Pockets - 12.5 yr old Maltese (Update: Pockets has passed away)

[da_lizard]

I just typed a LONG thread and it was deleted somehow....said I was not logged in but I was. Here is a short version:

My Maltese "Pockets" was dx with Cushing's after an ACTH stim test with pre>10 post >30. I am sure this is due to macroadenoma as some of the symptoms I thought were old age and her personality quirks were really neuro signs of increased intracranial pressure from the tumor and edema such as blindness, wandering, and confusion and possibly circling. I started Vetoryl on Sat. 10 mg.

My concern is that the usual treatment for increased intracranial pressure is Prednisone and diuretics, am I going to make things worse by lowering her normally high steroid levels with the Vetoryl and causing pain and more neuro problems. We have Salix due to her being in mild heart failure since Jan. but it is on hold due to diarrhea since the beginning of the month. It is better today with the return to her dry dog food instead of chicken and rice or either the addition of Fortiflora more for the taste as she was not eating well on Thurs. and the vet said try that for the smell....she thinks it is GREAT and licks the plate it is on!!

She has to go stay with Mema (my Mom) next week in a small town in south GA as my husband and I are going to Hawaii for our 10th anniv. I feel like such a bad Mom leaving her, but she has always loved going to Mema's.

I have always said I would never put a pet through radiation etc. but now faced with that decision I do not know. I would have to work it out to be off during the week so I could go to Athens to stay for the week as boarding her is not an option (she is not very friendly to strangers since becoming blind and does not like animals...lol) and she has never stayed overnight at a vet's. I don't know if it will be an option as we could not get the eval done until the week of the 17th due to this trip...

Any thoughts or questions bring them on ....
Thank you for a great site!!!
Elizabeth and Pockets

[frijole]

Welcome! A few questions - did the original cushings dx show it was pituitary type? Did you have a sonogram done? Have you had an MRI done to conclude it is a macro?

Timing never seems to be right - I hate it when vacations get in the way. :( Is your mom able to follow all of the special handling requirements of Pockets? I can see why you would be concerned leaving her right now.

We have had members who have had success with radiation therapy. It is a big commitment both timewise and financially. Needless to say it also requires finding a very experienced facility - perhaps a vet school.

Please tell us more about Pockets' journey thus far so we have a better understanding of the overall situation. Glad you found us. Kim

[labblab]

My Maltese "Pockets" was dx with Cushing's after an ACTH stim test with pre>10 post >30. I am sure this is due to macroadenoma as some of the symptoms I thought were old age and her personality quirks were really neuro signs of increased intracranial pressure from the tumor and edema such as blindness, wandering, and confusion and possibly circling. I started Vetoryl on Sat. 10 mg.

My concern is that the usual treatment for increased intracranial pressure is Prednisone and diuretics, am I going to make things worse by lowering her normally high steroid levels with the Vetoryl and causing pain and more neuro problems.She has to go stay with Mema (my Mom) next week in a small town in south GA as my husband and I are going to Hawaii for our 10th anniv. I feel like such a bad Mom leaving her, but she has always loved going to Mema's.

Elizabeth and Pockets
Elizabeth, welcome to you and to Pockets, although I am sorry for the reasons that have brought you here. Kim has already asked some great questions, so I just have a couple additional thoughts to add right now.

If Pockets does indeed have a macro, your concern as to the effects of lowering her cortisol and "short-circuiting" the ACTH feedback loop may be a valid one. So even though the only way to diagnose a macro with certainty is through imaging of the head (CT or MRI), you may receive some informal confirmation of a macro if her neurological symptoms actually worsen while taking the trilostane. If she WERE to worsen in any way while you are gone (neurological or otherwise), I'd definitely tell your mom to just hold off on giving her any more trilostane until you're back home again.

It sounds as if you're planning Pocket's evaluation at the University of Georgia vet school in Athens. So I'm hopeful that you'll get a lot more info once you've consulted with the specialists there. As Kim has said, we have had several members who have had success with radiation. But it is a "big deal" and a big decison. And from things that I have read, the treatment prognosis is less positive when the neurological symptoms that are being displayed beforehand are serious. Here's a link to a thread on our "Helpful Resources" forum that contains some helpful articles about macros:

http://www.k9cushings.com/forum/showthread.php?t=229

Later on, I'll try to come back and give you some links to members' threads who have opted for radiation with positive results.

I do understand how torn you feel about leaving Pockets while you are gone (my husband and I were in the same boat with a preplanned anniversary trip right when we were in the middle of Cushing's diagnostics :o). But it sounds as if Pockets will be in good hands, and this will give you the chance to get in some R & R in advance of dealing with Pocket's diagnostics and treatment options.

Once again, I'm really glad you've found us. And one hint: check the "Remember Me" box when you log-in, and that way you won't ever lose your replies while you're composing them -- and you'll also be automatically logged in the next time you return to the site...

Marianne

[da_lizard]

Hey, thanks for the help!! I have been reading these forums and following the links all weekend!!! I read the part about checking remember me after the post was deleted, and did not have time to repost everything, so I will try to fill in the blanks now.

