing's not being treated.....I think Jeanette (mypuppy) had this same question about her Princess. One of the voices of reason (perhaps Lori ?) said an untreated pup isn't having damage done while the cortisol is low or normal. That the damage to the internals happens when the cortisol has risen to pre-treatment / uncontrolled levels. If you'd like to read that on Jeanette's thread, I think it's about page 46/47 or a little after.

Hope Jed feels better soon,
Jane and Franklin xx
________
Oregon marijuana dispensary (http://oregon.dispensaries.org/)

[Karen & Jed]

Hi Jane,

I had thought that he shouldn't be treated unless the cortisol was too high. I guess what I'm not sure of is how much too high does it have to be before the drinking alot kicks in. Is the cortisol too high, even before that happens? I was wondering if we should go more by an acth stim test rather than waiting until he starts drinking & drinking like he used to which is what the vet wants to do.
Anyway, I just got back with the numbers. The copier wasn't working so I had to write it all out by hand. Here are the numbers that were not within reference range:

ALB 41 g/L ref 22 to 39 (high)
AMYL 1502 u/L ref 500 to 1500 (high)
MCHC 28.4 g/dl ref 30 to 36.9 (low)
WCB 25.8x10to9th power/L ref 6 to 16.9 (high)
Grans 23.5x10to9th power/L ref 3.3 to 12 (high)

While I was typing just now, the vet called. He said that he's not even sure it's pancreatitis since the 2 indicators are barely out of range. He says the infection could be anything in a dog this age. So, he just wants me to finish out the antibiotics and let him know if there's any more symptoms. Otherwise he wants me to discuss changes to his meds and diet etc with my regular vet who's much more familiar with his history.
Hopefully we caught whatever it is early and the antibiotics will do the trick.

Take care,
Karen

[Harley PoMMom]

Hi Karen,

I am so sorry to hear about Jed, poor fellow, my boy Harley has pancreatitis also. Too much of the oils can flare up the pancreas and bring an attack on, honestly almost anything can make the pancreatitis rear it's ugly head. :eek::eek:

I keep a close eye on Harley with cPLI tests, he gets one done every 3 months or sooner if needed.

He also get L-glutamine 2 times a week, for this you will need to clear with your vet.

I had a diet formulated for him because of his pancreatitis and it is working beautifully...it does contain low-fat yogurt and it is a very low fat diet.

If you have any questions, please ask, ok.

Will be keeping you and Jed in my thoughts and prayers.

Love and hugs,
Lori

[Karen & Jed]

Thanks Lori. I'm so glad to know that I have someone that I can ask questions of and who has experience with this. I see that the
L-glutamine is for inflammation. Good to know.
Thank you for your kind thoughts.
Karen & Jed

[Franklin'sMum]

Hi Jane,

I had thought that he shouldn't be treated unless the cortisol was too high. I guess what I'm not sure of is how much too high does it have to be before the drinking alot kicks in. Is the cortisol too high, even before that happens? I was wondering if we should go more by an acth stim test rather than waiting until he starts drinking & drinking like he used to which is what the vet wants to do.
Karen
Hi Karen,

That's a question for the experts here. Franklin's last stim (off trilo) was 18 Jan, and was pre-263 nmol (9.53 ugdl) and post 562 nmol (20.36 ugdl) and he's not drinking huge amounts as yet.

I really hope Jed feels better soon,

Jane and Franklin xx
________
Toyota liteace (http://www.toyota-wiki.com/wiki/Toyota_Liteace)

[Harley PoMMom]

Hi Karen,

With our senior pups it can get rather tricky treating especially when health issues are a major concern. A pup being treated and controlled by Lysodren, like your Jed was, needs the extra cortisol to deal with stress and his illnesses.

