Concerned about treating with Lysodren for Pebbles, 9 y/o Yorkie [Pebbles has passed]

[ShannonJ92]

This is my first post here and it may not be filled with as much detailed info as I'd like to offer but I'm currently very overwhelmed. Pebbles is my 9-year-old Yorkie who was diagnosed with Cushing's last week after having the ACTH and LDDS tests and also ultrasound plus a urinalysis. Initially, the week before, she went in for a lump removal by her rear end but the pre-anesthetic blood work wouldn't allow it. I don't have those results yet, we've asked the they be mailed to us. In May she had a dental cleaning done (including the pre-anesthetic blood work) and no indication at that time that I'm aware of.

As of right now, Pebbles' main symptoms are increased thirst and a swollen belly. The ultrasound showed enlarged adrenal glands and some protein in her urine. She actually has had a decrease in her appetite, which I understand is the opposite of what is typical for Cushing's dogs. If I were to elaborate, she has been mainly on EN canned food since her 1st birthday. That was when she had her first bout of pancreatitis, and has had several bouts a year since then - the span between bouts varies and are random. She seems to be interested in my other dogs' food though still, I have two 1 1/2-year-old sister Lhasa Apso/Poodle mixes. I can't give Pebbles much of that food though due to fat levels, I put tiny bits on her EN just for a touch of that flavor. Still her overall consumption has gone down. She typically weighed about 12 lbs. until maybe a year ago or so. Was told initially it was a good thing as she was always considered a little chubby for a Yorkie.

It's been discussed with our vet about what the best way to go would be. He seems to be suggesting Lysodren and is currently trying to figure out the dosage, as Pebbles is only 10 lbs. and had the underlying pancreatitis history. Also worth noting is she can't even handle routine rabies and DHLPP shots, the last times she had them they led us straight to the ER vet (for bad pancreaitis flares). Now she's legally cleared from having to have them.

So, now upon doing as much research as possible, I'm on the fence about even trying Lysodren. I'm very scared about the potential side effects, especially given her medical history. When I asked our vet on the phone tonight if he was even leaning one way or the other for what to do he said "it's a coin toss". He is an excellent vet, but I'm wondering why one of the other drugs with potentially less side effects wouldn't be favored. Is that something I should be pushing for. Initially he also made mention that sometimes it's better to not treat as the outcome could be made more complicated (if the med intervention doesn't work properly). I'm paraphrasing and hope I'm getting that right.

I have NO IDEA what the best route is. I do know that if we take the chance with Lysodren the first day or two will be done so at the vet's office, which is our safer bet should there be any reaction. But, how do we know if the risk is worth taking?

In another elaboration, and what makes this even harder (as if it isn't hard enough the way it is) is we lost two dogs in the span of less than one year - Frosty in April '10, an almost 17-year-old mix who was/is my heart and Bam-Bam in Mar. '11, an almost 14-year-old Shih-Tzu who was the gentlest guy ever. They were unrelated to Cushing's as far as we know but I'm still healing from each. How is this happening with Pebbles? I'm praying and hoping she still will enrich our lives for some time but I am very worried.

Anyone here who would graciously offer advice on Lysodren (I've read through the page about it here and, again, have been doing research on most of the drugs) I would greatly appreciate some help. What about Trilostane? Which is safer with an underlying health issue? We not only have to be concerned with side effects related to Cushing's but also causing her to go into pancreatitis or even kidney, etc., complications.

I'm so overwhelmed. Thanks for listening and thanks in advance for any advice/help/insight.

~Shannon

[ShannonJ92]

Also, forgot to ask, why does Cushing's make dogs resistant/unable to jump?

[StarDeb55]

Welcome to you & Pebbles! I only have a moment to post, so will tell you a couple of quick things. Both lysodren & trilostane are very serious drugs, but they are life-saving drugs. I, now, have successfully treated 2 pups with lysodren. My first boy, Barkley, was successfully treated with lyso for nearly eight years, crossing the bridge at 15. There seems to be somewhat of a misconception about trilostane being the safer alternative. Trilo is really no safer that lyso. Proper protocols for dosing, loading, & monitoring need to be strictly followed. We have seen repeatedly on these boards where a vet starts flying by the "seat of their pants", doesn't follow protocol, & the pup pays the price.

When it comes to the inability to jump, this is probably due to the muscle wasting caused by Cushings. All of the Cushing's symptoms are due to the overproduction of cortisol by the adrenals. Once the cortisol is brought down to more healthy levels, symptoms will resolve. The muscle wasting will probably be one of the last symptoms to resolve.

Debbie

[labblab]

Hi Shannon,

Welcome to you and Pebbles! Like Debbie, unfortunately I have only a few moments to post right now. But I do want to add a couple of quck thoughts. Again, like Debbie, I do not believe that either Lysodren or trilostane is "safer," one over the other. I totally agree with her that the safety of either is totally dependent upon the wisdom with which the drug is used and the appropriateness of the monitoring.

Having said that, due to the different mechanisms by which the two drugs control cortisol production, the effects of trilostane can generally be reversed more quickly in the event that treatment needs to be discontinued for any reason. And I suspect this is the reason why some people describe it as being "safer." Given Pebbles' situation -- the recurrent pancreatitis, and the lack of appetite which will make it more difficult to outwardly judge the effectiveness of either medication -- I think you might be well-served to ask for a consultation with an internal medicine specialist. An IMS is a vet who has received specialized training in more complicated disorders and who may have more extensive experience with both Lysodren and trilostane than does your general practice vet. It sounds as if your regular vet has some definite reservations about proceeding with treatment for Pebbles. And if this is the case, I think it could be very worthwhile to include a specialist's opinion before selecting a medication and making the decision to move forward.

I'll come back in just a little while and add a link that can help you locate an internal medicine specialist in your area. In the meantime, once again, welcome to you both. And please know that you can take whatever time you need to arrive at a decision with which you are comfortable. Cushing's is generally a slowly progressing disease, and taking some extra time on the front end may be well worth it in the long run.

Marianne

[labblab]

OK, I'm back again with that link re: locating an internal medicine specialist:

http://www.k9cushings.com/forum/showthread.php?t=182

If you do decide to consult with an IMS, this does not mean that you would be losing your regular vet. But instead, you both would be able to consider a specialist's opinion as to what might be the preferred strategy for treating Pebbles.

I do want you to know how sorry I am about your earlier losses. Each loss is such a blow, and they have to leave you all the more worried about what the future holds for Pebbles. But I am happy to report that we have witnessed many success stories here, and I have every hope and expectation that Pebbles will be among them! ;)

Marianne

[Keiko's Mom]

Hi. My dog, Keiko, takes Vetoryl...I don't know much about your medicine. Keiko could not jump up on the couch for quite awhile, but she can now. Rear leg muscles seem to weeken and waste...I walk my dog (slow and not too long) every day and it seems to help. I understand that the "fright or flight" seems to change....noises while we walk seem to bother her more....just for a minute...then she's okay. Good luck....you are in good hands with the peolpe here!

[ShannonJ92]

Thank you for the help so far. Much appreciated. Regarding the IMS, I think I ended up with the page I was supposed to and for PA there is nothing within reasonable distance for us to get to. I really wish there was, and it's worth noting we can't travel that much further than an hour (my mom is in and out of the hospital a lot and my dad and I have our own health issues as well). My vet mentioned Allentown, even Cornell, but realistically we just can't get there.

It seems to be from what I've read, difficult to get the dose at the proper/ideal levels for Lysodren and the others as well which is a concern in and of itself but my concern is worse given the pancreatitis history. It's like I want to try, because maybe it will help her in great ways, yet what if it not only makes her more ill Cushing's-wise but also worsens her pancreas, kidneys, etc.? I think our vet is being cautious at this point and I feel that understandable, weighing the pros and cons. I asked him if he's ever treated a dog with Lysodren that already had an underlying problem and he said he'd done so in dogs who had diabetes.

I also read that Lysodren should be given with food (preferably fatty meals?)... given that Pebbles appetite has gone down and can't have fatty foods anyway (which has been the case for over 8 years now she's been on the EN) will that affect Lysodren's performance? And if so, for the better or worse? I saw on a site last night that it should never be given to dogs without a very strong appetite, something Pebbles always had until recently - she's become picky with the EN in the last couple weeks but if I fed her what I think she'd eat it would likely throw her into more pancreatitis flares.

So, to those who have more experience with this, if Pebbles was your dog in the situation with the already sensitive issue of pancreatitis, would you proceed with Lysodren treatment? Especially if done so the first day or couple days at the vet's office? I'm so fearful yet somewhat hopeful and just can't figure out what's the best way to go. Having this all come on the heels of two losses is almost too much.

I will check here as often as I can for replies and post as much as possible. I'm glad to have found this board and thank you all for welcoming me and Pebbles.

~Shannon

[labblab]

Shannon, your concerns are certainly very reasonable. One of our moderators, Lori, also struggled with pancreatitis issues with her Cushpup, so I am hoping that she will have a chance to check in here and offer you her thoughts. From my own limited knowledge, it does seem as though the combination of pancreatitis and Cushing's suffers from the problem of the "chicken or the egg" -- we know that untreated Cushing's can increase the incidence of pancreatitis, but pancreatitis flares also have the potential to skew Cushing's diagnostics and testing. So it can be hard to know exactly whether or when to treat.

Because these are difficult questions, I am doubly glad that you have found us. We are not vets, so we may not be able to answer all your questions. But we are surely here to listen and to offer our thoughts as you sort through your questions. So definitely, please do keep checking in.

Marianne

[Harley PoMMom]

Hi Shannon,

Sorry I only have a moment to post but I did want to welcome you and Pebbles to our forum! My boy, Harley, suffered with pancreatitis and dealing with the Cushing's was difficult. When I did try loading him with the Lysodren, his pancreas did flare up and the Lysodren did have to be stopped.

I did try treating him with Vetoryl but unfortunately he started to have kidney problems which I truly believe that the Vetoryl had nothing to do with creating.

If Pebbles were my dog, I would try treating her with a low starting dose of Vetoryl.

I have done a lot of research about pancreatitis so if I can help in any way, please do not hesitate to ask any questions.

I will stop by later ( I'm at work right now :eek:)

Love and hugs,
Lori

[addy]

Hi and Welcome,

I did not have to deal with pancreatitis but with colitis. My dog started on a low dose of Trilostane. An endocrinologist thought Lysodren would be too hard on my dog because I would have to give huge doses to load her and you can lose the load if you stop it for more than a day or two;with Trilostane, you can start it and stop it.

I think Lori is right and perhaps you should discuss Trilostane with your vet.

Keep reading and learning all you can.

Hugs,Addy

[Harley PoMMom]

Concerning an IMS, I first took Harley to The Matthew J. Ryan Veterinary Hospital in Philadelphia and we saw Dr O'Neil (IMS), this was a 2 hour drive one-way for me.

Harley's GP vet recommended Dr Petrus (IMS) from the Chesepeake Vet. Referral Center in Maryland, this was only a 1 hour drive (one-way) from where I live.

Love and hugs,
Lori

[ShannonJ92]

I'm hoping someone sees this tonight still. To my surprise, after being told yesterday it'd be another couple days before the dosage for Pebbles would be ready, etc., we got a phone call after 7 saying we could drop her off in the early AM to begin the Lysodren. I am so flustered, don't know what to do. In the event of a bad reaction, is it reversible? Getting her back to a safer state I mean, I've read about the Prednisone but if it puts her in a worse pancreatic flare and or upsets the kidneys... I feel very panicked despite trying to think positively. I'm a 'glass half empty' kind of person anyway. If we proceed, I would GREATLY appreciate any positive thoughts, energy and/or prayers that you would be willing to send Pebbles tomorrow and the coming days. SOOOO nervous...

[labblab]

Shannon, if you do decide to proceed in the morning, by all means we will be sending tons of positive thoughts. However, just because the medication has arrived, I wouldn't think that you would be obligated to rush into starting the treatment until you feel more settled about the decision. The medication will still be there whenever you decide you're ready...:o

As far as leaving Pebbles at the vet during the loading phase -- how does she usually do at the vet? Is she stressed by being there? In the alternative, would you or a family member be able to stay home with Pebbles when she begins treatment? As long as you would be able to take Pebbles in to the vet in the event of an emergency, I'm just thinking that it would be better for her to stay in her own familiar environment during the loading phase. I'm thinking that less stress might make it less likely that she might suffer a flare of pancreatitis. And also, the signs that loading is complete are often very subtle, and family members who are familiar with her regular behavior will be more likely to notice these types of cues and changes.

