Angelina has passed away - 15 1/2 year old/7.2 kg Maltese Cross on Trilostane [Archive] - Page 2 - Canine Cushing's Information and Support Forums

John II

11-23-2009, 03:19 AM

Hello All,

Well yesterday in Sydney lived up to expectations - a top temperature of 41 degrees celsius (= 105.8 degrees Fahrenheit). No A/C, even the cooler mat didn't arrive in time. And on top of that, 2 sets of visitors (including 2 more dogs)! Who visits in a heatwave? :confused: Angelina, being a good hostess could not be persuaded to leave them and retreat to the cool of the bathroom until they left - by then even the bathroom was no longer cool. :(

http://www.k9cushings.com/forum/picture.php?albumid=96&pictureid=1061
Angelina and her best friend.
http://www.k9cushings.com/forum/picture.php?albumid=96&pictureid=1062
Angelina's cousin Mandy
http://www.k9cushings.com/forum/picture.php?albumid=96&pictureid=1063
Angelina's cousin Buddy

Angelina got soaked in cool water 3 times over the course of the day, and sprayed with water mist to the point where, by late evening, she started barking angrily as soon as I picked up the spray bottle. :rolleyes:

The cool change showed up about 3 hours late - about 12:45am. luckily it arrived with strong winds which blew through the house cooling everything down.

I'm not sure how much of a toll yesterday has taken on Angelina. That remains to be seen.

The A/C guy showed up today - to inspect the site to see what materials he would need for the installation. We may see him again, this week. The cool change is only set to last for a couple of days before things heat up again.

Angelina is still having to be persuaded about breakfast. Although yesterday, I reversed the process and gave her 100g of commercial dog food for breakfast, and her usual breakfast of raw meat - for dinner - which was acceptable to her. This morning I handfed her the first part of the raw meat and she continued on from there.

Poop report - after 8 days without Trilostane the poops are firmer and of a more poop-like shape. :o

Last Thursday I started giving Angelina a daily dose of Denamarin at 5am - followed by breakfast at 7am (or if she didn't feel like breakfast - a short walk - and then breakfast) - no obvious ill effects noticed.

Angelina spent some time lying in the bathroom today, despite the fact that today was cool and rainy. I'm thinking of restarting her Trilostane tomorrow at two doses of 20mg per day and see how we go.

Hi Lori & Marianne, thanks for checking in with the advice. Angelina doesn't take Tramadol as yet - but it's good to know that it should be avoided when taking Denamarin.

Hi Ellen, thanks for the further explanation of your Denamarin experience. It's worrying how it seems so many vets seem to speak with great assurance even when they're wrong about something. :(

And Jane, thanks for checking in -
Just wondering how Angelina is feeling. Is she eating better? I think I answered your question above. We'd be doing better if nature, A/C installers and Mail Order Companies would just co-operate! :(

John II

11-25-2009, 04:18 AM

Hello All,

Well, we had two days of cool rainy relief - but that's over now with a return of the heat today 33 degrees celsius - the cooler mat still hasn't arrived - my niece ordered one too and I pester her daily to see if it's come. And the A/C? Who knows? (deep cleansing breaths)

Today was the 7th dose of Denamarin - usually an hour or more before breakfast.

I restarted Angelina's Trilostane this morning with a dose of 20mg every 12 hours for the moment. Her not wanting to eat the breakfast she's eaten (and insisted on) most of her life is still freaking me out.:confused: But reversing her breakfast menu with her dinner menu seems OK with her.

For her Noon and 3pm meals she's currently getting Turkey Mince, Lamb Kidneys (thought it was liver until I opened it :o) Blitzed Vegie Mix, Rice, Oats and Yoghurt. One more meal of that to go - before the next menu.
http://www.k9cushings.com/forum/picture.php?albumid=96&pictureid=1065

Angelina's having a restless day - bathroom to loungeroom to kitchen and back - panting (of course) so I'm twitching.:(

I have a grooming question - the right side of Angelina's mouth is stained dark brown from hair that never dries properly - is there something I can use (when and if Angelina is agreeable :o) to wash this stuff clean?
http://www.k9cushings.com/forum/picture.php?albumid=96&pictureid=1066

Franklin'sMum

11-25-2009, 07:19 AM

Hi John,

I don't have anything helpful to say, :o just wanted to tell you my fingers are crossed Angelina's mat and your A/C both happen soon.

On that note, :) I salute you for not being in a homicidal rage regarding your A/C guy.:mad:

I used to use "Pretty Eye Tear Stain Remover" on Franklin, (I stopped because he kept trying to eat the cottonballs :rolleyes::eek:

Is there any chance Angelina is not wanting her regular breakfast much due to the heat? We hope she's back to feeling like her new old self real soon.

Sending good vibes and thoughts your and Angelina's way,

Jane and Franklin xx
________
MAZDA AZ-WAGON PICTURE (http://www.ford-wiki.com/wiki/Mazda_AZ-Wagon)

Roxee's Dad

11-25-2009, 10:10 AM

Hi Brother John,

Well first of all I hope that AC get's installed soon and Angelina (and you) get to enjoy some cool :cool: relief.

I have a grooming question - the right side of Angelina's mouth is stained dark brown from hair that never dries properly - is there something I can use (when and if Angelina is agreeable ) to wash this stuff clean?

That's a very interesting question. Yes they do sell stuff that if used daily will remove the staining. There are 2 types, one which contains a bleaching agent (I won't use) and the other contains all natural ingredients but you would have to use it every day or even multible times per day.

I have a special interest in this as I have been performing an experiment over the last year and a half with our Rozee. We do a rotation diet (3 months) and I noticed at times that her white hair around her mouth would turn brown and wherever she licked, like her white paws would turn brown. What we noticed was when her food contained grains, her white hair would start turning brown, when we switched to no grain food, the brown would clear up and be pure white again. We performed this test now for the 3rd time, her hair is white again and no more foods with grains in it for her.

I also ask my customers that have white dogs with staining around the muzzle and find that they all use grocery store purchased dog food. I ask them to get the bag and tell them before they even get the bag that the first ingredient is probaly corn. I have convinced many of them to change to a quality no grain dog food and find that the brown staining is going away.

One other thing, she also hasn't had a store purchased treat in over 6 months. All our doggy treats are homemade.

It's not all that scientific of an experiment but it has convinced me that at least in Rozee's case, it's the grains in her food that caused her saliva to stain her white hair.:)

Some of the foods we used in our experiment:
With grains- Chicken Soup for the Dog Lovers Soul (both kibble and canned)

No grain foods: Natures Variety Raw (with fruits and veggies) and Natures Variety canned (non-raw) mixed with "Taste of the Wild" Salmon kibble.

Give Angelina a nice ice pack from her Uncle John. :D

John II

11-28-2009, 08:20 PM

Hello All,

I was hoping that by the next time I posted cooling issues would have been resolved. But the King Of Putoff continues his reign of terror. We were expecting the A/C to be installed before the next blast of hell (which was scheduled for last Friday and especially Saturday).

I got a call Friday morning - "Will you be home Saturday?" he asked. "Yes, all day" I said. "Do you have a ladder?" he asked. (he doesn't have a ladder? :eek:) "Yes, all kinds" I replied.

"Finally!", I thought, it will get done. Friday evening he called back to say he won't be coming on Saturday because it was going to be too hot. :mad: (times 1000).

There were words - he was hung up on - I'm not holding my breath for Monday.

Anyway, yesterday Angelina got packed up and we spent to the day with relatives who have managed to get A/C installed. Unfortunately, returning home late the house was still at 33 degrees (down from a high of 40). And Angelina spent most of the night with a fan pointed at her... as the heat dropped by about a degree per hour.

The cooler mat seems to be lost somewhere in Australia Post. I'm not surprised, if I hadn't been right there to tackle the courier when the Denamarin arrived, it would probably have wound up in limbo as well.

Anyway Angelina for the last few days, has been getting her Denamarin at 4:30am. With a little raw meat - which isn't the treat it used to be. She still has no interest in raw meat for breakfast - so she gets 100g of commercial dog food instead (around 7am) - I tried to follow that this morning with 20mg of Trilostane wrapped in a thin peace of meat - she accepted it politely, then dropped it on the floor - twice. After that she stopped being polite. :rolleyes: I wrapped it up and will have to try again at dinnertime. The capsule would probably have dissolved by then.

Home-made for meals at noon and 3pm and by dinnertime (6pm), she has no problem with the raw meat. Odd.

Today, after rising she went outside, pee-ed, pooped (solid - I'm told) and vomited (a little froth/bile? - I'm also told - I missed the action) - went for a short walk after breakfast - it was already warming up. Angelina seemed weak and tired. :(

Hi Jane, thanks for the "Pretty Eye Tear Stain Remover" advice. And the good wishes. :)

Hi Brother John, thanks for passing on your grain theory - I do include some rice and oats in Angelina's homemade meals (for stomach settling and cholesterol easing properties respectively) plus whatever happens to be in the commercial food. Hmm... something to think about.

Now, what's this
rotation diet (3 months) of which you speak? And homemade treats? Are there recipes? :)

I'm thinking that I should be busted back down to a Junior Member, because I no longer know what's going on with Angelina. :(:confused:

Harley PoMMom

11-28-2009, 11:30 PM

Hi John II,

I have noticed with Harley, since I started feeding him 3-4 meals a day, that his breakfast meal has to be the smallest meal. His last meal of the day is around 8 pm, his breakfast is at 5 am but this breakfast meal is the smallest of them all because he just isn't that hungry in the morning. :confused:

I give Harley his Denamarin in cream cheese...I give all of Harley's pills in cream cheese...it's so easy to "mold" the cream cheese around the pills, sometimes he gets 5 at one time. :eek: (vitamins & minerals for his diet, etc)

Oh John II, if our dogs could only talk to us. I know my boy really likes to keep me on my toes, hair standing straight up, and alot of the time completely dumbfounded. :(:p:) But we're trying to find a niche together...he wants a smaller breakfast in the morning, well than ok...no problem, he has a certain amount of food that he is supposed to eat and as long as eats that within the day than I'm ok with how much he wants when he wants it. ;):) I know I'm not a breakfast person anymore, I used to be...so maybe some pups aren't and maybe it comes with getting older? So I believe your Senior Member status remains because all of our pups confuse us at one time or another. ;) :D You're a wonderful Dad to Angelina, don't forget that.

Love and hugs,
Lori

Harley PoMMom

11-29-2009, 03:46 PM

Hi John II,

One thing I forgot to mention in my last post about the staining, altho I am definitely not the grooming pro like John :D I did read about high minerals in ones water and how that can cause staining on a dog’s entire face and beard.

http://www.articlesbase.com/pets-articles/the-5-most-common-reasons-for-dog-tear-stains-993262.html

I only give Harley distilled water to drink and I only boil/cook his food in distilled water also. Harley has never had an UTI and I don't know if it is because of the distilled water...his vets thinks it's a possibility so I continue to do so.

Love and hugs,
Lori

lulusmom

11-29-2009, 06:33 PM

Hi John,

I have two Maltese boys and one them, Buster, has terrible staining. I tried every stain remover on the market and they just didn't work.
I finally ran across several sites for Maltese that recommended Tylan for tear staining. I bought a jar of it online and put about 1/64th of a teaspoon in Buster's food everyday for two weeks and was blown away by the improvements in that time.

I don't think you can buy Tylan in Australia but you can buy Angels' Eyes, which is made specifically for canine tear stains and what do you know, the active ingredient is Tylan (Tylosin). I am positive this will work for Angelina.

http://www.angelseyesqld.com.au/services.aspx
http://www.bowhouse.com.au/p/809383/angels-eyes---keep-tear-stains-away-with-just-a-sprinkle-a-day.html

Harley PoMMom

11-29-2009, 06:44 PM

Do you know tylosin is an antibiotic of the macrolide class (same class as erythromycin).

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

lulusmom

11-29-2009, 10:15 PM

Yes, Tylan/Tylosin is a mild natural antibiotic that is routinely used in animal feed (cattle, swine and foul) to treat and prevent respiratory infection and dysentery. Unlike erythromycin, which can only be obtained by prescription, Tylan can be purchased at feed stores and online. More dog owners probably keep it on hand for GI upset rather than tear staining. I believe that Sue, Zoe's mom, has Zoe on it for her tummy problems.

Roxee's Dad

11-30-2009, 11:23 AM

Hi Brother John,

Hi Brother John, thanks for passing on your grain theory - I do include some rice and oats in Angelina's homemade meals (for stomach settling and cholesterol easing properties respectively) plus whatever happens to be in the commercial food. Hmm... something to think about.

I would like to preface this with "this is my opinion based on some personal experience and alot of reading." :) Some dogs have to be on a low meat or high grain diet for various health reasons.

There are a few schools of thought on dog food with and without grains. Some dogs are actually allergic to some meats but it is also believed they may be allergic to chicken or beef that is "grain" fed?

I think some brown rice and oats are okay as they are somewhat benificial grains if they are added from your human cupboard. The grains put in dog food are usually that which is not approved for human consumption like the tail end of a storage vat, spillages, mold, etc...

Our pups get some rice and or oats in their homemade treats. We are trying to avoid commercial dog foods that contain all the filler grains like corn, wheat, soy and other filler grains, for various reasons as mentioned above (quality) and for the following reasons.

The "Rozee experiment", no grains, no brown staining around her muzzle. Less licking of her paws.

Grains are also full of carbohydrates which can be easily converted to sugars. It is believed that cancer cells feed on sugars, and it is believed that by decreasing the amount of carbohydrate in the diet, we reduce the risk of cancer.

Grains are believed to be one of the most common causes of allergies, and help feed yeast infections. Most dogs that I groom with yeast infections are eating low quality commercial dog foods where corn is the first ingredient.

Now, what's this
rotation diet (3 months)

Once again, this is just a personal opinion. We believe that not all dog food contains all the needed nutrients, so by switching once in a while, we hope they will not be lacking any needed nutrients. There is another belief that feeding the same brand dog food year after year may cause some allergies and eating the same food is just boring. :D

of which you speak? And homemade treats? Are there recipes?

I will send you one of Pattee's recipes as soon as she sends it to me by e-mail. Hopefully today. :)

There are some homemade dog food recipes by the somewhat popular "W. J. Dodds, DVM" at an epi angels site. Just scoll down about 3/4 of the page for various recipes under the heading Nutrition.

http://www.canine-epilepsy-guardian-angels.com/site_map.htm

So I hope Angelina is doing well and your AC is getting installed. :)

Cool belly rubs to our baby girl Angelina.

StarDeb55

11-30-2009, 11:32 AM

Grains are also full of carbohydrates which can be easily converted to sugars. It is believed that cancer cells feed on sugars, and it is believed that by decreasing the amount of carbohydrate in the diet, we reduce the risk of cancer

John, just to confirm what Roxee's Dad said above, I lost my first Cushpup, Barkley, to lymphoma a little over 3 years ago. When he was first diagnosed & starting chemo, his oncologist insisted that I get him on a high protein, low fat/carb diet. This is a direct quote of what she told me, "Carbs fuel cancer". Her office gave me a list of high quality, premium food that fit the above description, & I have been feeding that kind of food to my pups since that time. Barkley also had severe allergies, & Chewbacca, now, has allergies, so I try to feed as grain free as possible.

Debbie

Debbie

John II

12-01-2009, 11:15 PM

Hello all,

The good news - we have air conditioning! :D Of course, since it was installed on Monday, we haven't needed it :o. Turns out the guy, who I thought was the supervisor of a team of strong young men, was actually the sole installer. In his 60's, big boned... very big boned, diabetic, he arrived at 7:30am on Monday and didn't stop until 3pm. I regret what I said earlier about him - somewhat. ;)

We've had three days of cool rainy weather - fine by me.

Lori - sometimes it seems all I need is to know what the other pups are up to :) - I think I'm getting to the point where I wouldn't recognise normal if I saw it. :rolleyes:

Glynda - thanks for the info on Angel's Eyes - having a quick look around I think I can order it cheaper from America than from here! :D But I'll have to look into that - I'm nearing the halfway point on the Denamarin. And unless I'm missing something Amazon is starting to look good for that. Although it's now coming in a chewable form (and for some reason $10 more expensive?). Another place was very cheap for the Denamarin but charged twice as much for shipping!

Brother John - thanks for the emailed recipes and the link - very interesting. I think I'm overdosing Angelina on liver :o

Grains are also full of carbohydrates which can be easily converted to sugars. It is believed that cancer cells feed on sugars, and it is believed that by decreasing the amount of carbohydrate in the diet, we reduce the risk of cancer.

Wow - all things in moderation, huh? My current home cooking features about one tablespoon of rice and half a table spoon of oats to approx 300-350g of meat (today was turkey and liver) - what do you think, too much? :eek:

And Debbie, thanks for your imput on this worrying subject. :eek:

Roxee's Dad

12-01-2009, 11:48 PM

Hi Brother John,

Wow - all things in moderation, huh? My current home cooking features about one tablespoon of rice and half a table spoon of oats to approx 300-350g of meat (today was turkey and liver) - what do you think, too much?

I am surely no expert on nutrition and there are varing opinions on this subject. :confused: Mine is that oats and rice are okay in moderation and if it's from our human supply. It's the not fit for human consumption that is put in commercial dog food that always concerns me.:eek: We pretty much stay away from the corn, wheat and soy products.

In Rozee's case, the rice and oats (in great moderation) does not seem to bother her. The next step would be an elimination diet where I would add wheat, wait 3 months, then add corn and wait 3 months, etc.... I probably won't do that as I know the current diet she is on has eliminated her brown staining and reduced her paw licking. My guess is that's it the soy products. I read somewhere, can't remember now but Shih-Tzu are prone to being allergic to soy.

Sure glad you got your AC installed, I'm sure Angelina will be happy when it's time to use it.

Cool belly rubs to your baby girl:)

John II

12-11-2009, 01:01 AM

Hello All,

I took Angelina to the Vet for a biochemistry and electrolyte check. I've added today's results to my personal Angelina spreadsheet, and uploaded that to Google Docs:

http://spreadsheets.google.com/ccc?key=0AvulUcZrRvZSdGg5cDE1djhyYjJJTUVLMy0wUHR1a 0E&hl=en

After 3 weeks of Denamarin I was hoping for better numbers on the Liver Enzymes - however ALT has climbed from 297 to 384 U/L and AlkPhos has climbed from 1596 to 1720 U/L :eek: :confused:

Urea has climbed from 8.4 to 14.6 mmol/l (however Creatinine has dropped from 67 to 63 umol/l)

Angelina herself seems to be fading :( When I try to give her her medication in the morning, she turns her head away (from raw meat!) - although she was enthusiastic about my fresh home cooking yesterday - she showed no interest in her lunch today. I'm hoping she just doesn't like leftovers ;)

Going back over my notes, it looks as though she's been off since the end of October (prior to her last stim - prior to her new Trilostane supplier :confused:)

In other news, when I reached the halfway point of my Denamarin supply, I started looking around online for the best price (as I think I mentioned before) when I got to the Amazon checkout - they said I couldn't order Denamarin or Angel's Eyes without much of an explanation. So I tried elsewhere and saw that another supplier was out of stock. Tried another and finally got a message that Nutramax (the manufacturer) no longer allowed Denamarin to be sold online! :mad::confused::eek::(

Also, the last week or so, I've been driving Angelina to the park in the evening (taking a tip from Jane and Franklin) for a short walk - she seems very excited to be there again. It's a big park, so I keep driving to different sections, so she can update her messageboard :D

Brother John - thanks for the ongoing advice :)

PS: Angelina would like it to be known that she is 11.8kg now (not 13kg as listed on the header!) ;)

Casey's Mom

12-11-2009, 01:13 AM

Hello John, I hope Angelina feels better soon,

I wanted to tell you that I drive my dogs to the park every day (except today with a -21 windchill!) and I only miss about 5 or 6 days a year due to weather. Casey looks so forward to this and I am sure it is the highlight of her day. Angelina must feel the same - and in the summer time I go late in the evening when it cools down. Right now with it so cold I can't remember what that feels like:eek:

Give Angelina a belly rub from me,

littleone1

12-11-2009, 01:22 PM

Hi John,

I hope Angelina feels better soon.

Terri

Harley PoMMom

12-11-2009, 03:07 PM

Hi John II,

I only have a minute here but wanted to let you know that I called Denamarin and asked them why we could not purchase it online anymore and their reply was "Denamarin was not supposed to be sold online, only in a vets office," so you can still get Denamarin thru your vet if you want it.

I will write more later...:eek::)

Love and hugs,
Lori

MiniSchnauzerMom

12-11-2009, 04:32 PM

PS: Angelina would like it to be known that she is 11.8kg now (not 13kg as listed on the header!)

Angelina's wish is my command! Title corrected. :D

Louise

John II

12-11-2009, 05:48 PM

Thanks for checking in Ellen & Terri. :)

Thanks Lori
wanted to let you know that I called Denamarin and asked them why talk about going above and beyond! :)
Anyway after getting rejected by a few suppliers I tried another (probably shouldn't say who) and placed an order for a normal 30 pack of Denamarin for Medium Dogs and a 30 tablet bottle of the new Chewable (and more importantly - splitable) kind. I wonder why the old kind shouldn't be split - but the new kind can be? Hmmm... have to wait and see if they actually arrive. Forgot to include Angel's eyes in the order - I was so thrown by the supply line drying up. :o

Thanks Louise for the title update ;)

Casey's Mom

12-11-2009, 06:43 PM

John I used to get my Denamarin online from Alliivet if you haven't tried them already.