Hey Kim, she just had the Cortisol levels and the stim. test done. I am just making a pretty educated guess based on all I have read (thanks to this site) about the neurological signs and symptoms of pituitary macros and increased intracranial pressure. She has gone blind just recently, has circling, increased wandering-about the same time she went blind, what looks to be confusion which we thought was just due to the blindness, but now I do not really think so.

OK, here is some history, I do not have the labs with me, but I remember the basics. In Jan. she went to her regular vet. for her annual stuff (he is an older man who just does the basics-no labs, no x-rays, etc. but she has been going to him since she was 4 weeks old and he is VERY good and will quickly tell you when it is time to go for labs, etc.). He said that she was in the beginning stages of heart failure (I guess he heard a murmur) and that she was going blind. He placed her on Salix 1/2 pill a day. I took her to another office to get the usual senior labs after that and that vet did not hear a murmur, but he did an xray due to the fact that she had fallen the night before and was limping (of course after he took the xray she forgot to limp-lol) and he saw some fluid in the left lung border so he agreed she was in very mild heart failure. He added Enalapril daily. Her lab work showed a very slight increase in her creatinine, slightly elevated pancreatic enzymes, and the sodium potassium level worried him for Addison's, but only minimally and since she had no symptoms he decided to just retest after a couple of months on the meds.

Pockets has ALWAYS been a very picky eater and will only eat dry food so getting her to take the pills was difficult. She had to go stay with my Mom after that diagnosis for 3 weeks and she decided to try mixing the meds in a little chicken and rice which worked great.

The beginning of April she started having diarrhea, which initially I did no pay too much attention to it as she has always had a sensitive stomach also. I took her to see the old vet due to some ear gunk and mentioned the diarrhea. He held he Salix and started her on the ID diet for 4 days. She would not eat it after the 1st day so we started her on chicken and rice only. After a week of that and the loose stools cont. I called him and he wanted to stop the Enalapril for a week in case that was causing the problem. No luck. Then we started Sulfasalozine for 8 days. After the 3rd day, she would not touch the chicken we hid the pill in but would push it out of the plate and eat the rice. Thursday, she would not eat and I was convinced by now it was Addison's. I took her to get labs and her Cortisol level was 9.1 (do not have ref. range-sorry), pancreatic enzymes had tripled. Other labs OK with creatinine still slightly elevated. That night she ate her regular dog food as I figured it was better than nothing. I put the Fortiflora on a little chicken and rice and she ate that too. Friday is when we had the stim test.

I gave her the Trilostane on Sat. and Sun. morning. Last night before I went to work, she was really just very sad and not interactive. She slept all night my husband said and did not eat or drink during the night, which she did on Sat. night. She readily ate the pill mixed in with a little rice and fortiflora on Sat. and Sun. This morning, she was a little more alert and gave me a good tail wag when I got home from work. She would not eat the chicken and rice and Trilostane with or without the Fortiflora-but she had already eaten a little chicken that Dad "dropped" on the floor this morning when he was cooking a new batch of chicken and rice. ;) I tried to put it in her mouth with the rice and that did not go well, the pill turned in to mush and she spit it out. Any suggestions???

The other thing is that she uses puppy pads in the linoleum floor in the kitch. However yest. when I went to work, she acted as if she could not get her back legs up initially. This Am when Tom got up he noticed she had gone pee in 2 places in the living room carpet and also poo. (At least it is firmer now). I do not know if she could not hold it or if she could not get up and get to the kitchen. This morning though when I got home she was walking around fine. SHe has had alot of water this morning, but did not drink much if any during the night.

I am soooo torn about whether to get further testing and the referral to UGA vet school. I will not be able to go this week due to my work schedule, so it would be the week of the 17th before I could take her, but if we decide to go, we could call the vet and get the referral and appointment scheduled for when we return. I read the article about treatment being less successful if neuro. symptoms were severe, plus she really hates vets other than her primary one, esp. since she has gone blind and gets so stressed out.

I am very worried that she will deteriorate while we are gone and my Mom will have to have her put down. I am going to have my cell phone at all times except when I am scuba diving of course so she can call if there are any changes. I just worry about her getting the medicine in her, because she will be unable to force her, but my sister in law lives next door and she has helped before and Pockets likes her (usually). I do plan to get copies of her labs for my Mom to have if she needs to take her to the vet. there.

Sorry for the really long post!!!!
Thanks again!!
Elizabeth and Pockets

[labblab]

Hi again, Elizabeth.

I only have a couple of moments right now to post, but there are several "red flags" about Pockets' situation that are worrying me. I'd encourage you to consider holding off on giving her any more trilostane until you are back from your trip and can have more diagnostics performed.

First, is she still taking Enalapril? There are specific cautions about combining ace inihibitors such as Enalapril with Vetoryl. Here's a quote from the manufacturer's Product Insert (http://www.dechra-us.com/File/prod_vetyrol.pdf):


Angiotensin-converting enzyme (ACE) inhibitors should be used with caution with VETORYL Capsules, as both drugs have aldosterone-lowering effects which may be additive, impairing the patient’s ability to maintain normal electrolytes, blood volume and renal perfusion. Potassium sparing diuretics (e.g. spironolactone) should not be used with VETORYL Capsules, as both drugs have the potential to inhibit aldosterone, increasing the likelihood of hyperkalemia.
Even prior to beginng the Vetoryl, apparently Pockets exhibited some sodium/potassium abnormalities that worried your vet enough to make him consider Addison's? So combining the two medications now-- Enalapril and Vetoryl -- may be making that embalance even worse. She would need to have her electrolytes checked again to know whether or not that is a problem.