These are just a few thoughts to throw out there. And if you've already decided to proceed in the morning, I do not want to make you even more nervous by questioning your approach. But if you don't yet feel suitably comfortable about the decision and the arrangements, I'd encourage you to take some more time before launching into treatment.

Marianne

[Harley PoMMom]

Lysodren takes about 48 hours to clear a dog's system, Trilostane/Vetoryl takes only 8-10 hours to clear. This is one of several reasons why I believe Trilostane/Vetoryl is better suited for Pebbles over Lysodren.

Which ever medicine you decide on treating Pebbles with we will definitely be here to support you.

Love and hugs,
Lori

[ShannonJ92]

Thank you again. I've been debating all night as to what to do. I specifically brought up the other drugs to my vet but there has to be a reason he's preferring the Lysodren for Pebbles. At least I'd assume so. He did consult with colleagues on the matter as well. I would love to have another long conversation(s) with him about this (and we have talked several times about the options) though it's very much like a human doctor in that all the time you want is hard to get because they have so many patients with so many needs.

Marianne, she's been back and forth to the vet many times over the years (including admittances). While I doubt she's the biggest fan of being there, they do say she is good for them. We all came to the conclusion that she'd be safer there to start, though I can appreciate the idea of having her here as well. Yes, we'd be able to watch her but at the same time our vet's office is about 35 minutes away - which isn't bad but it's not like 5-10 minutes in the next town or something - and the closest ER vet is slightly over an hour.

Lori, by "clear a dog's system" do you mean the time it takes to determine if they have a good/bad reaction to the drug, the time it takes to do its thing so to speak? The support means a lot, even though I'm very stressed it's comforting to know I'm not alone. I hope I can help others one day in the way I'm being helped now.

Will post an update once I know anything further.

~Shannon

[Harley PoMMom]

Lori, by "clear a dog's system" do you mean the time it takes to determine if they have a good/bad reaction to the drug, the time it takes to do its thing so to speak? The support means a lot, even though I'm very stressed it's comforting to know I'm not alone. I hope I can help others one day in the way I'm being helped now.

Will post an update once I know anything further.

~Shannon

Lysodren has a cumulative effect and it will continue to work up to 48 hours.

Trilostane/Vetoryl has a short half life, so if any adverse reaction are seen at all, one just stops giving the Trilostane/Vetoryl and it is usually cleared by the dog's system in about 8-10 hours.

Good job with educating yourself! If you have any questions please do not hesitate to post them.

Love and hugs,
Lori

[ShannonJ92]

I see, thanks for the elaboration. I think what we'll do is request to talk to the vet in person prior to any administering of drugs. Hopefully that can happen. Will ask about Trilostane again and what the determining factor for Lysodren was in Pebbles' case. After that, during the day (should we decide to proceed), they better expect a lot of phone calls from me that's for sure! She's my baby after all.

~Shannon

[labblab]

Shannon, for your peace of mind, I think that's a very good plan to talk to the vet in person before starting the medication. Also, in further answer to your question about reversing the effects of Lysodren -- since it physically erodes the outer layer of the adrenal cortex, it may take an indeterminate time for those cells to regenerate after stopping the Lysodren. So even though the Lysodren no longer continues the erosion process after approx. 48 hours, it will take additional time for the adrenal cortex to regenerate after the medication is stopped. So if you continue through a complete loading and then decide that you no longer want to maintain the erosion, you may need to give Pebbles supplemental prednisone until her adrenal glands have rejuvenated to a point with which she is comfortable. That amount of time will vary from dog to dog.

Trilostane works in a different manner, however, and typically the effect reverses within a shorter time frame upon discontinuation of the medication -- as Lori says, within a day or so. This does not mean that dogs taking trilostane are never in need of supplemental prednisone. Sometimes, for reasons that are not entirely clear, the adrenal glands for trilo dogs also take a period of time to return to baseline in terms of cortisol production. But with trilostane, this tends to be the exception rather than the rule.

Once again, good luck with whatever route you decide to pursue. We will be here for you, no matter what.

Marianne

[addy]

Dear Shannon,

I don't mean to add to your stres levels but IMO, you should know EXACTLY why your vet thinks lysodren is the drug of chocie for your dog. You should know EXACTLY how much of the drug will be given to your dog. You should also know how many dogs with pancreatitis your vet has successfully loaded and treated with Lyosdren. And if your vet cannot answer these questions, I would doubt their ability

Make an appointment, leave Pebbles at home and discuss everything with the vet. We have had more than one member postpone starting a load after the lysodren was ordered so you certainly would not be the first.

Having said that, we will all support whatever you decide. After all, you are there with Pebbles and know the history.

Hugs,
Addy

[ShannonJ92]

Long day so long story short no Lyso was given today. Vet was spoken to first, discussion had (including an additional two calls during the day)... given some various issues with her blood and not having the best appetite the Lyso was postponed. She is still at the vet's office, with IV support and being monitored. Because we are dealing with not only the underlying pancreatitis issues, she does have an enlarged liver and has protein in her urine still we are in the process of trying to determine the best course of action (not wanting the Cushing's symptoms to worsen but also not wanting to risk putting her in kidney failure). I really am quite confused and overwhelmed.

What is the typicial normal dosage per lb with Lyso? Most of what I'm finding is per kg? Again, Peb weighs 10 lbs. Bear with me, as I said long day. He did state an amount but I want to compare what I've researched.

It would take me quite a while to type up all blood results - several things were high or low, some normal - but the test from Sept. 2 and 7 to determine Cushing's was (anyone who can offer further insight, feel free):


SNAPshot Dx (Sept. 7, 2011 10:59 am)
CORT 5.1 ug/dL (I think it's a 'u' but there's a straight line on the papers that looks kind of like a backwards 'y' if that makes sense)
baseline cortisol

SNAPshot Dx (Sept. 7, 2011 1:23 pm)
CORT 2.3 ug/dL
4 hour post low dose dex
Await 8-hour result for interpretive comments

SNAPshot Dx (Sept. 7, 2011 5:13 pm)
CORT 2.3 ug/dL
8 hour post low dose dex
Both 4 and 8 hour < 1 ug/dL - Normal
Both 4 and 8 hour = 1-1.5 ug/dL - Inconclusive, consider repeating in 6-8 weeks
Both 4 and 8 hour > 1.5 ug/dL and > 50 % of baseline -
Consistant with Cushing's syndrome, consider HDDST to rule out adrenal tumor

4 hour < 1.5 ug/dL or < 50% of baseline and 8 hour > 1.5 ug/dL and > 50% of baseline - Consistant with PDH

4 hour < 1.5 ug/dL or < 50% of baseline and 8 hour > 1.5 ug/dL and < 50% of baseline - Consistant with PDH

4 hour > 1.5 ug/dL or > 50% of baseline and 8 hour > 1.5 ug/dL and < 50% of baseline - Consistant with PDH


UA Analyzer (Sept. 2, 2011 1:05 pm)
pH 5.0
LEU 500 Leu/uL
PRO 500 mg/dL
GLU neg
KET neg
UBG norm
BIL neg
BLD 10 Ery/uL
S.G. = 1.014

UA Analyzer (Sept. 2, 2011 4:02 pm)
pH 5.0
LEU neg
PRO 100 mg/dL
GLU neg
KET neg
UBG norm
BIL neg
BLD 10 Ery/uL
S.G. = 1.014


Catalyst Dx (Sept. 2, 2011 4:14 pm)
UPRO 316 mg/dL
UCRE 30 mg/dL
UPC 10.53


Does any of this info shed any light to those of you here who can decipher this? More test results to come I'd assume.

~Shannon

[ShannonJ92]

I should add that the comment on the paper about ruling out adrenal tumor, to my understanding there is no tumor (based on the ultrasound) but both adrenal glands are enlarged.

[StarDeb55]

Shannon, I am a medical lab tech with 30+ years experience, so I can help you sort out some of the general lab results. Right now, I'm fixing to call it a night, so I will take a more in depth look tomorrow. I will comment on calculating a lyso dose. Normal dosing is usually 25-50 mg/kg, to get to kg, divide by 2.2, so for Pebbles, this is 4.5 kg. Now the dosage would be 114-225 mg. I would like to make a suggestion, now, that since Pebbles is one of our "wee" little ones, it will make it much easier, if you get her lysodren compounded. Lyso that you get at the pharmacy are these huge, 500 mg. tabs, that you would have to be cutting to get them the size you need. You can get any dose you need made at a vet compounding pharmacy. My Harley was a 14 lb Shih Tzu, so I wasn't about to deal with those 500 mg. tabs. A number of members use Diamondback Pharmacy in Scottsdale, AZ. They will ship anywhere in the country for a standard fee, & have excellent customer service. I have used them for years, & recommend them highly. They would compound Harley's lysodren in any dose I might need, the smallest dose they ever made was 50 mg. capsules.

With pituitary Cushing's, bilaterally enlarged adrenals are frequently what is noted on an ultrasound. With adrenal Cushing's, one gland is usually larger than the other one, the second gland may even be shrunken in appearance.

I will take a look at the rest of the labs tomorrow.

Debbie

[Harley PoMMom]

What is the typicial normal dosage per lb with Lyso? Most of what I'm finding is per kg? Again, Peb weighs 10 lbs. Bear with me, as I said long day. He did state an amount but I want to compare what I've researched.

This disease can be quite confusing to figure out dosages and such but to find a dog's weight in kg from lbs you divide the weight in pounds by 2.2, so if Peb weighs 10 lbs then in kg her weight is 4.54 kg (10/2.2=4.54).






Catalyst Dx (Sept. 2, 2011 4:14 pm)
UPRO 316 mg/dL
UCRE 30 mg/dL
UPC 10.53

Does the UPC stand for the Urine Protein:Creatinine Ratio test?

Love and hugs,
Lori

[ShannonJ92]

Thank you Debbie. I will check back tomorrow for your interpretation - thanks in advance. I hope to be able to share more info and type up more info as I can and as I receive it.

Yes, my vet actually did have Lyso compounded (which is what put the delay on starting treatment initially). He suggested 100 mg for Pebbles, should we choose to go the Lyso route, it's hard knowing which to attempt first - as maybe the kidney, liver issues are a direct result of the excess cortisol (in which case maybe the Lyso would help relieve?) or it could be unrelated (a possiblity).

I've had to try to absorb so much today...

[ShannonJ92]

Lori, according to the paper I have underneath UPC result is says: UPC Ratio = urine protein divided by urine creatinine (UPRO/UCRE).

Does that help?

[Harley PoMMom]

That looks like an Urine Protein:Creatinine Ratio test and it seems that Pebbles ratio is elevated. I was wondering if you could post some of the values that are related to the kidneys with their reference ranges such as; BUN, creatinine, phosphorus, and potassium. As an example: Potassium 4.4 (4.0-5.6 mEq/L.)

Thanks!

[ShannonJ92]

Here is some of that info (but keep in mind this may have changed slightly from any additional testing today, don't have the newest results yet). This is from Sept. 2 -

BUN 86 mg/dL (High) (reference range 7-27)
CREA (Creatinine I assume) 1.8 mg/dL (registered normal without a 'flag' but the highest end of normal range being 0.5-1.8)

I don't see potassium or phosphorus levels (or do they have unusual abbreviations?). I'll try to type up full results soon.

[lulusmom]

Hi Shannon.

Please see my comments in blue below.


This is my first post here and it may not be filled with as much detailed info as I'd like to offer but I'm currently very overwhelmed. Pebbles is my 9-year-old Yorkie who was diagnosed with Cushing's last week after having the ACTH and LDDS tests and also ultrasound plus a urinalysis. Initially, the week before, she went in for a lump removal by her rear end but the pre-anesthetic blood work wouldn't allow it. I don't have those results yet, we've asked the they be mailed to us. In May she had a dental cleaning done (including the pre-anesthetic blood work) and no indication at that time that I'm aware of.

It would be great if you can get copies of both blood chemistry panels and post the abnormal values here, including the reference ranges.

As of right now, Pebbles' main symptoms are increased thirst and a swollen belly. The ultrasound showed enlarged adrenal glands and some protein in her urine.

Does Pebbles also have increased urination…having accidents in the house? Can you please post the actual ultrasound findings as well as the results of the urinalysis. Do you know if the specific gravity (USG) was tested and if so, can you post the results? Was a urine culture done to rule out a UTI?