Hope Angelina feels better,

Harley PoMMom

12-11-2009, 11:10 PM

Hi John II,

I'm back!! :eek: I have a question, is Angelina on 20mg of Trilostane 2X a day? I've included a post from Jeanette's thread from Marianne that she posted about her conversation with Dr. Allen, an IMS who works for Dechra. Now I realize her conversation with Dr. Allen was about starting doses but with Angelina losing weight, and I believe you had made a comment about this in a previous post, that maybe her dose of Trilostane should be reduced...just a thought here.

I also went back and looked at Harley's chemistry's labs and seen that his ALP in 7/09 was 1289 and his ALT ~ 188. I started him on the Marin in 6/09 and the Denamarin in 8/09. Harley's ALP in 11/09 was 762 and his ALT ~ 272 :eek: So his ALP came down but his ALT went up :confused: but his cortisol is up too. :( So I'm thinking 3 weeks is alittle too soon for a change in Angelina's numbers, maybe another month.

I looked at her chart and I didn't see anything listed this time for her electrolytes...or maybe it was me. :rolleyes::confused:

I also went to that site Ellen posted about, Allivet, and they do sell the Denamarin! Thanks Ellen!! :D

http://www.allivet.com/SearchResults.asp?Search=denamarin&Search.x=13&Search.y=10

Hoping beautiful Angelina feels better soon.

Love and hugs,
Lori

Hello All,

Today was the 7th dose of Denamarin - usually an hour or more before breakfast.

I restarted Angelina's Trilostane this morning with a dose of 20mg every 12 hours for the moment. Her not wanting to eat the breakfast she's eaten (and insisted on) most of her life is still freaking me out.:confused: But reversing her breakfast menu with her dinner menu seems OK with her.

Hmmmm....Terri, I am thinking that there is some misunderstanding about this. As it turns out, I too have had occasion to talk to Dr. Allen recently. I had some general questions that I wanted to ask him, and initial dosing was one of them. He told me that he is personally recommending that people start at the lowest end of the Dechra range, which is 1 mg. per pound (and not 1 mg. per kg.). I don't think I misheard him, because we went on to discuss the differences in Dechra's recommendation from UC Davis.

He stressed that they are in no way challenging any vet's decision to follow Davis' guidelines if that is their preference. But the dosing protocols are not identical. I really wish that there would be written revision to Dechra's chart, in order to clarify this revised recommendation. But barring that, I will encourage people to contact Dechra directly in order to get the information first-hand in the event that they want more info. Here's contact info for Dechra's U.S. office: "Contact Us" (http://www.dechra-us.com/page/contact-us)

Marianne

John II

12-12-2009, 02:32 AM

Hi Ellen - thanks for the tip (psst I just ordered them from the same place I ordered them last time)

Hi Lori - the Electrolytes were right at the top:

11/12/2009 Units 11/12/2009

Fasted========>Normal Range

159 mmol/l 144 - 160 Na (Sodium)

5.6 mmol/l 3.5 - 5.8 K (Potassium)

28.39 (27-40) NA:K Ratio

116 mmol/l 109 - 122 Cl (Chloride)

3.01 mmol/l 1.98 - 3.00 Calcium

14.6 mmol/l 2.5 - 9.6 Urea

63 umol/l 44 - 159 Creatinine

6 mmol/l 3.89 - 7.94 Glucose

4 umol/l 0 - 15 TBIL

384 U/L 10 - 100 ALT

1720 U/L 23 - 212 AlkPhos

8 U/L 0 - 7 GGT (liver enz)

85 g/L 52 - 82 T Protein

37 g/L 22 - 39 Albumin

48 g/L 25 - 45 Globulin

855 U/L 500 - 1500 Amylase

1018 U/L 200 - 1800 Lipase

11.8 Kg Weight

After a break of about of 8 days I restarted Angelina on 20mg of Trilostane BID for 4 days (trouble is I was running out of the 20mg capsules). Then 25mg/20mg (until I ran out) and the last few days on 25mg BID - is it too much? There's the question. She had such a hard time after the last stim - I don't want to put her thru another one. I was hoping the biochemistry might give some clues.

I think I'll have to contact the pharmacy and see how much trouble it would be to turn the remaining 25mg capsules into 20mg capsules.

AlisonandMia

12-12-2009, 02:55 AM

Looks like she may have been a little on the dehydrated side especially with the electrolytes (K & Na) being high (but balanced). Don't know what effect this could have on the urea but I'm sure Debbie will.

I see her calcium is a bit above where it should be too although how significant that degree of elevation is I don't know - but (like I said) I'm sure Debbie will. It is only just over the max though so could be slight dehydration as well.

What did the vet think?

Got your air-con yet?

Alison

littleone1

12-12-2009, 03:16 AM

Hi John,

I'm not very good with test results, but when I read that Angelina had such a hard time after her last stim test, I was wondering if your vet used the gel? When Corky had his first stim test done in January, which was done by his vet, he had a very bad reaction to the gel and was very sick. His IMS uses Cortrosyn when she does the tests. Corky has done very well with this. He's had no bad reactions to it.

Terri

SasAndYunah

12-12-2009, 04:51 AM

Ha! Just wanted to say that the first thing I noticed, checking the threads, was the changed title (weigth) of Angelina's thread, just wanted to say....Congrats! :D

Saskia and Yunah :)

Franklin'sMum

12-12-2009, 08:54 AM

Hi John and Angelina,

Congrats to you both on Angelina's weight loss :) Good Work!

I'm sorry to hear that she's been "off". How's our sweet girl feeling today?

You may very well have a point about her new weight and that the current trilo dose may be too much for her.

Angelina's lost 1.2kg which is a 1.196% difference from the 13kg that she had been, so maybe her dose needs to be 1.196% less, as well. Scrap that. It would be .4784mg, and if her previous dose was 40mg, that 1.196% would bring it down to 39.5mg. So pretty much no difference. Well, it was worth a thought, maybe there's a different/better way to figure it out, but that was the best I could do. :o

Jane and Franklin xx
________
GENIE VAPORIZER REVIEWS (http://vaporizer.org)

Squirt's Mom

12-12-2009, 11:39 AM

Hey Bro Twitcher,

How is our svelte little girl today...or evening....or whatever it is! :p

Sending hugs to both!
Leslie and the girls

Harley PoMMom

12-12-2009, 12:25 PM

Hi John II,

Yep, I see her number now and it was definitely me who couldn't find them...I had a blonde moment! :rolleyes::eek::p

When Harley had his first u/s and it showed that he had prior bouts of pancreatitis, I almost fell over...I thought when? where? why did I not notice? Since then I've been on a mission to learn all I can about pancreatitis so I would never miss a subtle clue from Harley if he was having problems from his pancreas.

Now I realize that I have mentioned to you before about having Angelina tested for pancreatitis and I think this bares mentioning again.

Here is a really good general article about pancreatitis.

http://www.vetinfo.com/dpancrea.html

Pancreatitis, General Information

Here is an excerpt from that article:

Diagnosis of Pancreatitis in Dogs

Pancreatitis in dogs causes a number of changes in routine blood counts and blood chemistries. Taken in concert these changes can be highly suggestive of pancreatitis but do not definitely confirm its presence and can not be used to completely rule it out. Mild to moderate increases in white blood cell counts generally occur with pancreatitis. Serum amylase and lipase enzyme levels are often three times normal in dogs with pancreatitis, although these enzyme levels can rise for other reasons and do not uniformly rise in dogs with pancreatitis. Rises in liver associated enzymes, particularly alkaline phosphatase and alanine transferase (ALT) may occur in conjunction with pancreatitis. Mild rises in blood sugar and mild to moderate decreases in serum calcium levels sometimes occur. Some dogs will have moderate to severe rises in blood potassium levels. When several of these changes occur at the same time pancreatitis is very likely.

I hope you consider to have the cPL or the cPLI done on Angelina to see if she does have pancreatitis, this could be why she doesn't want to eat.

Give Angelina kisses and hugs from Harley and me.

Love and hugs,
Lori

John II

12-13-2009, 04:24 AM

Hello All,

Hi Alison - The vet called me later the same day and said that he thought the test showed Angelina to be a bit dehydrated (as you suggested) I asked what I could do to fix this, he said make sure she drinks enough. I think I'll have to make sure her meals are a little more watery (which will throw my water stats out - but what the heck).

I need to go back and look at calcium sources because I would have thought Angelina more likely to be deficient (going by her diet) - perhaps the commercial food?

I mentioned her seeming to be "off" since the end of October.
I mentioned her sudden dislike for raw meat breakfast.
I didn't mention I'd taken her off Trilostane for 8 days - which I realise now could have impacted the results of the biochemistry. The vet was most concerned with the rising liver results and suggested another ultra-sound and/or a liver biopsy to see what might be going on inside - but conceded that might do more harm than good.

Angelina was so upset by her vet visit on Friday that I want to keep such things to an absolute minimum. I've never seen her so desperate to get out of there. She even resisted the vet checking her mouth - and she's usually so meek in there. She has a growth on the right side of her tongue which looked to me to be swelling (due to lowered cortisol?) And the teeth next to the growth could be in better condition.

The last week or so Angelina seems altered somehow. The only new addition has been the Denamarin and I've been looking online for behaviour related side effects. The increase in Trilostane from 45mg per day to 50mg? Or the dreaded growth of the microtumour? :confused::(

Does anybody know is rosemary is good or bad for dogs? I've noticed that the turkey mince I use for Angelina's food includes some sunflower oil and rosemary. One site I looked at said beneficial, another said detrimental, a third said no impact. :confused:

Hi Terri - I'll have to ask the Vet what they use for the Stim test and if they've always used the same substance on Angelina. Thanks for the suggestion :)

Hi Saskia - thanks for the good wishes :)

Hi Jane - thanks for the congratulations and for the math :D however if Angelina was 13.1kg (or so at her heaviest) and has lost... well I guess 1.3kg, wouldn't that be 10%? 10% off 50mg would be 45mg - which could be the problem (if I was giving her 50mg for a while) - and if I want to run her "a little hot" to offset old age symptoms, that would be 40mg per day? I think. :confused:

Hi Leslie - hope all is OK with you and yours :( Your post was 2:39am over here - just so you know ;)

Lori - I regard you as the Pancreatitis expert of the group :)
But Angelina's Amylase and Lipase were both well within normal range

Serum amylase and lipase enzyme levels are often three times normal in dogs with pancreatitis, although these enzyme levels can rise for other reasons and do not uniformly rise in dogs with pancreatitis.(I asked the vet about the pancreatic enzymes and he said they could be influenced by the raised liver enzymes). I have broached the subject of Pancreatitis before with the Vet - he rattles off the symptoms and I have to answer no to his questions. And Angelina eats. Today she had - breakfast - mid morning snack - Lunch and a very recent watery dinner (which she ignored at first but I may have added too much spinach (silver beet) in her opinion. :rolleyes:

Franklin'sMum

12-13-2009, 05:03 AM

Does anybody know is rosemary is good or bad for dogs? I've noticed that the turkey mince I use for Angelina's food includes some sunflower oil and rosemary. One site I looked at said beneficial, another said detrimental, a third said no impact. :confused:

Hi John ll,

The "My Dog" brand has a flavour called Lamb Classic topped with potato, broccoli and rosemary, it's made by Mars Petcare, and their consumer phone number is 1800 640 111.
I'm certain that it's not the only food/brand that has rosemary in it, but I just went through the cupboard, and it's the only one I can find in there.
I have phoned them in the past, and they seem very nice people.

Hi Jane - thanks for the congratulations and for the math :D however if Angelina was 13.1kg (or so at her heaviest) and has lost... well I guess 1.3kg, wouldn't that be 10%? 10% off 50mg would be 45mg - which could be the problem (if I was giving her 50mg for a while) - and if I want to run her "a little hot" to offset old age symptoms, that would be 40mg per day? I think. :confused:

What can I say? It made sense to me at the time :o. Just tried it again, no idea where the 1.196 came from. I can't make it happen again, so in future, I'm just going to sit out anything mathmatical. (meek and apologetic icon.)

We hope Angelina continues to eat well, and feels better soon.

Jane and Franklin xx
________
WELLBUTRIN SIDE EFFECTS (http://www.classactionsettlements.org/lawsuit/wellbutrin/)

John II

12-13-2009, 05:15 AM

Thanks for that info Jane. :)
Actually, I think my math was off as well - I probably should be calculating the difference between 12.1kg (Angelina's last stim test) and her present weight of 11.8kg... hmmm... math! :eek: I'm lost - I used to be able to do this :confused:

Squirt's Mom

12-13-2009, 10:33 AM

Hey John,

The Rosemary is used as a preservative in some commercial feeds. The amount is usually not enough to cause a problem unless the pup is allergic - which some are. As an alternative to some of the chemical preservatives used, Rosemary ain't bad at all! :eek::eek:

Hugs,
Leslie and the girls

corgipallie

12-13-2009, 11:03 AM

Hey Spiderman,
I've been reading up on your thread and I hope Angelina gets to be feeling better soon. I really don't know anything about Rosemary or everything she's going through but I'm thinkin' about you both. Pallie was on Denamarin when she had some liver congestion but it really never worked as a medication per se. It was more of an anti-inflammatory effect on her.

Steph

Harley PoMMom

12-13-2009, 11:04 AM

Hi John II,

The rosemary, as far as I know, is only harmful to dogs that are prone to seizures.

Oh John II, you are such a sweetheart...me an expert on pancreatitis...haha. John II, in reality I just felt so guilty bc I thought, no, I knew I missed the symptoms with Harley with the pancreatitis and now I'm just trying to make sure I don't make that same mistake again.

Now as far as the amylase and lipase enzymes results on a chemistry lab test for a pup that does have pancreatitis...here is Harley's from 11/21/09. Amylase ~ 515 (290-1125) Lipase ~ 403 (77-695) but his cPLI , done 11/21/09, was 464 (0-200). Only the cPL or cPLI can tell if your pup has pancreatitis or not. It tests for the lipase that is pancreas specific only. Right now Harley shows no symptoms of his pancreatitis but it could rear it's ugly head anytime. :( :eek: but now, thankfully, I know the symtoms.

Hoping beautful Angelina continues to eat good for you and give her some gentle hugs from Harley and me.

Love and hugs,
Lori

John II

12-14-2009, 07:33 AM

Hello All,

Thanks Leslie and Lori - that eases my mind on the rosemary front.

And thanks Steph for checking in with your Denamarin experience.

I went back to the Compounding Pharmacist today to exchange 50 x 25mg capsules for 50 x 20mg capsules - that should take a day. I left myself with 29 x 25mg capsules to keep my options open.

I haven't given Angelina any Trilostane for the last 2 days, hoping she might spring back (if I was giving her too much) but... Angelina continues to fade. :confused: Weaker, doing the extremely old lady walk. I didn't take her for an evening park adventure today - partly because it was raining lightly, on and off. Mostly because of how difficult it is to watch her like this. :(

Lori, the fact that Harley had pancreatitis while seemingly in the normal range :eek:- well how does that work? Am I misunderstanding the concept of normal? :confused:

Harley PoMMom

12-14-2009, 08:15 AM

Hi John II,

Lori, the fact that Harley had pancreatitis while seemingly in the normal range - well how does that work?

Lipase is non-specific because there are digestive lipases, intestinal lipases, lipoprotein lipase and heptic lipase, hormone-sensitive lipase, and lysosomal acidic lipase.

Just so many lipases :eek::eek: but the cPL or cPLI can test for the lipase that is specific for the pancreas. The cPL has a >95% Specificity rate and a >95% Sensitivity rate, which I think is pretty amazing. If your interested you can read about the cPLI and the cPL at the link below.

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

Harley will always have pancreatitis, his lipase number on the cPLI may never come down but as long as they don't go up and as long as he does not show any symptoms of pancreatitis, I am a happy mom. :)

Hope this helped clear things up?

Love and hugs,
Lori

labblab

12-15-2009, 02:37 AM

Hi John,

I'm afraid I have nothing constructive to add, but I just wanted you to know that I am so sorry to hear that Angelina is not feeling better than she is right now. It is so hard to see our pups doing poorly. You are such a wonderful dad, and she is so lucky to have you watching over her. I am hoping that she'll start to perk up once again -- and quickly, too!

Healing hugs being sent her way,
Marianne

littleone1

12-15-2009, 08:23 AM

Hi John,

How is Angelina feeling today? I hope she's feeling better.

Terri

John II

12-15-2009, 08:36 AM

Thanks for the info Lori.;)

Thanks for the encouragement Marianne :)

Thanks for checking up on us Terri :)

I wish I had good news. Right now Angelina is lying on the floor and panting and it's only 25 degrees... now she's shuffling off to the bathroom.

I don't know - I thought we were doing OK - then suddenly she's weaker! And I don't understand it. :(:confused::(

I get nervous at this time of year, because on December 24 2006, I had to send Mimi the cat off to the bridge and I remember too vividly how that was.

I don't want history repeating - but as someone else said in another thread, when does the treatment stop being for her and start being to her?

Angelina lies on the cool bathroom floor.
Her feet flex and her eyelids twitch as she sleeps.
I want to know what she dreams, but she will never tell.

littleone1

12-15-2009, 08:43 AM

I'm sending positive thoughts and prayers for both of you, John.

I will be keeping you in my thoughts and prayers.

Franklin'sMum

12-15-2009, 08:52 AM

Hi John,

I'm so sorry that Angelina is behaving like this. I don't have anything to offer, except support and prayers for you all. :(

Is it possible she's uncomfortable due to the growth on her tongue? Oh, about the growth on her tongue... Could it be a swollen taste bud? Last year I had a couple of lumps on my tongue, went to the doc and he said taste buds can become enlarged sometimes, especially if dehydrated. Drink more. Wondering if it is the same with pups. Just a thought.

I'm sorry that Christmas time brings back upsetting memories for you. Wish I could do or say more.

Big hugs, sending good vibes and prayers your's and Angelina's way

Jane and Franklin xx
________
Masturbation Teen (http://www.fucktube.com/categories/762/teen/videos/1)

frijole

12-15-2009, 09:09 AM

John, I wish I had some advice to give but I too can only say that you and Angelina are in my thoughts and prayers. Kim

Casey's Mom

12-15-2009, 09:23 AM

John, I hope Angelina feels better soon, she is such a little sweetheart and you are an awesome dad.

Hugs and prayers,

Roxee's Dad

12-15-2009, 10:22 AM

Dear Brother John,
I wish we had some words of wisdom for you and all our senior cush pups. :( I hope this is just a passing phase for our Angelina.

My babies have kind of been in a funk these last few days, quiet, sleeping alot and not in a mood to play. :( I was getting a little concerned (That darn twitcher) but this morning Rozee and LittleBit woke up in an energetic mood and ran and chased each other around the yard and into the house. :) Mickee, well he's quite senior for his size, he weighs a bit more than Angelina, (about 14kg) deaf and limited vision, he finds an out of the way place to sleep and often times I have to go looking for him. He eats, he goes potty and back into the house to sleep. I make sure he knows he is loved and keep him as comfortable as I can.

When I last checked, Angelina hasn't had her trilo for a few days, probaly the reason the panting has increased. Has her apetite returned and is she drinking more?

Angelina lies on the cool bathroom floor.
Her feet flex and her eyelids twitch as she sleeps.
I want to know what she dreams, but she will never tell.

No they will never tell, ;) we had a few times where all three were dreaming and very vocal, appeared to be running. I chalk it up to happy dreams as they always seem to wake up happy.

We will be keeping Angelina in our thoughts and prayers and hope that it's just a few of those funky days.

Bellt rubs from her Uncle John:)

Squirt's Mom

12-15-2009, 10:31 AM

Hi Brother Twitcher,

I was thinking about Angelina last nite and wondering if perhaps some of the other hormones have become so elevated they are causing her some problems. We know that will happen with Trilo and she has been on it for a while now, providing plenty of time for those elevations to occur and worsen. The only way to find out would be to stop the Trilo for about 30 days and have the UTK panel done. That would be hard on you and Angelina, I understand, but if the Trilo is causing the "fade" you are seeing, it would be worth it in the long run. Treatment for those hormones is much gentler on the pup and if you needed to switch to Lyso, you would already have the wash-out period behind you. Just something to consider...

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

corgipallie

12-15-2009, 11:27 AM

I hope Angelina gets to be feeling better soon Spiderman.

I'm sorry I don't have any useful advice on trilo. I'm keeping you guys in my thoughts.

Harley PoMMom

12-15-2009, 01:19 PM

Hi John II,

How is beautiful Angelina today? Our pups do like to keep us, as you and Leslie say, "twitching." :eek::eek: Harley has his "off" days too, ie; when he turns his nose up at his food, like last nite, so I had to add alittle canned dog food to his home-cooked meal and hand feed it to him. Now this morning he ate like a piggy... without the canned dog food and being hand feed. :confused::)

I am hoping that Angelina is having just a "off" day and will soon be back to her perky self.

Keeping you and Angelina in my thoughts and prayers.

Love and hugs,
Lori

Casey's Mom

12-16-2009, 01:40 AM

John I was thinking about what Leslie says and even though I don't use trilo it makes sense to me given what I have read on previous threads. The elevated hormones could be what is making her feel not quite right - just a thought.

Nice cold Canadian winter happening here in Northern Ontario - just wishing I was there in your heat! Not so much for Casey but for me I would be at the beach . ..

Love to Angelina,

John II

12-16-2009, 09:22 AM

Hello All,

Thanks to Terri & Jane & Kim & Ellen & Brother John & Sister Twitcher & Steph & Lori & Ellen for your thoughts and prayers.

Unfortunately, the off days, and the heat continues. Have the A/C now, but don't want to leave it running around the clock. Took Angelina for a short park stroll this morning, and when we got home she trotted up the slope to the back door :) - but as the day wore on she seemed increasingly elderly. I keep expecting her to fall over. She has stumbled on occasion.