Secondly, you've told us that her pancreatic enzymes had tripled right before her diagnostic ACTH test -- plus she's had loose stools and eating issues for the past month. This worries me that she may be suffering from active pancreatitis. If so, that condition really is much more urgent than is the Cushing's treatment. In fact, an underlying illness like acute pancreatitis could have caused a "false positive" on her ACTH results by raising her cortisol for reasons other than Cushing's, and she may not even suffer from Cushing's at all. It actually does not sound as if she was exhibiting any typical Cushing's symptoms prior to her ACTH testing. Instead, ACTH testing was prompted because of a high "resting" cortisol level on labwork performed because she was not eating properly and was having ongoing diarrhea (neither of which are signals of Cushing's).

Thirdly, she has been acting unwell since beginning the Vetoryl...not "interactive," not eating and drinking normally, and having trouble standing up at times.

Bottom line...I'd feel really nervous about continuing the trilostane while you're away. I'm thinking it would be important to recheck her electrolytes, explore the pancreatic enzyme increases and depending upon the results -- then pursue some additional Cushing's diagnostics (like performing an abdominal ultrasound) before continuing with the trilostane treatment. A consultation with the specialists at UGA could be REALLY helpful as far as sorting out Pockets' situation. I'm hoping that some other folks will also be stopping by to add additional thoughts or opinions here.

Marianne

[frijole]

Elizabeth - I'm at work so can't post much but I wanted to chime in and agree with Marianne. Please trust us on this. Thanks!!!! Kim

[da_lizard]

Hey, looking back she has had some Cushing symptom's, such as increased water and urination, history of loose stools (could have been chronic pancreatitis), an infectious polyp on her tongue, multiple ear infections, pot-belly, and hind leg weakness. Starting the end of January we had to start limiting her food, as she would eat nonstop where before we could leave food out and she would eat here and there. It was only when the loose stools started (? pancreatitis flare up) that she stopped eating as much.

The vet she saw Friday, felt the heart failure was not really an issue at this point-very mild. The Enalapril had been stopped for a couple of weeks due to the diarrhea. I saw the warning in the package insert and was not going to resart it.

She had electrolytes on Thursday, which were normal.

I do trust you!! I had wondered about waiting until I return for the Trilostane. So you think that would be best? That would sure save Mom some headaches (if she would not take it) and me a stress over the side effects of the Trilo. I had thought about having Mom call me everyday before giving it to her anyway so I could assess her activity etc, but that would sure make things easier!!

Thanks!!!!
Elizabeth

[frijole]

Elizabeth - rule number one is never give trilostane or lysodren to a sick dog. So long a you are dealing with an upset stomach and the diarrhea you should not administer it. So go on the trip and let your mom focus on getting her stomach under control. If it is pancreatitus she'll have her hands full with that. Be sure she understands that when a dog is sick (vomit or diarrhea) for extended amount of time they really need to be seen by the vet so should something happen while you are gone she should take her in and not hesitate. Regarding cushings, there is no need to rush treating in most cases.

As Marianne suggested - she might not even have cushings.

Hang in there! Kim

[labblab]

Elizabeth, we are none of us vets, so I definitely encourage you to talk with your vet about any medication changes. But under these circumstances, if Pockets were my dog, I'd tell my vet that I wanted to hold off on any more trilostane until you are back from your trip and can monitor her yourselves. It doesn't sound as if Pockets is reacting very well to the trilo.

I do feel more comfortable about the general Cushing's diagnosis after hearing about her symptoms. But the ongoing diarrhea and the rapid elevation in pancreatic enzymes still has me worried. Has your vet said anything about pancreatitis? I am still thinking that scheduling at least an initial consultation at UGA may be a big help in figuring out the source of the intestinal problems, and whether or not it seems advisable to proceed with the trilostane. You wouldn't have to agree to any testing with which you are not comfortable, but just getting their feedback may be really valuable.

Also, how much does Pockets weigh, and what dose of trilostane is she taking? It's possible that her starting dose is just too high, and that is what is making her feel even more "off."

Marianne

[da_lizard]

Hey, the vet mentioned pancreatitis based on the labwork, but said since other than the diarrhea and slightly less appetite which we had tried treating with diet change and sulfasalozine for a month, she otherwise labs etc looked ok. She even mentioned pancreatic insufficiency but did not feel she needed IV fluids or anything at that point.
When the cortisol levels came back where they did she just said Cushing's and start Trilo. Then I read that Cushing's could cause pancreatitis, so I thought that may be some of the problem. The diarrhea actually got better Sat. and Sun. but was loose again yest. She did not get Trilo today and I really do not know if she got any yest. since she would not take the pill, but it turned to mush so she may have gotten some.
Pockets weighs 10 lbs now, down from her usual of 11-12. The dose of Trilo was 10 mg once a day.
She has not eaten much other than her dried duck treats and Blue liver flavored treats (only a very little though of those), and the little bit of chicken yest. am.
She has been sleeping most of the time, but that is not unusual. Last night she was happy to see Dad when he got home and gave me the "paw" which she has not done in a couple of days and ate the treats when we ate, but has not touched her dog food yest or today.
She also has had some episodes of sneezing and breathing funny like she has allergies last night and today-she has done this in the past but not much recently.
I plan to go by the vets. to get copies of labwork and to talk to her about everything you guys have said prior to going to Douglas in case Mom has to take her to the vet. there.
What further testing do you recommend so I can talk to the vet. I think the vet here may be able to do ultrasound. Also which service would I want to be referred to at UGA?
Thanks for all the advice and help!!!
Elizabeth and Pockets