One of the main points with giving Lysodren or Trilostane, the pup has to be eating and feeling well. If Jed is eating and feeling well then get an ACTH test done and see what Jed's numbers are, but remember it isn't always about the numbers, especially when it comes to our senior pups, and then when you couple that with health issues, sometimes one has place the important factor on how the pup feels and not on the actual ACTH numbers...am I making sense here?? :eek::)

Love and hugs,
Lori

[Karen & Jed]

That does make sense. Everyone's comments are really helping me to sort this out. Like Scott said, any treatment is going to both harm and help, so it's a matter of what's helping the most while harming the least at that particular time. I appreciated your comments about needing the extra cortisol and how their feeling being most important. Right now Jed hasn't been throwing up and his kidney values are normal. He seems to be holding his own, so I'll wait for now. Such a balancing act! I always have that feeling of waiting for the other shoe to drop, making it hard to enjoy his relatively healthy times. I need to take a lesson from dogs and live more in the now. :)

Thanks once again
Karen & Jed

[Karen & Jed]

Hi everyone, I hope this finds all my cushy friends doing well.
Jed's been holding his own. He hasn't been taking Lysodren since his crisis this past summer. His hunger and drinking has been slowly increasing, so we just had an acth stim done this week. His numbers were:
pre 9.35 & post 19.28 ug/dl
So, they're higher than what we kept him at while he was on Lysodren, but apparently within normal, so the vet said we will wait some more before we put him back on Lysodren.
Jed is 14 now and he's seeing another spring, so I'm grateful for that. He's enjoying roaming around in the back yard again, now that the snow is gone.

Take care everyone.
Karen & Jed

[sunimist]

Hi Karen and Jed! So good to hear from you with a good update on Jed! Hope everything continues being good with you guys.
We have missed you.

((Hugs))

Shelba and Suni

[StarDeb55]

Karen, I have PM'd you to let you know about moving this post. I have some serious concerns about not re-starting treatment for Jed at this point in time. It appears that your vet may have confused the normal range on the ACTH for a healthy, non-cush pup with the normal range for our Cushing's babies. I can assure you that 19.28 ug on a post result is not normal for our babies & with Jed's slowly increasing symptoms, the results do not surprise me. What surprises me is his symptoms are more pronounced. Normal range for our babies on their ACTH tests are from 1-5 ug/dl. I'm seriously concerned that if his lysodren is no re-started soon, you will have to reload him, & at this point, I'm not too sure you aren't going to have to reload little Jed, anyway.

Debbie

[frijole]

Karen,

Hi from me as well! I have to agree with Debbie. As much as I am sure you do not want to do a reload - that number is high and I am sure is the reason you are seeing the symptoms have returned. What is normal for a non cush dog is not the same as what is normal for a cush dog... so someone erred. Unfortuneately we need to maintain a level between 1 and 5.

My dog has been on lysodren for almost 4 yrs. She is currently 16 1/4!! Her last test came back at almost 9 after treating her at the same level all this time. Due to her age I am not reloading. But if she were a "young" and healthy 13 1/2 I would do a miniload and get her cortisol levels down.

Kim

[BestBuddy]

Hi Karen,

I sort of agree with the others but I also have some questions. How long has Jed been off Lysodren? My specialist said that after 3 months of no treatment for Buddy we would be looking at a diagnostic ACTH range not a treatment range.

I think our magic number to think about treatment was 17 but the brain is a bit foggy so I may not be exact. As it was Buddy only ever stimmed to around 7 so it was never an issue.

I think 19 is getting up there so maybe you need to ask your vet some questions.

Jenny

[frijole]

Thanks Jenny - I had never heard that. Maybe that is why she's just now seeing symptoms? If my dog were at 19 she'd be peeing rivers. :p:D:p Kim

[sunimist]

I sort of agree with the others but I also have some questions. How long has Jed been off Lysodren? My specialist said that after 3 months of no treatment for Buddy we would be looking at a diagnostic ACTH range not a treatment range
That's what my vet said also Jenny. As a matter of fact, she said if Misty's cortisol ever did come back up she would wait until it was around 20 to reintroduce treatment. This was after a few months of non stimulatory ACTH testing, and as many of you know she turned addison's and never did return to cushings. Just my experience.