Angelina was eager for breakfast - ignored lunch for 3.5 hours (until I handfed her a couple of pieces to get her going) - and later insisted on an early dinner... hmm... Breakfast and dinner are at the end of the dose's strength - while lunch is right in the middle... maybe she's just going back to two meals a day? I said it before - I wouldn't recognise normal if I saw it. :o

Jane - I don't think the growth is a tastebud - it's more from the area at the rear, and under the tongue - I've been looking around for a canine tongue diagram - but haven't found anything helpful yet. I told the IMS about it way back when - he looked but didn't want to guess - without a biopsy. Which would have meant putting Angelina under - so we didn't proceed. Her teeth next to the growth are becoming discoloured.

Brother John you're a good and wise man -
He eats, he goes potty and back into the house to sleep. I make sure he knows he is loved and keep him as comfortable as I can.

I skipped Angelina's trilostane for a couple of days hoping for some clue - then started her back on 25/20mg these last 2 days - I think she remained the same either way. I cut her fishoil, just in case Mr Pancreas was objecting to even that little bit of fat.

Leslie & Ellen - Aarrgh! Please dont't let it be
some of the other hormones have become so elevated they are causing her some problems My mind's a blank - I don't remember. (can't remember the last time I had a full night's sleep and it's starting to show) I know I read about it, but it's gone. :confused: I'm trying to find the links...:(

Can this be happening already, is it likely? To take her off meds for a month, at this point feels like going backwards. And have to explain it to the local vets! And have to send a sample overseas! Couldn't we have just one small golden period of wellness before everything falls apart? :(

Ellen - I'll happily trade you your
Nice cold Canadian winter for my hot Australian Summer!

In other news, my new shipment of Denamarin arrived today (30 old style - 30 new style) Customs didn't leave a calling card this time... am I on a list? :eek: Hmmm... could Angelina be having a reaction to the Denamarin?:confused:

Casey's Mom

12-16-2009, 10:06 AM

John try not to worry and get some sleep with Angelina - we are all here for you.

littleone1

12-16-2009, 12:26 PM

Hi John,

You and Angelinna are staying in my thoughts and prayers. I wish I knew what to tell you.

I know that when Corky had his adrenal panel, some of his intermediate hormones were elevated. He had already been on Trilo for 10 days when the panel was done. At that time, Dr. Oliver wasn't really concerned about the levels. However, the longer that they're on Trilo, it is possible that the levels might be a little too high.

Hopefully Angela will continue to improve. A little improvement everyday can go a long way.

StarDeb55

12-16-2009, 06:11 PM

John, I just don't think it's going to feasible to get a sample shipped to the US for a UTK panel. Even shipping within the US, the sample has to be overnighted on dry ice to insure that the sample viability remains intact. Coming from Australia, I shudder to think what the logistics & cost would be to get bloodwork to UTK in a reasonable timeframe where the results would still be valid. You may want to e-mail Dr. O directly to see if this is even possible, or he might have another alternative for Angelina.

Debbie

AlisonandMia

12-16-2009, 11:28 PM

I'm with Deb thinking that getting the UTK panel done from Australia may be for all intents and purposes, impossible. But I wonder if you could get, say, estradiol levels checked. I think that could well be possible. Estradiol seems to be a particularly potent hormone, is increased by trilostane over time and can certainly cause problems and can cause high liver enzymes.

With regards Angelina not wanting lunch - Zac who is a PHYD (perfectly healthy young dog) has recently gone to having only one meal a day. He did this last summer, which, of course, I'd forgotten all about:o:p:rolleyes:, and for a split second there I was wondering what was wrong! They just seem to need much fewer calories in the summer or, to put it another way, they need more when it isn't stinking hot. I try to look at it that way because it means I worry less.

He "likes" to run a little lighter (probably 0.7kg) over the summer but once that weight is off he doesn't lose any more weight so his seemingly paltry intake is clearly sustaining him fine. When the weather cools down he is hungry, hungry, hungry until he's regained that little bit of weight, too. He stays within his ideal range but is more towards the heavy end in winter and the light end in summer.

I've asked a couple of other people with PHYD's about appetite in hot weather and they reported the same thing, semi-eaten or refused meals and just not wanting to eat as much generally. Mia used to do it too and she had my twitcher going the first summer of being a treated Cushing's dog until I remembered that this was normal for her. The previous summer she had been cooking up the Cushing's and so her appetite had been unrelentingly ravenous.

Alison

Franklin'sMum

12-17-2009, 07:50 AM

Hi John,

I hope Angelina is doing better today. About the adrenal panel testing... I rang the University of Sydney a couple of months ago. The person I spoke with said they can do/ can get the tests done, but you need to be a patient there.

I asked if we come up, can they do the testing, and she said any vet can take the blood draw, and they will do/get the testing done. I said ok, so we just go to our regular vet, they do the draw and send the sample to you? She said no, they will only run the tests on their own patients. :confused::mad::confused: So we had the Q and A again, same responses.

Good luck if you phone them :rolleyes: and hugs to you and Angelina

Jane and Franklin xx
________
Wendie 99 (http://www.lovelywendie99.com/)

labblab

12-17-2009, 08:07 AM

Dear John,

Before you might try to get involved with full adrenal testing, I'd strongly encourage you or your vet to email Dr. Jack Oliver at the University of Tennesse here in the U.S. (joliver@utk.edu). Not that there is not a highly qualified adrenal expert at the U. of Sydney -- there undoubtedly is. But we already know from our experiences here that Dr. Oliver is unusually receptive to talking with vets and pet owners about testing issues, and he is likely as knowledgeable about this area as anyone in the world.

If you explain Angelina's trilostane history and current issues, I believe he could give you guidance as to whether or not the adrenal testing will likely be of significant value to you right now, and if so -- what the best timing would be. You could also discuss Alison's suggestion for the estradiol testing alone. I'd just hate for you to embark on the testing right now until or unless you know the optimal time frame and situation. But once you know more, you would be better armed to proceed with the U. of Sydney if that seems to be the route to go.

As you undoubtedly know from following other members' threads, Dr. Oliver is a genuinely nice man. And he is always gracious in offering his best opinion about every dog's situation. AND he is willing to talk directly to pet owners anywhere, which is very refreshing!

Marianne

Franklin'sMum

12-17-2009, 08:32 AM

Back again,

Marianne has valid points re: testing and time frames. I'm thinking of earlier posts about the difficulty of sending blood samples over seas, and thought this might be an option (if you contact Dr O, and if he or Angelina's regular doc recommends testing.)

Here's something I just found

Dr Michelle Dennis
Faculty of Veterinary Science
Phone: 9351 1671
Fax: 9351 1618
Veterinary pathology; Ruminant and aquatic animal health and production; Laboratory diagnosis; mortality of long-distance racing sled dogs, causes of canine tongue disease, the pathogenesis of bovine and ovine paratuberculosis, ovine footrot, and infectious diseases of fish so it may be worth while to contact her just for canine tongue info?
Just found an email address for her... m.dennis@usyd.edu.au

http://www.vetsci.usyd.edu.au/about/staff/mdennis.shtml

Fingers and paws crossed xx
________
CHRIS BANGLE (http://www.bmw-tech.org/wiki/Chris_Bangle)

labblab

12-17-2009, 08:55 AM

Back again,

I'm thinking of earlier posts about the difficulty of sending blood samples over seas, and thought this might be an option (if you contact Dr O, and if he or Angelina's regular doc recommends testing.)

Jane, I think your "legwork" re: U. of Sydney will be super helpful if the testing seems to be a good idea. And who knows, maybe Dr. O is acquainted with the related specialist at Sydney, and could help get John's foot in the door (or I guess it would be Angelina's paw in the door...:o)

Marianne

littleone1

12-17-2009, 01:53 PM

Hi John,

I just wanted to check in with you to see how Angelina is doing today.

I'm sending postive thoughts your way, and both of you are still in my prayers.

John II

12-22-2009, 08:52 AM

Hello All,

Thanks to Ellen for reminding me of the importance of sleep - think I was getting a bit loopy at the time of my last posting :o

Thanks to Terri for the thoughts and prayers - as always, knowing what the other pups have been through is very helpful. :)

Thanks to Debbie for the reality check :) I'm getting a bit annoyed with the way Australia seems to be lagging behind with the technology, the meds and the supplements. :(

Thanks to Alison for the Estradiol hint - and for reminding me what normal looks like. :o If I remove reduced appetite from the list of symptoms - that leaves weakness and sloppy poop - which still sounds like too much Trilostane. :confused:

Thanks to Jane for the University of Sydney information. :)

she said any vet can take the blood draw, and they will do/get the testing done So, does that mean any Vet can get the testing done? :confused:

Marianne as always, thanks for the good advice.

Jane, you get another thankyou for the tongue research! :p

Christmas/New Year is soooo inconvenient right now. ;)

In other news...

I skipped Angelina's Trilostane yesterday, she was turning grey and smelly, and it was time for a bath. I thought she could use the extra cortisol to deal with the stress. :o

I gave her 20mg this morning (after breakfast and after a walk - during which she pooped twice) and within the hour she pooped again! I wasn't on hand to witness, but reports are, it was sloppy.

I called the Compound Pharmacist who supplied my first few lots of Trilostane to see what filler they use - turns out, they use Lactose also - so it's not as if, Angelina is reacting to a different filler. The Pharmacist seemed nice and full of information, so I found out that:
* Their supplier of Trilostane is also in China
* They imported the name brand to analyse against the Chinese Trilostane and discovered the Chinese Trilostane to be the purer product! (not by a huge margin - but still)

One telephone call blew several of my theories out of the water.

It was a warm day in Sydney - the A/C was on and Angelina panted steadily despite the trilostane dose, and it being a comfortable 24 degrees celsius. After much too-ing and fro-ing I skipped Angelina's evening dose.

Then, in the relative cool of the evening we drove to the park for a little walk.

labblab

12-22-2009, 09:36 AM

I called the Compound Pharmacist who supplied my first few lots of Trilostane to see what filler they use - turns out, they use Lactose also - so it's not as if, Angelina is reacting to a different filler. The Pharmacist seemed nice and full of information, so I found out that:
* Their supplier of Trilostane is also in China
* They imported the name brand to analyse against the Chinese Trilostane and discovered the Chinese Trilostane to be the purer product! (not by a huge margin - but still)

One telephone call blew several of my theories out of the water.

John, I know this would be an added expense, but would it be worth it to you to order a bit more trilostane from that original compounding pharmacy to give to Angelina as a trial? If I'm understanding you correctly, it is the original pharmacist who did the analysis and comparison -- not your new pharmacy. So unless they are both getting their trilostane from the same supplier in China, it still seems possible to me that there could an issue with your current trilostane. I believe there are a lot of different chemical companies in China. Granted, a long shot. But if you were to re-order a small amount of the original trilostane as a test, it seems to me that you could then truly lay that issue to rest if Angelina reacts in this same way to the original product.

Marianne

John II

12-22-2009, 09:41 AM

Marianne - that's what I've been mulling over today - have I put Angelina through all this upset for the sake of $100? :( Second question would be 25mg - 22.5mg or 20mg? (I did ask, and they can do 22.5mg)

labblab

12-22-2009, 09:53 AM

John, does the trilostane come in a tablet form that is "splittable?" If so, maybe you could order a few 20 mg. tablets, and a few 5 mg. tablets. That way you could give the 20 mg. tablets intact, and then add in either a whole or half of a 5 mg. tablet if you want the additional dosage. Hopefully, you wouldn't have to order a huge supply -- maybe just a couple weeks' worth in order to accomplish the "test."

Marianne

John II

12-23-2009, 05:41 PM

Well there's a good idea - thanks Marianne. So far all the Trilostane we've used has come in specific dose capsule form - will have to investigate. :)

Franklin'sMum

12-23-2009, 09:20 PM

Hi John,

On Angelina's test results, does it tell you the lab info? If so, maybe contact them directly to ask what they can test for? From the chat with U Sydney, I don't know if any vet can get the testing done themselves, or just do the draw to send to Sydney. By the end of that conversation, I didn't know which way was up.

How's Angelina feeling today? Thinking of you both,

Jane and Franklin xx

John II

12-25-2009, 07:45 AM

Thanks Jane,

I think I'll start by asking my vet - and take it from there - see how it goes.

Angelina had an off Christmas day - a long car ride to visit relatives - first thing she did on arrival was poop on the floor which she never ever does :o - (once on a rug:o - and then on their carpet! :o) - and it was sloppy!:o Poor girl, she was restless in the car and I didn't understand what she was telling me :(

She couldn't wait to get home.

Squirt's Mom

12-25-2009, 11:33 AM

Hi John,

I am so sorry Angelina had such a rough day. :( Tough on you, too, huh?

How does she do off the Trilo for a few days? Do her signs come back strong? Does she seem uncomfortable? I am still wondering about the possibility of the Trilo as the culprit. Either too much, something in the compound mix like Marianne has suggested, the unfortunate effect on intermediate hormones, or something as yet unpondered by one of us. If she does ok without the Trilo, it might be worth it to let her take a break from it until you can get some things answered, especially concerning the compounding. Just a thought. ;)

I hope ya'll had a good Christmas otherwise!
Hugs,
Leslie and the girls - always

Casey's Mom

12-25-2009, 11:07 PM

Oooh John, how awful for Angelina and for you to have two accidents at the relatives!

I like Leslie's idea.

Merry Christmas,

Franklin'sMum

12-26-2009, 12:23 AM

Hi John,

I'm also sorry Angelina had a rough day yesterday :( hopefully she'll feel better soon.

Big hugs to you all,

Jane and Franklin xx
________
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John II

12-29-2009, 07:43 AM

Hello All,

Not much to report at the moment - Festive Season in pulling me in several directions at once. Friday with family and the poopfest. :o Saturday with friends. Sunday with more family. Monday with still more family. And today at a funeral.

There was a comforting reading at the service - I wish I'd written down a few words that I could have looked up, and shared with you all. But it wasn't a time for note-taking.

Anyway, onto other things. As you know I made an attempt to acquire a canine cooler mat for Angelina some time ago - unfortunately the original order got lost in the limbo that is Australia Post.

I am dismayed to think how long it took me to think of a solution - 3 days before Christmas, I got a friend to order me another one. It arrived on Christmas Eve.

Didn't look like much, but I followed the directions and poured almost 6 litres of water into the thing, pushed the air out, and I think it would be quite comfortable, if only I could convince Angelina to lie on it.

This is the closest she's come so far - last night:

http://www.k9cushings.com/forum/picture.php?albumid=96&pictureid=1185

Hi Leslie - I'm mostly giving Angelina a break from Trilo at the moment - that is to say, no dose or half the usual daily dose. Her symptoms seem to recur after a short period, increase in water, hunger, panting and I go :eek: when they do - then I give her a 20mg and her next poop gets sloppy and I go :eek: again.

Ellen and Jane - thanks for checking in with us :)

frijole

12-29-2009, 02:59 PM

Thanks for sharing the story and the photo of the infamous cooling mat! That is priceless. Kim

BestBuddy

12-29-2009, 04:44 PM

Hi John,

I can relate to your dismay at Angelina's reaction to her new cool mat. I got Buddy his mat several years before he passed and he never even got as close as Angelina in that time so you still have a chance.:rolleyes:

I had thought about giving it away but my new boys will sleep on it when it is hot and Phoebe will too if I place her on it. I also use it in the car with Phoebe because she is strapped in she has to sit on it and in this weather traveling 3 hours for Christmas dinner was a bit tough.

Jenny

Harley PoMMom

01-01-2010, 12:45 AM

Hi John,

Awww, that pic of Angelina sure is cute...well, at least her head is touching the mat!! :)

Love and hugs,
Lori

maggiebeagle

01-01-2010, 06:30 AM

Sorry you are having medication issues, hope you get it resolved soon.
The photo is priceless. :).
Virginia and angel Maggie

Franklin'sMum

01-01-2010, 08:32 AM

Hi John,

Well, at least Angelina's touching the mat! :) Have you tried bribing her with munchies or some chicken to maybe get her feet on it? Or picking her up and then laying on it yourself with her,so you're both on it? If Angelina is the least concerned about the mat, she may relax if she sees her big, brave Dad use it ;):p

Hope our sweet girl feels better real soon, and please give her a special cuddle from her aunty Jane

Jane and Franklin and Bailey xxx
________
Halfbaked (http://half-baked.com)

John II

01-05-2010, 03:22 AM

Hello All,

Took Angelina in a for a checkup at the Vet today (got the other partner) - I think he's mad with me for reducing her Trilostane. :(

Her Temperature was normal. Her heart sounded OK. Her liver is enlarged - but then, how is that different? Her weight is either 11.4 of 11.5kg (down another 300-400g from last time) - the scale was indecisive. He recommended another ultrasound to check out what's going on inside. And an ACTH Stim test to check her Cortisol (I asked what they use for the stim - they use SYNACTHEN from Novartis). Her teeth need work. And the tongue growth is bigger, but liver problems and anaesthetic don't mix, he said. Otherwise removing it would be a straightforward procedure.

It's the time of year for Angelina's All-In-One vaccination - I asked him if it would be more or less important for a Cush dog to get vaccinated. He said with the compromised immune system it would be more important. And they've had no bad reactions to date.

Virginia - thanks for taking the time to stop by at this sad time ((hugs))

Jane & Lori & Jenny & Kim - Angelina actually put her head on the mat a couple of days ago.
http://www.k9cushings.com/forum/picture.php?albumid=96&pictureid=1210
Last night I sort of slipped into position in the spot where I guessed her head would come down, when she lay down.
http://www.k9cushings.com/forum/picture.php?albumid=96&pictureid=1211
That worked too.
Or picking her up that's the kind of suggestion that gets me injured :-)

littleone1

01-05-2010, 03:39 AM

Hi John,

I wish there were easier ways to take care of our cushpups. Once they have Cushings, it seems like they also have additional problems.

Angelina seems to be getting more use to the mat, even though you're having an issue with it.:)

Franklin'sMum

01-05-2010, 04:12 AM

Hi John,

Hello All,
- I think he's mad with me for reducing her Trilostane. :( Poop to that vet. You know her better than anyone else, and you gotta do what you think is right for her.

Her teeth need work. And the tongue growth is bigger, but liver problems and anaesthetic don't mix, he said. Otherwise removing it would be a straightforward procedure. Poor sweet Angelina. I'm thinking brushing her teeth is out of the question?:eek::p

It's the time of year for Angelina's All-In-One vaccination - I asked him if it would be more or less important for a Cush dog to get vaccinated. He said with the compromised immune system it would be more important. And they've had no bad reactions to date.Hmmm..Interesting.

that's the kind of suggestion that gets me injured :-)
Oops!:eek::p I thought that only was a risk if you surprised her:p

Big hugs to you all,
Jane, Franklin and Bailey xxx
________
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Squirt's Mom

01-05-2010, 01:28 PM

Hey Brother Twitcher,

...that's the kind of suggestion that gets me injured :-)

Hummmmm....wonder if Angelina and Goldie have been talking? :D

Creeping up on the mat usage may be the best way to go. Gradually let her learn that it is not going to hurt her or do anything other than lie there and be cool. She will get the idea that it feels pretty good on her face and schootch on up on it pretty soon. Remember, royalty does things in their own good time. ;):p

Hugs,
Leslie and the girls - always

Casey's Mom

01-05-2010, 02:23 PM

She's getting closer to that mat! At least her head is cool. :)

As far as the vaccinating IMO you should not have her vaccinated when her immune system is low. My vet told me that with Casey last spring and we waited until everything was well with her this fall until vaccinating. We vaccinated and she was so lethargic for two days that I will not do it again - it too was an all in one vaccine (except for Rabies).

Casey had the same reaction to her vaccine two years ago when her Cushings was undiagnosed. This is just my opinion and my reaction maybe someone else out there has a different opinion.

Harley PoMMom

01-05-2010, 03:49 PM

Hi John II,

Hello All,

Took Angelina in a for a checkup at the Vet today (got the other partner) - I think he's mad with me for reducing her Trilostane. :(

I agree with Jane...You do know Angelina best, so if he is mad, well he'll get over it!

Her Temperature was normal. Her heart sounded OK. Her liver is enlarged - but then, how is that different? Her weight is either 11.4 of 11.5kg (down another 300-400g from last time) - the scale was indecisive. He recommended another ultrasound to check out what's going on inside.

I think an ultrasound is an excellent idea.

And an ACTH Stim test to check her Cortisol (I asked what they use for the stim - they use SYNACTHEN from Novartis). Her teeth need work. And the tongue growth is bigger, but liver problems and anaesthetic don't mix, he said. Otherwise removing it would be a straightforward procedure.

Just to give you an example of a pup who has some medical issues and has come out of anesthesia fine...look at the Corkster, these are some of his medical issues: collapsing trachea, enlarged right side of the heart, mass on his liver + adrenal tumor and masticatory muscle myositis. Corky had 3 teeth extracted and a mass removed. Even my boy Harley has an enlarged liver, his last ALT levels were higher then before and he came thru the anesthesia well. His vet said that he woke up really fast and was alert and he is 13 years old. Now John II, I'm not trying to talk you into having any kind of surgery done on Angelina, I just wanted to show you some examples of pups that recently went thru a procedure and came thru it with flying colors!! :)

It's the time of year for Angelina's All-In-One vaccination - I asked him if it would be more or less important for a Cush dog to get vaccinated. He said with the compromised immune system it would be more important. And they've had no bad reactions to date.

