Overwhelmed (Gibrien, 8 year old mini poodle)

[gibbiesmom]

Hi, I am the mom of an 8 year old mini poodle who has had seizures since the age of 2. He has been on phenobarbitol and potassium bromide and is monitored every 4 months.

About 2 years ago, he started limping on his left leg. I took him to my vet who x-rayed him and did bloodwork and said it was probably Lyme Disease and treated him with antibiotics. Well the limping continued and they were unsure what to do with him next so they ordered me a "support splint" for his leg and told me to use that. Every time I put it on him he would cry out in pain so I stopped. He did stop limping for quite some time. Come to find out, he had a hairline fracture which he must have suffered....and it ended up healing on its own only not in the right position. Needless to say there isn't much they can do with this foot. I am so angry with my former vet about this.

About 2 weeks ago I woke up to my Gibrien not being able to walk on either one of his front legs. I just lost it completely and thought for sure I was going to have to put him to sleep. Thankfully I have changed to a new vet and they were very understanding. They put him on some pain meds and then ordered some bloodwork.

My new vet had mentioned Cushings Disease and Gibrien has some of the signs. Thinning fur, pot bellied appearance, thirst. This week he underwent tests for Cushings, Rheumatoid Arthritis and Lupus. His levels were up for the Cushings but they said only slightly. The others were all negative. The vet seems to be at as to why he is still limping and says that in fact, that usually isn't a sign of Cushings. Although then in the next breath says that if the ligaments are all stretched it could go with the Cushings!

They want me to take him to see an orthopedic now. After having just spent over $800.00 this week I'm going to have to save up for a few weeks to do that. They did also mention treating Gibs with Anipryl. She said that this is a mild drug for treating the Cushings and she would rather start out with that first and see if it helped at all.

Does anyone use Anipryl? Can anyone advise me on this? I am so lost and have been so upset this week. I am told that I can just not treat the Cushings also and it is a slow progressive disease. With his history of seizures, I am very scared to try some of the other meds I've read are very hard to get regulated on.

I thank you in advance for reading my "mini novel" and look forward to any information I may receive.

Heidi & Gibrien

[Franklin'sMum]

Hi Heidi and Gibrien,

Welcome to the forum, but sorry for your circumstances. There are 2members here that use/have used Anipryl, and they will most likely be along shortly to answer your questions.

My understanding is Anipryl only works if the pituitary tumor is located in the pars intermediate part of the brain. Since there hasn't been a definitive diagnosis as yet, personally I would hold off using anything just yet, until you and your new vet are sure of what's happening with Gibrien.

Do you know if the seizures are caused by epilepsy? Hypothyroidism can also cause seizures, and a number of the symptoms of hypothyroidism and diabetes are very similar to symptoms of cushings.

It would be helpful to the members here if you posted details of the tests that were performed, (names, results, normal range for that lab, units of measurement) and Gibrien's weight, herbs and/or supplements that he is on.

Is there any chance that his leg can be set properly, or are things too far advanced? Also, if he is limping due to his leg healing wrongly, I would be thinking more of arthritis and mobility issues.

The others much more knowedgable than me will be able to help you much more. Have you had a look at the helpful resources for new members section?

Hope that helps some, and welcome again from me and my little boy Franklin,

Jane and Franklin xx
________
Herbal store (http://herbalhealthshop.com)

[SasAndYunah]

Hi Heidi and Gibrien,

welcome from me as well.

I'm sorry for all the problems Gibrien is experiencing. Some thoughts occur after reading your post. You said that 2 years ago Gibrien started limping with his left leg. Was that a front or a backleg? Also, I have never heard of a hairlinefracture healing in the wrong position...since the bone isn't actually in two. It could happen that if a hairline fracture is missed and the dog still runs around that the hairline fracture fractures completely but then, with a complete fracture a dog would not use the leg at all anymore. In which part of the leg was the hairline fracture located? Anyway, what happened the past 2 years with that leg? Did Gibrien stay limp, or once every while would he limp, did it disappear completely...?

It would be very helpful to know which values were raised and if and how the vet took into consideration Gibrien's PhenoBarb use, since interpreting bloodtests in a dog that uses PhenoBarb as well is a specialists job.