Shelba and Suni

[Karen & Jed]

Thanks for your input everyone.
Jed has been off of Lysodren since August, when he had an addisonian crisis that was really bad. In November his cortisol was great (pre- 2.28 & post 4.39) I questioned the vet then because I thought it would be the perfect time to put him on a maintenance dose. But he said it was best to wait until he was symptomatic again. I just looked back at his acth stim when he was first diagnosed and he was pre - 7.5 & post 23.81. So, if he's at 19.28, I don't think it will be long before he will start drinking a lot more. His stomache isn't distended as much as it used to be. His drinking and appetite have increased. So some symptoms are returning, although not to the same degree as post treatment. I don't think it will be long before we'll have to put him back on Lysodren. I'm anticipating that I will be calling the vet within the next couple of weeks and I'm sure that if I tell him Jed's symptoms are much worse, that he will agree.
Kim - how wonderful that your dog is 16 1/4. That's very encouraging to hear. Jed has been being treated for about 2 1/2 years and is now 14. I'm grateful for every minute, since there's been times I thought he only had a few days left.

Take care
Karen & Jed

[frijole]

Karen, I know what you mean about those days when you wonder... It is strange how you'll think "darn this is it" and then they show a burst of energy and you think...wow they are fine. I know I am fortunate and now cherish every minute - not just the days. I wish you and Jed the best as you continue on your cushings journey. Kim

[Karen & Jed]

Hi all,
It’s been a while. I hope this finds you all well. Jed was doing really well for some time.

He’s been on ¼ tablet Lysodren every 3 days since Apr 25th. He’s on thyrotabs for hypothyroidism and Benazapril to help his kidneys since his addisonian crisis last summer. He’s also taking medacam for his arthritis. For supplements milk thistle, glucosomine w/msm & condroitin, omega 3-6-9.

I had to take him to the kennel, so I took him on June 22nd to get his kennel cough and annual shots. He was fine. I took him to the kennel June 30th and picked him up on July 5th (yesterday). We were home for 3 hours when my husband called to ask me to bring him something at work. I went out to the garage to get it and my step son came upstairs in order to go with me. He opened the garage door and told me that Jed was leaning his head to the right. I went in and saw that he had lost coordination on his right side and was pulling in that direction. He was conscious, in no pain and trying to get up and walk. He staggered and fell a couple of times and got progressively better until after a couple of minutes, he seemed like nothing had happened.

I took him with me in the car and on the way home stopped at the vet’s. It was probably about a half hour after the episode that we saw the vet. He looked in his eyes and said that they weren’t acting like it was neurological and he wondered if it was old dog vestibular? disease which affects their balance. He gave him some antibiotics since there was a slight infection in one ear.

I took Jed to the groomer this morning and picked him up at 1:15. She took him out of the crate and put him on the ground. He came excitedly towards me and the same thing happened that had happened yesterday. I now think it’s seizures. I’m wondering if the pituitary tumor is getting bigger and putting pressure on his brain. I don’t think it could be a side effect of the Lysodren, could it? I have been watching for signs of overdose, since he has lost some weight again. He’s at 5 kg. He had been up to 5.7 kg. He still asks for food but is a lot fussier about what he eats, when he’s on the Lysodren. He did vomit just a little bit, a couple of hours before I took him to the kennel last week, but not since I picked him up. His bm’s are fairly loose, as they usually are on Lysodren. He's due for more Lysodren today, but am hesitant now.

If anyone has any thoughts, I’d greatly appreciate it.

Thanks, Karen.

[lulusmom]

Hi Karen.

I'm so sorry to hear that Jed is having some problems. Can you tell us when you last had Jed in for an acth stim test and can you post the results? When a dog loses weight, there is always the possibility that a long standing maintenance dose can lower cortisol too much. The only way to know is to have a current acth stim test done.

I know what it's like to feel iffy about giving the Lysodren because you can be damned if you do and damned if you don't. I am always afraid that if I skip any doses, we'll lose the load and have to reload again. Then you have to order more pills and pay for more acth stim tests, etc. The last time I went through that with Lulu, I gave her the dose and kept a close eye on her. She had thrown up a little a few days before but seemed to be perfectly fine on pill day. I had the prednisone handy just in case but we didn't need it.