[da_lizard]

I forgot one other thing is she is having times where she shakes like she is cold or in pain....any thoughts on this?
Thanks again.
I have to go to work, but hopefully I will have a chance to check replies tonight.
Elizabeth and Pockets

[Harley PoMMom]

Some info about Exocrine Pancreatic Insufficiency:


The acinar cells in the pancreas manufacture digestive enzymes that empty into the duodenum in response to the stimulation of a meal. Without them, food cannot be adequately digested and nutrients therefore cannot be adequately absorbed. For reasons that are unknown, the acinar cells may atrophy and stop producing enzymes. This condition is called pancreatic acinar cell atrophy (PAA), and is one of the major causes of pancreatic insufficiency.

For Exocrine Pancreatic Insufficiency most dogs respond well to having the missing enzymes added to their meals.

http://pets.webmd.com/dogs/dog-pancreatitis-symptoms-and-treatment?page=2

If Pockets was indeed showing any signs of pancreatitis, either in lab work or in symptoms, I would ask her vet to run a cPLI or cPL test to confirm the pancreatitis. These tests are specific to the pancreas lipase enzyme only.

http://www.idexx.co.uk/animalhealth/laboratory/speccpl/

http://www.cvm.tamu.edu/gilab/

My boy Harley has pancreatitis, didn't know this until his first ultrasound :eek: his first cPLI came back at 528 (0-200). We have gotten his cPLI levels down to 303 with diet changes and other things. Pancreatitis can be life-threatening, I know it scared the crap out of me. :eek:

Best of luck to you and Pockets.

Love and hugs,
Lori

[da_lizard]

Hey, after thinking and reading more, I am wondering if her shaking may be pain from pancreatitis. She ate the dried duck treats and that was all before I left fo work. She is getting around and making it to the kitchen to do her business but in between not much.
I am going to have her Dad bring her to the vet. in the morning when I get off work, which I hope will be on time and be there when they open. I am going to get them to further workup the pancreatitis and see if it is worse and ask for the cPL test. Problem is I am on call all day tomorrow (Neonatal ICU transport and ECMO nurse) and we have a baby on ECMO which means I have to be able to be back at work in 30 minutes if there is a transport or if anything happens to baby.
I guess if I can't pick her up if they keep her for the day, they can keep her overnight-she would be stressed to the max though!!

You would think being a baby nurse for 18 years I would be used to my patient not being able to tell me what is wrong, but this sux!! Everyone keeps telling me it is because it is My baby though so it is different.

Any other thoughts on what I can do prior to taking her to my Mom.

(We leave for Hw on Sat. AM so I need to be back Fri. night to pack etc as all I have had time/energy for is Pockets and work. I wanted to take her on Thursday evening so I could spend the night and get her settled in a little and leave around noon on Friday.)

Sorry to be so needy and stressed, I just need to try to get as much done tomorrow as possible... This dang trip (and work) is messing everything up!!!

Thak you,
Elizabeth and Pockets (oh and Dad too)

[labblab]

Hi Elizabeth,

I'm so glad that Lori has given you the additional info about the pancreatic testing. And I doubt that you would be able to work this in prior to your trip, but the other testing that I would recommend at this point is an abdominal ultrasound (but that should be performed on a high resolution machine, which may require a trip to a specialty clinic or UGA). As I said earlier, your description of Pockets' symptoms now sound much more consistent with Cushing's. But an ultrasound could provide additional confirmation as to the existence and type of Cushing's, as well as supplying helpful info about the state of Pockets' internal organs.

Unfortunately, it does really come down to a judgement call as far as continuing with the trilo while you're gone. Although, hopefully, the pancreatic testing will help shed more light on that issue. As you already know, Cushing's does predispose pups to pancreatitis. So if Pockets does not have acute pancreatic issues right now and is, in fact, a Cushpup -- then treatment for the Cushing's is a "plus" in terms of warding off future episodes of pancreatic problems...

But as far as what to do while you're gone -- since Pockets didn't seem to be doing that well during her first days of dosing, it feels a bit like "dealing with the devil you know" as opposed to the "devil you don't know"...:o Even though Pockets was not doing well prior to the trilo, either, I'm still thinking that it may be best to leave things as easy as possible for your mom, without the risk of unexpected surprises? But for today, let's see what the pancreatic testing turns up.

