Rusty the Beagle (UPDATE: Rusty has passed)

[Sabre's Mum]

Gretchen

I am so sorry to hear the latest on Rusty. Unfortunately my knowledge on blood transfusions is how they relate directly to IMHA dogs (whereby transfusions are given when PCV is about 12) and I don't know anything about injectables.

Sending healing white light Rusty's way.

Take care
Angela and Flynn

[missbeagle]

Hi guys -

Rusty spent last night in the ICU at NCSU Veterinarty Teaching Hospital. His heart rate has stabilized, his PCV has come up from somewhere between 17 and 20% to about 24% again. The vet is trying to figure out if he really has non regenerative anemia or not. He says Rusty is in a gray area.

They have had him on an ECG machine all day today, and he was all day yesterday at the regular vet's and the emergency vet's. So far, no incidents which is good.

They offered him some kidney food this morning, but he turned it down. They affered food again when I came by to vist and he wolfed it down in 2 minutes flat. It was Hills KD - yucko! He must have been hungry.

They have continued to give him the zonisimide for his seizures. So far, so good since Wednesday.

They have run a urine culture, a CBC, and have checked his adrenal glands, his kidneys, his pancreas, and his heart in ultrasound. They found a bit of fluid in his abdomen and took a specimen that came back negative. His enlarged uereter is still enlarged. They think his pancreas is a bit enlarged too.

His potassium is elevated and they are trying to figure that out too. They were thinking that he had Addison's secondary to his Cushing's and the jury is still out on that. Because of the elevated potassium, they nhave been giving him saline via IV catheter at about 60 some ml/hr.

Tomorrow they will check his blood again, PCV and liver enzymes. They are even speculating that something with his liver might even be causing his seizures.

So we are still here in Raleigh again tonight. he's been upgraded to the regular ward for tonight and won't be on the ECG. The vet was talking about running a complete EKG tape on him too, but I'm not sure if they did that or not.

Rusty is tired and worn out from the poking and prodding. Apparently he isn't going to be getting a transfusion at this time. They are talking about giving him depo, maybe once a week. We'll see what tomorrow brings.

I'm not sure what was going on with his heart, but I hope he's over it now.

Thanks for the well wished and good thoughts. It is very much appreciated.

My husband says he's anemic because we are always taking his blood to test. LOL!

Gretchen and Rusty, NC
Cushing's and GN/CRF
10 yrs. old
(10mg Prilosec, Royal Canin, Azodyl, 3 tsp AlOh powder, 35lb. Beagle boy)

[Bo's Mom]

Sending Rusty some well wishes. I know it is tough being away from home where people are always poking and prodding. But, hopefully all the poking will yield some answers and he is on the mend soon.

[Squirt's Mom]

Mornin' Gretchen,

That sounds more positive than the last post and I am so glad to hear it! :) I hope he continues to improve and gain strength.

Hugs,
Leslie and the gang

[jmac]

Hi Gretchen,

Glad to hear Rusty is feeling a little better and is a little more stable. I hope they'll figure out exactly what's going on soon! He's a lucky man to have such dedicated owners who are determined to figure things out!

Julie & Hannah

[Patty]

Gretchen,
I am new to posting at k9c but am a mod at k9diabetes. I'd heard about your Rusty and his seizures and feel for you. My Ali has recently developed non-hypo grand mal seizures.

Well wishes for your guy and all you are going through!
Patty

[missbeagle]

OK guys -


There's a lot here. I copied it right from his discharge notes.