She actually has had a decrease in her appetite, which I understand is the opposite of what is typical for Cushing's dogs. If I were to elaborate, she has been mainly on EN canned food since her 1st birthday. That was when she had her first bout of pancreatitis, and has had several bouts a year since then - the span between bouts varies and are random. She seems to be interested in my other dogs' food though still, I have two 1 1/2-year-old sister Lhasa Apso/Poodle mixes. I can't give Pebbles much of that food though due to fat levels, I put tiny bits on her EN just for a touch of that flavor. Still her overall consumption has gone down. She typically weighed about 12 lbs. until maybe a year ago or so. Was told initially it was a good thing as she was always considered a little chubby for a Yorkie.

It is a good thing to maintain a healthy body weight; however, it is rare that a dog’s appetite decreases with cushing’s. That concerns me, especially since your vet has prescribed Lysodren. This drug should not be given to a dog who is not eating normally and Pebbles is not eating normally. As a matter of fact, one expert, Dr. Edward Feldman, doesn’t prescribe treatment to his patients unless they have a huge appetite.

It's been discussed with our vet about what the best way to go would be. He seems to be suggesting Lysodren and is currently trying to figure out the dosage, as Pebbles is only 10 lbs. and had the underlying pancreatitis history.

Also worth noting is she can't even handle routine rabies and DHLPP shots, the last times she had them they led us straight to the ER vet (for bad pancreaitis flares). Now she's legally cleared from having to have them.

If my dog’s chronic pancreatitis was so bad that local authorities waived mandatory vaccines, Lysodren, a drug whose most noteable side effect is GI upset, would not be my treatment of choice. Actually, if Pebbles were my dog, I would not start treatment with Lysodren or Trilostane until I saw more overt symptoms. The goal of treatment is not to cure the disease but rather to remedy symptoms which become problematic, not so much for the dog but for the pet owner.

So, now upon doing as much research as possible, I'm on the fence about even trying Lysodren. I'm very scared about the potential side effects, especially given her medical history. When I asked our vet on the phone tonight if he was even leaning one way or the other for what to do he said "it's a coin toss".

Both Vetoryl and Lysodren are serious drugs, each with different modes of action, different half lives, different contraindications and different possible side effects. All of these factors must be weighed against a dog’s physical presentation, symptoms associated with cushing’s, type of cushing’s, concurrent medical conditions, complete medical history, etc. For a vet to say that determining which drug to prescribe is a coin toss is pretty disconcerting.

He is an excellent vet, but I'm wondering why one of the other drugs with potentially less side effects wouldn't be favored. Is that something I should be pushing for. Initially he also made mention that sometimes it's better to not treat as the outcome could be made more complicated (if the med intervention doesn't work properly). I'm paraphrasing and hope I'm getting that right.

A lot of us members have come to learn through experience that a general practice vet can be the greatest thing since sliced bread for common ailments our dogs experience but but when it comes to cushing’s, very few possess the experience and knowledge needed to safely and effectively treat a cushdog. That’s not a slam against gp vets, it’s simply a fact that internal medicine specialists have spent a lot more time in veterinary school studying their chosen specialty, making them more knowledgable, qualified and usually more experienced than a general practitioner.

I am lucky to live in an area where getting to an internal medicine specialist is doable; however, members in rural areas are not so fortunate. If you can’t consult with an internal medicine specialist and you have concerns based on what we’ve shared here, then speak for Pebbles because you are her only voice. Discuss your concerns with your vet and don’t hang up the phone or leave his office until he has answered all of your questions.

Medical complications are much more likely to occur over time if a dog is not treated. Adverse reactions; however, can occur with treatment but those can be mitigated or completely eliminated if proper protocol is followed by an experienced vet and an educated pet owner. I have two cushdogs who are smaller than Pebbles (4.5lbs and 6.5 lbs) and both have treated with lysodren and trilostane. Both have aced loading on lysodren more than few times and both did very well previously on Trilostane, with no adverse reaction.
I have NO IDEA what the best route is. I do know that if we take the chance with Lysodren the first day or two will be done so at the vet's office, which is our safer bet should there be any reaction.

The average loading time is 5 to 8 days, and that is for a dog who getting a maximum daily loading dose of 50mg/kg. The first two days of loading are usually uneventful. It is after the first two days that you are more likely to observe signs of loading or adverse reactions. Is your vet open 24 hours or do they have someone there at all times to monitor their patients?

But, how do we know if the risk is worth taking?

The answer to the question comes with knowledge. Most of us had never heard of cushing’s when our dogs were diagnosed, much less know what the risk of particular treatment was. I don’t know about you but after my dog’s specialist explained what the disease was, I was reeling for a long time and scared to death for my dog. In looking back all those years, I am surprised that I had the presence of mind to sit down at my computer and research lysodren. That’s how I learned and understood the risks.

In another elaboration, and what makes this even harder (as if it isn't hard enough the way it is) is we lost two dogs in the span of less than one year - Frosty in April '10, an almost 17-year-old mix who was/is my heart and Bam-Bam in Mar. '11, an almost 14-year-old Shih-Tzu who was the gentlest guy ever. They were unrelated to Cushing's as far as we know but I'm still healing from each. How is this happening with Pebbles? I'm praying and hoping she still will enrich our lives for some time but I am very worried.

I am so very sorry for your losses. I can certainly understand the added worry over Pebbles but you are not alone now. We are here and will help you in any way we can.

Anyone here who would graciously offer advice on Lysodren (I've read through the page about it here and, again, have been doing research on most of the drugs) I would greatly appreciate some help. What about Trilostane? Which is safer with an underlying health issue? We not only have to be concerned with side effects related to Cushing's but also causing her to go into pancreatitis or even kidney, etc., complications.

I'm so overwhelmed. Thanks for listening and thanks in advance for any advice/help/insight.

~Shannon




So, to those who have more experience with this, if Pebbles was your dog in the situation with the already sensitive issue of pancreatitis, would you proceed with Lysodren treatment? Especially if done so the first day or couple days at the vet's office?

I’ve already answered this question but it’s worth repeating. No, I would not choose to treat right now and certainly not with Lysodren.

~Shannon


Thank you again. I've been debating all night as to what to do. I specifically brought up the other drugs to my vet but there has to be a reason he's preferring the Lysodren for Pebbles. At least I'd assume so. He did consult with colleagues on the matter as well. I would love to have another long conversation(s) with him about this (and we have talked several times about the options) though it's very much like a human doctor in that all the time you want is hard to get because they have so many patients with so many needs.

Marianne, she's been back and forth to the vet many times over the years (including admittances). While I doubt she's the biggest fan of being there, they do say she is good for them. We all came to the conclusion that she'd be safer there to start, though I can appreciate the idea of having her here as well.

Did your vet also conclude that the optimum time for his office to handle things was the first two days? If so, I would be very concerned with his lack of experience and knowledge of Lysodren. As I mentioned before, the first couple of days of loading are usually not a problem so having the vet watch Pebbles the first two days makes no sense, especially if you have to pay.

Yes, we'd be able to watch her but at the same time our vet's office is about 35 minutes away - which isn't bad but it's not like 5-10 minutes in the next town or something - and the closest ER vet is slightly over an hour.

Honestly, I think you would do just fine dosing and monitoring Pebbles on your own. We have lysodren loading instructions in our Helpful Resources sections and if you were to have any questions or concerns, somebody is usually around to offer some guidance.

Lori, by "clear a dog's system" do you mean the time it takes to determine if they have a good/bad reaction to the drug, the time it takes to do its thing so to speak? The support means a lot, even though I'm very stressed it's comforting to know I'm not alone. I hope I can help others one day in the way I'm being helped now.

What Lori meant by clearing the system is that Trilostane’s effectiveness is short lived and it starts to wear off after only 8 to 10 hours.

Will post an update once I know anything further.

~Shannon

[Squirt's Mom]

Hi Shannon,

Nice to see you! How is our little Pebbles doing? Have you heard from the vet this afternoon? I am such a PEST when one of mine is in the hospital. :o Squirt had a tumor removed along with part of her spleen and the hospital finally set up specific times of the day they would call me with an update on her. :o:p

Kidneys are sneaky organs; they don't let anyone know something is wrong until the majority of function is gone - 75% gone. This is true in humans and dogs. The two main values on the general labs that tell the story are the BUN and the creatinine. BUN can be affected by many things - hydration, diet, stress to name a few - and therefore controlled/managed to some degree. Creatinine does not work quite the same way. When this gets out of whack it usually indicates permanent damage. However, let me tell you about Trinket...

I adopted Trink almost a year ago. Before she came home, I was told she was in kidney failure -based on creatinine levels and the BUN. Ok, fine. But this baby had been through so much just in the short time we had known about her and no telling how much before that. Her BUN was 74 but her creatinine was 1.6. Not the best picture. I expected her to fail within a few months of coming home....but she has fooled me. In Aug. this year, her BUN was 31 and her creatinine was 0.8. So the creatinine can be affected by outside influences even tho I don't think Trink's case is typical.

I think you are wise to hold up on starting the Lyso - a "rule" to always remember is never give these meds to a sick pup. ;) In addition, Lyso should "be used with caution" in pups with liver or kidney disease. So until Pebbles is feeling better and eating well again, and you have some answers on the questionable blood work, etc. I think it's best to wait to start treatment.

Please let us know how Pebble is doing when you talk to the vet, 'k?

Hugs,
Leslie and the gang

[Sophie]

I am also wondering why Trilosane was not offered as an option. I know they are both dangerous drugs but I feel that is the safer option. I just started Biscuit on 10mg of Trilosane, she is 10lbs and is doing good so far. Nothing negative to report.

I too was worried about starting Biscuit on meds for Cushings. My vet told me that he has never seen a severe adverse reaction to trilosane but he has seen some close calls with lysodren. But nothing that could not be reversed with intervention.

Maybe you should try talking to a different vet. It could be your vet only has experience with the lysodren so that is why he is offering it as an option.

[ShannonJ92]

I want to thank you all for the info, opinions and advice. I've been so distraught the last couple hours, cried so much I can't cry anymore.

I won't be posting the blood work results from the 2nd because of learning just a short while ago they've changed during yesterday's workup. BUN dropped from 86 to 82, Creatinine rose from 1.8 to 2.3. Got one call already, just called to check on her and was told we'd be getting another call shortly. We will get the new paperwork with values as soon as possible.

lulusmom, no it wasn't the vet who suggested the starting phase be in office but seemed fine with it when I brought up the concerns for the new med flaring already existing issues. It was actually the smart thing to do, knowing now what we didn't know then about kidney issues.

She hasn't been having accidents in the house, even though she's been drinking more. She has been going outside as usual. We were given the image of the ultrasound but I'm not sure which info is of those findings. I don't see a USG but there's a UBG that says 'norm' and the abbreviation of S.G. (would that be the specific gravity you mean?) which says 1.014. I did also read that about Lyso should only be given to dogs with large appetites, it was one of those things where the vet said all dogs don't present the same (and we've been investigating the cause of the appetite issue). Keep in mind no Lyso has been given yet. They are more concerned about kidney and pancreas currently. It's my understanding that these issues could be a direct result of the Cushing's throwing them out of whack or they could be seperate issues, her known signs of pancreatitis and now the kidney issue which may or may not be related and a problem with or without the Cushing's. We're dealing with a host of problems and my mind is spinning.

So with her Cush symptoms being the increased thirst and swollen belly and dull fur coat you feel it would be appropriate to wait (even if the other more serious problems were not present)? She also doesn't jump on the couch like she always did but has been doing steps. He did not say "it's a coin toss" in reference to which drug (Lyso or Trilo) would be better, he meant that it's uncertain whether or not the Lyso would help her symptoms while not creating additional issues with her already underlying problems. Hope that makes more sense.

No my vet is not open 24 hours, NO vet around here is. I'm in a small town area where the closest ER vet is just over an hour away. I know that they are monitored and checked on outside business hours (at my vet), I would not be comfortable otherwise obviously. There are several vets that work within the pratice, however we have been with Dr. Berg for about 10 years when we started taking our first Yorkie there. All our dogs have received excellent care.

For the list I saw of IMS there is none we can get to realistically, Philly is over 3 hours and Pittsburgh is 6-7 hours. In an earlier post I mentioned I myself deal with health problems but my mom especially so while I will do everything in my power for Pebbles and am truly doing the best I can.

Leslie, you're not a pest. And, please, if being a pst means checking in on us a lot and talking to me then by all means be a pest. I need the communication and support badly.

Thanks for sharing your experience with Trink with me. That's so interesting her numbers went down. I will be waiting anxiouly for the next batch of results for Peb, I feel so mixed up and confused and not coping well at all today. I wish we could explain to them why they're there, that we still love them and are not abandoning them and are trying hard to help them.

I'm learning that about kidneys. Once a problem is noted and that much function is in question I don't know where the road leads from there. I need to do more research on this now too.