At this point, I personally, would not put Gibrien on Anipryl since I would not be the slightest convinced at this moment that Cushing's plays a roll in Gibrien's problems and adding medications to the meds he already uses for the epilepsy on an experimental basis, would not be my choice. I think that indeed an orthopedic specialist would be your best bet at this point. First sort out what's happening with his front legs...

If it turns out that Gibrien would have Cushing's after all, then you need to find a specialist that is familiar with both Cushing's and epilepsy, since the Cushing's meds and PhenoBarb aren't a good combination. It's prefered to first wean an epileptic dog of off the PhenoBarb and switch to the Bromides if possible and to stabilize the epilepsy on the new medication regime first before starting Cushing's treatment. But that is (perhaps) for the future and not something to extensively discuss now.

I would go step by step in trying to get to the root of the problems and given the problems with the frontlegs, I would start there.

Best of luck,

Saskia and Yunah,
The Netherlands :)

[frijole]

Welcome from me as well! I agree with Saskia... too soon to consider more drugs and I'm not sure anipryl with the pheno would be a good combo.

Besides... you'll be better able to get a good diagnosis if you do it BEFORE throwing more drugs into the equation.

In addition to Saskia's questions, please let us know if there are any other drugs that Gibrien is taking. At this point I would not think it is cushings but perhaps we can help point you into the right direction. Hang in there!!! Kim

[Harley PoMMom]

Hi Heidi & Gibrien,

Welcome from me and my boy Harley as well...overwhelmed, huh, Oh Heidi I know exactly how you feel. When my boy was first dx'd with cushing's I was so confused and scared but these wonderful, kind and very knowledgeable people here took me into their arms, guided me with their experience and wisdom and now my boy is doing so tremendously better, and so is his mom!

According to Dr. Feldman, a reknown cushings expert, he says


Diagnosis of dogs with signs of Cushing's syndrome that are receiving anticonvulsant medication can be confusing. Such medication (primidome, phenytoin, phenobarabital) can cause polydipsia, polyuria, polyphagia, lethargy, increased serum liver enzyme values, and abnormal plasma cortisol concentrations. The clinician must be cautious when establishing a dianosis in dogs taking these medications.
Anitconvulsant Medication Chapter 118 page 1559
http://www.io.com/~lolawson/cushings/articles/feldman4.pdf

polydipsia = excessive thirst.
polyuria = increased urination.
polyphagia = excessive hunger.

Cushing's is a slow progressive disease so it can be a difficult disease to diagnose and not one test can confirm it 100%. Some other non-adrenal illnesses can mimic the same symptoms of Cushing's, like diabetes and hypothyroidism, that is why a through diagnosis is vital before starting a treatment of any kind.

Remember Heidi we are here for you and Gibrien, you are not alone on this journey.

Hugs.
Lori

[Squirt's Mom]

Hi Heidi,

Welcome to you and your sweet Gibrien.

I am with the others, honey. Nothing so far indicates Cushing's to me based on what little info we have so far. His signs are not typical of Cushing's, tho that does not rule the possibility out.

If it were me, I would certainly see the ortho doc first, then based on what is found or not found there, move on to an IMS - Internal Medicine Specialist, or other specialist as the tests suggest.

I am one of those who has used Anipryl and do support it's use for Cushing's under certain conditions, but I don't see that it is needed based on the signs you have mentioned. It can help control excess peeing, thirst, hunger, and give some energy plus it is most often used for canine cognitive disorders. Like any drug, it should not be given unless it is needed, tho. So for now, I would put that waaay on a back burner...along with any other Cushing's meds. ;)

I know this all too much right now, you are terrified for your little boy and lost as to where to go next. But you can get through this...with a little help and you have found that here. :) We are a Cushing's board but we also have a myriad of experiences with other conditions plus we don't object to researching and learning more to help our family here. ;)

Take this one step at a time, keeping Gibs as comfortable and pain-free as you can meantime. Step one - see the ortho doc. ;) While you wait for that appt, fill us in on all the details of Gibrien's medical history, especially the most recent testing and current meds, supplements, herbs, etc. The more details we have, the better insight we will have and the more meaningful our input will be.