PHYSICAL EXAM FINDINGS UPON PRESENTATION

Temp: 99.2 F Pulse: 88 bpm Respiration: 20 breaths/min BCS: 3/9 Wt: 14.9 kg
Attitude: QAR MM: pale pink CRT: 3s Hydration: adequate Pain Score: 0/4
GEN: Quiet, shaking, seems weak
EENT/oral: Eyes- Clear corneas, anterior chambers OU. No ocular discharge OU; Ears- Mild cerumous debris, skin intact, no
erythema, Nose- No nasal discharge or crusting, T/oral- Severe dental tartar, multifocal gingival hyperplasia, especially on maxillary
incisors, approximately 2 cm pedunculated gingival mass behind right molars. Neck palpates normally with no cough on tracheal
palpation.
CV/R: Grade III-IV/VI left sided systolic murmur, no arrhythmias at presentation, femoral pulses strong, symmetric, and synchronous.
Lung sounds normal, no crackles or wheezes ausculted.
M/S: Ambulatory x4, mild global muscular atrophy, no palpable joint effusion or pain.
INT: Full coat, no evidence of alopecia, or ectoparasites. Hyperkeratosis on nasal planum, soft, perianal adenoma (historic)
GI/GU: Soft, non-painful abdomen with no masses, liver extends 2-3cm beyond the costal margin. Unable to palpate kidneys, bladder
is 3-4cm and soft.
NEURO: PLR, menace, gag and palpebral intact. Weak and wants to lay down.
PLN: All lymph nodes are smooth, soft and symmetrical.
RECTAL: No masses or lymphomegaly palpated, prostate is smooth, enlarged with no cysts palpable; normal preputial conformation
with no discharge or observable lesions.

DIAGNOSTICS

1.Big 4 (presentation): Glu-150, Azo- 15-26, PCV- 21%, TS- 6.8

2.Blood pressure (Doppler) (pres): 145 (#4 on left leg)

3.ECG (pres): HR 105 normal sinus rhythm, with exaggerated sinus arrhythmias (HR 33) when resting. Atropine responsive. As
continuous ECG monitoring continued when Rusty was bradycardic there became variable sized P waves with tall T-waves, HR- 33-
58bpm.

4.iStat Blood Gas (pres)- K+ 6.7

5. Critical Care Panel (6:00 am 7/13): BUN 134 (7-25), Crea 4.6 (0.3-1.4), ALT 124 (10-118), K+ 6.2 (3.7-5.8)

6. CBC (7/13/12): RBC 3.57 (4.39-11.61), Hgb 8.0 (5.7-8.0), Hct 24.9 (13.8-20.3), RDW 14.1 (11.3-13.5), Plt 629 (190-468), PCV 24% (39-58)

7. Chemistry Panel (7/13/12): BUN 97 (6-26), Crea 5.1 (0.7-1.5), Phosphorus 7.5 (2.5-5.6), ALKP 241 (16-140), ALT 142 (12-54),
GGT 7 (0-6), K+ 6.3 (4-5.3), Amyl 1411 (236-1337)

8. Baseline Cortisol (7/13/12): 4.0 (1-4.5)

9. Urinalysis (7/13/12): SG 1.008, pH 7.0, trace protein (15mg/dL), trace protein (bumin)

10. Urine Aerobic Culture (7/13/12): pending

11. UPC (7/13/12): 2.5

12. Abdominal Ultrasound (7/13/12): Trace peritoneal effusion (aspirated: SG: 1.010, not submitted); Suspect acquired mesenteric
shunt vessels but cannot reliably document portal hypertension; Probable pancreatitis; Colitis and gastritis; Mild splenic
lymphomegaly - likely reactive hyperplasia to pancreatitis; Bilateral adrenomegaly - probable hyperplasia; Persistent nonspecific
splenic nodule; Persistent nodular hepatopathy most consistent with vacuolar change; Probable urinary bladder wall hematoma or
accumulated mucinous debris; Bilateral chronic nephropathy; Persistent prostatomegaly consistent with benign prostatic hyperplasia

13. Reticulocyte Count (7/13/12): 52000

14. Chemistry Panel (7/14/12): BUN 92 (6-26), Crea 5.2 (0.7-1.5), Phos 7.8 (2.5-5.6), TP 4.9 (5.2-7.3), ALKP 226 (16-140), ALT 116
(12-54), K+ 6.2 (4-5.3), Amyl 1692 (236-1337), Lipase 201 (12-147)