We have had alot of dicussions about vaccinations in Jane's Thread, alot of the members have posted links about it and even given their own opinions. Here is a link to the pages if you're interested.

http://www.k9cushings.com/forum/showthread.php?t=1327&page=3

http://www.k9cushings.com/forum/showthread.php?t=1327&page=4

http://www.k9cushings.com/forum/showthread.php?t=1327&page=5

Virginia - thanks for taking the time to stop by at this sad time ((hugs))

Jane & Lori & Jenny & Kim - Angelina actually put her head on the mat a couple of days ago.

I am sure that beautiful Angelina will soon discover that the mat is her friend!!

Last night I sort of slipped into position in the spot where I guessed her head would come down, when she lay down.

That worked too. that's the kind of suggestion that gets me injured :-)

You're such a wonderful Dad to Angelina and you're doing an excellent job taking care of her too.

Love and hugs,
Lori

BestBuddy

01-05-2010, 04:05 PM

Hi John,

Both our vet and specialist said that we should vaccinate Buddy every year. He never had a reaction to it and they said that he would not survive if he got one of those diseases. The other thing was that if we wanted to board or in most places even get him groomed then he had to have proof of vaccination. We were past the boarding and even clipping for the last few years of his life but I just went along with the vet. Right or wrong I don't know but that's just what we did.

Jenny

Roxee's Dad

01-05-2010, 05:43 PM

Hi Brother John

You may want to consider a titer test, it's an extra expense:( and they do a titer for rabies, parvo and distemper and probably more.

The titer test reveals your pet's antibody status. May want to discuss this with your vet. Many cities here will allow a waiver if the titer test shows enough antibodies. If you are taking Angelina for walks and to the park, it would be wise to ensure she is resistant to all the buggers left by other doggies out there.:eek:

There are alot of varing opinions and studies on this as it can be a volitile subject. May want to research the web.

Special hiney scratches to Angelina from Uncle John:D Be sure to keep an eye on your fingers:eek: :D

MiniSchnauzerMom

01-06-2010, 03:11 AM

Hi John,

I'm absolutely loving those pictures of Angelina and her mat! Gave me a good chuckle. Please keep snapping and posting pictures of her mat progress. They'd make a good series for her photo album. Too cute! :D

Louise

John II

01-10-2010, 09:30 AM

Hello All,

Once again we are having a heatwave - but at least now we have the A/C for the worst of it. Angelina is happy with the A/C - I think ;)

http://www.k9cushings.com/forum/picture.php?albumid=96&pictureid=1230

From last Wednesday, I've put Angelina back onto 20mg every 12 hours.

Today, we had heat. Visitors, including 2 dogs. Angelina didn't want my home-cooking, so she got 100g of commercial dog food for breakfast and (after giving her 3 hours to eat the homemade lunch I made for her) more commercial dog food for lunch instead, and steak and a bone to chew on for dinner.

http://www.k9cushings.com/forum/picture.php?albumid=96&pictureid=1231

About 5 hours after dinner Angelina had her first poop of the day. Started out firm and ended with liquid. :confused:

I can't seem to make up my mind on the whole vaccination thing.

If you are taking Angelina for walks and to the park, it would be wise to ensure she is resistant to all the buggers left by other doggies out there.:eek:

Both our vet and specialist said that we should vaccinate Buddy every year. He never had a reaction to it and they said that he would not survive if he got one of those diseases.

As far as the vaccinating IMO you should not have her vaccinated when her immune system is low. My vet told me that with Casey last spring and we waited until everything was well with her this fall until vaccinating. We vaccinated and she was so lethargic for two days that I will not do it again - it too was an all in one vaccine

I'm hoping the less cranky vet will be working tomorrow and I can raise my various concerns.

Poor sweet Angelina. I'm thinking brushing her teeth is out of the question?
Yes Jane, I think we've well and truly missed the boat on that option! :eek:

I think an ultrasound is an excellent idea. I've seen ultrasound reports from other members which had great detail in the findings, right down to precise measurements - I was therefore quite disappointed by the lack of information in the one we had done last time.

But the thing is, if we had another ultrasound done and if problems were discovered (well we had liver nodules and right adrenal mass last time) what would I do? I think, the only improvement in Angelina's condition since she started Trilostane is her weight, her hair perhaps, less water intake (but then that fluctuates). Compared to earlier in the year (2009), she's faded considerably. How much more do I put her through?

Angelina is now 14 years and 3 months old (plus) - sadly, more than some have made it to, but less than some others. But this past year (we had the first anniversary of me hearing the word "Cushings" on December 23), this past year would be the worst of her life.

There's a word that seems to have gained great popularity, appearing in various threads lately, and it makes me wonder about the quality of my darling girl's life. :(

Thanks to Louise & Terri & Leslie for stopping by with your good wishes. No further progress has been made with the cooler mat. You can't teach an old (stubborn) dog new tricks. ;)

Franklin'sMum

01-10-2010, 11:13 AM

Hi John,

We're thinking of you both, and sending healing thoughts and prayers. I just wish there was something more I could do. :( Please do double check on the vacc. issue tomorrow. Apparently on the box or in the insert (which we as the parents never get to read) it says only healthy dogs should be vacc'd. That includes things like a mild fever, UTI, lameness and also covers someone like a stray dog with a flea infestation. (which I know Angelina's not, but just to give you an idea.)

Love, big hugs and positive thoughts from my home to yours,

Jane and the gang xxx
________
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Buffaloe

01-10-2010, 12:08 PM

John,

I think if you asked 12 people about vaccinating an elderly dog with cushing's, you'd probably end up with 6 and 6.

Here's what happened with vaccinations with Shiloh...about 18 months ago Shi was in for her annual check-up. My trusted vet asked, "what about vaccinations?" I probably got a bit of a negative look on my face but replied, "what do you think?" He said that she's had her vaccinations all of her life and probably has plenty left in her for the duration.

So, Shi has had no vaccinations since well before her adrenalectomy, maybe close to four years. It's not like she covers miles and miles of territory frequented by many dogs...a nice little cruise around the block and she's good.

I think you could go either way on the ultrasound. It would be nice to know more, but it probably wouldn't change how you proceed forward and it doesn't sound like the quality of the last one was anything great.

It sounds to me like Angelina has some good life left in her. I think she will let you know when it's time but it's sure a tough position to be in. Take care.

Ken

Roxee's Dad

01-10-2010, 01:51 PM

Hi Brother John,

Vacinations are such a hot topic and as Jeff mentioned, varing opinions. You can read and read and still not know what the right thing to do is :confused::confused::confused::eek: I'm a fan of the titer test.

I've mentioned before that our senior pups are just that, senior. :( We keep a mental list of what each of ours enjoys. I consider Mickee our Wheaton mix in about the same weight range as Angelina. He's about 30 ish pounds. He is 14 1/2 and I was just shocked last summer when I gave him his summer haircut. He was fairly muscular and good shape to his body, but when I shaved him down, his skin was hanging a bit, muscles wern't what they used to be. I was really saddened and it made me come to the realization of his age. He's deaf now and eyesight failing. He still wags his tail, still loves to push the pillows off the couch and enjoys getting attention. Loves his treats and meals. He has a bit of a limp, worse on some days and doesn't jump up on the couch so easily anymore. Loves to go outside and leave his "pee mail" :D and he sleeps alot more than he used to. He's old and I'm going to keep on letting him know he is special to me and keep on lovin on him. I think he will let me know when it's time.

So I keep this list in my head all the time as I did with Roxee. I pushed the envelope with Roxee as she no longer enjoyed or wasn't able to enjoy the many items on her list but I had hope. When Saskia wrote about the quality of life "dogworthy" it hit me as clear as day and released alot of my guilt. So keep in mind as I know you will, her quality of life. She does have a job, it may be just guarding the house, meeting you when you come home or bugging you for a walk to smell the roses or just keeping you on your toes. You will know when it's time, in the meantime just keep on letting her know she is loved.

When I look at the posted pics, I see a very content and happy little girl. :):):) Maybe not as energetic as a younger pup but happy and content all the same.

Good thoughts to you and Angelina.

littleone1

01-11-2010, 04:37 AM

Hi John,

I'm so sorry that Angelina isn't doing very well. It's sometimes very difficult to make decisions about additional testing.

Corky has had 3 U/Ss done. The mass on his liver has stayed about the same size. His 3rd U/S showed that the mass on his right kidney is an adrenal tumor. This is when his IMS started his treatment with Trilo.

Sending healing thoughts and prayers and kisses for Angelina from Corky.

Roxee's Dad

01-25-2010, 02:42 PM

Hi John II
Haven't heard from you or Angelina in a while, hope all is going well with our little girl. :)

Casey's Mom

01-29-2010, 12:52 AM

Hi John, just wondering how you and Angelina are - please let us know when you can.

Love and hugs,

John II

01-29-2010, 06:49 AM

Hi All,

Sorry for the long delay. Non-Cushings related events grabbed me by the throat and smacked me around for a while. Happy 2010! :( I thought 2009 was bad! I had no idea what bad was. :eek:

Anyway, Angelina seems to have adjusted to 20mg of Trilostane, every 12 hours. Even, her poops have been solid lately - just don't ask me why. Her diet hasn't changed. At all. :confused:

We went to the Vet today, I finally bit the bullet and went to get her vaccinated. Checked her weight - I hate those digital scales - it came back with every reading between 10.6 and 11kg - but whichever it is, she continues to lose weight. Her belly remains big, however.

The weather is warm and muggy. That doesn't help. She's not moving well at the moment. Yet, quite restless today. The osteo supplements don't seem to be helping. The cooler mat is completely ignored.

Also, she's taken to chewing on her rear legs lately. The hair there is stained by saliva.

But, we are still here, and we thank you for your concern. :o

littleone1

01-29-2010, 07:43 AM

Hi John,

It's good to see you back on. Thank you for the updates on Angelina. Is she okay after having her shots?

I'm glad she seems to be adjusting well to her new Trilo dose and that her poops have been better. She might not be interested in the cooling mat since you have the AC now.

I'm sorry you are having other issues. I know the feeling. When you think that things can't get any worse, for some reason, they do.

Give Angelina a hug from me and kisses from the Corkster.

Casey's Mom

01-29-2010, 08:42 AM

Thank you John for the update - you know how we worry when we dont hear anything for a while - I hope everything else in your life is going well now and Angelina what a sweatheart she is - love her photos.

Keep well John and give Angelina a belly rub. Hopefully it cools down a bit there - hey you can have my -23 okay?

Love and hugs,

John II

03-01-2010, 03:19 AM

Hello All,

So, where was I? :o

Terri - Angelina seems to have survived her vaccination unscathed. And is happy to have regained access to the park. Although, it seems that as soon as one problem goes away, something else appears.

We were cruising along on 20mg of Trilostane every 12 hours, for about a month - and then on February 6 she only drank 245mls of water! The day before that was only 310mls - but I though I'd missed something.

I stopped the Trilostane until February 10, when I restarted her on 20mg - but only the evening dose. And we've continued on one dose of 20mg per day to the present. She's now averaging about 500mls of water per day. She also weighs only about 10kg (!!) maybe a little under.

Despite the 3kg weight loss, which I would have thought to be relief to her poor little legs - her walking has deteriorated (rear legs seem weak with a tremble). She chews on her rear legs, all the time and has started on her front left leg. :confused: It doesn't stop her insisting on going for a walk every morning. :rolleyes:

I took her to the Vet a couple of weeks after her vaccination, he gave her a once over. But was reluctant to prescribe tramadol due to it's impact on her elderly kidneys. So we're a bit stuck. :(

I'm sure she's bothered by her teeth/tongue growth, which may be affecting her eating of certain foods. She has no problem with commercial food or my home cooking, but tends to chew, then spit out raw meat. After a few goes, she manages. She still is able to wolf down her favourite foods. The other Vet is reluctant to fix the mouth issues due to the impact of anaesthesia on her liver. Stuck again. :(

The Vet did say that I had bought her a lot of time.

Ellen - thanks for checking up on us :)

littleone1

03-01-2010, 07:09 AM

Hi John,

I'm glad you let us know how Angelina is doing.

I'm sorry that she is having other issues. I know that I was concerned about Corky having to have anesthesia when he had to have his teeth extracted and the masses removed from his mouth. His vet/surgeon assured me that the anesthesia he was using was
safe for our cush pups. Corky really did well with it.

Does your vet have any idea as to why Angelina is chewing on her legs? If she's in pain from arthritis, you might be able to give her baby aspirin. That's what I give Corky, as long as I give him 1/2 tablet of Pepcid AC in the morning.

I'm glad that she still wants to go for her walks. That's a good sign.

Please keep us updated.

Franklin'sMum

03-03-2010, 02:54 AM

Hi John,

Thinking good thoughts for you and Angelina, and hope her leg chewing/trembling is just a phase she's going through. I'm sorry to hear that her tongue is still giving her trouble.

Big hugs to you and the little lady,
Jane, Franklin and Bailey xxx
________
Coach Handbags (http://icoachhandbags.com/)

Squirt's Mom

03-03-2010, 12:20 PM

Hi Brother T,

Just some ponderings here....

Did the feet biting start after the vaccines? Do you know exactly what the vet used for each of these vaccines?

Has anything in her environment changed? New laundry soap? Floor cleaner? Air freshener? Beddings? Toys? Collar/harness? Shampoos or conditioners - yours or hers? Cologne, aftershave, lotion, soap, etc. of yours? Any neighbors had lawn work done? Construction nearby?

Has anything in her food changed? Ingredients? Manufacturer or supplier? Supplements?

Try to think of when this started and what is different about her environment, if anything, that might have had an impact on her to cause this.

Again....just navel-gazing....

Hugs,
Leslie and the girls - always

AlisonandMia

03-03-2010, 10:48 PM

Hi John,

What is the specialist's view on Angelina's liver and how well she'd cope with anesthesia? The thing is, rotten teeth are not exactly great for the liver either and can even be the source of liver enzyme elevations in some cases. So maybe getting a second opinion on that could be a good idea.

I don't really understand the worry about tramadol and elderly kidneys.:confused: I checked out prescribing info for Tramadol in humans and it doesn't seem to be a particular issue with regards kidneys except that they say that if renal function is decreased (as evidenced by raised creatinine etc - so they mean really quite impaired) that the dose should be reduce because of poor excretion leading to a big build up of the drug in the system and leading to an overdose. I know that NSAIDS are not exactly kidney friendly (or liver friendly for that matter) - but Tramadol shouldn't be an issue especially if you start low and go slow with the dose - which seems to be a good idea as so many dogs don't need or tolerate anything like the "usual" dose. The info said that tramadol is metabolized in the liver (like just about everything) and excreted by the kidneys (like a lot of things). Maybe the vet simply heard you mention a pain med and his mind jumped to NSAIDS or something?

I think you should probably bring up the pain management issue again just to make sure there was no misunderstanding and maybe ask the specialist what he thinks too. Most dogs do seem to be able to tolerate and benefit from some sort of pain med despite being old and having multiple health issues.

Could the leg chewing be allergy (or infection) related? Low cortisol can sometimes make allergies flare up (can be the only sign that cortisol is low in some) but that probably isn't the cause with Angelina as she has other ways of showing that her cortisol is low. Like us you must have a lot of flowering grasses after the rain - and a lot of mold in the environment generally as well. I feel very sorry for the allergy prone dogs (and their owners) that live around here - they must either be housebound or on steroids or both at the moment:(. My asthma and hayfever has been playing up lately - all down to the rain and what it has brought in its wake. My legs are also itchy after a walk if any grass touches me. Thank goodness Zac is made of sterner stuff than am I!

Alison

Re food: Have you tried the human-grade kangaroo mince? (Macromeats, available at supermarkets.) Angelina might like that - raw or cooked. . I gather it is the only kangaroo mince that is hygienically handled. The stuff sold for pets has a had a really checkered past, to say the least, as well as having preservative added. I use it as part of Zac's diet to keep the overall fat level down.

Hello All,

So, where was I? :o

Terri - Angelina seems to have survived her vaccination unscathed. And is happy to have regained access to the park. Although, it seems that as soon as one problem goes away, something else appears.

We were cruising along on 20mg of Trilostane every 12 hours, for about a month - and then on February 6 she only drank 245mls of water! The day before that was only 310mls - but I though I'd missed something.

I stopped the Trilostane until February 10, when I restarted her on 20mg - but only the evening dose. And we've continued on one dose of 20mg per day to the present. She's now averaging about 500mls of water per day. She also weighs only about 10kg (!!) maybe a little under.

Despite the 3kg weight loss, which I would have thought to be relief to her poor little legs - her walking has deteriorated (rear legs seem weak with a tremble). She chews on her rear legs, all the time and has started on her front left leg. :confused: It doesn't stop her insisting on going for a walk every morning. :rolleyes:

I took her to the Vet a couple of weeks after her vaccination, he gave her a once over. But was reluctant to prescribe tramadol due to it's impact on her elderly kidneys. So we're a bit stuck. :(

I'm sure she's bothered by her teeth/tongue growth, which may be affecting her eating of certain foods. She has no problem with commercial food or my home cooking, but tends to chew, then spit out raw meat. After a few goes, she manages. She still is able to wolf down her favourite foods. The other Vet is reluctant to fix the mouth issues due to the impact of anaesthesia on her liver. Stuck again. :(

The Vet did say that I had bought her a lot of time.

Ellen - thanks for checking up on us :)

Casey's Mom

03-04-2010, 09:29 AM

Glad to hear from you John, I like the vet's comment at the end!

Love and hugs,

lulusmom

03-04-2010, 03:58 PM

Hi John,

Wow, it's been a long time since I've posted to your and Angelina's thread but I can no longer spare you the pain of reading my drivel. :D I have questions, observations and comments that I need post while it's fresh in my memory or they'll end up in the black hole that swallows up most of my recent memories.

Hello All,

So, where was I? :o

Terri - Angelina seems to have survived her vaccination unscathed. And is happy to have regained access to the park. Although, it seems that as soon as one problem goes away, something else appears.

We were cruising along on 20mg of Trilostane every 12 hours, for about a month - and then on February 6 she only drank 245mls of water! The day before that was only 310mls - but I though I'd missed something.

I stopped the Trilostane until February 10, when I restarted her on 20mg - but only the evening dose. And we've continued on one dose of 20mg per day to the present. She's now averaging about 500mls of water per day. She also weighs only about 10kg (!!) maybe a little under.

I've noticed that you have been tweeking Angelina's dose here and there but when was the last acth stim test done to confirm whether Angelina's current dose is adequate? Can you remind us of the results of that stim test?

Despite the 3kg weight loss, which I would have thought to be relief to her poor little legs - her walking has deteriorated (rear legs seem weak with a tremble). She chews on her rear legs, all the time and has started on her front left leg. :confused: It doesn't stop her insisting on going for a walk every morning. :rolleyes:

I took her to the Vet a couple of weeks after her vaccination, he gave her a once over. But was reluctant to prescribe tramadol due to it's impact on her elderly kidneys. So we're a bit stuck. :(

If Angelina's cortisol is not within the desired range, it is quite possible that her rear leg weakness and trembling is due to the continued muscle wasting. I checked out her album and she appears to have quite a pot belly in the pictures you posted when you got her the cooling mat. Has her pot belly gotten any better since then? If your vet thinks Angelina is in pain because she is arthritic, has your vet done appropriate imaging to determine if this is the source of her pain?

Has your vet diagnosed chronic renal failure and is that why he is hesitant to prescribe Tramadol? I tend to agree with Alison on this one and I think that Tramadol can be safely prescribed in lower doses to arthritic dogs, even those with kidney disease. I would certainly opt for Tramadol over NSAIDs.

I'm sure she's bothered by her teeth/tongue growth, which may be affecting her eating of certain foods. She has no problem with commercial food or my home cooking, but tends to chew, then spit out raw meat. After a few goes, she manages. She still is able to wolf down her favourite foods. The other Vet is reluctant to fix the mouth issues due to the impact of anaesthesia on her liver. Stuck again. :(

Unfortunately, Maltese is a breed that is predisposed to periodontal disease so Angelina has a double whammy because cushdogs are more prone to profound dental disease than a normal dog. My cushdogs need a cleaning every six month. I waited nine months for one of Jojo's cleanings and his mouth was a mess and required emergency dental. Within 10 days after his surgery, he was a different dog so I had no idea how much pain he was in nor how much it impacted him both physically and mentally. Severe dental disease is more likely to adversely impact the liver of a controlled cushdog and it is a lot more likely to kill a dog. They have made huge advancements in anaestesia, especially for senior dogs, so I agree with Alison that a second opinion would be a good idea for both cleaning and assessment of the abnormal growth in her mouth.

The Vet did say that I had bought her a lot of time.

I wholeheartedly agree that you've been a tremendous advocate for Angelina and what a lucky girl she is to have you as her daddy.

Franklin'sMum

03-26-2010, 11:39 AM

Hi John,
How are you and Angelina going these days? Is Angelina walking any better? A few of our people use L-Glutamine for leg trembling/muscle wastage, and when I was at the health food store some months ago, asked the sales lady about it. She said it's great for muscle wastage/weakness, and that a lot of doctors advise it for patients with muscular dystrophy and such.

If Angelina's vet isn't comfortable with prescribing Tramadol, and if she is developing arthriris, has the doc mentioned glucosamine? (Speaking for myself, since starting it, I don't creak nearly as much as before.)

I do hope she is feeling better with her teeth and tongue issues.
Hugs to you, and belly rubs and ear scratchies to our girl,
Jane, Franklin and Bailey xxx
________
JAILBROKEN (http://jailbroken.org/)

Casey's Mom

03-26-2010, 11:53 AM

John, I heartily agree with Jane re L-Glutamine. I have used it with great success for Casey.

One of the members here mentioned it in a post a while back and I figured I would give it a try after discussing with my vet.

She runs in the park at 14!

Love and belly rubs for Angelina,

John II

03-30-2010, 10:29 AM

Hi All!