You've done great so far! You and Gibs aren't alone any longer; we will be here for you even if all we can do is listen...but we usually get all involved! :p

Keep your chin up and keep in touch!
Hugs,
Leslie and the girls

[littleone1]

Hi Heidi and welcome. You will find that everyone here is very supportive, helpful, and caring. I hope you are able to resolve the issues you are having with Gibrien.

[sunimist]

Hi Heidi and Gibrien!!!

So glad you made it over here! :)

You have been given some great info to start with and I'm sure when you get the time to post all the tests and results Gibbie has had there will be a lot more experienced and documented info for you to absorb. I know you have already been searching our resources, etc, so you should be getting a better grasp on cushings and maybe understanding it better. That's the best thing you can do right now in case Gibbie does indeed have cushings. However, it does sound like (to me) something else besides cushings is going on, JMO, and getting to the bottom of the pain in his front legs would be my first concern.

It can all really sound overpowering in the beginning but we will help you wade through it, and the more you learn and the more we discuss, the better and more confident you will feel. So please don't get to feeling overwhelmed and frustrated with all the information cause we will all be here to support you and answer your questions.
One thing to keep in mind...if Gibbie is diagnosed with cushings disease, it's not as bad as it might sound and is very treatable. With that in mind, ask away! No question is too trivial. :)

Again, welcome to our community. :)

Shelba and Suni

[gibbiesmom]

Wow thank you so much to everyone. You are all so kind and knowledgeable.

From my receipts this week, this is the info I have on what they performed on my boy; CBC Profile (organ function) Cortisol Level, Rheumatoid Factor, ANA lab, 2 X-rays, Abdominal ultrasound.

These are the meds that he's taking at the moment; Baytril, Tramadol, Rimadyl. For his seizures he takes 60mg Pheno x2 and also .8 of the potassium bromide.

I am going to call the orthopedic on Monday and see about getting him in for a consult. The hard part is that I'm running out of money pretty quickly. I can't go much further in the testing until I save up some more money which is a horrible thing to have to say but I've spent so much money on my boy with his seizures and now this.

He has never really been diagnosed outright with epilepsy. He started with his seizures at the age of 2. At first they were cluster seizures where he would have 3 or 4 at a time and multiple times throughout the month. We've finally after all these years gotten it down to about 1 seizure every 2 months which I'm thrilled with after witnessing all those horrible years with multiple seizures.

They did tell me his levels were slightly elevated and that's why they were pretty sure he was Cushinoid. I guess the next step with that will be that 8 hour test!

When Gibs first started out with the limping it was in one leg down towards his ankle, that is where this vet found the misaligned bone. But he's been pretty good with that foot for a while now and the opposite leg is now the one bothering him although this morning he was back to not wanting to put pressure on either leg in the front. It's horrible watching your dog sit on his haunches like a rabbit and then try walking on his hind legs like a human because he's in so much pain. Thankfully as the day progresses his meds seem to kick in.

Once again I appreciate all your help and kindness. I had tears reading some of your responses. I definitely don't feel alone anymore.

Heidi & Gibs

[Franklin'sMum]

Hi Heidi and Gibbie,


From my receipts this week, this is the info I have on what they performed on my boy; CBC Profile (organ function) Cortisol Level, Rheumatoid Factor, ANA lab, 2 X-rays, Abdominal ultrasound.

Would you mind posting the results of those tests, the normal range for that lab, and the units of measurements (ug/dL, nmol/L)? We have a lab tech with over 29 years experience here (Hi Deb) who is brilliant:) There are also members whose pups have other conditions along with cushings, so the combined knowledge is quite broad.


These are the meds that he's taking at the moment; Baytril, Tramadol, Rimadyl. For his seizures he takes 60mg Pheno x2 and also .8 of the potassium bromide.

I don't want to alarm you, but Rimadyl has some safety issues with some pups.


Summer 2009 -- Reports of Adverse Reactions Continue, No Warnings Given by Veterinarians......Ten Years Later!!!