15. Bile Acids Test (7/14/12): pending

16. Big 4 (7/14/12): PCV= 26%, TS=5.8, Glu= 91, BUN=92

17. SPO2 (7/14/12): 95%

TREATMENT: Darbepoietin 6.6mcg(0.26ml) SQ @ 12pm

DIAGNOSES/PROBLEMS

1.Bradycardia: R/O high vagal tone vs hyperkalemia(less likely)

2.Anemia: blood loss vs. destruction vs. decreased production due to CKD

3.Historical labored breathing

4.Recent cluster seizures-like episodes

5.Chronic kidney disease (proteinuric) with hydroureter (not seen on U/S at this visit)

6.Hyperadrenocorticism(Historic, not undergoing therapy)

7.Hypertension (controlled)

ASSESSMENT

Thank you for bringing Rusty in to see us. He is such a sweet boy. While hospitalized, Rusty's heart rate was monitored closely and
was within normal limits, averaging between 108-116 bpm throughout the day. He was dehydrated when he came in and was started on IV fluids to reverse this dehydration. He has been doing well since hospitalized, has had a normal blood pressure and has been
rehydrated. We have started Rusty on a few medications for nausea and gastritis. As discussed, some GI disease can cause high
vagal tone and may have been related to Rusty's bradycardia. His abdominal ultrasound showed some changes in his GI tract
consistent with gastritis. Additionally, his pancreas was mildly enlarged which may represent a chronic or mild acute pancreatitis. We
have started Rusty on other medications to help prevent and GI ulceration and further gastritis.

Rusty has been eating relatively well while he has been here and we hope he continues to eat well at home. If you have any
concerns regarding his appetite please contact us or your regular veterinarian. As we discussed, an esophagostomy tube may help
provide nutrition and hydration in the future. Please contact your regular veterinarian regarding this option if you have any questions.

We have started Rusty on Darbepoeitin. This medication will stimulate the bone marrow to make more red blood cells. Because of
Rusty's chronic renal disease, the natural hormone (erythropoeitin) is in insufficient amounts to stimulate the bone marrow enough.
With this medication, Rusty's PCV should improve over time. The Darbepoeitin will be continued weekly until we have normalized his

PCV. Once Rusty's PCV reaches 35%, Darbepoeitin can be given every other week and when it is 45% it can be given every three
weeks. At this time, the Darbepoeitin injections can be given as needed to maintain PCV.

Over the last 24 hours prior to discharge, Rusty began having diarrhea. As you mentioned he sometimes gets stress colitis. We
would like Rusty to eat a bland diet (see below) until the diarrhea resolves.

INSTRUCTIONS FOR CARE:

MEDS:

Darbepoeitin 25 mcg/mL- Administer 0.26 mL under the skin once a week until directed otherwise. This medication should be given
on Saturdays at 12:00pm.

1. Ondansetron 4 mg Tablets-Give 2 tablets by mouth every 12 hours.

2. Omeprazole 20 mg Capsules- Give 1 tablet by mouth every 24 hours in the morning. This is a proton-pump inhibitor medication
that will decrease stomach acidity. You may purchase this medication from your nearest pharmacy as it is an over-the-counter
medication. Please ensure that the product you purchase ONLY contains omeprazole and it is the 20mg strength.

3. Zonisamide 50mg capsule: Give 1 capsule by mouth every 12 hours until directed otherwise. This medication is an anticonvulsant
and can take up to 1 week to reach therapeutic levels.

4. Clopidogrel (Plavix) 75 mg tablets: Give 1/4 tablet (18.75mg total) by mouth every 24 hours. This medication is a platelet inhibitor;
please watch out for signs of bruising or bleeing.

5. Gabapentin 100mg capsule: Please give 1 capsule by mouth every 12 hours for cervical pain

6. Gabapentin 50 mg capsule: Please give 1 capsule by mouth every 12 hours for cervical pain.

7: Amlodipine 5 mg Tablets- Give 1 tablet by mouth every 12 hours. THIS IS HALF OF RUSTY'S PREVIOUS DOSE

6. Enalapril: PLEASE DISCONTINUE AT THIS TIME

7. Aluminum hydroxide: Please continue to administer as previously prescribed.

8. Sucralfate 1 gram Tablet- Give 1/2 tablet by mouth every 12 hours

OTHER

1. SQ Fluid Therapy: Continue to give SQ fluids as directed by your regular

Any comments or suggestions are welcome!