And as for the tremoring, just to muddy the waters even further -- we've had several occasions through the years when members have reported unexplained tremoring or "shivering" episodes in their Cushpups. Mine was one of them. Shortly after beginning trilostane, he developed severe tremoring across his shoulders, especially during times of rest or sleep. We consulted a neurologist, but were not able to identify a cause prior to the time that they ceased, just as mysteriously as they had begun. Other members have reported similar episodes, with pups on Lysodren as well as trilo. And some before treatment has even begun. What I am talking about here is different from the quivering of legs or the hind end from muscle wasting. That type of quivering is very common for Cushpups prior to treatment. But you're right, shivering can also be a result of pain. So once again, the pancreatic testing may help shed some light on that as well.

Definitely keep us updated as to how things go today!
Marianne

[da_lizard]

Hey everyone. Thanks for all the info.

I took Pocket to the vet. this AM. She did not really eat anything except the duck treats Monday night and nothing Tues. No vomiting, but still diarrhea. She has been drinking water and peeing.

This morning at the vet, she was interactive and nervous as usual. Wagging tail when she thought vet was finished with her and looked pretty good. I asked the vet about a cPL and he did not really say anything, but then I hit him with a lot about the trip, waiting on trilo, diarrhea, etc.

He did a chemistry panel (and I forgot to bring the labwork with me so I will tell you what I remember.

Na:K ratio was 30

pancreatic enzymes had decreased (I think lipase was 3100ish before and was now 2600ish) I can post full values tomorrow if you want them

BUN and creatinine were improved

That was the main points I remember.

He did not run a cPL though:confused:

He gave me a sample bag of ID dry food to see if she will eat it - she would not eat it today for them but that does not suprize me!!
Also since it seemed to get better after a couple of packets of Fortiflora when she would eat it, he gave me some diarrhea gel to squirt in her mouth a couple of times a day.

He agreed it would not be a bad idea to hold the Trilo until we are back as he said "the devil you know is sometimes better than the devil you don't know." He said he likes Trilo because he has seen less reactions with it over the Lysodren, but has seen some GI problems with it initially (so it sounds as though he has used it).

Now though Pockets is having what he said was reverse sneezing and a lot of nasal congestion (she was not doing it there for him, but was before I came to work again tonight). This started on Tuesday.

I do feel better knowing her labwork is better and that the Trilo is going to be held until we get back!!

Thanks for all the information and good wishes!!!

Elizabeth and Pockets

[AlisonandMia]

Hi Elizabeth,

Just a quick question - those duck treats, where are they made? There can be problems with treats from China. Stuff from China has to be irradiated for import and this seems to cause some (as yet unidentified) chemical change in the food. The problem caused is a type of acquired Fanconi Syndrome.

Jerky treats actually manufactured in the US should be ok though.

Alison

[da_lizard]

I think they are probably from China will look in the AM. We had stopped giving them to her in April when the diarrhea started and we went to just straight chicken and rice and just started back Mon. night. Will try chicken and rice again.

She is just so finicky-loves somethng one day and not the next, it is hard to tell when she is not eating versus not having what she wants.

Is it OK to give Benadry to Cushing's dogs? I wondered if this might help the stuffiness and reverse sneezing. I have given it to her in the past for itching.

Thanks for the info!!

[AlisonandMia]

Here's a link to some info on the Chinese treats/Fanconi issue: http://www.k9cushings.com/forum/showthread.php?t=599

Alison

[littleone1]

Hi Elizabeth,

I have not posted to you before, but I have been following your thread.

Corky has allergies, and his IMS has approved of him taking Benadryl, or a generic for it. I would check with your vet or IMS first. Every furbaby is different.

I'm hoping everything will go well.

Terri

[da_lizard]

Thanks Alison, will definately stop with those!!!

Elizabeth

[da_lizard]

Thank you Terri I will call and ask tomorrow.

[AlisonandMia]

Here's some more info with regard the jerky treats- it describes the clinical picture:



http://www.idexx.com/animalhealth/news/tfs.jsp

Jerky Treats causing Transient Fanconi's Syndrome---From 2007

Background: The American Veterinary Medical Association recently has posted a Media Alert to their Web site warning veterinarians that multiple brands of jerky treats manufactured in China have been making dogs sick. No cats have been reported to be affected. A contaminant has yet to be identified. At this time there is no list of specific brands affected and there is no recall in effect, so these products are still being sold to consumers.

Presenting Signs and Laboratory Findings: The dogs appear to be developing an acquired Fanconi’s syndrome which appears to be transient. Small dogs with a history of ingesting jerky treats (mostly chicken jerky) are typically affected. Clinical signs include vomiting, diarrhea and lethargy. Physical examination findings have been unremarkable. In addition to mildly elevated liver enzymes, the most common clinicopathologic abnormalities include severe hypokalemia and acidosis along with glucosuria and granular casts on urinalysis. Azotemia is not a consistent finding.

Testing Recommendations: IDEXX internal medicine consultants have also noticed an increase in consultations on dogs with apparent Fanconi’s syndrome. We recommend a CBC, chemistry panel including electrolytes, urinalysis and urine culture. Blood gas analysis, if available, is ideal. Additional testing for other causes of acute proximal tubular damage including leptospirosis serology is also recommended. Renal imaging, fractional clearance studies and Fanconi screens on urine may be warranted in some cases.


Unfortunately the link above doesn't work anymore (takes you to the Idexx site but not the article) - but the info below it was quoted from the article.