Even though the FDA mandated revised labeling for Rimadyl and the distribution of a "Client Information Sheet" when Rimadyl is dispensed, problems continue with this drug. We discontinued the regular posting on this website of adverse events due to Rimadyl quite some time ago, but, in the past few days several new cases appeared in the space of 48 hours. Is this just coincidence, or is something going on here? If, after reading these latest case histories, you're concerned about your dog's possible adverse reaction to Rimadyl, please follow these guidelines.

Bear with me while i try and insert a link....http://www.srdogs.com/Pages/rimadylfr.html


If Carprofen is used concurrently with phenobarbital, it is especially important that appropriate liver monitoring be performed. (Mar Vista Animal Hospital recommends bile acids testing every 6 months for dogs on phenobarbital.) ACE inhibitors such as enalapril or captopril may not be as effective in the presence of carprofen. (ACE inhibitors are used in the treatment of hypertension or heart failure.) It is also advised that the drug not be given to pregnant or nursing females because it has not been tested with them.

http://www.srdogs.com/Pages?rimadyl.html#Symptoms

Rimadyl should never be given along with any other non-steroidal anti-inflammatory drug (NSAID) such as aspirin, or along with any corticosteroids such as prednisone, prednisolone, or dexamethasone. The University of California at Davis recommends a two week "rest" period when changing from any NSAID to carprofen or from carprofen to another NSAID.



I am going to call the orthopedic on Monday and see about getting him in for a consult. The hard part is that I'm running out of money pretty quickly. I can't go much further in the testing until I save up some more money which is a horrible thing to have to say but I've spent so much money on my boy with his seizures and now this.

There's some info on the helpful resources section about (I think) finance help for vet bills. There is also a GE credit card called "Care Credit" which can be used for vet bills and it can be paid off over time.


He has never really been diagnosed outright with epilepsy. He started with his seizures at the age of 2. At first they were cluster seizures where he would have 3 or 4 at a time and multiple times throughout the month. We've finally after all these years gotten it down to about 1 seizure every 2 months which I'm thrilled with after witnessing all those horrible years with multiple seizures.


They did tell me his levels were slightly elevated and that's why they were pretty sure he was Cushinoid. I guess the next step with that will be that 8 hour test!

As somebody posted earlier, if the pup is on Phenobarb, the results may need to be interpreted by somebody who can take that into consideration, instead of a regular GP vet.

When Gibs first started out with the limping it was in one leg down towards his ankle, that is where this vet found the misaligned bone. But he's been pretty good with that foot for a while now and the opposite leg is now the one bothering him although this morning he was back to not wanting to put pressure on either leg in the front. It's horrible watching your dog sit on his haunches like a rabbit and then try walking on his hind legs like a human because he's in so much pain. Thankfully as the day progresses his meds seem to kick in.

Once again I appreciate all your help and kindness. I had tears reading some of your responses. I definitely don't feel alone anymore.


You are definitely not alone, Heidi. The incredible people here on the forum have held my hand and stopped my head and heart from exploding on more than one occasion:o

Hope Gibbie's issues can be resolved soon,

Jane and Franklin xx

PS Gibrien is GORGEOUS!!!
________
THE CIGAR BOSS (http://thecigarboss.com/)

[sunimist]

G'morning Heidi! :D

From my receipts this week, this is the info I have on what they performed on my boy; CBC Profile (organ function) Cortisol Level, Rheumatoid Factor, ANA lab, 2 X-rays, Abdominal ultrasound.
Would it be possible for you to get photo copies of all the test results from your vet? Most of us always get copies of all results to keep in our personal files and then we are able to discuss the actual results here for further understanding. It's a very good idea to have these at your disposal and you are entitled to them, so you might want to consider it.

Just hang in there and it will all work out for you and Gibrien. :)

Big (((hugs)))

Shelba and Suni

BTW, Gibbie is so handsome! Glad to finally "meet" him!

[Casey's Mom]

Hi Heidi and Gibby - you have found a great site with plenty of very knowledgeable people to help you sort out your issues. Best of luck and try not to worry - I know that's easier said than done. You are doing a great job for your pup - hang in there!

[Harley PoMMom]

Hi Heidi,

Oh Gibrien, or Gibbie for short? is so adorable...what a precious pup you have.