Thanks so much for the prayers and the white light! I am sure it helped!

Gretchen and Rusty, NC
Cushing's and GN/CRF
10 yrs. old
(10mg Prilosec, Royal Canin, Azodyl, 3 tsp AlOh powder, 35lb. Beagle boy)

[missbeagle]

Hey gang -

Here's the new plan for Rusty man. The vets at NCSU have changed his BP meds from 10mg of amlodopine BID to 5mg of amlodopine BID.

Because his potassium was elevated, they have discontinued his enalapril altogether.

I have cut back on his fluids too. I was giving him 400ml of fluids every day. In doing some math, that comes of to 12ml/pound for him. I have now cut him back to 270ml ish...(I have to eye ball it) every day. That's about 8ml/pound for him.

I am still giving him the zonosamide for seizures twice a day.

I am now giving 20mg of Prilosec everyday instead of 10mg once a day.

The vets upped his Ondansetron to giving him 2 4mg tablets twice a day.

He is still getting 1/4 of a 75mg tablet of Plavix for his clotting factor.

He's getting 3tsp of aluminium hydroxide over the course of the entire day for his high phosphorous levels.

I'm wondering is his seizures were due to a high potassium level? He was 6.2 (3.7-5.8), while he was at NCSU.
The vets seem to think he has some GI something going on that caused his bradycardia late last week. That's why they have upped his Prilosec dose.

He's been eating pretty well, not exactly all kidney dog food legal, but at least he's eating. So far, he's not had any more Sei**r*s either. Fingers crossed.

He's been pretty spunky too, which I haven't seen in a month or so.

The kidney dr at NCSU says that the minimum levels of fluid should be given for hydration purposes, so they drink plain water (that has less salt, potassium and calcium in it). So that's another reason why I lowered his fluids a bit.

The vets also put him on Darbepoietin once a week to help build some red blood cells. He is getting a daily 1ml of Hi-Vite drops too.

So far this seems to be working for him.

Thanks for the prayers and white light.

Gretchen and Rusty, NC
Cushing's and GN/CRF
10 yrs. old
(20mg Prilosec, Royal Canin, Azodyl, 3 tsp AlOh powder, 33lb. Beagle boy)

[GabbySue]

I'm glad to hear that Rusty is feeling better, now that his blood count is climbing he will have more energy and feel like eating more as well.

Sending prayers for a continued easy recovery!

[Squirt's Mom]

Hi Gretchen,

I'm glad that Rusty is feeling better and hope the trend continues. You are such a great mom and I know his heart is full of love for you.

Hugs,
Leslie and the gang

[molly muffin]

Isn't it great to have a plan :) Best wishes for continuing recovery and happy days.

Sharlene

[mytil]

It is with sadness we learn of Rusty's passing.

Gretchen, my heart is with you.

Always remembering Rusty
(((hugs)))
Terry

[molly muffin]

Gretchen, I was so sorry to hear that Rusty has passed. What a trooper he was. You guys had a really rough road for a long time and each step seemed like you battled for it.
Love and condolences
Sharlene and Molly Muffin

[Bo's Mom]

Gretchen,
So sorry to read about Rusty's passing. Our prayers are with you tonight and the many nights that come. You were an AWESOME mom and I know Rusty knows how lucky he was as you are so lucky to have had him in your life. RIP Dear Rusty.

[jmac]

I'm so sorry to hear about Rusty's passing. You are in my thoughts...

Julie & Hannah

[frijole]

RIP dear angel Rusty. Run free of pain and know you were deeply loved. Kim

[NoonelovesmelikeNorman]

Gretchen,

I am sorry to read about Rusty's passing. Sending prayers of comfort and peace to you and your family.

Hugs to you and yours,

Sharon and Norman