Sophie, I'm not against talking to another vet, however I've been with my vet for a decade and they know Pebbles there, know her long detailed history, so I'm not sure if consulting another practice would be the thing to do. A second opinion is an option of course, but we'd be starting from complete scratch. Thank you for the suggestion though, as I'm open to all info and advice.

Need to go wait for the call now. Will check in soon.

~Shannon

[labblab]

Dear Shannon,

My heart goes out to you in the midst of your struggle to deal with so many difficult decisions. It is such a hard (and exhausting!) place to be stuck. If only we had that crystal ball that could point us to the best pathway to the future...:o

There can be so many tough decisions related to Cushing's treatment. But I think it is especially hard when a dog suffers from problems such as kidney disease or chronic pancreatitis. Because on the one hand, a vet or owner may be reluctant to add even more physical challenges (such as introducing a new and powerful medication) if a dog is unwell. But on the other hand, those underlying problems -- if caused or worsened by Cushing's -- may never improve UNLESS treatment is started. I truly think that is such a tough spot to be in! And a very complicated dilemma, as well.

You have done a really good job of telling us about all the puzzle pieces that you and your vet are struggling with right now. And now, knowing even more about your entire situation, I can see why there are no black-and-white answers. I know you and your vet are trying to arrive at the very best course of treatment for Pebbles. So whatever that turns out to be, I will be here, cheering you on!!

Sending continuing hugs,
Marianne

[ShannonJ92]

I can't tell you how much I appreciate your kind words of support, Marianne.

This statement you made:

"But I think it is especially hard when a dog suffers from problems such as kidney disease or chronic pancreatitis. Because on the one hand, a vet or owner may be reluctant to add even more physical challenges (such as introducing a new and powerful medication) if a dog is unwell. But on the other hand, those underlying problems -- if caused or worsened by Cushing's -- may never improve UNLESS treatment is started. I truly think that is such a tough spot to be in! And a very complicated dilemma, as well."

is EXACTLY why we don't know what to do first. If the Lyso is given in hopes of not only relieving the Cush issues but also the kidney and pancreas issues (if indeed they're being complicated or worsened by the Cush) it may help. BUT it could also do the opposite and give her system far too much to handle and make it worse anyway. So, what do we do???

The vet did call and I asked about the specific gravity and he said she's considered isothenuric. Can these values differ per lab as far as range goes because during my research tonight I found where it said that 'ranges between 1.012 and 1.030 are indicative of some kidney function but not high enough to say kidneys are functioning fully'. Granted she's literally only a smidge within this range but doesn't that count? What is an ideal specific gravity?

Thank you for listening.

~Shannon

[ShannonJ92]

Another question I'm throwing out there - if/when you've had a hopitalized pup it's hard to know if a visit would help perk them up or make them more upset when you leave again without them if they need to stay longer, so to visit or not visit?

[Harley PoMMom]

Dear Shannon,

It is truly challenging trying to decide whether to treat or not to treat for Cushing's in a dog that has both pancreatitis and kidney problems. My dog, Harley, did have Cushing's, pancreatitis and kidney issues and my heart goes out to you as you struggle through this difficult decision.

Concerning the hospital visiting; take a piece of your clothing that has your scent on it and placing it into Pebbles hospital cage would help her feel more comfortable and secure. Whether the visits are stressful, I really don't know, maybe the vet's staff could tell you if after you leave her at the hospital if Pebbles does show signs of being very stressful.

From what I've read a normal healthy dog's USG should be 1.030 but the labs usual norms are between 1.015-1.045. It really depends on the dog and what is going on with that particular dog. I believe there are many different conditions that can alter the USG, so what might be a normal USG in one dog is not in another.

Hope this helps.

Love and hugs,
Lori

[ShannonJ92]

We didn't know if she'd be coming home today or not but the vet said it's best to keep her. Hopefully he'll check in with us again tomorrow, will still call first thing Monday morning regardless.

Thanks for the suggestion about leaving something with the scent, Lori. That's actually what I typically do - one of their blankets from the dogbeds or a soft toy, etc. - but I had no idea she was going to be there longer than a day or two.

Might I ask what you chose to do for Harley, which you thought was best treated first? My gut is saying it's the kidney issue that should be prioritized... well everything is a priority but in terms of at least a starting point. Oh, also, can you (or someone who may know as well) recommend one diet over the other? She has been on the EN for 8 years but now with a switch is Hills K/D or Purina N/F better? My opinion, based on what I've read, is leaning towards the N/F.

I need to find out what her last S.G. reading was as it was 1.014 on Sept. 2. I'm having trouble finding the normal ranges for UPRO, UCRE and UPC. Can someone help me out with this? Thank you.

Just now, in the middle of typing, the phone rang - the vet. He updated saying her BUN, creatinine have come down, as well as phosphorus level. He said she ate four times for him today. He will re-check her RBC again for anemia tomorrow. He thinks, and stressed thinks, the kidney issue is a result of the Cushing's. So, with that info, and should she remain stable particularly upon release, is that when Lysodren should be started? - to TRY to avoid her decline with the kidney stuff? I'm sure he'll discuss more with us about that but I ask you as well - hunches on best steps to take and when to take them?

For being so new here, and even though I've already expressed my thanks, I can't tell you all who've replied to me how much I appreciate the responses and concern expressed for me and Pebbles. So again, I thank you so much.

I will be checking in as I can with updates.

~Shannon

[Harley PoMMom]

Might I ask what you chose to do for Harley, which you thought was best treated first? My gut is saying it's the kidney issue that should be prioritized... well everything is a priority but in terms of at least a starting point. Oh, also, can you (or someone who may know as well) recommend one diet over the other? She has been on the EN for 8 years but now with a switch is Hills K/D or Purina N/F better? My opinion, based on what I've read, is leaning towards the N/F.

I did try loading Harley with Lysodren but his pancreas just could not tolerate it. During his loading phase I believed he was loaded because he did not want to eat so I had a stim test and a cPL test done. The cPL test is specific to the pancreas and his results were in the 900's with >/= 200 ug/L being in the normal range, his stim showed that his cortisol was 18 ug/dl, still elevated.

I did a wash-put period and started him on 10mg of Vetoryl. After 10 days on Vetoryl a stim test and Chemistry panel were performed. The Chemistry panel showed that his creatinine went from 0.8 to 2.5, his phosphorus and potassium were in the high normal ranges. Harley's vet and IMS believed that he was heading into kidney failure and should not be treated for Cushing's so the Vetoryl was stopped.

I do not believe that the Vetoryl caused his kidney issue, I think it just unmasked it. If I had to do it over again I would not of stopped the Vetoryl. Now, every dog is different and can react differently so one has to take all things in consideration when deciding to treat or not to treat. I do know first hand that elevated cortisol wrecks havoc on a dog's internal organs.


Concerning the diet, since Harley had so many health issues I had a diet formulated for him.


I need to find out what her last S.G. reading was as it was 1.014 on Sept. 2. I'm having trouble finding the normal ranges for UPRO, UCRE and UPC. Can someone help me out with this? Thank you.

Thsi quote comes from the IDEXX website:
We don’t have reference ranges for urine protein and urine creatinine. The individual urine protein and urine creatinine results should not be evaluated on their own since the individual measurements (UPRO and UCRE) can change significantly within a short time frame, and are sensitive to urine volume and concentration. The benefit of the urine protein:creatinine ratio is that it automatically corrects for variations in urine volume and concentration.http://www.idexx.com/view/xhtml/en_us/smallanimal/inhouse/vetlab/urine-pc-ratio.jsf?SSOTOKEN=0

The normal range for the UPC is usually < 0.5. http://ahdc.vet.cornell.edu/sects/clinpath/test/urine/protein.cfm


Just now, in the middle of typing, the phone rang - the vet. He updated saying her BUN, creatinine have come down, as well as phosphorus level. He said she ate four times for him today. He will re-check her RBC again for anemia tomorrow. He thinks, and stressed thinks, the kidney issue is a result of the Cushing's. So, with that info, and should she remain stable particularly upon release, is that when Lysodren should be started? - to TRY to avoid her decline with the kidney stuff? I'm sure he'll discuss more with us about that but I ask you as well - hunches on best steps to take and when to take them?



So glad to hear that Pebble's levels have come down and that she is eating!!!

Truthfully, I would not start Lysodren in a dog that does not have a ravenous appetite. Vetoryl/Trilostane would be my choice, however if Lysodren is the only option then waiting until she is eating good on her own, I believe, is the best time to start. We will definitely support you in any decision that you make.

Love and hugs,
Lori

[ShannonJ92]

An update... for today anyway... We picked Pebbles up today so she is home now. She was perky at first, ate several small meals (the vet placed her on Purina NF to help support her kidneys with a small amount of Hills a/d mixed in) when she got home. Tonight she's been sleeping and wasn't interested in eating again - basically she licked all the a/d off the NF food which has me concerned as, again, we're trying to support kidney function and also put some weight back on. I know typically Cush dogs there is weight to come off but with Pebbles it needs to go on due to other issues. Anyway, she will go back in a couple days for follow-up blood work.

The most recent results I have are from Sept. 15 and 17, some of which were:

UCRE 40 mg/dL
UPRO 148 mg/dL
UPC 3.7

BUN/UREA 54 mg/dL (ref. range 7-27)
CREA 1.2 mg/dL (ref. range 0.5 - 1.8)
PHOS 6.4 mg/dL (ref. range 2.5 - 6.8)

She had numerous High and Low (out of ranges) on various things, not sure what all of that means yet. Lipase and Amalyse pretty high which makes me even more nervous about potential Cush drugs. SO complicated! Vet was in surgery when we picked her up, he called us tonight but I hope we get the chance to talk in person asap.

Not sure what tomorrow will bring but I'm still in a very confused, concerned state. I need more support in real life, I have some but just not enough. People just don't understand.

~Shannon

[Squirt's Mom]

Hi Shannon,

Did the vet say anything about pancreatitis? With elevated lypase and amalyase that is a real possibility. Would you mind posting the abnormal values you mentioned?

Is Pebbles drinking enough on her own? Water consumption is critical for the kidneys. ;)

I'm glad she is home; that will help her feel better being in your loving arms and under your tender care. If you get concerned or scared, don't hesitate to call the vet back....and know we are here for you.

It's sad to me that so many people miss the value, the immeasurable value, of the love between human and canine. To look at these precious souls and see only a dumb animal is beyond me. I know how difficult it can be to feel so alone in this belief, to constantly defend your actions, and how lonely it can be when struggles arise. But, honey, you are not alone. You can't see us or feel our arms around you, but we are there with you. Our little family is comprised of like-minded, same-hearted folk as you who love our babies to distraction and who go to extreme lengths on their behalf. Squirt, Trinket and Brick are my children, I love them just as much as I did, do, my daughter. In the 3 1/2 years we have been around here, I can't tell you the number of times I have come to my family here completely terrified or heart-broken and I found safety, love, support, and understanding every time. You and Pebbles are family now, too. ;) Never forget we are here for you any time for any reason. We do understand.

Hang in there! You're doing a fine job, Mom.
Hugs,
Leslie and the gang

[ShannonJ92]

Leslie, your post made me tear up a bit. Your kind words mean more than you know. I have immediate family who just... they like animals, but... they don't get it. They just don't understand why I've always held my dogs in such high regard or why my devotion to them is so high, I don't have human kids, these dogs are my kids. I'd do anything for them. When it's talked about by others in such a way that's perhaps not intentioned to be mean but comes off as disrespectful in a sense because of how my I value my furkids I feel my defenses go up.

The out of range for Amylase and Lipase on the 15th were 2450 U/L (ref. range 500-1500) and 6000 U/L (ref. range 200-1800) respectively. Yes, I know all too well about pancreatitis, my sweet girl has suffered many bouts of it. Always has been very random, never because of her getting into things she shouldn't - fatty food or treats, etc.

The other out of ranges I may try and type up another time as she'll have more blood work on Thursday, though I don't know if it'll be a full work up or solely BUN and Creatinine. Have no idea what to expect but remain nervous. So if I have more updated info then I'll post or if not I'll try to do what I have from the 15th.

She just isn't taking to the NF food either, she seems to be better with the a/d but due to the kidneys and pancreas (protein, fat content) it's not ideal despite the fact that it's for dogs/cats recovering from serious illness or injury. She ate two small meals today of the mixture with some coaxing and hand-feeding but showed more interest in my other dogs' food (which, again, she can't have except very small amounts, I'd mix a tiny bit with her EN though). She should eat again but she went upstairs early tonight and is sleeping at the moment. I hope she eats more asap - when they really don't favor the food, what can be done when the restriction for options is there? Advice? I think she's drinking enough. It didn't seem as much today as it had been, will keep an eye out tomorrow again.