Glynda

[Karen & Jed]

Thanks for your reply Glynda.
Yes, that's what happened last summer. His weight went down alot and he was on a pretty aggressive dose. I have to say, he doesn't seem at all like he did before he went addisonian. He was very lethargic and hardly wanted to eat. Other than the seizures, he looks and acts really good. It's looking like we'll have to get a full blood work done again. His last one was the end of April.

Karen

[zoesmom]

He opened the garage door and told me that Jed was leaning his head to the right. I went in and saw that he had lost coordination on his right side and was pulling in that direction. He was conscious, in no pain and trying to get up and walk. He staggered and fell a couple of times and got progressively better until after a couple of minutes, he seemed like nothing had happened.

I took him with me in the car and on the way home stopped at the vet’s. It was probably about a half hour after the episode that we saw the vet. He looked in his eyes and said that they weren’t acting like it was neurological and he wondered if it was old dog vestibular? disease which affects their balance. He gave him some antibiotics since there was a slight infection in one ear.

I took Jed to the groomer this morning and picked him up at 1:15. She took him out of the crate and put him on the ground. He came excitedly towards me and the same thing happened that had happened yesterday. I now think it’s seizures. I’m wondering if the pituitary tumor is getting bigger and putting pressure on his brain.
Thanks, Karen.


Karen -

What you describe does sound to me like CVS (canine vestibular syndrome, also known as old dog vestibular). My Zoe had a severe case of that last December and the listing to one side, falling over, vomiting (as they feel 'seasick' so to speak) etc. are the signs. They will often give an anti nausea drug to help them with the latter. Zoe's was so bad she spent a week in the hospital, unable to stand and walk for the first few days. If there's an ear infection, that could be a contributing factor, altho' it can be neurological (brain tumor) as well, but that is rather rare. Zo's eyes would do a funny kind of twitching sideways (nystagmus). Does Jed have that? Depending on the character of the nystagmus, a vet can sometimes tell whether it's just idiopathic CVS or from a brain tumor. We withheld Zoe's trilostane for over a week, thinking perhaps the rise in cortisol would help any nerve inflammation in the head (also a factor). But I don't know about withholding lysodren as you don't want to lose too much ground and lose total control of the cortisol. I think the antibiotic is a good idea. They put Zo on it, just in case there was an infection.

Dogs who have CVS almost always get better, but it can take anywhere from just a couple days to as long as 2 or 3 months. Apparently, it does not go away but rather their systems learn to adapt to it. Even when Zo got to feeling better, she'd still weave and lose her balance sometimes. Stairs, not good. Darkness not good either. They need to be able to see in order to keep their balance. But she got back to taking walks and her usual routine pretty well after about a month. Zoe also had seizures and it just doesn't sound like that to me(even tho' they can manifest in various ways). Still, it sounds like CVS. Sue

[Karen & Jed]

Thank you so much for your reassurance. I'm just doing some research on the net and I had just realized that it really does sound like CVS. He didn't vomit and he wants food. It's hard to tell about the eyes because they are so dark it's hard to tell what they are doing, but I will have to watch next time. The cases I was reading about seem to not get better instantly like Jed's. It seems to take at least a few days. I'm hoping that these differences don't mean the more serious type. I'm going to continue to do some research and see if I can see any more tell tale signs. In the mean time, thanks again for your response and I will continue to give him the antibiotics and hope for the best.

Karen

[AlisonandMia]

I think mild cases sometimes to get better very rapidly like Jed's (there was a case at K9Diabetes the other week that was like that). Maybe with these mild cases they only get a brief dizzy spell - just as people do sometimes?

You are right though - generally it takes a while for them to recover. This is because they balance mechanism doesn't really recover as such but the dog's brain learns to "ignore" the funny signals coming from the vestibular system and therefore stops feeling so dizzy. Their balance is often still a little affected and they can have a persistent head tilt for the same reason - however they generally function well and feel ok. (I have a human friend with similar problems and she has also sort of 90% recovered and isn't so bothered by it any more - no more nausea and falling over these days. She still doesn't feel safe to drive though, unfortunately.)