Where does the time go? It's almost midnight again :eek:

Let's see:

Jane & Ellen, I've had Angelina on Glucosamine 375mg/Chondroitin300mg /MSM 375mg tablets for several months now - but they don't seem to have much effect (the last couple of days I've ground them into powder because I'm wondering if Angelina's digestive system is processing them too fast to absorb them properly) - of course a tablet is easier to hide than powder.

I went off in search of L-Glutamine and found some 750mg capsules in the Health Food store - my research says that the dose should be about 500mg for a 25lb dog - would that be right? And preferably given in 2 x 250mg doses? (I was hoping they'd have 500mg - dividing 750mg into 3rds might be a bit tricky) - great, more powder!

I also saw a mention of the use of BCAA's (branched-chain amino acids) to combat muscle wasting - has anyone used these? Or know anything about them? :confused:

New thing - I gave Angelina 250mg of Spirulina this morning. She also gets 2333mg (3rd of a tablet) of MilkThistle and I give her Salmon Oil for a couple of days then 100iu of Vitamin E for a day to offset the Omega 3.

Oh - while searching for the L-Glutamine, I saw one of the local pharmacies had SAMe tablets - I think about $33 for a bottle of 400mg tablets. I've still got a jar of Denamarin chewable (which are huge! Well, for Angelina's size, anyway - haven't quite figured out how to get her to eat them - she certainly doesn't consider them a treat!) The old style pills were much easier to hide.

(I asked the health food store guy why the original container of fish oil capsules had vitamin e added - but none of the new ones did - he said that vitamin e was used as a preservative - so even though they don't say it in the ingredients - all the fish oil capsules have vitamin e as well - anyway, as I said I give Angelina a vitamin e capsule every couple of days... just in case the health food store guy was full of it ;) )

You creak Jane? LOL

Yike's, it's already 12:30am and I've gotta get my new Human patient to the medical centre for a blood test first thing - so I'll have to get to Glynda and Alison and Leslie and Terri's points later! Thanks for all your suggestions!

Nathalie

03-30-2010, 11:43 AM

Hi John, :)

Whenever possible I use supplements/herbs/nutraceutical in liquid form for better absorption.

If you are not seeing any benefit after 2 months I would switch to a liquid Joint formula, making sure to ‘load’.

500 mg L-Glutamin should be just fine for a 25 lbs dog.

Spirulina also comes in liquid form as well as Milk Thistle (tincture).

Vitamin-E should always be given with Fish Oil on a daily basis. The amount of vitamin-E found in fish oil is minimal and not enough to be therapeutic.

Liquids are initially a bit more expensive but studies show these are more readily absorbed and also mix easier with the food so I believe at the end I am getting more bang for my $.

You may also want to look into giving Esther-C and B-Complex - given 2x per day.

I was able to get a liquid B-Complex for little Sophie which is bacon flavored and meals have taken on a complete new meaning to her.

Cheers,
Nathalie

John II

03-31-2010, 06:01 AM

Thanks for all the information Nathalie :)- I have to admit I hadn't really considered liquid supplements (I thought they often come suspended in alcohol:o) I'll have to track the pet friendly versions down.

Just quickly - before I have to run off again...

http://www.youtube.com/watch?v=yEGV6UHWQ8Y

A video speaks a thousand pictures. :p

Casey's Mom

03-31-2010, 09:06 AM

Thank you for that John, its see what our furry friends look like on video. I got some of her personality from that one :D:D

Love and hugs,

Nathalie

03-31-2010, 12:33 PM

Hi John,

The only thing containing alcohol is the Milk Thistle tincture and I am not worried about it since it is such a small amount.

Regarding Joint formulas - if you don't see improvement after 2 months you are either giving too little or the formula is not working for your dog -> time to move on to another product.

Eg. the manufacturer of Phillip's joint formula recommends 1 week of double-dosing. I am 'loading' for full 6 weeks.

Cheers,
Nathalie

Squirt's Mom

03-31-2010, 01:19 PM

Hi John,

Tinctures are made via alcohol usage but glycerites aren't. You can sometimes find the glycerite forms if the tincture is bothersome to Angelina. I use glycerite forms when possible. ;)

Hugs,
Leslie and the girls - always

Squirt's Mom

04-01-2010, 11:57 AM

Hey John,

I need to clarify something about the tinctures VS glycerites. Both use alcohol in the extraction process. Here's the difference - The alcohol remains in the tinctures as the suspension for the extract. In glycerites, the alcohol is removed once the extraction is complete and the extract is then suspended in glycerine, often with a sweet fruit extract for flavoring like strawberry.

Ok....I feel better now. ;)

Hope our little girl is doing better today!

Hugs,
Leslie and the girls - always

John II

05-02-2010, 11:13 PM

Hello All,

Sorry about being missing in action – I wanted to wait until I actually had something to tell you.

Well, after a few false starts I finally took Angelina to see a new vet last Thursday. It’s a lot to lay on someone new, but the Vet did a thorough once over, and we talked about Angelina’s various issues.

Also, after a recent bath I discovered Angelina’s undercarriage (chest/belly/groin) was quite discoloured. I thought the invisible fleas had run riot - I see the dirt, but not the fleas. I tried giving Angelina an extra thorough scrub during her next bath, and followed that with Frontline to the back of the neck – but the stuff wasn’t coming off and fleas were still evident.

The Vet said, that while some of it was flea dirt, a lot could be attributed to blackheads and a skin infection caused by the Cushings. Also, Frontline wasn’t working anymore because the fleas had built up a resistance. And recommended we switch to Advantage.

Angelina got antibiotics for her mouth and skin issues (risky dental work pending – the Vet made it clear that Angelina might not wake up – but for her comfort it was necessary). A biochemistry and (for the first time) CBC was done. Was given medicated shampoo (Dermcare Pyohex) for dirt/skin issues. And got a droplet container of Meloxicam (on Saturday after the blood test results) – the Vet prescribed a loading dose of 10 drops (1 mg) followed 24 hours later (and so on) by a maintenance dose of 5 drops every day (which is all half the normal dose – considering Angelina's liver issues).

What worries me about the meloxicam is that the side effects I’ve been told to watch out for (gastro/intestinal) are the same as when I increase Angelina’s dose of trilostane. Which I’m sure the new vet will suggest I do. Good grief. :eek:

Angelina returned on Saturday for an ACTH Stim test and the Vet called this morning with the results:
Cortisol Resting 15 nmol/L (Aus) which is 0.54 ug/dl (USA)
Cortisol 1 Hour 113 nmol/L (Aus) which is 4.10 ug/dl (USA)

I know everyone discounts the resting but FIFTEEN!!! Seems worthy of an eek to me. :eek:
The target everyone seems to be going for is somewhere between 28 and 55 nmol/L for both
(the range for a normal dog is 15 to 170 nmol/L)

We’re heading for the other weather extreme in Sydney, things are cooling down – quite cold on Friday, and so I didn’t give Angelina a medicated bath then. Saturday was stressful enough with going to the Vet and having the Stim in her system (although this time I didn’t see much in the way of side effects – but as I said, it’s cool, and that would probably help).

Sunday, I was psyching myself up to dose Angelina with the meloxicam at lunchtime (but she got whisked away for a grooming instead – and a small cut on her ear :mad:). The Vet was open until 2pm on Sunday (I have to get used to all the new consultation hours), so I was hoping to have the support if there was a reaction – by the time the grooming was complete, my window of opportunity was just about closed. And again – Angelina was already way too stressed for a bath. The fact that the shampoo has a “CAUTION” :eek: on it and advises the bather to use gloves also worries me. But then what doesn’t?:rolleyes:

So, here we are on Monday. Angelina has been on 125mg of Amoxyclav BID since Thursday night.

I’ll give her a small can of commercial food for lunch, with the meloxicam – so she’ll be guaranteed to eat it all.

The Vet wanted to talk to me about Angelina’s Trilostane dosages for her previous Stim Tests – but I didn’t have the information at hand, so she said she would call back (she had patients queued up at the time). Waiting...

Biochem results all scrunched up - first number is the result, then the normal range - didn't realise until later that pancreatic enzymes weren't listed.
(or go to http://spreadsheets.google.com/ccc?key=0AvulUcZrRvZSdGg5cDE1djhyYjJJTUVLMy0wUHR1a 0E&hl=en )

29/04/2010 29/04/2010 Units
Not Fasted Normal Range
Na (Sodium) 149 140-155 mmol/l
K (Potassium) 5.8 3.8-5.8 mmol/l
NA:K Ratio 25.69 (27-40)
Cl (Chloride) 109 100-120 mmol/l
Calcium 2.72 2.00-2.80 mmol/l
Phosphate 1.3 0.8-2.0 mmol/l
Bicarb 20 16-24 mmol/l
Anion Gap 26 15-25 mmol/l
Urea 11.9 2.5-9.0 mmol/l
Creatinine 55 40-140 umol/l
Plasma Glucose 4.5 3.5-6.7
Glucose 3.4 3.5-6.7 mmol/l
TBIL 2 < 11 umol/l
AST 103 1-80 U/L
ALT 442 < 80 U/L
AlkPhos 1808 1-120 U/L
GGT (liver enz) 12 < 6 U/L
T Protein 76 55-78 g/L
Albumin 41 22-36 g/L
Globulin 35 25-40 g/L
Alb/Glob Ratio 1.2
CreatKinase 341 < 401 U/L
Cholesterol 9.9 3.6-8.8 mmol/l
Weight 10.6 Kg

I'm wondering if I should give Angelina Milk Thistle at the same time as Antibiotic/Meloxicam. I know a lot of articles say Milk Thistle protects the liver... but I found one http://www.hcvadvocate.org/hepatitis/hepC/mthistle.html
that said:
Researchers at the University of Pittsburgh have suspected that milk thistle can slow down or reduce the activity of enzymes in the liver. What does this have to do with HIV? you might ask. Well, enzymes in the liver break down many of the substances that we eat and drink, including medications. If the activity of these enzymes are reduced, then drugs remain in the blood longer than they otherwise might. This could lead to having higher-than-expected levels of drugs in the body, causing side effects or intensifying already-existing side effects. Indeed, in recent experiments using milk thistle and human liver cells, the researchers found that relatively small concentrations of milk thistle did significantly slow down the activity of the liver enzyme CYP3A4 by 50% to 100%."

John II

05-02-2010, 11:42 PM

Me again - The Vet just called, based on Angelina's Stim Test numbers (especially the low resting value), she advises to continue on 20mg SID for the time being.

I was not expecting that! :o

And 15 minutes ago, Angelina ate her lunch (laced with 1mg of Meloxicam/Metacam).

Fingers crossed! :o

Harley PoMMom

05-03-2010, 08:30 PM

Hi John II,

All various body parts crossed here for beautiful Angelina! You know I had the same problem with Frontline Plus and Harley's vet suggested Advantage too! Them fleas :eek::mad: they are buggers to get rid of but they are gone now...Thank God!

Give Angelina some gentle belly rubs from Harley and me, and we will be looking for more updates!

Love and hugs,
Lori

John II

05-03-2010, 08:47 PM

I had this twitching in the back of my head that I had forgotten to reply to something. And going back a page, there were the huge, helpfull and thoughtful messages from Alison and Glynda!

And I just feel awful! Considering how much time and effort went into those posts!:o

By way of some of the answers to your questions:

I got another call from the new Vet last night - she had been in touch with a colleague to discuss Angelina's test results. The result of which is that they want to increase Angelina's Trilostane dose to 30mg SID with another ACTH Stim, two weeks later. They are also concerned about the risk of pancreatitis, due to the level of fat in Angelina's bloodwork.

So:
* I'll need to order some 30s today - have to decide from whom.
(I was hoping Angelina's trilostane dose would remain stable because her first sign of too much trilo - gastro-intestinal upset, is also a sign of problems developing with meloxicam - darn & drat!)

* Give her another dose of meloxicam :eek:

* Give her a medicated bath :eek:

I think, between my last two posts - that might cover most of the questions (hopefully). Although I don't know why the vets seem to prefer Meloxicam over Tramadol (going over Angelina's records I noticed she'd been given a shot of meloxicam, when I'd gone in to see the vet about her limping - last year).

And Alison - I did finally find the Macromeats (after searching about a while). I gave some to Angelina, she tried a bit and gave me the "What the heck is this &*%$?" look. So there's a kilo of kangaroo in the fridge, I'll have to do something about. :rolleyes: Maybe I'll poach some and try again...

Lori - thanks for the good wishes, and the Advantage confimation.

labblab

05-04-2010, 09:04 AM

I got another call from the new Vet last night - she had been in touch with a colleague to discuss Angelina's test results. The result of which is that they want to increase Angelina's Trilostane dose to 30mg SID with another ACTH Stim, two weeks later. They are also concerned about the risk of pancreatitis, due to the level of fat in Angelina's bloodwork.

John, I only have a moment to post right now. But I've just been talking with Alison, and her eagle eye has spotted some concern with Angelina's electrolye results. Angelina's potassium is at the highest end of normal, and her sodium/potassium ratio is already below normal. We are concerned that increasing her trilostane may elevate the potassium even more and further worsen the imbalance :(. Not only does trilostane lower cortisol, but it also lowers aldosterone. And aldosterone plays a crucial role in maintaining the proper sodium/potassium levels.

Would you feel comfortable checking back with your vet in order to discuss Angelina's electrolyte situation prior to increasing her dose?

Marianne

littleone1

05-04-2010, 01:54 PM

Hi John,

It's good to see some updates on Angelina. I'm sorry she's experiencing pain and going through so much right now. I personally don't use Metacam anymore. If Corky's arthritis starts acting up, I give him baby aspirin, but he also takes 1/2 a tablet of Pepcid everyday. He's been taking the Pepcid AC since he started on the Trilo.

Keeping you both in my thoughts and prayers.

Franklin'sMum

05-08-2010, 07:49 AM

Hi John,
Thinking positive thoughts and sending good luck wishes for you and Angelina
Jane, Franklin and Bailey xxx
________
Ipad cases (http://accesoriesipad.com/)

John II

06-03-2010, 05:23 AM

Hello Everyone,

Well, here we are in June. I wanted to wait until I had something to tell you (and numbers to go with it) – then when I got the results... I needed a little time to go hmmm...

So, I ordered the new batch of (a very optimistic) 100 capsules of Trilostane 30 mg from the original compounding pharmacy "A". They had dropped their prices to within reach of compounding pharmacy "B". "B" was still cheaper (by about $40), but I had a long running twitch in the back of my head...

Anyway, after seeing the new vet for the first time, I started giving Angelina half a tablet of antibiotics (125mg of Amoxyclav) every 12 hours with meals from April 30. Then started giving her a daily dose of Meloxicam on May 3. On May 6, she got her first medicated bath. So, by this time, a lot was going on. Thursday afternoon, she started pooping chocolate sauce. About 5 minutes after her dose of Meloxicam.

At 6am the following morning she vomited some yellow froth. I called the vet later that morning, and the vet advised I stop the Meloxicam. When Angelina vomited more yellow foam the next morning, I stopped the last of the antibiotics (1.5 pills left) as well. There was no more vomiting - and the pooping went back to normal.

In the meantime I was running out of 20mg doses of Trilostane - I couldn't bring myself to up the dose while other things were going on, so I used up the 20's.

Monday May 10, we started on the 30mg capsules.

I held my breath, crossed my fingers and...

Not much impact. Although, as day's passed, was she hungrier? It seemed so. Was she thirstier? On average, yes. On the 3rd day, she drank 805mls, before dropping down to more normal levels. If I was guessing by her symptoms, I would think the 30mg capules from compounding pharmacy "A" were equal to or weaker than the 20mg capsules from compounding pharmacy "B".

On the 20th day of 30mg dosing I took Angelina back to the vet for her ACTH Stim Test.
The results of the previous test were (May 1):
Cortisol Resting 15 nmol/L (Aus) which is 0.54 ug/dl (USA)
Cortisol 1 Hour 113 nmol/L (Aus) which is 4.10 ug/dl (USA)

The results of the latest test were (May 29):
Cortisol Resting 16 nmol/L (Aus) which is 0.58 ug/dl (USA)
Cortisol 1 Hour 125 nmol/L (Aus) which is 4.53 ug/dl (USA)

Can you see why I'm going "Hmmm..."?:confused: and :mad:

http://www.k9cushings.com/forum/picture.php?albumid=96&pictureid=1688
May 29 2010 - recovering from ACTH Stim Test (shaved neck and bandaged leg) I wasn't brave enough to take the bandage off, so Angelina did it herself a little later.

Anyway, started Angelina on a 12 hour dose of a new antibiotic from Monday (May 31) this time it's 100mg of Metrogyl. So far so good.

Angelina has started, the last couple of days, chewing on the small pink growth on her left rear leg. I don't know if she caused the slight bleeding, or if she was responding to it. There's alway's something.

I'll have to leave it there for the moment - haven't responded to the forumers who responded to my last post... but I'll get back to that later, as Angelina is due her 12 hour dose of antibiotic & dinner. ;)

Just wanted to bring you all up to date.

John II

06-03-2010, 06:27 AM

Part II

Marianne & Alison, I did catch your post before I went back to the vet to order the new batch of trilostane. I raised the potassium concerns with her. The vet's response was that the levels of potassium fluctuate all the time, and I shouldn't be overly concerned by a higher reading. (of course this conversation was a while back now - so my memory may be suspect).

Interestingly I found the following in my research:
"Strangely, it is easy to obtain inaccurate measurements of your blood potassium levels. It's very likely that your blood sample has been "hemolyzed," where the pressure of drawing blood into a vial or syringe breaks open the delicate walls of red blood cells. These cells leak their concentrated amounts of potassium into the plasma and other parts of blood, so hemolyzation will give false high potassium readings. For this reason, elevated potassium levels may be difficult to determine without further medical attention." from http://www.wisegeek.com :eek:

Terri, you can add Pepcid to the very long list of things not readily available in Australia. I asked the vet about giving Angelina low dose aspirin - but she said that aspirin was in the same class of drugs as meloxicam, so it should be the same result. (but I will have to make another attempt at the painkiller option, once we've gotten used to the new additions to the regime).

Thanks Jane for the positive thoughts and good luck wishes ;)

Following on from the latest results, the vet said she would talk to her expert again and get back to me with their new plan of action. The almost identical stim result has been a surprise, and I have to wonder if the capsules that I had thought were 20mg, were in fact 30mg... and if that was true, then it would explain a lot... when I tried to up Angelina's dose to 40mg per day, was I really increasing it to 60mg? When 45 to 50mg seemed to be a good dose for her?

If that's the case then, all I can say is AAAAAAAAAAAAAAAAAAARRRRRRRRRRRRGGGGGGGGGGGGGHHHHHH HHHHHHHHHH!!!!!!!!!!!!!!!!!!!!!!!! :mad::confused::(:eek::mad::confused::(:eek:

BestBuddy

06-03-2010, 06:34 AM

mmmm is right.

It is rather strange if the trilo is indeed 30mg and has given you the same result at the 20mg. Could it be that Angelina was a bit under the weather and the cortisol started to climb quickly so that the 30mg has just kept the numbers the same??

Regardless the numbers look pretty good. I am wondering if we have a product like Pepcid here?

Jenny

AlisonandMia

06-03-2010, 07:16 AM

Pepcid AC is the US trade name for famotidine. It looks like that drug is available in Australia, but probably under another name(s). I'm sure a pharmacist can help and maybe there is a veterinary equivalent too (probably 10X the price though!). It looks like quite a few pharmacy chains sell their own brand of famotidine: http://www.google.com.au/search?hl=en&q=FAMOTIDINE+australia&aq=f&aqi=g1&aql=&oq=&gs_rfai=

My favorite tummy settler-downer/protector is slippery elm powder (available from health food stores and maybe supermarkets in the supplement section). Not the greatest tasting stuff (from a human point of view anyway) but you could try mixing it into some yummy, strong-tasting wet food. I can't take an NSAID unless I take it with slippery elm. It's great stuff!

Alison

PS: Re the potassium - when a blood sample is hemolyzed the lab will usually mention it, because of the way it can skew some results. I would think a potentially alarming potassium/sodium ratio would warrant another test - just to make sure it was indeed a furphy - especially when using a med that affect electrolytes.

PPS: It would be a good idea to get that irritating pinkish growth checked out ASAP. Mast cell tumors can be itchy and irritating. They are something you want to get onto quickly.

John II

11-22-2010, 08:35 AM

Gosh, it's been a while. :o

Angelina is currently on 15mg of Trilostane every 12 hours plus 100mg of Metrogyl (antibiotic - to offset her dental situation) every 12 hours. She's a skinny girl now, at 8kg (vet scale). Movement isn't great and legs (particularly the back legs) are weak.

But her eyes are bright and her smile is constant.

However, she had her Spring trim a couple of weeks back. And this revealed a large growth on the back of her upper right rear leg. The skin of which, once uncovered, split and it has been bleeding off and on since.

Last week the Vet did a fine needle aspiration on the growth, sent it off to the lab (also did one on the smaller growth on her left rear leg, and the hard pea sized ball in her left armpit).

I got a call a couple of days later to say the results had returned, but the lab had taken all the labels off the samples and the vet couldn't tell which result was for with growth.

GRRRRRRRRRRRRRRRRRRRRR!:mad::mad::mad::mad::mad:

So, we did it again.

The one in the armpit was a fatty tumour, the one on the left leg was "unknown" but the one on her butt was a plasmacytoma. The vet recommended removal - plus a significant margin. It's ulcerated, isn't likely to heal by itself, likely to grow and/or become infected. :eek:

So, I have to take Angelina to the Vet in 11 hours. And, as the Vet said, I have to prepare myself for the fact that she may not survive this. :eek::(:eek::(:eek::(

But if all goes OK, the Vet will work on Angelina's teeth as well.