Will check in again soon,
~Shannon

[Squirt's Mom]

Hi Shanon,

I'm a big believer in home cooking for our babies whenever possible and when dealing with kidney issues this can be great. There is a nice lady named Monica Segal who is a canine nutrition consultant and she can help design a diet for Pebbles that will address the kidney, pancreas and other issues. I cook for my Squirt ever since she had an acute pancreatic attack following surgery. She does excellent on her menu and after fixing it for nearly 3 years, I can almost do it in my sleep! :p

You can reach Monica at -

Monica Segal
http://www.monicasegal.com/

She has a nutrition forum at -

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

IMHO, home cooking is always the best approach when dealing with health issues in our babies. Your vet may have a cow but they will get over it. ;) Vets tell us that human food is not good for dogs but that is a huge fallacy. It isn't good to give them what we have cooked for ourselves with all the spices and seasonings in them but there is absolutely nothing wrong with giving them good plain human food on a regular basis. Monica will work out what foods she needs, what supplements need to be added, and tell you step by step how to prepare it. It won't hurt to contact her and see what she has to say. ;)

Hugs,
Leslie and the gang

[ShannonJ92]

Think I'm gonna' be needing more support than I even thought. Her BUN started rising again (likely since being off the IV fluids since being home a couple days) and a new ultrasound was done on a more sophisticated machine and vet noted a tumor (possibly one on each) on her adrenal glands. Cushing's was initially thought to be the pituitary type but now suspected of being adrenal based. Kindey insufficiency, which we already knew. It comes down to what the heck we do. He said we could go to Cornell, which distance and financial-wise just isn't possible. We may go up the Scranton way but depending on whether or not it will just be a second opinion or an actual option for trying treatment methods that our office as a GP office doesn't do then I'm considering that but our vet said that just because we do proceed with more aggressive treatment, or decide on Lysodren, or do nothing (pretty much watching and waiting, for the time-being anyway) that we may end up in the same place regardless.

She dropped a bit more weight, NOT what we want. She doesn't like the kidney support food and giving her what she seems to want may flare the pancreatitis. Trying to do mostly a/d today. It's like I feel so so overwhelmed... if you were told you had heart failure, a brain tumor, luekemia and diabetes. What do you treat first and if you do attempt to treat what you do for one thing may likely flare one of the other problems. The adrenal tumor(s) for Peb may be benign or not, there's no way to be sure (probably not without invasive surgery and who or where that'd be done, or IF it should even be done is a risk any which way we'd go).

Doing nothing feels sickening to me as is that neglectful but what if pursuing the Lysodren usage complicated matters further rather than helping... how can I know what's right? The vet thinks the kidney issues are a result of the Cushing's but now we've got the additional adrenal info to consider. We knew they were enlarged but now the tumor(s)???

I CANNOT BELIEVE this is happening. I mean, I haven't lost hope and will follow her cues but after going through the heavy issues and losses of Frosty and Bam this cannot be happening. I'm in a shock I think, when it sinks in more I'll be in a heap on the floor.

She is a strong girl, been through so much, she is a fighter and I will fight for her. I need to be realistic but also be hopeful, somehow.

Forgive me if I'm out of it or any any repsonses are delayed. I need to let this sink in and figure out what to do or not do or I don't know what. Very confused about what this means. Already fighting depression and anxiety so much the way it is. Need help badly. Your continued thoughts and prayers and support for Pebbles remains sincerely appreciated.

~Shannon

[jrepac]

Hi Shannon,
Just getting caught up on your thread. Keep your chin up and do your best...it's tough. Other folks will weigh in, but I am pretty sure lysodren is the recommended treatment for adrenal cushings (when tumors are present). Lysodren works just like chemo, so it would shrink the tumors. You can also look into surgical options; I think a few folks on this board have gone that route, but you don't see it too often.

Home cooked food may be your best option if Pebbles is fussy. I never had much luck w/the specialty diets either. I wound up just cutting down on the regular pet food and mixing in veggies and stuff like that to cut down on fat and calories and protein.

Everyone here understands that our pups are more than just pups. They are like our children and we treat them like family ::) I have my own 4lb Pebbles at home (chi-chi) along w/3 other "kids" of varying ages. They get treated with kid gloves :p And, when my last girl came down w/Cushings, I doted on her 24/7. It's just a natural response:D

Just take things one day at a time and it will feel less overwhelming, I guarantee. Breaking these problems into small, bite-size pieces makes them a little easier to handle, I have found! Keep us posted on your progress. I will cross my fingers for you and Pebbles.

Jeff & the Gang of Four

[addy]

Hi Shannon,

I am so sorry for all the isues you are facing and I understand completley why you are overwhelmed. I do know some of our members have used Trilostane for adrenal tumors and you could research that. It does have to be used with caution with kidney problems.

Have you thought of contacting Dr. Allen at Dechra (the drug manufacturer) and discuss if he feels Trilostane might be right for Pebbles? Just a thought. Alot of us email or call him.
I remain concerned about the Lysodren and Pancreatitis. Gastro problems are the number one side effect of the drug.

You do not have to make a decision right away. Take some time.

Sending hugs and love and support to you and I hope you can feel all of them.

Love,
Addy

[frijole]

Shannon, I don't have time right now to reread your whole thread but wanted to give you the condensed version of my Annie's story in case it helps. I had treated another dog for cushing's so was not naive.. and she was diagnosed with pituitary cushings. Perfect curve, acth also was indicative of cushings and we started her on lysodren. Her cortisol nos went down and then they went up while on lysodren. She had periods of inappetance which made me worry about giving lysodren before I started... well it got worse and she quit eating more frequently.

She lost weight, she shivered all over, her hind legs were giving out on occasion... everything from hunger, to shivering, to hind legs was intermittent. I could not chart out any cause and effects. It took a year but finally we realised that she had false positives on 2 ldds tests and like 5 acth tests and did not have cushings but a pheochromocytoma adrenal tumor. By then she was too frail for surgery.

I ended up driving 5 hrs each way to K State Univ Vet Hospital and that is how we figured it out. She is still alive and a happy dog 1 yr and 6 mos later but if I'd have figured it out earlier I would have removed the tumor. What I thought might be pancreatitus ended up being lesions all along her esophagus caused by the adrenaline that is emitted from the tumor. When it is active she shivers and quits eating and her back leg fails her. I could go on but that is the short version. It comes and goes and the adrenaline in the tumor causes her to lose weight. You can view her pictures and see.

My point is simply - with the possibility of a couple tumors this is where working with an internal med specialist really comes in handy as you try to figure out what to treat first. They can help guide you thru the options and make the decision regarding surgery or drugs or what. As much as I love lysodren for saving my Haley's life (the cush dog) - it was not what Annie needed as she didn't even have cushing's. I could have bought a nice car with the money I spent trying to figure it out locally.

My heart goes out to you as I know it is tough. Sending love and strength. Kim

[Harley PoMMom]

I'm intrigued by this statement (I really apologize on bringing my situation into someone else's thread) but seeking elaboration on the above quote. If it takes a 75% loss in function to in fact show up with symptoms and testing, etc., then isn't that considered significant lost function? I've been confused by the low protein things for Pebbles too and have been advised of the low protein diet to help ease the load on her kidneys. But, she doesn't like the low-protein/renal support foods but will usually eat boiled chicken with rice and sometimes carrots. How safe is the chicken given the protein content - and now with her adrenal tumors which we don't know at this point if they're benign or malignant. How much chicken and/or higher protein content food is safe, or safer, to give?

Hi Shannon,

This link: Welcome to the website of the International Renal Interest Society (IRIS). (http://www.iris-kidney.com/index.shtml) has a wealth of information about Chronic Kidney Disease (CKD) in dogs and cats. Here's an excerpt from their website:
The mission of IRIS is to help veterinary practitioners better diagnose, understand and treat kidney disease in cats and dogs.


In the IRIS Guidelines you will find the current IRIS Algorithm for Staging of Chronic Kidney Disease (CKD) in dogs and cats, and the IRIS Treatment Recommendations for each stage of CKD. We hope that these Guidelines will assist you in your day to day management of patients with CKD.


There are four different stages of CKD listed on the IRIS website. According to the IRIS, protein reduction in the diet is not recommended until stage 3.

Another informative canine kidney disease website is: Kidney Disease in Dogs (http://www.dogaware.com/health/kidney.html) This website has information concerning diagnosing, treatment, diet, and much more.

Hope this helps.

Love and hugs,
Lori

[labblab]

Hi Shannon,

I see that Lori has given you some excellent resource links. I am no expert on canine kidney issues, by any means. But from following your reports re: Pebbles' lab results, I do want to throw out one more thought. And that relates to persistant proteinuria (or protein being leaked into the urine). From the links that Lori has given you and also my own reading, I do believe there are situations in which moderate protein restriction may be recommended for dogs who exhibit elevations in their urine protein–creatinine ratio (UP/C), even when they do not otherwise exhibit any outward symptoms of uremia. It is definitely true that non-renal medical conditions (such as Cushing's) can cause protein to spill into the urine, and the first and best strategy is to treat the underlying condition so as to eliminate the problem altogether without the need for renal intervention. But in some cases, depending upon the severity of the leakage and the time frame needed to resolve the underlying problem, I do think that moderate dietary restriction as well as medication may be recommended. Once again, this may not call for a low-protein diet, but instead one in which moderate restriction is involved.

Here's a related quote from the "Dogaware" article to which Lori has given you the link:


If your dog has significant amounts of protein in the urine (urine protein:creatinine ratio above 1.0), then you may need to reduce protein moderately, enough to control the proteinuria, but a really low-protein diet is not considered beneficial, as it can lead to hypoalbuminemia (low albumin levels).

Other vets/researchers may offer different UP/C "cut-off" points or treatment criteria, but I think the gist of the recommendations are often similar. If a dog is leaking significant protein into the urine, some degree of moderate dietary restriction may be desirable depending upon the speed or ability with which the underlying condition can be resolved. And with a UP/C of 3.7, I'm guessing Pebbles would fall into most folks' critieria as far as at least raising a "red flag." Here's another link that may give you some helpful info as to when/if/how to treat proteinuria:

http://www.idexx.com/pubwebresources/pdf/en_us/smallanimal/education/proteinuria-round-table.pdf

Marianne

[Cyn719]

Everyone here has given you great advice - their stories - and different plans of action - keep posting - you will get through this - and all the Cush Angels are here to help - you and Pebbles are in my prayers each and every day!!! Hang in there!!

[ShannonJ92]

Hello all,

I absolutely cannot think straight so I will keep this post rather basic. I always want to thank everyone who posts and responds to me and wants to help Pebbles. I'm touched by the interaction and desire to help on this forum.

I woke up today thinking that I'm leaning towards taking her to the Northeast Veterinary Referral Hospital in Plains (is anyone here from PA and/or familiar with this hospital?). It is one of several that my vet made mention of and the mose realistic in our ability to get to.

The problem remains how to treat multiple issues, where to start, what is reasonable, how to try to manage one problem without interfering with another. Already complicated enough. Which trumps what - the kidneys, the adrenals, the pancreas and is ths Cushing's to blame or would these problems exist on their own? Now I'm more confused about her diet too. She just doesn't like the kidney diets but she needs to eat but if she eats the wrong thing it could potentially be another complication but if she doesn't eat she'll lose more weight...

I'm scared about the adrenal tumors, I read it's a 50/50 shot at being benign or malignant. I am so scared! Either way, do we opt for surgery? Which may not even be an option anyway if her blood work wouldn't allow a basic lump removal surgery early this month. Or do we go the Lysodren route which is risky if we do it or don't do it? It could make it better or worse. I keep thinking and debating but am no less confused.

Kim (frijole), may I ask how it was determined what specific kind of adrenal tumor Annie had? What test was done I mean.

All I want to do is help Pebbles but I don't know how and it's breaking my heart.

~Shannon

[Harley PoMMom]

Hi Shannon,

I am from PA. but I don't know anything about the Northeast Veterinary Referral Hospital, I don't get out much! :o:)

I really believe a skilled IMS would be beneficial at this time.

Concerning diet; have you tried skinless and boneless chicken breasts with some very mushy rice? White fish such as tilapia and eggs are a good source of protein for dogs that have kidney and pancreas issues.

Sending huge and loving hugs, Lori

[ShannonJ92]

Thanks Lori. They do have a website. I don't get out much either and really am unable to travel far for many reasons, it's very rare I'm ever more than an hour away from home.