As far testing Gibbie for Cushing's, IMO, I would seek an IMS. With Gibbie taking phenobarbital you really need a cushings savy vet/IMS who can distinguish whether Gibbie's symptoms and his slightly elevated tests are from the pheno or truly Cushing's.

The exerpt I included in my previous post was from Dr Edward C. Feldman, he along with Richard W. Nelson and/or Stephen J. Ettinger have written and published Textbooks of Veterinary Internal Medicine in which I am sure your vet has heard of or probably have read.

http://search.barnesandnoble.com/booksearch/results.asp?ATH=Edward+C%2E+Feldman&SZE=10&SAT=1

This is from Dr. Edward C Feldman's web page at UC Davis:


Edward C.Feldman
Professor

Department of Medicine and Epidemiology
2108 Tupper Hall
University of California
One Shields Ave
Davis, CA 95616
Phone: 530-752-1387
Fax: 530-752-0414
E-mail:

RESEARCH: Canine, and feline adrenal, pancreatic, parathyroid, thyroid, endocrine diseases.

TEACHING: Small Animal Clinical Reproduction and Endocrinology

SERVICE: Reviewer, JAVMA
Co-Founder and Past-President, Society for Comparative Endocrinology
Speaker at national and international meetings on Endocrinology
Service on SVM committees: Student Affairs, Executive, School Personnel

http://faculty.vetmed.ucdavis.edu/faculty/ecfeldman/

This is from the Mar Vista Animal Medical Center web site:

The use of phenobarbital will interfere with thyroid function testing as well as with adrenal function testing. Monitoring hypothyroidism or Cushing’s disease in patients taking phenobarbital is extremely difficult as test results will be difficult to interpret.

SIDE EFFECTS

Excessive thirst and urination and excessive appetite are not uncommon side effects of phenobarbital. If they occur, they do not generally go away as the patient adjusts to medication. If they are severe, medication may have to be changed.
http://www.marvistavet.com/html/phenobarbital.html

We do realize cost is an issue, as it is for many of us...oh where, oh where are those money tree's! :p:) Jane has already given you some information about the GE credit card (CareCredit), which I have used for my boy Harley and I am also including the link to our Financial Resources thread.

Financial Resources to help with Vet bills

http://www.k9cushings.com/forum/showthread.php?t=212

The tests that you have had done on Gibbie: on the ultrasound; what where the findings and could you post them here, cortisol level; was this an ACTH test and could you post the results here with the units of measurements, CBC profile (organ function); any abnormal findings could you post them here with the units of measurements and the references ranges.

How much does Gibbie weigh? And when exactly did Gibbie first start showing these symptoms of excessive thirst, hair-loss and pot-belly appearance? I know just what you need more questions, :eek: but the more we know the better we are able to help you help Gibbie. :)

Keep your chin up Heidi and hang in there, and remember you are not alone on this journey we are with you every step of the way.

Hugs.
Lori

[gibbiesmom]

Hi Everyone:
I am taking Gibs to see the orthopedic doctor this afternoon. He's been really bad with his two front legs and I am so hoping to get some answers for whatever this is.

In the meantime I had to pick up his records and I have the lab papers here. I'm not sure what is needed but I will list what I have here and hopefully someone can tell me what it all means:

Ref. Result: Ref. Range Units
Cortisol (Urine) 15.7 5-55 ug/dl

Urine cortisol/Creatinine Ratio=13

Creatinine (Urine) 195.4 100-500 mg/dl
Urine Cortisol/Creatinine Ratio=13

Cortisol/Creatinine (Urine
Ratio Results:25(High)


In his bloodwork there are lots of numbers but the ones that were high I am listing below:
ALT(SGPT) 211 (High) Ref Range:12-118 Units:U/L

Alkaline Phosphatase 1343 (High) REf. Range:5-131 Units:U/L

GGTP 17(High) Ref Range:1-12 Units:U/L

Complete Blood Count:
Hemoglobin 17.3 Range:12.1-20.3 g/dL
Hematocrit 46.5 36-60 %

I hope this will help out.

Thanks so much for all your help. I will let you know how we do with the orthopedic today.

Heidi & Gibs

[StarDeb55]

Heidi, I just wanted to let you know that I have merged your thread with Gibrien's lab results into his original thread. We like to keep all posts for one pup on the same thread as it helps other members when they need to review the thread for other information that may have been posted earlier.