I wonder if some of Pockets' not being that well could be related to this?

Alison

[da_lizard]

Hey Alison I am not sure. We did not really give her much of them, usually just really small pieces when we ate. She did not have them the Month of April due to diarrhea. Monday and Tuesday she may have had a total of 1 duck treat.

That 1 duck treat is all she has eaten since Sun. AM when she ate a tiny bit of chicken.

Since returning from the vet yest. afternoon she has been really out of it, I thought she was just worn out from going to vet. all day. She continues to have the stuffiness and reverse sneezing. Last night when Dad got home he said she had peed and her butt was laying in it. This morning he gave her some chicken and rice right under her nose and she just sat there with it under her nose and did not move or eat it. She was sitting up as she had just had an episode of reverse sneezing.

Any thoughts on how/what to get her to eat????? Just when I thought things were looking up yest. when she felt good at the vets and lab results looked better.:confused:

Thanks!!

[da_lizard]

This morning when I got home, I got Pockets to drink some water and a little bit of a fried chicken (skin and breading removed) chicken breast- I know not the best thing for her, but I wanted to see if she would eat anything. She would not touch chicken and rice or Fortiflora.
I gave her the diarrhea paste and then some more water. I carried her to the puppy pad in the kitchen and she had a large pee and then navigated her way back to where she likes to sleep. So I thing later tonight maybe after we go to my Mom's we will try some boiled hamburger for something new.
Here is an article I found about getting sick pets to eat:

http://www.petplace.com/dogs/encouraging-your-sick-pet-to-eat/page1.aspx

Elizabeth

[da_lizard]

Pockets is at Mema's. She is still not eating very much, no dog food, no chicken, no hamburger. Mom did give her (I do not want to say this) Vienna Sausage which she ate, but that was all since Fri. when she ate a small amt of hamburger. She is drinking well. Still has diarrhea (I am sure the Vienna Sausage will not help) and sis in law is giving her the diarrhea gel.
I think the sneezing and runny nose is because they gave her a kennel cough vaccine when she stayed at the vet to have labwork. I will start Trilo when I return. Hopefully I can get her to take it and eat.
Thanks,
Elizabeth

[Harley PoMMom]

With the sneezing and runny nose there is a good possibility, for the time being, that Pockets has lost her ability to smell. If this is the case then she will be not so proned to eat, dogs are driven by their noses! I suggest feeding her very stinky stuff, one thing that comes to mind is tripe.

I did read the article about Encouraging Your Sick Pet to Eat...onions are toxic not only to cats but to dogs as well, so if you do try to feed her the meat baby food, no onions can be in the ingredients.

Please reconsider starting her Trilostane until Pockets is eating better, her diarrhea has stopped and her poops are normal. What I'm afraid of here is that diarrhea and poor appetite are listed as some of the adverse reactions of VETORYL (Trilostane). If you start Pockets on her Trilostane she could go low on cortisol and many times this low drop of cortisol has been detected by the furbaby's parent by a loss of appetite and/or diarrhea.


Another thing for her eating...Nutri-Cal


Nutri-Cal is a high-calorie palatable dietary supplement used for stressed or debilitated pets, pets suffering from illness, surgery or whelping, aging pets or picky eaters, who need increased caloric and nutritional intake.

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

You can probably find Nutri-Cal in any pet-store in your local area.

Love and hugs,
Lori

[da_lizard]

Hey Lori, thanks for the reply. That makes perfect sense about her not eating since her smell is off.

Today my Mom and sister in law took her to the vet in Douglas since she has not eaten in 2 days and was still stuffy and sneezing.

They ran chemistries and the vet said she is in renal failure with BUN 90 (I do not have ref. ranges) and creatinine was 4 something. Last week it was only 2.2. She said pancreatic enzymes were ok this time but she was going to do another test (I am thinking the cPL).

She is going to start her on IVF for dehydration, antibiotics for runny nose, possible urinary tract infection, and dental disease. She is going to do them IV since she is not eating. She is also doing a CXR to see if there is any pneumonia, but said her lungs sounded clear.

They wanted to keep her a couple of days, but my sister in law said she wanted to take her back to my Mom's house at night since they will not be there anyway, so that is what they are going to do.

She mentioned special renal diets etc if we can get her eating and feeling better.

I will check with them about the Nutri-Cal to see if it can be used with renal failure before I order it.

Thanks for any input or thougts you all have!!

Elizabeth

[Harley PoMMom]

I am so sorry that Pockets is not feeling better and I am hoping that the IV fluids make her feel better.

Concerning the amylase and lipase enzymes; Back in Nov. 09 Harley had his amylase and lipase checked plus a cPLI test done all on the same day. His cPLI results were 464 (0-200), his amylase 515 (290-1125), lipase 403 (77-695). Altho his amylase and lipase enzymes were in the normal ranges his cPLI was not, in fact it was indicative to pancreatitis, which his vet and I already knew he had...his cPLI in Aug 09 was 528 :eek: I am very glad to hear that your vet is doing the cPL test on Pockets.

I will be keeping you all in my thoughts and prayers.