I think all you can do at this stage is watch and wait - and hope that it all just goes away. One other thing: is his gait completely normal - is he throwing one front leg our further than the other one or anything? You can often see this from behind and above while walking them. That can be a subtle sign of a balance problem, too.

Good luck and keep us posted.

Alison

[StarDeb55]

Karen, it's great to hear from you! I'm sorry that Jed is having some problems, again, but I'm also glad to hear that like the little soldier he is, that he had been doing pretty well before recently. I wish I could offer some advice, but have absolutely zero experience with vestibular syndrome. Here's hoping Jed can recover quickly on his own!

Debbie

[zoesmom]

He didn't vomit and he wants food. Karen

Actually, Zoe didn't vomit either and continued to want to eat. She probably could have gotten by without the anti-nausea med. Then again, maybe she would have vomited if not for that med. Her problem was making her mouth go where it needed to go in order to get the food. I'd have her lie sphinx style and put her food bowl smack between her front legs.

I recall quite a few cases of CVS on this board and its forerunner, and in each dog, it seems to run its course differently. I do recall dogs whose owners reported only transient episodes. In fact, I think Truffa's mom (Marcela) may have been one of them. You might check out her thread - don't remember if she posted much about it. Sue

[Karen & Jed]

I really appreciate all your input and concern guys. I feel much better tonight than I did yesterday and today. Here's hoping it goes away quickly.

Take care, you and all your furry babies.
Karen

[Spiceysmum]

Hi Karen,

My non-cushings dog, Brin, had a vestibular episode earlier this year. He didn't lean to one side but he collapsed when he tried to stand, especially on the wooden floor. He was sick a small amount twice but didn't have the eye twitching either. The vet didn't give him any medication and he was better in two or three days. It is very frightening but hopefully Jed will get over it soon too.

Linda and Spicey

[addy]

I had to take him to the kennel, so I took him on June 22nd to get his kennel cough and annual shots. He was fine. I took him to the kennel June 30th and picked him up on July 5th (yesterday). We were home for 3 hours when my husband called to ask me to bring him something at work. I went out to the garage to get it and my step son came upstairs in order to go with me. He opened the garage door and told me that Jed was leaning his head to the right. I went in and saw that he had lost coordination on his right side and was pulling in that direction. He was conscious, in no pain and trying to get up and walk. He staggered and fell a couple of times and got progressively better until after a couple of minutes, he seemed like nothing had happened.

I don't mean to highjack this thread but could any senior member comment on the possibility of this reported problem relating back to multipe vacines given at one time? I know some people are of the mindset no vaccines for our Cush pups and if you have to vaccinate limit the number and don't do more than 1 at a time.

Thoughts and comments or experiences on this?

Addy

[Squirt's Mom]

Hi Karen,

So good to hear from you an Jed again! Can't help with the CVS but you are in good hands with those who have experienced it first-hand...as is always the case here! ;)

Keep in touch and let us know how things are going!

Hang in there!
Hugs,
Leslie and the girls - always

[labblab]

I don't mean to highjack this thread but could any senior member comment on the possibility of this reported problem relating back to multipe vacines given at one time? I know some people are of the mindset no vaccines for our Cush pups and if you have to vaccinate limit the number and don't do more than 1 at a time.

Thoughts and comments or experiences on this?

Addy
Hi Addy,

I'm not aware of CVS (canine vestibular syndrome) being linked as a reaction to vaccinations. Here's a list of suspected causes from vetinfo.com (http://www.vetinfo.com/canine-vestibular-syndrome-symptoms.html):


The vestibular syndrome can have various causes including:

•Brain trauma or damage
•Tumors located in the brain of inner ear
•Ear infections, which may be due to mites that are present in the ear
•Severe poisoning
•Inflammation of the brain
•No known causes
I think the category of "No known causes" is the biggest one. As Sue has said, we've had several cases of CVS here on the site over time. And I don't think a consistent cause or "trigger" (including vaccination) has been associated with them.

Marianne

[Squirt's Mom]

Hi Karen,

It's been too long! How is Jed doing? How are you doing? We would love to hear from you!

Hugs,
Leslie and the girls - always