What else? Oh the growth on her tongue responded to the antibiotics as well, and now looks like a small shrivelled balloon. Out of the way and not causing problems.

I fear going to bed - because sleep is all the separates me from tomorrow. And I fear tomorrow. :(

Please send good thoughts and prayers and crossed fingers Angelina's way.

12 hours from now, it might just be beginning...

labblab

11-22-2010, 09:03 AM

Oh John!!! I am indeed beaming healing thoughts and prayers to our Angelina. And also giant bear hugs to you. We will all be there with you in spirit. Please update us as soon as you are able, OK?

Marianne

addy

11-22-2010, 09:23 AM

I too am sending positive vibes and prayers for Angelina and for you.

I pray all will go well.

Addy

Harley PoMMom

11-22-2010, 10:27 AM

We are most definitely sending tons of positive energy, healing thoughts and prayers your way for sweet Angelina. Also crossing all various body parts too. Big, big hugs to you, my dear friend, please keep us posted.

Love and hugs,
Lori

Altira

11-22-2010, 10:39 AM

Angelina, such a pretty name. She is in my prayers too.

Squirt's Mom

11-22-2010, 10:52 AM

Hey Brother Twitcher,

Sending prayers, healing white light, many hugs and cautious belly rubs to you and our sweet Angelina. Please let us know as soon as you can when she's back home with her dad, ok?

Love ya,
Leslie and the girls - always

Roxee's Dad

11-22-2010, 11:26 AM

Hi Brother John,

Keeping you both in my positive thoughts and prayers. All fingers and paws crossed here.

(((Hugs))) to you and belly rubs to Angelina.

littleone1

11-22-2010, 12:02 PM

I am keeping you and Angelina in my thoughts and prayers, John. Sending positive thoughts that everything goes well. Give Angelina some belly rubs from me.

John II

11-22-2010, 04:52 PM

Thanks everyone for your thoughts and prayers and crossed bits! :D

Angelina has been for her morning walk, and is now lying on the kitchen floor. We'll leave in just under 2 hours.

It's going to be a tough day. :(

John II

11-22-2010, 11:31 PM

NEWS!!! The lump has been removed - plus a reasonable margin - the vet didn't go too deep. And some dental work was done - 2 broken teeth removed and the rest cleaned. I can pick her up in 2 hours! (relief) I mean she's still an old dog but... she still has cushings... she's still weak in the hind legs... etc etc etc... BUT (relief)(relief)(relief)(relief)(relief) :D

Thanks everyone, you helped to tip the scales in her direction! :D

Harley PoMMom

11-22-2010, 11:55 PM

This is great news, John!! What a sigh of relief, huh? Give our precious Angelina some gentle belly rubs from Harley and me because I don't think she would like any hugs or kisses right now.

Keep us posted, ok?

Love and hugs,
Lori

John II

11-23-2010, 02:51 AM

Angelina is back from the vet :D - the area is yellow with antiseptic and the whole thing looks ghastly! :eek::eek::eek:

Before:

http://www.k9cushings.com/forum/picture.php?albumid=96&pictureid=2081

After:

http://www.k9cushings.com/forum/picture.php?albumid=96&pictureid=2082

But she's home :D (She's looking a little dazed and confused)

I'm not supposed to give her any food or drink until tomorrow morning. But when she got home she went straight to where her water container usually is. And circled, confused.

So I called the vet, who relented and said Angelina could have a little to eat/drink after 8pm (it's currently 5:50pm) - but after she's had a rest.

Have to return in 5 days for a checkup - and 10 days to remove the stitches. Sooner if there are any complications - of course.

BestBuddy

11-23-2010, 03:51 AM

Ouch.
It really looks like poor Angelina has had a tough time. I bet you are glad it's over. She will be sore and sorry for herself for a bit but should feel so much better with the lumps gone and the dental work. So glad she is home and looking for her water.

Jenny

Franklin'sMum

11-23-2010, 03:53 AM

Hi John,

Woo Hoo!!! :):):):):):):D:D:D:D:D:D:D Great news on our beautiful girl!! :D:D I'm so happy for you both, and now you can take a breath ;). Both of those photos look nasty, but I'm glad the vet got it all.

Hoping for a speedy recovery for Angelina :D

Really, John, :):):):):) and HUGE (((((HUGS))))) to you

Jane, Franklin and Bailey xxx

John II

11-23-2010, 05:49 AM

Thanks Jenny & Jane,

Although Angelina only had the raw lump removed (of the 3 growths).

Angelina had me worried by the way she was looking for water constantly. In the end I couldn't wait until 8pm, so I gave her a bit at 6:30pm (8 laps) and about the same every 15 mins after that until she finally got to the stage where thirst became hunger, so I gave her 50g of Mydog at 7:30pm - and now, finally, she's sleeping.
I hope she rests a long while.

mytil

11-23-2010, 06:18 AM

Am so very glad she is home and resting!!!!

Gentle smoochies to her
Terry

John II

11-23-2010, 06:43 AM

Thanks Terry,

I have to remember Angelina didn't get her morning of evening doses of Trilo - before I freak out. Even with the rationing, she's drunk 400mls since 6:30pm to 9pm.

littleone1

11-23-2010, 07:26 AM

I'm glad that everything went well and that Angelina is home and resting. That had to be a large growth. Poor Angelina. I hope the healing process goes very quickly.

I'm glad she is now eating and drinking water. She's on the road to recovery.

Roxee's Dad

11-23-2010, 10:27 AM

Hi Brother John,

Such a relief to hear the good news, here's hoping she has a very speedy recovery.

Give Angelina a hiney...... ummmm....scratch that, make it a gentle pat on the head from me and mine. :)

Squirt's Mom

11-23-2010, 11:49 AM

Hi Brother Twitcher,

OUCH! That booty looks like it hurts! Poor baby. :(

I am so glad that is over, Angelina is home, eating and drinking, and I hope that she is back to her usual self in no time! I also hope you got some rest last nite! ;)

Keep us updated on her progress tho I expect nothing short of miraculous under your loving hands.

Hugs,
Leslie and the girls :D - always

John II

11-23-2010, 05:01 PM

Thanks Terri, Brother J & Sister T,

We had a restless night, lots of position changes - but that's not really unusual lately. That could just be a changing seasons thing - it's warm, it's cool, I heard about climate change, but I wasn't expecting it to change every day. ;)

Went for a little walk this morning, I carried Angelina to the street, like I usually do, she walked a couple of houses down, sent 5 pee-mails (so that still works! ;)) then turned around and looked at me, so I picked her up and carried her home.

Gave her her Trilo and Antibiotic - upgraded from half a 200mg Metrogyl tablet to half a 250mg Amoxyclav tablet, every 12 hours. Wrapped in BBQ chicken skin (I'm running out of things she'll gobble down without chewing). :o

Was starting to cook chicken breast with rice, but decided that would take too long, so gave her a MyDog Senior (Turkey) instead (soft and has rice) - then she had a little drink and is... (goes off to check)...

Snoozing under the kitchen table (but opens her eyes when I take the picture):
http://www.k9cushings.com/forum/picture.php?albumid=96&pictureid=2083

I should call this picture "Touch Me - If You Dare!" :p

Harley PoMMom

11-23-2010, 05:10 PM

Love the picture and definitely love the caption underneath it!!

Did they give any pain meds for Angelina?

John II

11-23-2010, 05:24 PM

No Lori, no pain meds were given. I suppose the vet is worried about Angelina's liver. The vet did a simple, in house blood test before the operation, and said Angelina's liver values were still high - but her kidneys are good (:)) and her glucose is good. I was a little too distracted to get a copy of the numbers. :rolleyes:

Harley PoMMom

11-23-2010, 05:46 PM

Do you think this was just an oversight on their part...not giving the pain meds. I mean, if the vet believed Angelina's liver could handle the surgery then why can't it handle pain meds?

Of course, you know Angelina better than anyone, so what do you think?

John II

11-24-2010, 12:35 AM

Lori,

When I first started seeing this vet back in May (I think - I'm getting fuzzy brained :p) she immediately put Angelina on Amoxyclav (for her teeth & skin) and Meloxicam to help with any arthritic pain.

Unfortunately one of the medications - or a combination of the two caused Angelina to start vomiting (bile) a few days later. Or maybe it was just bad timing, and she would have anyway? :confused: But unusually, Angelina vomited 2 days (once a day) in a row - which she never does. She usually does it once and she's fine for a few months.
The first day, I stopped the Meloxicam and after she vomited on the 2nd day, I stopped the Amoxyclav. On the 3rd day - no vomiting.

At the moment Angelina doesn't seem much effected by her wound - she even lies on that side more often than not! So I would like to dose, for as long as possible, only with the Amoxyclav and see if it has any side effects in the next few days - and if it does we might be able to blame it for the vomiting and give Meloxicam another try in the future.

If however, Angelina shows any new discomfort I'll be hassling the vet immediately! ;)

BestBuddy

11-24-2010, 01:59 AM

We didn't get pain meds for many of Buddy's or Phoebe's surgeries. They included dentals, eye grids and even a lump removal. They were given an injection of pain relief during or just after the surgery and I was to call if I felt they needed any more. They didn't and seemed to get over it much quicker than I did.:o

I know they don't look at a wound and then think oh wow that looks like it must hurt so don't require more pain relief.

I am sure it is better not to give it just in case and only if it is needed.

Jenny

John II

11-24-2010, 02:07 AM

Thanks for that info Jenny. Angelina is my one and only dog, so it helps to touch base with others and find out their (your) experiences.

You've eased my mind. :)

As much as it can be eased, of course ;)

Altira

11-24-2010, 04:41 AM

So glad she's ok!

John II

11-24-2010, 08:20 AM

Thankyou Altira, it's so good of you to come by - especially with all you have on your plate ((hugs)) :(

I got a call from the vet - the final pathology came back. It was a plasmacytoma and it was benign! :D

Now, have to work on getting Angelina all healed up.

Big news, I took her out for an evening walk, and she pooped, from a solid start to a soft serve finish. :o At least we know that still works. Stuff goes in and stuff comes out. Good. :)

Squirt's Mom

11-24-2010, 11:31 AM

Hi Brother Twitcher,

BENIGN!!! :D:D:D:D:D:D:D What a wonderful thing to see first thing this morning! :D:D:D:D:D:D:D

You have got to be on Cloud 9, flying high, and I am so happy for you and Angelina both! :D:D:D

Hugs and gentle belly rubs,
Leslie and the girls :D - always

littleone1

11-24-2010, 01:35 PM

Hi John,

I'm glad that Angelina is doing so well after her surgery. I'm sure you feel very relieved. I'm also glad that the pathology report was a good one.

Take care.

Roxee's Dad

11-24-2010, 02:49 PM

Good news Brother John, Glad she is doing better...everything crossed that the improvement continues. :D:)

Belly rubs and...oh wait....after seeing the pic, maybe just give her a verbal hug from me. ;)

Harley PoMMom

11-24-2010, 06:53 PM

I am so very happy that our Angelina is doing so well. Benign!!!! YAAA!!! And she's POOPING!!!! YAAA!!! :D:D:D I am very happy to see that everything is coming out alright!! ;):D

Keep us posted, ok?

Love and hugs,
Lori

John II

11-24-2010, 07:10 PM

Thankyou Leslie and Terri and John and Lori!

Angelina was up early and came to get me for her walk this morning :) No pooping (not surprising after last night's performance :rolleyes:) but a lot of pee-mail.

Now I have a question:

Recently my brain has turned to fuzz - so many Cushings and non-Cushings things occupying my mind. So I'm turning to the Gurus.

The topic is Trilostane dosing versus Surgical recovery:
For or Against or Reduced?
Ok... go!

littleone1

11-24-2010, 08:18 PM

Hi John,

I'm glad Angelina is continuing to improve.

I know that surgery would be the best option for Corky, but because of his age and other medical conditions, he is not a good candidate for the surgery. If surgery was a good option for him, I definitely would have had it done. His Trilo dosage has been increased a few times, but he is doing well on it. He is also on BID. Each furbaby is different. It all depends on what is actually going on with them.

John II

02-27-2011, 07:21 AM

On December 23 2008 I took Angelina to the vet for her annual vaccination and to run some worrying symptoms past him. That was the first time I heard of Cushings Disease. He suggested I check online for more information.

I did so. And I read everything. A lot went over my head, so I read it again. Googled what I didn’t understand. And read it again, until things began to stick. Some time after that I found K9C and discovered I wasn’t alone in my terror, or my love for my dog. I have found friends here, who have advised me, led me, gave me a shoulder to cry on or lean on, a sounding board or a hug when I needed one.

Now my little girl reaches the end of her path. Her eyes are bright, her smile is there, but her legs have given way. She’s finding it difficult to walk. Her front right foot is crippled by arthritis. When she walks, often she is unable to straighten out her foot in time and tumbles to the ground. Landing on her chin. Or onto her side. Her front left foot, is going the same way. Her rear legs are weak. Even the curve of her tail has become crooked.

But her eyes are so bright. She is so aware.

I changed vets in April last year and thought it seemed to start well. But I think we went off track almost at once. I let the vet start Angelina on Meloxicam, and Antibiotics (Amoxyclav) and Medicated Shampoo all at once, instead of suggesting one new treatment at a time. I keep making the same mistake of deferring to the vet. So when Angelina started vomiting after only a few days, we couldn’t be sure what was at fault. So we stopped everything. And then I didn’t suggest trying each singularly, after a recovery period, to isolate the cause.

Instead we just continued on with Trilostane and the gentler antibiotic Metrogyl.

Time passed.

On July 27 2010 we did her last ACTH Stim test with the following results:
(Dose was 30mg of Trilostane once a day)
Cortisol resting: 14 nmol/L which is 0.51 ug/dl
Cortisol at 1 Hour: 79 nmol/L which is 2.86 ug/dl

I admit I tied this Vet’s hands, as my own hands were tied, having to put each treatment decision to “The Family Council” and getting shot down as often as not. But, working within those limitations there were still treatments that could have been tried. I should have pushed more.

And Angelina slowly, steadily deteriorated. I should have changed vets again. But, how could I know the next one would be any better? This vet had been recommended to me by a family member. So we stayed on.

When the seasons changed and the fleas became a plague, the vet fixated on flea treatments because the fleas were affecting Angelina’s “quality of life” – I was dumbfounded. Somehow she couldn’t see how arthritis was crippling Angelina. But the fleas were the major concern? No further treatment was suggested for Angelina’s mobility. :mad:

Then in November Angelina developed an ulcerated tumour which needed to be removed. I didn’t think she would survive. But she did. :)And the horrible wound healed. :D We couldn’t finish the course of Amoxyclav because after 5 days, Angelina started showing signs of gastro-intestinal upset. Did that finally answer that earlier question from back in April? I switched her back to the softer Metrogyl. And I cut back on her Trilostane, so the extra cortisol would speed up her recovery. The vet said her recovery was “remarkable” I didn’t tell her why.

Some time later I pointed out greasy patches on Angelina’s skin to the vet – who prescribed Amoxyclav & medicated shampoo again. As we were leaving, I asked what we could do about the arthritis, Adequan? Duralactin? She said we’d look into it after Angelina’s skin cleared up. Were these greasy patches more important? :mad:
She mentioned the best treatment for arthritis is cortisol. That was the last time I saw that vet. :(

After the first half a tablet of Amoxyclav Angelina already had diarrhoea. :mad: So I stopped giving them to her and restarted the Metrogyl. Angelina was too stressed by bathing for me to even think of giving her the multiple medicated baths a week advised.

Then there was the festive season. Between many visitors and a couple of road trips I decided Angelina could use the extra cortisol. And there was also a lot of mucus coming from the eye with the small growth – an infection even though she was taking the antibiotics? So I stopped the Trilostane for 12 days until January 1. Then resumed the Trilostane at 15mg BID.

The vet’s words had stayed with me: the best treatment for arthritis is cortisol.

January 23 and as Angelina’s walking got worse, I cut her Trilostane dose from 15mg BID to 15mg only once a day. But it didn’t seem to help. :(

I finally tried a new vet. Trying to avoid new medications, this vet specialised in acupuncture and trigger point therapy for arthritis. We tried the acupuncture for 4 weeks, and included trigger point for the last two weeks. As usual I hoped for a miracle. Here are some pictures (via phone camera):

http://www.k9cushings.com/forum/picture.php?albumid=96&pictureid=2439

http://www.k9cushings.com/forum/picture.php?albumid=96&pictureid=2438

http://www.k9cushings.com/forum/picture.php?albumid=96&pictureid=2441

The new vet mentioned something the first day, which I didn’t know, and which I was shocked to hear: Cortisol masks arthritis. I knew that. But, she went on to say,
Cortisol accelerates the development of arthritis! :eek::eek::eek::eek:

Had I gone too slow, increased and tweaked Angelina’s dose too gradually? Or too often? Is this all my fault? Why didn’t I know this?

At her 5th appointment the new vet got us to take a walk around the carpark as she watched. There had been no improvement. In fact it seemed after every appointment Angelina had gotten worse. The new vet said we could continue with the treatment if we wished but if there was no improvement at all after 4 weeks then it was unlikely to help. :(

I asked if there was anything else we could do. She suggested trying Tramadol. I queried the used of Adequan. She had to look it up. And advised that they use a version called Zydax. The vet was going to call the previous vet to arrange for her to give Angelina the injection. As the new vet had called the old vet to keep her in the loop. But I didn’t want to waste more time, so I asked the new vet to give Angelina the first shot of a 4 week course. The new vet also cut up a week’s supply of tramadol (20mg pills into 5mg-ish quarters).

The day after the shot, and on the first day of tramadol, Angelina could hardly walk. The falling became constant. I didn’t give her anymore tramadol – and put a call into the vet, it was near closing time and the vet got back to me the next day. Said it was unlikely to be the Zydax. I should retry the tramadol, after a couple of days, and I should use one of the “smaller” quarters.

It was only later that I realised I should have asked for a biochemistry to be done before any new medications were tried. It’s important to always have a base level, and to know how things are going. It was out of my head because my intention for this vet was non-medication treatment of Angelina’s mobility issues.

I withheld Angelina’s Trilostane that first day, but restarted the next day as her panting increased, still one 15mg capsule per day.

Thursday, was she a little better or was it just wishful thinking?

Friday, unsteady, tumbling, at one point she couldn’t get up (she was lying on her right side next to the couch), I noticed her whimper too late, so she peed where she lay. I haven't retried the tramadol.

I think the time has come. We have an appointment for the next Zydax shot tomorrow at 12:15pm. I would rather put Angelina to sleep at home – with a vet making a housecall. I don't want Angelina to be afraid. :(

Do I keep the appointment and see what the new vet has to say? Perhaps take blood for a final biochemistry to get a hint of what’s going on? Just so I know? Or do I reschedule for that housecall?

I can’t believe we are here.
My heart is collapsing into itself, only an aching emptiness remains.
:(:(:(:(:(:(:(:(

Today Angelina is 15 years 5 months and 4 days old and weighs 8kg.
It's now 10:20pm.
Time is moving so fast.
Soon it will be tomorrow. :'(

Franklin'sMum

02-27-2011, 08:04 AM

John,

I am so sorry you are facing this decision, but please don't second guess your actions. Especially at this time. Everything you have done for Angelina, you have done with love in your heart, with the best intentions, and with the best knowledge you had available to you at the time. She could not ask for more than all the things you have done for her, and continue to do for her.

Your love for her is evident in everything that you write, and my tears flow with yours. Know that we are here with you, holding you and Angelina in our thoughts, hearts and prayers.

I pray that you will find peace in the coming days as you and your family decide which path to take.

Hugs to you my dear friend, and gentle hugs to my sweet niece.

Jane, Franklin and Angel Bailey

John II

02-27-2011, 08:27 AM

Thanks Jane for your kind words and I'll be needing those hugs :(

frijole

02-27-2011, 10:10 AM

John, I have to run out but I am so glad I saw this before leaving. I wanted to share my experience with tramadol with you. It was not good. It is an opiate. I gave it to Haley one night for arthritis pain. She walked into walls and then just stood there in a daze, she paced all night til finally I went to bed. Woke up to diarrhea all over the house. A mess.

At 2 am I logged on here and cried out for help. Come to find out every person (and there were quite a few) ended up having to reduce the dosage by 1/2 as it was just too much and made the dog dopey. Don't know if it was an age thing or what but if by chance some of what you saw during the tramadol could be drug related vs actual illness it could have been the dosage was too high.

I googled the drug and my vet was following the manufacturer's instruction so it was right but I cut it in half and she did well on it.

I send you the hugest of hugs across the pond as I know this has to be hard on you. Much love, Kim

PS You can buy duralactin online and it does not require an rx. My Annie's hind legs are so much better after using it. She has to stay on it but it is working. It is not well known yet so a vet might not recommend it.... might be worth a shot if you can get some. xoxox

John II

02-27-2011, 02:23 PM

Thanks Kim,

The vet prescribed 5mg of tramadol x twice a day. The manufacturer's guide is 1-2mg per kg. Angelina is 8kg so that would be 8 to 16mg per day. So, it was already, just a little over half the manufacturer's instruction. And I stopped after 1 dose 5 days ago - but Angelina's weakness continues.

I've heard of someone trying to import into Australia duralactin but having the shipment stopped by customs, because it was a milk-based product. I'll have to ask the vet.

BestBuddy

02-27-2011, 03:59 PM

Hi John,

I wish you were not having to question Angelina's quality of life. I hope today there is some improvement.

I wouldn't try to get meds through quarantine. I tried and was made to feel like a criminal, I ordered metacam and some eye creme. They destroyed the eye creme and said that this once they would let the metacam through but not again.