Love and hugs,
Lori

[da_lizard]

Hey Lori,
I hope the fluids and antibiotics help. Wow that was a high cPl level. I am guessing that is what she ran, I was asleep when they called and kind of out of it (with the time difference). She told my Mom that her belly was sore, which might be why she bit my Mom and sis-in-law yest.
My Mom said the vet there seemed good and knowledgeable and was not ready to throw in the towel. They are dropping her off in the morning at 0730 for IVF.

Thanks for the thoughts and prayers! I feel terrible being so far away!
Elizabeth

[da_lizard]

I picked Pockets up from Mema's on Monday. They had done 2 days of IVF and plaed her on Clavamox antibiotic. Urine was negative for UTI, but she had thick yellow nasal secretions.

They put her on Sulcrafate liquid for possibility of ulcers from renal failure.

The IVF were stopped on Thurs. evening. My Mom said she ate and drank for them over the weekend but not as much on Monday. She did not eat much for me on Tues. but did drink. No drinking or eating on Wed.

She continues to have loose stools, her cPL was recorded as abnormal. Amylase has improved since last test. (1267-ref 500-1500)

I plan to take her to the vet. here in Augusta in the AM.

I see Trilostane is not to be used with renal insufficiency/failure (not that I was going to give it anyway with her in this shape). Can any treatments for Cushin's be given with renal failure, mild heart failure?

I plan to get Nutri-cal after talking with vet. tomorrow.

Any thoughts on what I should ask in the morning?? I really fear the end of our ride together is near...

Thanks,
Elizabeth and Pockets

[da_lizard]

Pockets labs today were far worse than I could have imagined!
Creatinine 12 up from 4.4 last week
BUN 124 up from 90
Phosphrus > 16.1
The options were 1. IVF and antibiotics as she still has a cough, eye drainage, and snotty nose, and see what values do after treatment for a couple days leaving her there overnight so that IVF can be given around the clock (even tho no one is there at night). He felt taking her home at night would delay getting numbers down.
2. Do nothing and let nature take its course. The vet said if we did nothing, she had maybe a couple of days.
3. Subq fluids to see if she would start eating and drinking.
Tom and I chose option #1, in case maybe things will improve after treating infection, although we know that is a long shot. I hate leaving her there overnight!

[labblab]

Elizabeth, I am so very sorry that Pockets is doing so poorly. I'll be keeping you all in my thoughts, and hoping that this therapy will turn things around for her. Please do keep us updated!

Big (((hugs))),
Marianne

[AlisonandMia]

I too am sorry to hear that Pockets is in such a bad way at the moment.

What I'm wondering is if she can come home to you of an evening while still on the IVF. I've heard of pets having IV therapy at home before and I'm sure with your professional knowledge you can more than handle it.

I've got everything crossed that Pockets can come through this - we've seen some that have so there is hope!

Alison

[da_lizard]

Hey Marianne and Alison,

I asked about bringing her home at night on IVF and they would not go for it initially. She kept kinking her IV off at night and not getting any fluid at night anyway. Her labs this morning were not improved, so I decided to bring her home. I did finally convince them to let me bring the pump and IVF home to run through the weekend rather than leave her there. I plan to show my husband how to mangage it tonight when I am at work, but if he does not feel comfortable, then I will run it higher during the day and stop it at night just to buy time until Monday so we can have some time together.

I just got her home and put her in a box next to the sofa so she would not try to wander off while I take a nap, and she immediately went to sleep.

Thanks for the prayers and well wishes, we are going to need them in the next few days!!

Elizabeth and Tom and Pockets

[Harley PoMMom]

Hi Elizabeth,

I am so sorry that Pockets has not improved but I am glad she is home with you both.

Now, I am not an expert on Kidney Disease but did they say anything about putting Pockets on a Phosphate binder?

Here are some links that I hope will be of use; the first is about the Phosphaste binder, the second is about kidney disease.

Phosphate Binders: What Are They And How Do They Work? (human oriented)
http://www.aakp.org/aakp-library/Phosphate-Binders--What-Are-They-And-How-Do-They-Work-/index.cfm


Kidney Disease in Dogs
http://www.dogaware.com/health/kidney.html

You all are in my thoughts and prayers.

Love and hugs,
Lori

[littleone1]

Hi Elizabeth and Tom,

I'm so sorry that Pockets is going through this. I know this is very rough on you.

I will be keeping all of you in my thoughts and prayers.

[Casey's Mom]

Love and warm thoughts for you both and Pockets. I am glad she is with you and not at the vets by herself.

Love and hugs,

[da_lizard]

Hey Lori, thanks for the info. The vet did not mention it, I think because things have just shot up so quick, and did not show any signs of improvement on the IVF (they did increase the rate during the day to make up for what she did not get during the night), that he feels the kidneys are not going to work. I had some Sulcrafate from the vet my Mom took her to, which was for possible ulcers. I saw on one site where that was a phosphate binder even though that was not what it was used for very often, so I had Tom start it back last night when I was at work.

He made a pretty good nurse. When I got home this morning, he had her laying on the sofa next to him IVF and all and they were sound asleep!!! She ate part of a chicken filet biscuit this morning(breading removed). This was the first she has eaten since Tuesday so the IVF are making her feel a little better.