I've been adding some small amounts of boiled chicken (and rice) to Pebbles' food but have been concerned about the protein levels. I didn't know that about fish, tilapia is one of the better ones then? How much egg is ideal, do you know? The whole egg or just the white?

She did just eat some a/d with a little boiled chicken and broth (hardly any salt, strained of fat).

I'm really quite rattled at having so much to consider. Not that I don't want to do everything in my power, just that I don't know what the right things are.

[Harley PoMMom]

Phosphorus levels are of great importance with a dog having kidney issues. If the phosphorus level is elevated this can make a dog feel very ill and not want to eat.


Feeding a low phosphorus diet has been shown to slow progression of kidney disease. NRC guidelines are to feed no more than 22.25 mg/kg phosphorus daily (about 10 mg per pound of body weight)for a dog with advanced kidney failure. For dogs in early stages, recommended phosphorus amounts can be as high as 60 mg/kg (or 30 mg/lb). Anywhere from 15-40 mg/kg (7 - 18 mg/lb) is considered a low phosphorus diet.

10 pound dog: 68 - 182 mg (up to 272 mg in very early stages)
25 pound dog: 170 - 455 mg (up to 682 mg in very early stages)
50 pound dog: 340 - 900 mg (up to 1364 mg in very early stages)
75 pound dog: 511 - 1364 mg (up to 2045 in very early stages)
100 pound dog: 680 - 1818 mg (up to 2727 in very early stages)
This information plus more can be found here: Diet for Dogs with Kidney Disease (http://www.dogaware.com/health/kidneydiet.html#phosphorus)

This website Nutritional Information on Selected Foods (http://www.dogaware.com/health/kidneytable.html) provides information about the phosphorus levels in certain foods. Eggs have the highest quality protein, but egg yolk is high in phosphorus but egg whites are not, so you may want to feed 2 - 3 egg whites for every egg yolk that you feed.

Hope this helps.

Love and hugs,
Lori

[frijole]

Hello all,




Kim (frijole), may I ask how it was determined what specific kind of adrenal tumor Annie had? What test was done I mean.

All I want to do is help Pebbles but I don't know how and it's breaking my heart.

~Shannon

Shannon - Don't get down on yourself for being undecided - you can't make a decision until you know more. The tumor was studied at K State via ultrasound extensively. They were confident it was not malignant and thought it was a pheochromocytoma. They could not dx it as one originally because when she was there she did not have high blood pressure (it was not active). What would happen is the tumor would act up and Annie would get these symptoms. I would then go to K State and by the time I got there it was inactive again. Most regular vets (in small towns) don't have the equipment to adequately measure high blood pressure - eqpt is expensive and hard to recoup costs if hardly used... I finally found a vet in town that had the eqpt! Her episodes were usually at night in the beginning so it took like 3 episodes before we finally hit her with high blood pressure. This partcular type of tumor emits adrenaline.
It is also very rare even in humans so not alot is known about them.

I didn't want to drive 5 hrs each way but I would never ever have figured this out without the help of K State Vet Hospital. A specialist with experience will level with you and tell you your options. You need this in order to make an informed decision. Hang in there. You are doing a great job even if it doesn't feel like it. Kim

[ShannonJ92]

Lori, your info was good as it was just confirmed by our vet when he called. We had left a message earlier that the intention is there to take her to the specialist(s) at the hospital in Plains and we need our vet's referral, so since he was on the phone I asked about the fish and eggs and with his go ahead it's something I plan to try. I got some tilapia tonight at the store, have boiled more chicken and rice already too. I'm about ready to give up on the NF unless I can figure out how to blend it in enough that she doesn't notice it. Still have to try the K/D.

Kim, thanks. If you only knew how many serious things are on our plate right now (been that way for two years) it makes it hard to think straight about anything. Thank you for the info on Annie. See, this is what I was wondering - if sensitive ultrasounds can better pick up the origin of tumors, what their nature is. I'm also wondering if we'll get a fair amount of time and tests/results in the initial visit, as I don't know if it's likely we can go back and forth on a frequent basis (for both personal and financial reasons). Will be doing all I can.

Will post updates when I can. All thoughts and prayers remain greatly appreciated. I'm glad to have had the forum suggested to me (thanks Leslie!).

~Shannon

[Harley PoMMom]

If you have a blender or food processor you might want to try adding the NF and or K/D to some chicken, fish, and rice and make a puree out of it. I did this with my boy, Harley, and for a while he would eat his food this way.

Will definitely be keeping you and Pebbles in my thoughts and prayers.

Sending huge and loving hugs too...Lori

[Skye]

Hello, I am so very very sorry for the loss of your pet children, i know the pain is searing to the soul, and now to be going on this journey with Pebbles must feel very overwhelming. What may be working in your favor, is that this was caught early, since her clinical signs were not strong, since there may be conditions making treatment difficult, early detection will hopefully allow you and the doctors to a better time frame to chose best and most productive treatment. It is very very overwhelming, my little girl is not confirmed and i so hope it is not, and something simple, her symptoms sorta match your Pebbles. I am hoping to have ACTH and ultrasound done beginning of week. What is the LDDS test you had done if you dont mind me asking? by chance could your doctor run the tests, that perhaps the specialist requests, and they work together via conference or web? And seeking extra opinions is always a good idea, laying the facts out for another doctor and getting his opinion. And maybe you could try some of the meds and if there is adverse effect how long before things could calm down for her. I am not sure of the 3 or 4 i have heard mentioned, what the differences, pros, cons are of each. Thinking of you......I know your heart must be filled with worry. The support here has been incredible for me, i hope that you find the comfort to ease the long hours of the day and nite.

[Squirt's Mom]

Hi Shannon,

Another trick with the KD food - use the canned variety, slice it into thin pieces, and bake in the oven til crisp. Most pups here who have tried it this way will eat it better. My Crys had struvite crystals and she would NOT eat that kd food any other way.

Your kitchen will have a unique aroma, but Pebbles just might eat it which would make it worth a try. Keep on with what I call the "freshies" - fresh foods - that have been recommended....they will encourage her to eat, too.

Keep your chin up, honey! We are all right there with you.

Hugs,
Leslie and the gang

PS. I'm glad you came to our family and have found your home here, too.

[ShannonJ92]

That's a good idea Lori, I might just try that. I minced the NF today super fine and mixed it with what she does like but my girl is super smart and figured me out ;) I used to give my other two dogs (Frosty and Bam, both recently at Rainbow Bridge as I've said) baby food - the very mushy basic 'chicken and chicken broth' and they liked the 'sweet potatoes and chicken' and some of the veggie blends.

Skye, thank you so much for the supportive words. I think of Frosty and Bam every day, I miss them terribly and yet they are always with me. Those losses are the freshest, lost two more previously (Winky in '93 and Sable in '02), each very painful. I'm scared for Pebbles but will do all in my power.

I wish you and your pup well for her upcoming testing. The LDDS is low-dose dexamethasone suppression and was part of Pebbles' Cushing's testing, done the same day the ACTH was done. I don't mind you asking at all, I just may not be the best person to explain the ins and outs of the test(s). Many here seem so knowledgable though if you need help with that info. There's also an HDDS that I don't know will be done in Pebbles' case but it was mentioned. I don't know what more it'd prove. It's all very overwhelming, us trying to educate ourselves in order to try and be as informed as possible (as I'm still so new to all this too). My vet did do a lot of the testing already including several blood draws and ultrasounds. The specialist is wanted in order to try and determine what specifically we're dealing with with her adrenals, the tumor(s), underlying issues, etc., and from what I understand there will be a relationship between the specialist and our vet. It's hard to know what to do about Lysodren at this point, nothing has been decided in that regard. Please post and let us know what is found out from your girl's test results, I wish you the best as I'm sure you're filled with worry too.

Leslie, I'll try that with the canned food slices. Should be an interesting experiment. Pebbles will be the deciding factor on that end, will let you know her verdict. Perhaps she'll know I'm trying to pull a little trickery, again very smart girl! We'll see...

~Shannon

[jrepac]

Baking the KD food? that's one I have not heard of! interesting...
terriers can get SO fussy sometimes! I was lucky w/my last one...she was a real good eater..

If you get desperate, try a can of tuna, or yes, even CAT food. That's one of those little dirty secrets the vets don't tell you about. The sick pups often will eat cat food over the regular dog food.

I am over in NJ, but I have not heard much about the Northeast Veterinary Referral Hospital....their website looked interesting.

University of Penn's Veterinary School is very highly regarded....

Crossing my fingers for you and Pebbles!

Jeff and the Gang

[ShannonJ92]

I haven't tried baking the K/D slices yet as she's been eating it fairly well the last couple days (I hope by saying that I didn't just initiate a jinx). I will also be trying the tilapia tonight with some chopped, boiled egg whites.

Thanks for the input, Jeff. I've done tuna occasionally for all my dogs (basically as a treat and not too often) but for Pebbles right now I'm not sure if it's a good or bad idea given her current problems, plus tuna's salt/sodium levels. Cat food, really? I recall hearing it was either cats shouldn't eat dog food or dogs shouldn't eat cat food, not sure why or where I recall that from. The U of PA vet school is a fair suggestion, I just searched for it online, however it's not somewhere we can get to. Just too far from us. I sincerely hope the Northeast Referral Hospital can help us, I read through their whole site basically after our vet listed that as one of our options.

After some phone calls today we now have an appt. for Monday afternoon to see an IMS there in Plains. I'm not sure what will be done but I hope the dr. is nice, gives us appropriate time and will be able to determine what exactly we are dealing with. I want to know and don't want to know if that makes sense. Pebbles' belly is pretty swollen and I'm hoping their equipment is better suited to pick up on more details of the adrenals and kidneys. She has to fast the night before so I assume more blood will be drawn. Beyond that I have no idea what will be decided, depending on what we are told. I already feel guilty for putting Pebbles through this but I just want to help her.

I remain very appreciative of all thoughts and prayers sent out to her and especially on Monday if anyone would be willing to send her extra good thoughts and energy it would be so welcome.

~Shannon

[Cyn719]

Shannon - Pebbles is in my prayers always and we will pray even harder for Mondays visit - you are doing all you can - your a fantastic mom and its so hard when things get this difficut - as I know right now first hand - we will be there for each other and our babies - Love Hugs Kisses Prayers to you and Pebbles xo

[Harley PoMMom]

Hi Shannon,

Did the IMS in Plains ask that all test results be faxed or emailed to her. If not I would call and ask if this can be done so when you do have your visit with the IMS s/he is already familiar with Pebble's issues.

When I took Harley to the vet or IMS I would bring along either a tape recorder or pen/pencil and paper. My brain is frazzled and I cannot remember anything so making notes or tape recording is what helped me recall what the IMS/vet said at the visit. I also would take along some food and water for Harley to have afterwards, usually his IMS visits lasted a long time.

Keeping you both in my thoughts and prayers.

Love and hugs,
Lori

[ShannonJ92]

Thank you SO much Cindy - I'm a nervous wreck the way it is, I'm pretty sure I'll be a basketcase on Monday. I will be checking your thread soon to check on Penny.

Lori, some info has already been faxed and the rest should be faxed by then. I'll be taking notes the best I can, that's a good idea about a recorder. I don't have any of the new digital kind but have old ones that'd probably work. Thanks also for the food and water tip, I was planning on that as I anticipate a long day.

Can either of you, or anyone at all, answer the swollen belly issue? I understand it's part of Cushing's but my concern is just that it does seem so big. Could it not only be from Cushing's but also from the adrenal enlargement and/or whatever is going on with the kidneys? I'm pretty worried about her belly.

~Shannon

[Harley PoMMom]

The distended belly could be a combination of several things; fat redistribution due to Cushing's, could be fluid build-up, an enlarged liver which Cushing's and pancreatitis could cause and or gas.

Sending hugs, positive thoughts, and calm energy your way.

Love and more hugs,
Lori

[jrepac]

Distended abdomen (big belly) is very common with Cushings...so, don't be too alarmed.

[Squirt's Mom]

Hi Shannon,

Just dropping in to let you know prayers and healing white light continues for you and sweet Pebbles.

Hugs,
Leslie and the gang

[ShannonJ92]

My continued appreciation for all your well wishes. Big day tomorrow (Monday), I'm soooo nervous and just don't know what to expect. If I don't get to post an update tomorrow night I'll do so as soon as possible. Please send all the prayers you can for Pebbles during the afternoon when her appt. is. Thank you.

~Shannon

[Squirt's Mom]

Hi Shannon,

You have prayers, positive thoughts, healing white light and good wishes flying your way. There will be a crowd in your car as you and Pebbles are on your way, and a crowd in the waiting room, and a crowd again in the car on the way home. We are right there with you all day - all you gotta do is reach out.