Jenny

littleone1

02-27-2011, 07:43 PM

Oh John,

I am so sorry to hear that Angelina is not doing well. My heart goes out to you. I know this has to be a very difficult decision for you. You have been doing everything you can possibly do for Angelina. You are both in my thoughts and prayers.

(((HUGS))) for both of you.

Roxee's Dad

02-27-2011, 11:04 PM

My Brother John....

I am at a loss for words remembering how close Roxee and Angelina were in treatment. I do know and remember exactly what you are going through and having a hard time typing this through the tears.

I am offering you my heartfelt prayers and hopes that this shall pass. It's not easy to know when it's time and I just think of the words Sas has put in my mind about a "Dog Worthy life"

Big huge (((Hugs))) to you my brother and a very gentle pat on the head for our Angelina.

corgipallie

02-28-2011, 01:28 AM

I am just now catching up and tears are rolling down my face. It's more than a day after you posted and I'm hoping you are doing ok in the face of this latest bad news. I am here for you always.

Steph, Gypsy, Apollo, Alfie and Angel Pallie

John II

02-28-2011, 02:28 AM

First of all let me just say that Angelina has not crossed that bridge - yet. :o

I took her to see the latest vet at 12:15pm (it's now 4:36pm) and we discussed the situation at length. Decided to discontinue the zydax and the tramadol (not that she believed either medication to be a problem - but for the moment...).

She examined Angelina, and found a mass in her abdomen - couldn't tell if it was in her spleen or her intestines.

I told the vet that Angelina hadn't been very interested in breakfast the last week, and had rejected both BBQ chicken and MyDog (commercial food) this morning - which also meant I couldn't give her her antibiotic (Metrogyl half 200mg tablet).

The vet advised that if this mass was in her intestine it might be the cause of Angelina's inappetance. If it was in her spleen - considering all of Angelina's other issues - there would be no point in removing it.

The vet asked about Angelina's behaviour.
Is Angelina still interacting with her family?
Yes.
Is Angelina still excited to see visitors?
Yes.
Questions like that.

Based on the examination and interrogation, the vet thinks (drawing a line in the sand) that in her opinion, Angelina is just - just - on the living side of the quality of life question.

Although, since I'm with her for more time and see more, I would obviously know better. And therefore, the vet could not fault me if I decided to put Angelina to sleep.

So... there's that.

I also remembered to request a full blood test and the results just came back:

ALB 36g/L (22-39)
ALKP 1647 U/L (23-212) **
ALT 796 U/L (10-100) **
AMYL 549 U/L (500-1500)
UREA 9.1 mmol/L (2.5-9.6)
Ca 2.77 mmol/L (1.98-3.00)
CREAT 63 umol/L (44-159)
GLUC 4.94 mmol/L (3.89-7.94)
LIP 880 U/L (200-1800)
PHOS 1.12 mmol/L (0.81-2.19)
TP 72 g/L (52-82)
GLOB 36 g/L (25-45)
HCT 48.2% (37-55)
HGB 15.2 g/dL (12-18)
MCHC 31.5 g/dL (30.0-36.9)
WBC 9.5 x10^9/L (6.0-16.9)
GRANS 8.1 x10^9/L (3.3-12.0)
% GRANS 85%
NEUTS ~ 7.0 x10^9/L (2.8-10.5)
EOS ~1.1 x10^9/L (0.5-1.5)
L/M 1.4 x10^9/L (0.5-1.5)
%L/M 15%
PLT 870 x10^9/L (175-500) **
Na 159 mmol/L (140-160)
K 4.9 mmol/L (3.5-5.8)
Cl 121 mmol/L (109-122)
Manual WBC Differential: 82/10/7/0/1, Increased numbers platelets.

The abnormalities in Angelina's results:

Elevated ALKP: likely secondary to Cushing's disease, hepatic nodules possibly also primarily implicated.

Elevated ALT: indicative of liver inflammation, consistent with previously- diagnosed hepatic nodules.

Elevated numbers of platelets: may be incidental, but may indicate a recent episode of bleeding.

I need to go back and dig out the last set...
Is it just me, or apart from the liver enzymes and the platelets - those results aren't bad? :confused:

Steph, I'm keeping her one more day - I held her so close to my chest at the vet's today!
Brother John, I've been thinking a lot about you & Roxee lately, and all the pups who have passed. :'(
Terri, thanks for your thoughts and prayers and (((HUGS)))
Jenny, thanks for your hope.

Thanks to all for your support and your empathy :o)

Also when we returned home from the vet, Angelina had a plate of (non fatty) roast pork for lunch. :o)

Franklin'sMum

02-28-2011, 04:09 AM

I am so happy that Angelina is still with you, and hope that there is nothing nasty about the mass in her tummy. I really hope you see some improvement in Angelina.

Always love and hugs,
Jane, Franklin and Angel Bailey xxx

Casey's Mom

02-28-2011, 09:20 AM

Thoughts and prayers with you John here is to today and tomorrow and the next day, enjoy your Angelina. She knows how much you love her.

Love and many hugs,

Harley PoMMom

02-28-2011, 05:06 PM

Hi John,

Keeping you and sweet Angelina in my thoughts and prayers.

When Harley is being picky with his food, the two things I can get him to eat are eggs (hard-boiled or scrambled) and baby-food (the first-stage variety).

Love and big hugs,
Lori

John II

03-01-2011, 06:08 AM

Thanks Jane, Ellen & Lori.

I'm at the don't know what to do point.
I keep hoping for a miracle, but I've been chasing those for 2 years. And there always seems to another dangling off in the distance.
Perhaps it's time to just stop.
I'm finding it hard to let go.
I've always been a "where there's life there's hope" guy.
I feel like if I put her to sleep, that I let her down.
That I failed her.
That I gave up on her before it was her time to go.

I can't stop bursting into tears.

littleone1

03-01-2011, 06:48 AM

(((HUGS))) John.

Don't ever feel that you are letting Angelina down. She knows how much you love her and that you will make the best decision for her.

Franklin'sMum

03-01-2011, 09:14 AM

John,

Angelina knows how much you love her and that everything you do for her is with love in your heart. I know your heart is breaking as you decide where to go from here. We are beside you and will support you whatever your decision.

Love and hugs,
Jane, Franklin and Angel Bailey xxx

addy

03-01-2011, 09:30 AM

John, I am so sorry you are in that hard place. Your all encompassing love for Angelina could never let her down, everything you do and have done is because of that very love. Love can break our hearts, tear it to shreds but it also gives us a joy, a special joy.

Little Angelina has been able to wrap herself in your strong, devoted love and she loves you back. She does not doubt you, she does not second guess you, she just loves you.

Saying prayers for you and my heart aches for you.

Love,
Addy

corgipallie

03-01-2011, 11:19 AM

Spiderlizardman,

Whatever you decide, you are not letting her down. Unconditional love means no one is ever let down. Because of you, she has had the most wonderful 15 years a dog could ask for.

I know what you mean though. I never had the chance to make the decision for Pallie. I had talked to her vet about it, but the opportunity never came. One evening, we were getting ready for bed and she couldn't breathe. She was having a pulmonary embolism and passed out and passed away before I could get her to the vet. It was so fast. I feel like I let her down because we never had the proper goodbye. 12 years together as soul mates and I never gave her the chance to say goodbye to me. I was grateful I was home so I could kind of say goodbye but it wasn't ideal. However being in the position to actually do what so many have to do was ripping my heart out. I guess she made the decision for me.

Talk to Angelina and look deep in her eyes. You'll find some answers there. If the answers aren't there today, they'll be there when she needs to tell you.

Love,
Steph

Spiceysmum

03-01-2011, 11:35 AM

John,

I am so sorry that you have to make this decision but I know when the time comes you will know. The last week of Spicey's life I felt physically sick the whole time not knowing what to do and frightened of making the wrong decision. The vets gave me hope that they might be able to get her better but deep down I knew she wouldn't. If she had not been in hospital the last few days I am sure I would have made that decision earlier as it was heartbreaking hearing her laboured breathing. It is the hardest thing we have to do and is only possible because we put how they feel before how we feel. My thoughts are with you and Angelina.

Linda

lulusmom

03-01-2011, 01:35 PM

Hi John,

I understand exactly what you are going through because I'm in the same place with Jojo. Like you, I'm not throwing in the towel yet.

I have to admit that Angelina's bloodwork looks great. Do you have her on liver support? When was the last acth stim test? The last one I saw was done in July and the results were great.

I can honestly say that I have never heard of excess cortisol excelerating arthritis. As as matter of fact, I've heard the opposite. There are many articles that suggest if a dog has debilitating arthritis, it might be more humane to forego treating the cushing's. I have, however, heard that because cushing's affects bone metabolism, it can cause and excelerate osteoporosis. Perhaps that's what your vet meant??? :confused:

Hang in there and rely on your gut and the special communication you and Angelina have to guide you.

Hugs,
Glynda

John II

03-01-2011, 11:04 PM

Thanks Terri & Jane & Addy & Steph & Linda & Glynda - we're still here. :o Your words give me so much comfort. :)

Steph - I'll go easier on myself - if you go easier on yourself. :o
I think about how you only had 12 years with Pallie and here I am with 15 year old Angelina - and I'm feeling greedy! :o I wish Angelina would make the decision for me. I doubt I'll feel any peace otherwise. :( Instead she keeps giving me smiley face, sparkly eyes! But again, thankyou for your advice - it means so much to me that you took the time and shed the tears (and that goes for all of you :) )

Glynda - I'm so sorry that you and I are in the same position, but with The Oracle on the case, I'm sure Jojo has the best of care possible ((hugs))

I had Angelina on Milk Thistle up until the beginning of December - then gave her a 3 month break (learning from Leslie's experience with Squirt) and was going to restart the Milk Thistle this month. At the moment Angelina is being fussy (ate dry food last night & this morning) and it's hard to hide pills in there.

I have to find the next treat that I can wrap around pills. She's just decided that she doesn't like BBQ chicken anymore or roast pork. :confused: We haven't done an acth stim test since July. That was on 30mg of trilo once a day - shortly after we switched to 15mg BID and stayed that way until December. I should have done a stim while the dose was stable - but there was a serious illness in the family (still is) and the entire year got away from me. :o

I'm down to my last 10 trilo capsules and if Angelina doesn't feel like taking them, I won't force her. Perhaps the extra cortisol will help.

Glynda - if you haven't heard of something, then I'm wondering where this vet got her information! I'd trust you over a vet anyday! ;)

littleone1

03-02-2011, 10:19 PM

Just checking to see how everything is going.

Casey's Mom

03-03-2011, 12:14 AM

Hope is here for you John, how are you two doing today?

Lots of love and hugs,

Bichonluver3

03-03-2011, 03:08 AM

John,
I have just read through your thread and am so sorry that you are in this sad place. I am amazed at the incredible care you have taken of Angelina. She is one lucky dog and you are one lucky person to have had over 15 years with such a special friend. Whatever you decide, Angelina will just know it is because you love her so much. Remember, you will see her again one day and she will be the healthy, happy Angelina you knew. We are also standing beside you and are sending thoughts and prayers to you. We are sending healing light to our sweet Angelina in the hopes that she will improve.
Love and big hugs to you both,
Carrol & Chloe

John II

03-03-2011, 03:47 AM

Hi all,

Terri - we're both still here - thanks for checking. :o
Ellen - thanks for the continuing hope :)
Carrol - thanks for your kind words, thoughts and prayers, and healing light :)

It's 2 days without Trilo and 1 day without Metrogyl this morning I thought Angelina was a little better, maybe a little stronger. We went for a carry-walk across the road (carried her there - put her down on the grass). I think she's figured out that like a bicycle, she needs to travel at a certain speed to stay upright, and so Angelina moved fairly quickly - if awkwardly - to deliver her pee-mail. Then when she tumbled, I picked her up and carried her home.

Then Angelina had breakfast - including some Metrogyl and Milkthistle hidden inside a piece of frankfurt - but since then - she seems a little worse. So now I'm wondering about the Metrogyl. :confused:

Checking the Metrogyl factsheet - http://www.racgp.org.au/cmi/afcmetro.pdf

"If you take too much Metrogyl, you may feel disorientated, unsteadiness when walking and vomiting may occur."

And also:
"If you notice a persistent numbness, tingling or weakness of the arms or legs, stop taking Metrogyl and tell your doctor immediately."

And:
"Metrogyl may cause confusion, dizziness or hallucinations in some people."

And:
"Tell your doctor as soon as possible if you notice any of the following: tingling or numbness in the hands or feet, or muscle weakness... dizziness, unsteadiness when walking"

I asked the latest vet on Monday if she thought the Metrogyl might be at fault - she did not.

But I wonder. So... hmmm... :eek::confused::mad::confused::eek:
Think I'll discontinue the antibiotic as well.

AlisonandMia

03-03-2011, 04:01 AM

I think I'd discontinue it as well.

I don't know what dose she's on but I'd think it is possible that she needs/can only tolerate a small dose and maybe the standard dose amounts to an OD for her. This happens with older dogs (and people) - their ability to metabolize and clear drugs is diminished by age-related changes and suddenly a med which was previously well-tolerated becomes a problem.

Unsteadiness, apparent frailty and confusion is often what is seen, too (in people) - and it can be easily mistaken for simple "old age" and tragically often goes uninvestigated and unremedied. Meds (and particularly dosages of meds) always have to be a suspect when an oldster goes down hill in a short space of time, I think.

Alison

PS: Found this: http://www.vetcontact.com/en/art.php?a=572&t In your position I'd definitely stop giving it.

John II

03-03-2011, 04:35 AM

Thanks Alison - I hadn't seen that one and it lead me to this one:

http://veterinarynews.dvm360.com/dvm/article/articleDetail.jsp?id=113198

"It seems that most affected dogs recover within a week or two of drug withdrawal. Evans et al suggest that dogs treated with diazepam had a more rapid resolution of clinical signs than dogs treated with supportive therapy alone. In this study, the authors evaluated potential differences in the recovery time between dogs with metronidazole toxicosis treated with diazepam and a similar group that did not receive diazepam as part of the therapy. Diazepam is believed to facilitate the effects of the inhibitory neurotransmitter gamma-aminobutyric acid (GABA) within the vestibular system. Evans et al treated patients with a single IV bolus of diazepam followed by TID oral treatment for three days. Dogs treated with diazepam had an average response time of 13 hours (range 20 minutes to 24 hours) and an average recovery time of 38 hours (range 24-72 hours). Dogs that were not treated with diazepam had an average response time of 4.25 days (range 2-10) and an average recovery time of 11.6 days (range 5-21)."

I may be continuing to clutch at straws - but if Angelina's current problems are actually due to this... and if I had made that final decision... :(

AlisonandMia

03-03-2011, 04:38 AM

Diazapam would almost certainly make her unsteady too (while it is in her system).

My Zac had a paradoxical reaction to diazapam and went completely off his skull for a few hours!

Alison

John II

03-03-2011, 06:01 AM

Alison - yes I think I remember you saying that about Zac.

As much as I'd love to speed up an improvement - I'd hate to go from one problem to another. So, for the moment I think we'll just try "cold turkey" ans see what happens. :o

AlisonandMia

03-03-2011, 06:22 AM

I'd go for the cold turkey approach too. I remember a doctor saying to me that she really didn't like using drugs to ameliorate the effects of drugs -although it does definitely have its place, of course.

You really don't want to have any sort of "bad trip" (even if it is just unsteadiness) with the diazapam.

I think the fact that you saw what could have been improvement after a day off is a good sign. Hopefully it won't take too long to get out of her system.

Alison

John II

03-03-2011, 06:24 AM

Thanks for your help Alison - you may literally be a life-saver! (hug) :o

Franklin'sMum

03-03-2011, 06:28 AM

The thought that some of Angelina's problems could be caused by her medication is cause for great hope, and I'm so hoping you see improvement very soon :D.

Big hugs,
Jane, Franklin and Angel Bailey xxx

forscooter

03-03-2011, 12:39 PM

I'm sorry...I misread this.

John II

03-04-2011, 08:16 AM

Hi all - not much to report yet - early days yet :o

Harley PoMMom

03-04-2011, 10:05 AM

Beaming positive and healing energy your way. Keeping you and sweet Angelina in my thoughts and prayers.

Love and big hugs,
Lori

John II

03-07-2011, 03:15 AM

Thanks Jane, Beth & Lori :)

Still no real improvement :o

littleone1

03-07-2011, 01:18 PM

Sending positive thoughts and prayers that Angelina will start to improve. Sometimes it takes awhile.

frijole

03-07-2011, 10:15 PM

Sending lots of love John to both you and dear Angelina. xoxo Kim

SasAndYunah

03-08-2011, 08:04 AM

Not commenting much at all, but keeping an eye on the both of you :)

Hugs,

Sas and Yunah :)

Franklin'sMum

03-08-2011, 12:22 PM

Sending hugs and healing energy :)

Jane, Franklin and Angel Bailey xxx

John II

03-15-2011, 04:53 AM

Thanks Terri & Kim & Sas & Jane,

Status Report:
No Metrogyl since March 3.
No Trilostane since March 1.
And also no improvement. :-(
Although Angelina is only a little hungrier and no noticeable increase in thirst. The panting is there - but summer is lingering into autumn so, that may change with the weather.

John II

03-24-2011, 03:58 AM

Angelina my darling puppy girl was put to sleep at 17:17 March 24 2011. :'-(

Enough was enough. :( :( :( :( :( :( :( :( :( :( :( :( :( :( :(

BestBuddy

03-24-2011, 04:03 AM

Oh John I am so sorry you had to let her go. I know it is so hard but loving means letting go and Angelina is now free. I wish it was better news and my thoughts and prayers are with you.

Jenny

Spiceysmum

03-24-2011, 04:29 AM

John,
I am so sorry to hear about Angelina. My thoughts are with you at this sad time.

Linda

littleone1

03-24-2011, 04:42 AM

Oh John!

I am so very sorry to hear about Angelina. My thoughts and prayers are with you. I know this had to be a difficult decision for you, but you did what was best for Angelina. She knows how much you loved her. You did everything you could possibly do for her. RIP sweet Angelina.

(((((HUGS))))) and more (((((HUGS)))))

John II

03-24-2011, 06:50 AM

Thankyou dear Jenny & Linda & Terri for your kindness and sweet words.

I know it was her time. But I would have exchanged years of my life for more healthy and happy years with her. I don't love easily, and I don't love much, but I loved her completely from the very first moment she came into my life until the very last. And now I'm finding it difficult to breathe.

mytil

03-24-2011, 06:51 AM

Oh John,

I too am so very sorry your little Angelina has passed - my heart is with you. She knows you did everything you could for her.

(((((hugs))))))
Terry

labblab

03-24-2011, 07:46 AM

I would have exchanged years of my life for more healthy and happy years with her. I don't love easily, and I don't love much, but I loved her completely from the very first moment she came into my life until the very last.
John, the news about your Angelina brings tears to my eyes. Your loving tribute says it all. Absolutely everything. Angelina's was a life well-lived and well-loved. No pup could ever ask for more.

My thoughts and my prayers are with you. I believe that Angelina's spirit has been released, but I know that your own spirit is aching from the pain. We will always be here for you, John.

Sending many hugs across the miles,
Marianne

frijole

03-24-2011, 08:08 AM

Oh John I am sorry! Sending healing thoughts and strength your way. I know its a huge loss and hope that all the wonderful memories get you thru the coming days. Run free of pain dear Angelina. RIP sweet one. Kim

Casey's Mom

03-24-2011, 08:14 AM

John I am so very sorry - you did so much for her she knew that the love you had for her is never ending. I wish I could help heal your pain but just know I am here for you with love and support.

Love and many hugs,

John II

03-24-2011, 08:24 AM

Thankyou Terry, Marianne, Kim & Ellen.

Angelina was Fifteen Years, Six Months and One Day Old.
She weighed 7.2kg at the end.
I was shocked to see that today.
She lost 6 kilos since she started treatment.

mypuppy

03-24-2011, 08:30 AM

Dear John,

Very sad. We feel your loss as if it was our own. God bless you and your precious baby girl.

Tight hugs and much love. Xo Jeanette and Princess

k9diabetes

03-24-2011, 09:14 AM

I am so very sorry to learn of Angelina's passing. No dog has ever had a better friend than you to her, blessing her life as much as she blessed yours.

With greatest sympathy,

Natalie

Cindy Thoman

03-24-2011, 09:15 AM

John, I am so very sorry for your loss. Your little angel was beautiful.

xoxo
Cindy and Alex

lulusmom

03-24-2011, 09:25 AM

John, I am so very sorry for your loss. I never would have guessed that you don't love easy because your love for Angelina was so incredibly apparent. She was a lucky girl, indeed, to have you for a dad. My thoughts and prayers are with you.

Glynda

Squirt's Mom

03-24-2011, 09:29 AM

My dearest Brother T,

You and Angelina gave your all, loving and sharing every step of way through your lives together. There is no doubt that she loved you with the same devotion that you did her. I am so, so sorry for your loss, John.

Our deepest sympathies and love, dear friend,
Leslie, Squirt, Trinket, Brick and our Angels, Ruby and Crystal

sunimist

03-24-2011, 10:14 AM

John, my heart is so heavy for you. Sweet Angelina was so blessed to have you for a dad. You two have been an inspiration and blessing
to me in so many ways. You are in my thoughts and prayers.
RIP sweet girl.