We are going to stop the fluids in the morning and take the pump back and see what the vet says. I do not think I want to put her through subcutaneous fluids as I do not think it will be very helpful. She is just miserable and I do not want her to suffer. We are going to see what they say and see what happens. I would like to have a day or two with her before making that tough decision.

Thanks for all the prayers, love, and hugs!!!

Elizabeth, Tom, and Pockets

[labblab]

Oh Elizabeth, we'll all keep those prayers and warm thoughts flowing. No matter what, I'm so relieved that you have been able to spend some time at home with Pockets. I know how important that can be for you all.

Continuing (((hugs))) being beamed your way,
Marianne

[Harley PoMMom]

Oh Elizabeth,

We are all here for you and Pockets, please remember that, ok. And we are all sending positive energy and healing thoughts your way. Keeping you and Pockets in my thoughts and prayers.

Love and hugs,
Lori

[da_lizard]

Hey Lor and Marianne,

Pockets started having seizures on Wednesday, with Tom and I here. We took her to the vet and helped her cross over. She had a pretty good day Tuesday and ate some of her favorite foods and we got in some good cuddling.

I wish I had been able to use the wealth of information on this site and your experiences to treat her Cushing's, but things just happened too fast.

Thank you for all the information, prayers, warm thoughts and hugs!!!

Elizabeth and Tom

[littleone1]

I'm so sorry for your loss Elizabeth and Tom. You did the best you could do for Pockets. She is now in a better place. She is now pain free and isn't suffering anymoe.

I know this is not an easy decision to make. Sending more thoughts and prayers your way to help ease the loss you must feel.

[Casey's Mom]

I am so sorry to hear your sad news. Many healing hugs to you and Tom -

[frijole]

Elizabeth and Tom,

I am truly saddened at this news. I had to make that same decision last Saturday and I know it is hard. As someone told me - it was the right one because you wouldn't and couldn't have made it if it wasn't. I'm lighting a candle for Pockets here: http://www.gratefulness.org/candles/candles.cfm?l=eng&gi=K9C

Peace. Kim

[bgdavis]

Elizabeth and Tom,

I'm so sorry for your loss. Pockets is now at the Bridge and in fine shape and no pain.

Bonnie and Angel Criss

[bkdice]

So sorry for your loss of Pockets. May you have many happy memories to help you heal.

Bettina & Angel Niko

[EllyAugie]

Elizabeth and Tom,
I am so very sorry for the pain you are feeling now in the loss of your precious Pockets.
It is so hard to say goodbye even tho we know they will be free from pain. My heart goes out to you.
Healing prayers.
Elly and always Augie

[John II]

Dear Elizabeth and Tom,

I am so sorry for your loss,
my thoughts and prayers are with you.

[Squirt's Mom]

Dear Elizabeth and Tom,

I haven't been able to post to you before but am still saddened by the news of Pocket's passing. From reading ya'lls story there is no doubt that you did all you could for your baby and in the end gave her the greatest gift you could - freedom from her pain and discomfort, a gift that can only come from the depths of love.

Please know we are all here for you any time you need to talk and I hope you will one day feel like telling more of your life with Pockets in our In Loving Memory section. That way we can all help you honor her life.

In sympathy,
Leslie, Squirt, Crystal and our angel, Ruby

[Spiceysmum]

So sorry to hear about the loss of Pockets. Thinking of you both.

Linda and Spicey

[labblab]

Dear Elizabeth and Tom,

I'm so very sorry. But thank you so much for coming back to tell us what has happened. And I am so grateful on your behalf that you were able to spend some special time together, at home, with your little sweetie.

Please know that we will always welcome you back here at any time. Although your time with us was not long -- you will always be members of our family, and Pockets will always be honored and remembered here.

With many (((hugs)) to you both, in loving memory of your baby girl ~
Marianne

[zoesmom]

Elizabeth and Tom -

My heart goes out to you. Pockets placed all her trust in you and you gave her that final gift of release. As hard as it was, I know she appreciated that. Sue

[Harley PoMMom]

Dear Elizabeth and Tom,

I am so sorry for the loss of your dear Pockets. My heart goes out to you both. Although I realize words can not heal the pain you are feeling, please know that we are here for you, always.

Peace sweet Pockets

With Heartfelt Sympathy,
Lori

[sunimist]

Tom and Elizabeth, I am so sorry to hear the loss of your precious Pockets. My heart goes out to you both.

Many (((((hugs))))

Shelba and Suni

[katiesmom]

Elizabeth&Tom.....so sorry to hear about your loss. May Pockets be at rest and take heart in knowing that she is no longer suffering. She is in a much better place. It's so hard on the pet parents that are left behind to deal with the excruciating pain of the loss

May your hearts heal and god bless!
Love&Hugs Cathy and my Katiebear.

[Franklin'sMum]

Dear Elizabeth and Tom,

I am so sorry for your loss. You both did everything you could for Pockets, up to and including helping her to cross the bridge. May your memories of Pockets help you through this painful time.

Lots of love and (((hugs)))
Jane, Franklin and Bailey xxx
________
Nexium settlement info (http://www.classactionsettlements.org/lawsuit/nexium/)

[Roxee's Dad]

Dear Elizabeth and Tom,

I am so very sorry for your loss. I'm sure Pockets is now in peace and watching over both of you as you did for him.

Rest in peace sweet Pockets.