Debbie

[gibbiesmom]

I posted Gibrien's test results but I guess I broke some kind of rule, they've deleted my post! Oh well! Didn't know I wasn't allowed to do this as I wasn't doing this to use as "gospel" was just looking for some helpful info.

[acushdogsmom]

I posted Gibrien's test results but I guess I broke some kind of rule, they've deleted my post! Oh well! Didn't know I wasn't allowed to do this as I wasn't doing this to use as "gospel" was just looking for some helpful info.:) You didn't break any rule - and your post with the results was not deleted. One of the Moderators (Debbie) just merged your test results post together with this topic that had already been started about Gibrien - just look back just a few replies previous to this one and you'll see your test results post there. :)

We just like to try to keep everything about each individual dog all together in one "thread" (topic) so that we can look back and find everything easily that's been talked about before. We have lots of dogs here with many different things going on and it's just easier for us to be able to keep the stories straight when each dog's "story" is all in one place (topic).

[gibbiesmom]

We survived our visit to the orthopedic doctor last night.

What a wonderful doctor we found. She actually talked with us for over 2 hours, she was great.

After going over absolutely all of Gibriens history and giving him a thorough check, she has come to the conclusion that he has a subluxation in his ankle. It has partially fused. He is full of arthritis in there also as this has been ongoing for so long. She wants us to bring Gibs in next week where they will sedate him and she is going to take better x-rays of both front legs.

She has given us a few options as to what will be done. We can opt for surgery where they would put in a rod and some pins and he would have a very long recovery of 8-10 weeks where he would have to remain very still for all that time (and that's impossible especially if he has a seizure) and it's also very expensive approximtely $2, 500-3,000. Or we can try some new pain medications.

Also while she has him sedated she is going to go into the elbow on the opposite leg as she still is not quite sure what is going on in there. She wants to draw some cells from in there.

At this point they want to hold up with the cushings testing until we get some pain management going and I fully agree with that.

So for now, we wait until next Thursday to take the next step in this very long and expensive journey! I am just praying that we can find something that will help him out. Poor little guy is so good and tries to be so brave. I'm just a basket case at this point.

Thanks again for all your help.
Heidi & Gibs

[frijole]

Heidi, Thanks for the update. Sounds like you found a good vet. Agree that you have to deal with the leg issues first and worry about cushings later. We are here so don't feel alone in this journey. We have lots of experience and compassion to share. Do keep us posted. Kim

[Squirt's Mom]

Hi Heidi,

The only thing I can comment on in Gibbie's blood work is the elevated ALKP (Alkaline Phosphatase), which is a liver enzyme. This elevation is seen with just about any physiological stress and it indicates the liver is really working hard for some reason - but not always indicative of Cushing's, even tho this is one of the enzymes we always see elevated in cush pups.

Based on the results from the ortho visit, I am willing to bet this elevation is a result of his problems with his legs. And I whole-heartedly agree with waiting to look into the Cushing's possibility until the issue with his little legs is dealt with.

I am soooo glad that you liked the ortho doc! :) Ain't it wonderful to have a doc take that kind of time with you and your baby? As if ya'll are the only ones in the world that matter at that time. :cool: My Squirt and I are lucky there, all her vets are exceptional and make us feel that same way! Doesn't make her like them any better, but it sure helps mom! :p

Poodles are one of my fav breeds, which surprised me to realize! I have been blessed to share my life with four of them and they are each very special in my heart. Your Gibbie reminds me of Dr. B, a black mini; only Dr. B had kept his tail and he was so very proud of it! His partner in crime was a white mini, who also kept his tail, named Dork - already named when I got him and he wouldn't learn a new one. :rolleyes: They were holy terrors when they put their minds to it but loved my daughter and me, plus each other, like mad and didn't hesitate to show it! They were so much fun! I can imagine how it sounded when they were outside and I called to them 'cause it sounded something like, "B a Dork"! LOL :p

Please keep in touch and let us know how Gibbie is doing, what you decided to do, and all that good stuff, ok? You are both family now and we care about you both.

Happy Turkey Day Hugs,
Leslie and the girls