(((HUGS)))

Shelba

Squirt's Mom

03-24-2011, 10:17 AM

A Simple Message From Your Pet

by Ken D. Conover

To have loved and then said farewell is better than to have never loved at all.
For all of the times that you stooped and touched my head, fed me my favorite treat and
returned the love that I so unconditionally gave to you. For the care that you gave to me
so unselfishly. For all of these things I am grateful and thankful. I ask that you grieve
not for the loss but rejoice in the fact that we lived, loved and touched each other's lives.
My life was fuller because you were there, not as owner, but as my friend. Today, I am
as I was in my youth. The grass is always green, butterflies flit among fthe flowers and
the sun shines gently down upon all of God's creatures. I can run, jump and play
and do all of the things that I did in my youth. There is no sickness, no aching joints
and no regrets and no aging. We await the arrival of our lifelong companions and know
that togetherness is forever. You live in our hearts as we do in yours. Companions such
as you are very rare and unique. Don't hold the love that you have within yourself.
Give it to another like me and then I will live forever. For love never really dies,
and you are loved and missed as surely as we are.

Your pet in heaven.

corgipallie

03-24-2011, 11:12 AM

Spiderman,
I'm just now seeing this. I'm so so so very sorry. You did EVERYTHING you could for her and gave her an amazing life with the most love ever possible. I'm thinking of you.

Love,
Steph, Gypsy, Apollo, Alfie and Angel Pallie

Bichonluver3

03-24-2011, 01:34 PM

Dear John,
My heart is breaking for you. The picture of little Angelina always brought a smile. You were an amazing Dad, giving her a lifetime of love and caring. She is not gone from you. She has a little, special place in your soul that will always be her's. You fought a good fight against something beyond your control, but when it was time, you took control and gave her peace. I hope that before long the aching will start to be replaced by happy memories of your life together.
To sweet Angelina: Run free, sweet angel, through the fields of heaven with all your new friends, May the sun warm your face and gentle breezes be at your back. Watch over your Dad and all of us here fighting battles. I will look in the California desert sky for your twinkling star. Until we all meet at the Rainbow Bridge, precious princess....
All my love and healing thoughts and extra special big hugs to the best Dad,
Carrol & Chloe

Buffaloe

03-24-2011, 02:35 PM

John,

I am so sorry you lost your sweet Angelina. I know your love for her was as deep as the sea and the loss of a dog is absolutely devastating. You did a phenominal job of taking care of her but finally it gets to where there's nothing more you can do.

You do know that she lived a very long and wonderful life. I know your heart is broken now but you mark my words....in a while she will visit you and let you know she is doing great. She is a young, strong girl now, in her prime running and playing, doing all the things she loved to do. And she's got her eye on you.

Ken

Sabre's Mum

03-24-2011, 03:22 PM

Oh John ... I am so sorry for your loss of dear Angelina. My thoughts are with you from across the Tasman.

Angela and Flynn

jrepac

03-24-2011, 08:04 PM

So sorry to hear about Angelina; she had a long life, but as we all know, it's never enough time! It's very hard to see them go, but something of a relief to free them from their illnesses.

Jeff & Angel Mandy

Roxee's Dad

03-24-2011, 09:14 PM

My Dear Brother John,

I am so very sorry:( I know this is such a very difficult time for you and am sending healing thoughts your way. I always felt so close to Angelina, maybe it was because your girl and mine were so close in treatment, maybe it was just her spirit. My heart hurts for you and the pain you are going through.

I will miss you little girl. Rest in peace Angelina, you are our newest and brightest star in the sky. Give my Roxee a smooch from me.

Big Huge (((HUGS)))

Always your Brother.

bev

03-24-2011, 10:17 PM

John,
I am so sorry for your loss of your sweet baby. You faced a day that I am so dreading. I understand about trading years of your life for theirs, if only.....
Prayers for you,
Beverly

MiniSchnauzerMom

03-25-2011, 12:01 AM

John,

I am so very, very sorry that your sweet Angelina has passed. You are in my thoughts and in my heart.

Peace, precious Angelina.

Louise

John II

03-25-2011, 03:51 AM

24 hours have passed. :(

It keeps hitting me in waves. I'm Ok. Then I'm not. Over and over. :(
She's gone. :(
I never get to hold her again, like I used to, everyday. :(
She'll never lick the end of my nose again.
She'll never be so very happy to see me come home again, regardless of how long or short my absence :-(

http://www.youtube.com/watch?v=hJoBmVfwJTE

It's all gone.

I question every decision I made. :(
I look at the new thread title. :(
"Angelina has passed"
and I think "Angelina was pushed".
I could have done more, I could have fought harder. :(

I probably shouldn't post anything for a while.

Last night, I wrote about what happened yesterday, but it might be a case of too much information.
I was afraid to go to sleep. I was afraid to dream. I was afraid to wake up to this new reality. :(

John II

03-25-2011, 04:00 AM

But one more thing.

Thank you all so much for your kindness, for your empathy, for your hope, for your help, and now for your tears. It's such a comfort to know there are others out there who understand. Thankyou.

Thankyou Louise, Beverly, Brother John, Jeff, Angela, Ken, Carrol, Steph and Leslie, Shelba, Glynda, Cindy, Natalie and Jeanette.

Angelina has been buried under a weeping conifer and I've placed and lit a candle at the site. :(

bernie47

03-25-2011, 06:27 AM

I to know just what you are going through , i lost my girl 4 months ago ,and i think about her every day ..I am sure god has a special place for our fur babies, that have suffered so on this earth ..special ((( hugs))) from our family to yours .. may you take comfort in this poem .

Catherine Ken & Natcho ..

The Last Battle (http://www.petloss.com/poems/maingrp/lastbatt.htm)

SasAndYunah

03-25-2011, 08:39 AM

Dear John,

I am so very sorry to read that you had to let Angelina go. I know, as many here do, how incredably it hurts and how devestated we feel at first. Don't try to second guess yourself, no one knows what if... And sometimes, or maybe even many times, trying to do "more" is not in the animals best interest...but merely our own desire to keep them a bit longer with us. They have loved us all their lives without being selfish, without asking anything in return and without hidden agenda's. If there's one time in their life we need to show them that same selfishless love, that same attitude of not wanting anything in return, and forget about our own hidden agenda's, it's at the end of their lives, young or old. And you did just that, you gave her all the respect she has earned throughout her life with you by doing right by her...forsaking your own feelings. There's no greater love then that. And any dog that can leave this earth in that manner, is a blessed dog...

The time will come, one day, when you will feel good about you not trading years of your life because that way, you would have cheated another dog that desperately needs you, out of some good, safe and loving years together with you. Because you are one of the most loving and caring persons I know...and I know a lot :)

Big hugs and a lot of strength,

Saskia and Yunah.

zoesmom

03-25-2011, 11:32 AM

John - I am so sorry. Sas has said it perfectly. Angelina was a blessed dog and your final gift to her was a selfless act of love. RIP, dear Angelina. Sue

Squirt's Mom

03-25-2011, 11:44 AM

Because you are one of the most loving and caring persons I know...

Dearest Bro T,

Saskia hit the nail on the head, smack on! Everything, everyone, who comes in contact with you feels this immediately. You take spiders back outside, for crying out loud! You worried over a lizard with missing toes; you cook for and feed every living thing in your world. What a blessing to find oneself IN your world!

Angelina was blessed more than we will ever truly understand but she knows. She carries this knowledge with her still, always, deep in her soul that is now free from the pain and loss of dignity aging cost her. And her love for you remains as strong as ever. For now, she knows you need to grieve but the day will come when she lets you know she is never far away. One of these days you will feel the barest tickle on the end of your nose and you will know that your sweet precious girl has kissed you once again and the tears will come once more, but this time they will cleanse you.

I told you this when you and Angie first came to us and I will say it again - you are not alone on this journey, we are with you every step of the way. You never walk alone, Brother, never.

Hugs,
Leslie and the gang

May I Go

Do you think the time is right?
May I say goodbye to pain filled days and endless lonely nights?
I've lived my life and done my best, an example tried to be.
So can I take that step beyond, and set my spirit free?
I didn't want to go at first, I fought with all my might.
But something seems to draw me now to a warm and living light.
I want to go, I really do; it's difficult to stay.
But I will try as best I can to live just one more day.
To give you time to care for me and share your love and fears.
I know you're sad and afraid, because I see your tears.
I'll not be far, I promise that, and hope you'll always know,
That my spirit will be close to you wherever you may go.
Thank you so for loving me. You know I love you too,
And that's why it's hard to say goodbye and end this life with you.
So hold me now just one more time and let me hear you say,
Because you care so much for me, you'll let me go today.

by Susan A. Jackson

marie adams

03-25-2011, 11:58 AM

Oh John,

How I know what you are feeling....It has been a little over 2 months since I lost Maddie. It does get easier, but then it doesn't. What you said about not getting to ...... any more so hit home!!! :( I still have my moments. I just lost my mother 2 weeks ago and it now makes it hard again because I think of losing Maddie. A client asked me yesterday if losing Maddie was harding than losing my mother--my response was yes because I was with Maddie 24/7 and I didn't see my mother everyday--both are hard, but when you care for a being everyday and are trying so hard to make them better with the Cushings and you got it under control, but something else comes along and takes them from you....it is hard!!!:(:( My client said it was many years ago he lost his dog and he still isn't over it and for right now doesn't want to go through the pain again, but I got him talking about aussies and he said that is the only dog he will get; so there is hope for him. :D:D

Take care!!! There are going to be moments and you think you see them around the house, but the joy is in the stories you remember of the silly things they use to do--that is what brings a smile to your face!!!:):)

Harley PoMMom

03-25-2011, 05:07 PM

Oh John,

I am so, so sorry and I wish that I could ease this pain that you are going through. Please know we are here for you, my dear friend, and we love you so very much.

With much love and big hugs,
Lori

apollo6

03-26-2011, 06:17 PM

Dear John
May your sweet Angelina be a peace.
Sonja and Apollo

Wally P's Mom

03-27-2011, 12:44 AM

John:

Words can not wipe away the pain you feel now. I lost my Wally over a week ago and still miss him beyond belief.

I have cried. I swear I have seen him lying on the bed. My chest feels very heavy. Every thing that I am sure you are feeling now.

My sadness has eased some what. Not gone away completely. My husband insisted that we "look" at puppies. No one did not come home. However, I learned that there is a place in my heart for one more and that would never diminish the love for my Wally. Today we did not add another family member, but one day we will.

I wish that one day you will come to this realization. I wish I could remove the sadness you feel today. It is a pain that no one should ever experience.

Marge

Franklin'sMum

03-27-2011, 03:43 AM

Dearest John,

I am so very sorry for the loss of beautiful Angelina. Your love for her is so clearly evident in everything you write, and so is your heartbreak. She was so very blessed to have you as her person, and I know that you know how blessed you were to be her person.

If there was anything any of us could do to ease your pain, you know we would. We do understand the despair you feel, and share your tears. Angelina is free from her pain, because you were loving and selfless enough to make that pain yours.

Sending thoughts and prayers to you and your family, and giant (((HUGS))),
Jane, Franklin and Angel Bailey

John II

03-27-2011, 08:33 AM

OK 3 days have passed. I think the key is to be distracted.

But then I find something of hers...

My Aunt & her dogs visited today. I thought that would be hard, but it might have been helpful to see two healthy dogs moving freely (up on furniture and down) and realise how much mobility my girl had lost. Anyway, my Aunt left with the remainder of Angelina's food, Schmackos and flea treatments. So there's less stuff around to remind me. :'-(

I'm hoping to be able to respond to your kind messages. I'll take a deep breath, grab a few tissues, and here we go:

Catherine - even now I can learn from those who have walked this path to it's sad conclusion before me. Thankyou for taking the time to share your thoughts, hugs and the poem (hugs back at you)

Saskia - you are a true guide, "dogworthy life" stayed in the back of my head since I first read it in your thread. I tried so hard to get Angelina back to that dogworthy life. And now you're here to try to soothe my self doubts. Thankyou so much for your kind words.

Sue - Thankyou your message comforts me.

Leslie - My twitcher has been disconnected! :( (not really - I have to turn this Angelina part of my attention to my human charges - so I twitch on!) Thankyou for my appraisal :'-) The poem, and this line you wrote:

One of these days you will feel the barest tickle on the end of your nose and you will know that your sweet precious girl has kissed you once again
And for keeping me company on the path!

Marie - Thankyou, for putting your grief aside and taking the time to console me. I'm so sorry to hear of the loss of your mother. ((Hugs)) Thankyou for sharing your experience with me. RIP Maddie.

Thankyou Lori & Sonja - I may have to speed up now, my throat is aching again. But I want to get up to date with the thankyous, to all of you who have taken the time to ease my sadness and self-doubt.

Marge - I am so amazed by those who can put aside their own grief to console me! Let's share a tearful cyber-hug at our mutual loss. I hope Wally and Angelina are racing about the green fields together, young again and joyful again. With Maddie and all the others lost to us, who now wait for us to rejoin them.

Jane - who has become my guardian angel. Thankyou for your words here and your heavy-duty consoling on FB. I don't have the words to convey my appreciation for all you have done. ((((hugs)))

Oh, could someone with the proper authority change Angelina's age to 15 and a half years and weight to 7.2kg? Thanks.

labblab

03-27-2011, 08:58 AM

John, 'tis done. And it was my honor to perform this final task on behalf of dear Angelina.

Marianne

Bichonluver3

03-27-2011, 12:11 PM

Dearest John,
Just checking in on you. I know how much you must still be hurting but I also know it must be of some comfort to see how many caring friends you have here to support you. What you have given comes back many times over and you and Angelina have given to each and every one of us. We are standing beside you now.
Love & hugs,
Carrol

Dollydog

03-29-2011, 10:25 PM

Hello John,
I'm so sorry to hear that you had to let Angelina go and that you have to go through this terrible time. I hope that you do keep distracted till the pain eases and the wonderful memories are in the forefront of your mind and heart. Please be kind to yourself at this time....
Jo-Ann & my Dollydog Angel

John II

03-31-2011, 03:37 AM

Thankyou Carrol for checking in :o You're right - it is a comfort to receive so many messages from friends. :) I hope Angelina's story could be of some help to those who come after us. :o

Jo-Ann thankyou for your hopes & words. :o

The first week just ticked over. As I do everyday, at this time, I lit a candle at her grave. I blow it out before I go to bed. :(

Angelina, One week ago I sent you away. I miss you so much my puppy girl.

:'-(

SasAndYunah

03-31-2011, 04:43 AM

Dear John,

As sure as I am that Angelina's life touched many, and as sure as I am that Angelina's passing is mourned by many, I am as sure that her story will help many as well :) Apart from helping each other on this board, for me, perhaps the greatest gift of this board is the fact that the lives of all dogs that came here, will always be cherished and will always have an impact on numerous people from litterally all over the world and therefore on other dogs as well...

Hang in there friend :)

Saskia and Yunah :)

clydetheboosmom

04-04-2011, 12:18 PM

John -

I am thinking of you again. Hoping you are doing as well as you can. Hugs....and more hugs.

Lynne, Bailey & Angel Clyde

John II

04-07-2011, 07:38 AM

Thankyou Saskia & Lynne :'-)

It's now two weeks since I lost Angelina. I keep hoping I'll wake up and find her young, healthy and playful. I'd so much like to discover this has all been just a dream. :'-(

Yesterday I tried to notify the local council that she had passed. There's a 28 day deadline to inform them of a registered pet's passing. They want me to send a signed letter, with microchip number as a sort of statutary declaration. Seems my call wasn't good enough. Heartless people. I was already in tears just trying to make the call. :mad:

Why do we have local government again? :mad:

bgdavis

04-07-2011, 09:13 AM

John,

I'm so sorry for the loss of your long-time puppy girl, Angelina. To let one of our 'babies' go is amongst the hardest things we will ever do. Don't doubt yourself. Angelina knew you loved her completely.

Bonnie and Angel Criss

John II

04-09-2011, 10:36 AM

Thankyou Bonnie. :)

John II

04-09-2011, 11:01 AM

Hello all. It's time for me to end Angelina's story. I wrote the following the night after my little girl was put to sleep. I planned to polish it a bit, but couldn't bring myself to reread it until just now, 16 days later. If you don't feel like becoming a mess like I am right now, perhaps you should skip this post - it may be too descriptive:

It’s past 1am, if I was going to do this I should have done it earlier. I should go to bed.

But... I am afraid to sleep, I am afraid to dream, for I know that in my dreams I show myself no kindness. I show myself no mercy.

And then, if I make it through the night unscathed, I’m afraid to wake. I’m afraid of that moment when reality will all come rushing back in a wave and I’ll remember that she is gone.

How can she be gone?

Her food is still here. Her treats are still here. Her medications are still here.

This wasn’t how I had planned it. I was just going to take her to Vet #2 to see what she thought. Then I would thank her for her service and make an appointment for a house call with Vet #1 on Monday. There would be time to prepare. To say goodbye.

But Angelina was deteriorating, she was having increasing trouble walking without falling over. I held her upright and secure when she ate, drank, peed and pooped. When I released her, she might launch herself at her target, but it was no longer a straight line, as her unstable legs led her off course.

When I drove her to Vet #2, she lay on the seat beside me. Not sat. Not eagerly moving all about. Just lay. Though at one point she struggled to rise, but could not. And whimpered. After parking, I carried her to the strip of grass, near the parking lot, and put her down, with my hands on either side to steady her. She could not ever just go, she had to find the right spot. So she moved off, and nose dived. I picked her up and plucked the leaf from her nose. Gave up and went inside.

I put Angelina on the digital scale and as usual the reading went all over the place, starting at 6kg – going to 8kg, then settling at 7.2kg. She’d lost weight, despite eating more.

Finally, the Vet called us in. She asked how Angelina was doing. “Not great”, I said. I told the Vet about the lameness, the tumbling and the nosedives. Told her I’d stopped the medication. I expected to be yelled at, but wasn’t. The Vet put a towel on the floor and wanted to see Angelina walk. I put her down released her and she toppled straight away.

We put her back on the table. I held Angelina upright while the Vet examined her. Her liver and spleen were enlarged, her forelimbs were stiff, the vet suspected multiple lesions on the spine, causing the mobility problems. She suggested seeing a Neurologist. I had the usual moment of hope. The vet said that because of Angelina’s advanced age, the Neurologist probably would choose not to operate – but we could see what she had to say. By this time, I was holding Angelina in my arms like a baby. She looked tired. And I knew I couldn’t put her through any more of this.

The vet suggested I should have the euthanasia talk with my family. I already had. I had no intention of putting Angelina to sleep today, I had things still to do. I hadn’t taken her pawprint for a possible future tattoo yet. I’d made a crappy attempt at a tombstone which needed a redo.

But... I made a point of having her say goodbye to her family. To my mother, and to my father, who’s face she licked.

Do I take her home, and let her continue to fall about while I wait for a housecall? Or do I end her suffering now? I had promised myself I wouldn’t let her die afraid. I had promised myself, she would die at home, with her loved ones. I had promised myself, she would die in my arms.

But... we were there. In a moment it would be done, and there would be no more suffering.

For Angelina.

The vet asked me officially if I wanted to put Angelina to sleep. I couldn’t speak. I finally croaked: “Please” through my tears and sobs. She went off to print a release form, which I signed without reading.
The vet said the best position would be on the table. I was given a seat, so I’d be on the same level. They shaved her foreleg, cut a vein and there was the syringe, full of that dark green liquid. The vet asked if I wanted her to proceed.

“Wait”, I croaked, trying to steel myself, “OK” I sobbed after a moment.

I watched the plunger slowly depress. Slower it seemed than when my cat was put to sleep. But that had been a different vet. I tore my eyes away from the green death. And stared into Angelina’s eyes. I leaned in to my darling girl. And as she died , she licked my nose... one... last... time...

And then she was gone. She was gone. She was gone. She was gone. She was gone. She was gone. She was gone.

But she lay there warm. The Vet listened for a heartbeat and found none. Then left us alone.

I stroked Angelina’s head, rubbed her belly, ran my fingers through her hair. She felt alive...

After a while I thought I had composed myself enough. I asked for the bill and a copy of Angelina’s file. Angelina was placed in a body bag and a towel wrapped around it. Did I want a cup of coffee? No thank you. The Vet asked me what I wanted to do, have her cremated, or bury her at home? I said I would bury her at home. Did I want to go home and come back for her, when I’d had time to recover? No, I’d take her now. The Vet carried Angelina to the car for me. And placed her on the passenger seat. I thanked the vet for all her help and drove home. Occasionally reaching out and touching her, as I always did. But this time through plastic.

I made it home. Turned off the engine. Sat there. Crying. Got out of the car. Threw up. Went around to the passenger side. Picked up my little girl, and carried her to the backyard. My father watched me approaching. His heart breaking.

I placed my bundle on the bench where she was always groomed... and lost it for a while. I went inside to tell my mother. And hoped that after the multiple cardiac problems she’d experienced in the last year that this sadness wouldn’t kill her. I’m still hoping that.

I untied the string of the bag, and opened it. Running my fingers through her hair again. I leaned down and kissed her forehead, three times, I nuzzled her neck and tried to memorise her scent.

A few weeks earlier, I had bought a metal, probably steel, toolbox. I wanted her to be protected from the dirt, and not crushed by it.

I placed paper in the bottom of the box. Then Angelina’s towel. Then Angelina, still in the bag. After a while I decided to take away the bag. Then rearranged the towel around Angelina, placed three of her tennis balls near her nose. Covered her with another towel. Placed a copy of today’s newspaper, and a few Schmackos in their bag on top.

Again, if I had thought, for one second... I would have fed her every Schmacko in the house.

I buried Angelina under a weeping conifer, alongside the southern fence.

Now it’s past 2am. And I still fear sleep.

http://www.k9cushings.com/forum/picture.php?albumid=96&pictureid=2596
Angelina's Grave, with a row of bromeliads planted over it. The flowers will bloom at this time of year.