You have done a good job of learning as much as you can so you can advocate for Pebbles! :) You are a good mom, don't forget that, honey.

Let us know how things go when you can!
Hugs,
Leslie and the gang

[Cyn719]

Shannon - PRAYERS - LOVE - KISSES - HUGS - SUPPPORT - THOUGHTS - You have it all and will be waiting for your post - keep your chin up - you are doing a great job with Pebbles - xoxoxoxoxo

[ShannonJ92]

Basics on Pebbles - she does have Cushings in all liklihood. The IMS dr. who saw her (worth the trip imo and they were very professional and nice to us, Pebbles was nervous but a very good patient) who performed another ultrasound (very sophisticated equipment from what I understood), based on what she saw from those results she didn't detect any adrenal tumors as we were recently told from our vet (but their ultrasound may not be as sensitive) but the glands were confirmed pretty enlarged and rounded in the front. Heart sounded good. Her liver is enlarged, no fluid in abdomen, she gained a pound (good!) and I'd been so concerned it was fluid build-up. At this point no, praying it stays that way. That leaves us back with pituitary dependent Cushing's, said we had the option of doing another test (the HDDS) at our vet's to confirm further. Not sure of what benefit it'd be if we probably already know. Thoughts on this? Anyone? Instead of Lysodren she suggested Trilostane, still a serious drug. Is that the safer (and I use the word 'safer' cautiously) given her medical background of other problems? It's risky not to treat but also risky to treat. I keep thinking what the best way to go is(????). Very concerned about side effects but then I wonder if the drug could help with her kidney issues (those levels are still high, BUN more than Creatinine but that fluctuates too - BUN yesterday was 70 and Creatinine was 1.5) if the kidney stuff is indeed being brought on by the Cushing's. I'll call our vet soon to try and set something up to at least discuss what his opinion is now after learning of the specialist's findings.

I felt everyone's support when we were there and we thank you!

Now, thoughts??

~Shannon

[Harley PoMMom]

On the ultrasound report was any abnormalities found with her pancreas or kidneys?

[jmac]

Shannon,
I am (slowly) trying to get up to speed with your thread. I am glad to hear your appointment went well today and that Pebbles did well too. Unfortunately, I don't have any good advice for you, as I am not using either of those drugs. Hannah is on Anipryl right now. I know people will come along with lots of good advice for you, and I will do my best to read up on Pebbles' story.

Hang in there!

Julie & Hannah

[ShannonJ92]

Further info - they did take her blood pressure too and I quote from the paperwork we have "170 mm Hg #2 cuff Left rear foot; normal".

The diagnostics performed and interpretations noted (again, quoting) "Abdominal ultrasound; liver: slightly enlarged and hyperechoic throughout; gallbladder, spleen, GIT, kidneys all appear normal. Bohm adrenal glands plump but no obvious tumors noted."

Nothing noted about the pancreas, I would think if it were an issue (other than her strong history) it would've been emphasised. Also, with kidneys being noted as normal, wondering about the BUN and Creatinine levels in such case. Can they appear normal on ultrasound while still having elevated levels?

Also another test said PCV/TP 35/9.0 - this has to do with checking anemia, is that correct? The IMS specialist was very explanative (and I did record most of it, haven't reviewed it yet) but can anyone interpret this result? I think the 35 is just at the lowest end of normal(?) but can't figure out the 9.0 behind it. Anyone?

Hope everyone reading this is doing well and I continue to think of and pray for all your beloved furkids.

~Shannon

[Harley PoMMom]

On Harley's ultrasound, abnormalities were found with his pancreas and kidneys, so I do believe if they found any deviations from normal it would be noted.

If Pebbles' Cushing symptoms are strong then I would treat her with Vetoryl/Trilostane, starting out at a low dose. Using UC Davis' protocol at 1mg/kg, with Pebbles weighing 12lbs, her starting dose would be 5.45mg.

[ShannonJ92]

The clinical symptoms are increased thirst and swollen belly, I guess protein in the urine is another symptom. It is handwritten by the IMS vet as "Trilostane 1 mg/kg" but no actual amount. I will note the 5.45 mg. She did say she wanted the lowest dose possible for her, does that sound like the lowest dose then?

Any insight on the 9.0 question I posed/meaning of it?

~Shannon

[Harley PoMMom]

The clinical symptoms are increased thirst and swollen belly, I guess protein in the urine is another symptom. It is handwritten by the IMS vet as "Trilostane 1 mg/kg" but no actual amount. I will note the 5.45 mg. She did say she wanted the lowest dose possible for her, does that sound like the lowest dose then?

Trilostane, which is the active ingredient in Vetoryl, can be compouned in any dose. So, starting her out at 5mg from compounded Trilostane is what I would do.


Any insight on the 9.0 question I posed/meaning of it?


I am not sure what that means; PCV is packed cell volume and I think the TP is total protein. Hopefully Debbie, our lab expert, will be along and provide you with this information...sorry I could not be helpful with this. :(

Love and hugs,
Lori

[Cyn719]

Shannon could the 9 be the total protien ? just guessing from Pennys pass testing but that question is for the higher ups which will be back to answer soon - they are the best!! Prayers for you and Pebbles - you are doing all the right things and just remember low does to start - ACTH test 2 weeks later very important - Dr Allen is wonderful to check dosages - side effect - etc he takes all phone calls free of charge - He helped Penny out so much - penny is on trilo also - I am her for you and Pebbles - you are doing a great job mom!!:)

[ShannonJ92]

I just realized the dosage figured for Peb's weight may not be correct, I didn't catch the 12 lbs. at first reading. Pebbles' current weight is 10 lbs. so I'm wondering if the dose would be lower than the 5.45 mg or even 5 mg. The vet called today, our regular vet, and he asked how she was doing and we could go in to talk to him soon (he's on vacation next week) but the IMS vet said suggested doing so after she finishes her doses of Carafate - we were given a 10 day dosing's worth.

I'm undecided about the HDDS, wondering if it's really necessary or if we should just move forward without it. I wish I didn't feel so uneasy about the Cush meds, before it wa sthe Lysodren and now the Trilostane. I'd have caution anyway but I'm just so scared of side effects or it causing additional/worse pancreatitis, etc.

Cindy, not sure if that's what the 9.0 means. You mention the ACTH 2 weeks later. How safe are those tests if done repeatedly? I know it's needed to monitor levels but if it takes a lot of tweaking then I'm wondering how many ACTH/LDDS/etc. tests are safe. I'm not familiar with Dr. Allen (if he's been written about along the way it must've slipped my mind with so much going on). How is Penny doing? I need to go read some other threads to catch up, I want to be supportive to others, sometimes just not enough time in the day despite best intentions. Feeling rather scatterbrained these days.

~Shannon

[Squirt's Mom]

Hi Shannon,

Trilostane usually takes a bit more tweaking to get the dose right so more ACTHs are required when using Trilo than Lyso. ACTHs are safe, no need to worry about that. The LDDS shouldn't need repeating - it is the ACTH that is used for monitoring treatment. Since Trilo can, and usually does, require more testing, cost is something to consider when deciding which med to use. Both are safe when proper protocols are followed; both have the exact same potential for adverse effects. So one is no "safer" than the other. ;)

At 10lbs, Pebbles weighs 4.55kgs (10 / 2.2 = 4.5454545...). At 1mg/kg, her dose would be 4.55mg.

The HDDS isn't used much any more. It's primary function is to help determine whether the tumor is on the pituitary or the adrenals. Since no tumors were seen on the adrenals with the ultrasound, you can pretty much assume this is PDH - pituitary dependent hyperadrenocortism. 85% of cush pups have PDH. ;) So I'm not sure I would spend the money on the HDDS.

Hang in there!
Hugs,
Leslie and the gang

[Cyn719]

Shannon - I do not think the ACTH test is harmful but someone else can come along and let you know that for sure - ACTH is every two weeks when it is started and every two weeks when a dose is changed -- Dr Allen is the vet at Dechra the company who makes the Trilo - he is good with answering questions and amount of trilo to take - but Leslie is very good too!!!! If you want to email him you can and he has a toll free number which I cannot find now maybe one of the other members has it - but you can email also ask for his number and the best time for you to call him - hes very nice -- tim.allen@dechra.com

we send our love and prayers to you and Pebbles everyday!!

[jrepac]

ACTH test is pretty safe....I was always bothered about it requiring the pup to stay at the vet all day....but that's about the only down side.

And the cost, I suppose.

Jeff, Angel Mandy and the Girls

[addy]

Hi Shannon,

I started my pup on a low dose of Trilostane and we are working our way up. She has had 5 ACTH tests since June, I am not too concerned except for her stress levels from so many tests.

Hugs,
Addy

[Cyn719]

Jeff and Addy how long does your dogs stay for the ACTH test? Penny stays 2 hrs

[StarDeb55]

ACTH testing should take no longer than about 2 hours. A baseline blood draw is done, the medication, usually cortrosyn is injected. A blood draw is done 1 hour after the injection. The test that takes all day is the low dose dex test.

Shannon, I must apologize for not getting back to you, but I have been following & you have been in excellent hands. I really didn't have anything to add. Now to your concerns about the safety of repeated stims. After treating 2 cushpups, I can assure you that there is no problem with getting this testing done on the regular basis that is required to monitor whichever drug you choose to treat. As Leslie has already mentioned, trilostane will probably require a few more stims since it can take a little bit tweeking to get the dose right. With lysodren, once you get the maintenance dosing correct, & the pup stabile, ACTHs can be done as little as every 6 months, if the pup is stable. This will be dependent on your vet & the overall health of Pebbles. My Harley, who was 13 1/2 when diagnosed, had a couple of other issues going on, & those, along with his age, led my vet to be very cautious monitoring him, & his stims were being done every 3-4 months.

Debbie

[jrepac]

The ACTH test itself does not take long; but vets can be pretty jerky in asking you to bring your dog in early and then pick it up late day. They often want to make it convenient for their schedule, not yours or the comfort of your pet. I always found the timing pretty annoying, but maybe my vet was just a jerk.

[ShannonJ92]

As for the HDDS that's what was said - basically to confirm it's PDH. I can't say as I see much point (other than the small chance it'd rule out Cushing's, in case of a false positive, which I doubt is the case).

Thanks for the new calculation, Leslie. Calling the vet's office tomorrow to find out if the Trilo can be ordered (compounded). Our vet won't be back until next week but I'd just assume get the ball rolling should the Trilo be decided on).

Thanks for the email addy, Cindy. I may just contact him.

Thanks also to Jeff, Addy and Debbie. I've been feeling so overwhelmed in terms of trying to learn as much as I can and wanting to do what's best for Pebbles. I guess right now I'm still thinking about the possible side effects and questioning what if she has a bad reaction. I know not treating is risky but treating can also be risky. Being that she does have other health issues is this something where the Trilo may improve the Cushing's but complicate something else or just backfire in general? Or, it could work wonders and be amazing for her. If only I had a crystal ball to look into.

~Shannon

[addy]

Hi Shannon, there is no crystal ball and we do not know once we drop the dog's cortisol what we may uncover or make worse because the dog may have been self medicatiog with the high cortisol.

Zoe has colitis (now diagnosed with inflammatory bowel disease) the experts thought it would get worse once I started to treat her so I waited until her symptoms were a concern to me and then we started on Trilostane at a very low dose and inched up very slowly even thought her cortisol was not in optimal range. her colitis flare in the beginning and I dealt with it. The thing about Trilostane is you can stop it and start it without losing the load as with lysodren.

So if your pup can use Trilostane with the other health issues, IMO I would start there, very low and go very slowly so you can judge what else becomes a problem.

You are doing just fine:D

Hugs,
addy

[Cyn719]

Its so hard to make these decisions - I know for sure and understand - but I agree with Addy that a very low dose of trilo might me a good start - sending our thoughts and prays and lots of HUDS!!!!!!!!!! OOOOOOOOOOOOOOO :D

[ShannonJ92]

Love that name Zoe, so cute for a pup :) Thanks for sharing that with me, Addy. I've been trying to do what you stated once the Cushing's was even suspected. Watch for the symptoms and their level. Mainly it's been the drinking and the swollen belly. Now, whether or not the elevated kidney levels are a direct result of the Cushing's remains to be seen (but my vet suspects so, not certain though).

I did call today to ask if one of the other vets could order the Trilo compounded (hoping to speed up the process and avoid delays) but so far it hasn't been. Dr. Berg won't be back until next week and we'll see him on Tuesday.

I'm curious what anyone here uses to give the pills to their dogs. I've generally always done so (when needed) in peanut butter but Pebbles breaks out in hives and can't have most treats due to the diet restrictions and won't go near the pill pockets. Any suggestions?

She was not as eager to eat tonight as she had been recently, picking around the K/D and left most on her plate. She had some chicken and rice though but I hope she eats better later tonight as that makes me nervous. Seems a little restless too.

With Leslie's calculated dose of the 4.55 mg is that the lowest does ideal or should it be started even lower to then see how it's tolerated and then work up to that?

Cindy, your support means a lot. I appreciate you checking in and sending good thoughts and prayers to Pebbles. I need to go check how Penny is doing. I hope well. Love her pic you have up - what a face!

~Shannon

[frijole]

I found cream cheese to be the easiest because it is like playdough and you only need a small bit. My dog won't eat it anymore so we went to pill pockets which knock on wood.. mostly work still. Good luck!!

[ShannonJ92]

I never would've thought of that and it might just work (if I get the fat-free). Not sure if Pebbles will take to it but I guess I'll find out if tried, thanks for the suggestion!

~Shannon

[Cyn719]

Our little ones are fussy - penny wont take the cream chesse or the pill pockets - she is really fussy but sometimes if I put a pill in a little ball of her soft fool and roll it like a meatball she would eat it - that wore off soon - once they catch on you have to move to something else - good luck

[Harley PoMMom]

Another option is called Flavor-Doh™, Here is link about it: http://209.190.189.14/Products/Flavor-Doh--Pill-Wrap-for-Dogs__7601e.aspx

Love and hugs,
Lori

[Cyn719]

Lori - I may try that cause penny loves chicken - just may work!!

[ShannonJ92]

Help, need advice please:

Our regular vet just called to check up on Pebbles and when my dad asked about the Trilo being compounded he still wants to go with Lyso. So...... the specialist recommends Trilo and ours suggests Lyso. Our vet is concerned about the Trilo being too hard on Pebbles, but wouldn't Lyso also be? I have NO idea what to do - our appt. is on Tuesday, I just called and left a message for the specialist to call us back about this. Just wish everyone was on the same page, makes it harder for us to make an educated decision. I hope I don't get more confused by asking those of you here but help please :confused:

She's been drinking a lot and still picky with the food but ate some chicken and rice tonight. Had her for a short ride in the car today with her sisters (our other two dogs).

~Shannon

[frijole]

Shannon, I treated my first dog with lysodren successfully for over 4 yrs. Then my 2nd dog was MISdiagnosed with cushings and we gave her lysodren. She had inappetance issues occasionally and trying to figure out if she was loaded using lysodren was near to impossible and I was familiar with it!

On top of that my poor dog didn't even have cushing's! My point is that I would never ever go with lysodren over trilo in a dog with eating issues, pancreatitus, etc. I would go with trilo. And I am a real fan of lysodren. From what I have read on your thread I would push real hard for the trilo and wouldn't lose one minute of sleep over upsetting a vet who has never lived thru this. Loading is very very stressful and doing it with a dog that won't eat beforehand just compounds it. Trilo is an alternative that doesn't come with those problems. Why put yourself thru loading hell if you don't have to?

Kim

[ShannonJ92]

This is what I don't understand. My instinct, and granted I'm mainly basing this on my gut feeling, is to go with Trilo. It was hard enough to even get to the point of leaning one way or the other but Dr. McBrien (the specialist) went that way too. Dr. Berg (our reg vet) is who we have more contact with but I hope he discusses the case again with her and a best course of action can be decided on. If this weren't already overwhelming enough... just don't know what to do.

~Shannon

[Harley PoMMom]

I completely agree with Kim, I would not even try loading with Lysodren in a dog that does not have a healthy appetite. One of the signs of a dog being loaded is hesitation in eating and if one already has a dog with inappetance issues than the risk of an Addison crisis becomes greater.

If this were my dog, I would go with Trilostane which is what the IMS recommended.

Love and hugs,
Lori

[ShannonJ92]

Pebbles' appetite is a confusing thing in that sometimes it seems she's indeed hungry but just not real thrilled with the new kidney diet (but it was better on K/D than N/F) and wants what she wants but here's the kicker... she can't have higher fat foods due to the pancreatitis issue and she can't have the higher protein now due to the kidney issue (which, again, may or may not be a direct result of the Cushing's). But, it's so important that she's eating.

I guess I'm putting the cart before the horse here but the phone call threw me off. Now I'm hoping the specialist will be able to explain to us and Dr. Berg further why that's her recommendation. I don't want to encounter resistance for it being compounded if that's the way we decide to go.

~Shannon

[frijole]

Shannon, Sorry if you already posted this but did you have an ultrasound done? It can tell you alot about what is going on with organs that may or may not have anything to do with cushings. Thanks Kim

[ShannonJ92]

Yes, ultrasounds were done (both at my regular vet's office and via the IMS vet hospital. Results were posted somewhere along the way. Is there something you're wondering about specifically?

~Shannon

[frijole]

Yes, ultrasounds were done (both at my regular vet's office and via the IMS vet hospital. Results were posted somewhere along the way. Is there something you're wondering about specifically?

~Shannon

I wanted to make sure they ruled out an adrenal tumor. Your description of the appetite that comes and goes reminded me a bit of my Annie. Just checking. Kim

[lulusmom]

FYI, the abdominal ultrasound findings are: liver: slightly enlarged and hyperechoic throughout; gallbladder, spleen, GIT, kidneys all appear normal. Both adrenal glands plump but no obvious tumors noted.

[Cyn719]

Hi Shannon - just popped in to say thinking of you and Pebbles!! These decisions are so hard I know!!! You will make the right choice - :)

[frijole]

FYI, the abdominal ultrasound findings are: liver: slightly enlarged and hyperechoic throughout; gallbladder, spleen, GIT, kidneys all appear normal. Both adrenal glands plump but no obvious tumors noted.
Thanks G! Great news.

[ShannonJ92]

Not sure what to expect on Tuesday (at Peb's next vet appt.) but I hope some sort of agreement in terms of what to do or not do will be reached. I don't know if my vet has spoken with the IMS again yet but they were supposed to be in touch with each other, still confused at their not seeing eye to eye. Mind if I ask for the good energy, thoughts and prayers for Pebbles again that day? Thank you in advance.

~Shannon

[Harley PoMMom]

So many of your cush angels will be showering you and Pebbles with good energy, positive thoughts, and tons of prayers will be said. ;):)

Sending huge and loving hugs, Lori

[frijole]

You got it. We are all with you in spirit. Prayers and strength sent. Kim

[addy]

Showers of love and prayers from me and Zoe and Koko too:) I hope the two vets can agree on something for Pebbles.

love,
addy

[ShannonJ92]

Brief update - Pebbles' appt. was Tuesday and another blood draw was done at my request. Her BUN was 77 and her Creatinine was 1.5 and she gained weight and up to 10.9 lbs. which is good. Dr. Berg still seems to feel Lysodren is the way to go, I'm just undecided and taking it day by day. I remain undecided (and overwhelmed) which way to go.

I had our other two dogs, Mireya and Bella, with us that day to have their glands emptied and I wanted blood work done on Mireya as her appetite has been off lately. Or, what I should say is she's been incredibly picky. Everything was okay except GGT which is something I wasn't familiar with. GGT was 32 I think, vet said he'd monitor but since all else came out fine he wasn't overly concerned at this point. Hope it will be okay. Anyone know much about GGT?

~Shannon

[jmac]

Hi Shannon-
Don't know anything about GGT. Sorry. I'm glad your vet isn't incredibly worried right now though. That's a good sign. I'm glad Pebbles put on some weight too. I wish I had some advice for you on what to do with your girl. I will continue checking in on you and keeping you and Pebbles in my thoughts. She sure is a cutie!

Julie & Hannah

[StarDeb55]

Shannon, GGT is gamma glutamyl transferase, another liver enzyme. It can be found in other organs, also. This link about canine liver disease gives you specific information about all liver enzymes & what elevations might mean. I wouldn't be terribly concerned with just an elevation in the GGT, if all other liver function tests were normal. Your vet's plan to monitor is probably a good one.

http://canineliverdiseasefoundation.org/?p=23

Debbie

[ShannonJ92]

Thank you Julie, much appreciated.

Pebbles hasn't been acting well since about 2 am. She ate her later night snack and then started with a jerking movement in her neck and smacking her tongue in and out. Seemed to settle a bit then this morning around 9 it started again. On and off since. She did eat today but seems restless. Called vet this am and he said to give Cerenia (which we had on hand) and a bland diet (which is the same K/D, a/d boiled chicken and rice mix she's been getting the last couple weeks). This isn't the first time she's done this, it's happened intermittenly in the past and they never quite knew what caused it so debating now about whether to take her over again or let it run its course. I want to do everything but getting so exhausted - mentally, physically, financially - with several issues going on at once (personally I mean).

That's the basic info I found last night on GGT, Deb (thank you), but will look at the link you included. I'd just never heard of that abbreviation before (that or never noticed it on test results) and was curious if anyone here had experience with what an elevated level means. Mireya's only 17 months old so concerned. I did read it could mean a blocked bile duct.

Having a down day, feeling depressed and just overwhelmed. I'm appreciating the blessings yet just emotionally and physically run down. All prayers and good energy remain welcome, as I send the same to all of you.

Thanks for listening,
~Shannon

[jmac]

Oh Shannon...I'm so sorry to hear Pebbles is off today. I know how it is when there seem to be many things that are going wrong (or just not "right"). I can relate to the feeling of being exhausted in every way. It isn't a fun place to be. I wish there was something more I could do to help or make you feel better, but since there isn't, just know that I will keep you and all your pups in my thoughts and prayers and hope that tomorrow will be easier for you.

Take care of yourself, too!

Julie & Hannah

[Cyn719]

Shannon - reading your post was like reading my own - that is what happened when I had to bring Penny in to the vet a few weeks ago - started at 11 ish at night - but she jerked her body into the back door and groaned and the tounge was in and out like a snake - like she was tasting something really bad - she always wanted to yawn but it was like a quarter of a yawn - she was so restless - took her to the vet and no idea what it exactly was - ? the pain in her legs and lumbar - question of a marco cause pressue in her head - both?? put her back on Rimadyl and she was fine for two weeks and then back to that again for 2 weeks and today she has a good day finally! Dont understand it - they said if she has a marco the pressure could flare up here and there - we just dont know - I understand how you are exhausted mentally - physically and finacially - I am in the same boat - we just put in a $5,000 heater/boiler and painted a couple of rooms and it wiped us out - and Penny with her bills is so much and a son in college:eek: My fibromyalgia is kicked in big time -- I am here when ever you need to talk vent whatever - You and Pebbles are in my thoughts and prayers everyday -- Sending you big warm hugs to you and your little one!!

[ShannonJ92]

Julie, it's enough knowing that you would like to do something. I greatly appreciate that but know that mainly what we can do for each other here is offer support and advice. The fact that you are doing that for me and my furkids means a lot and I thank you so much. It was a weird "off" day indeed, continue feeling helpless but don't know what to do. The spells have been on and off today, the vet called at 10 pm to check in (he'd left the office early today when I'd called during office hours, said he'd check in again tomorrow). They never knew what to do before so I don't know that they'd know now. We've been with our vet's office for almost a decade now but admit sometimes I wish it was closer. It's a long story how we came to use one farther away but being pleased with the service at the time we stayed.

Cindy, I recall the posts in which Penny was doing something similar. It sounded familiar to me but Pebbles (so far) doesn't groan or act like she's in pain - I certainly hope she's not - rather she just keeps jerking and smacking her tongue. She was picky with her food today too. So glad Penny had a good day, that's wonderful. Cherish the good days that's for sure. I sent you a pm btw in case you didn't notice, I found something you said especially coincidental.

Praying for a better day tomorrow, so exhausted now (and this is early for me as I'm a major night owl).

~Shannon

[jmac]

Shannon-
Just wanted to check in and see how your night went with Pebbles. I hope you both got some sleep and were able to relax a bit. As I read some of these posts about dogs doing weird things with their tongues, it makes me wonder if what Hannah has been doing for a few years is somehow related to Cushing's and similar to what you guys are saying. She will occasionally do this thing where she continues licking her nose over and over for about 15 sec. to a min. It's like she's licking peanut butter or something. I have never been concerned about it and it doesn't seem to bother her; if I interrupt it somehow she just stops. But it sure is strange. Then you read something on here and start to wonder if they are all related. At any rate, Hannah seems to be doing pretty well for now (with her back injury and Cushing's) so I am definitely cherishing this time. I know how quickly it can change. I'll keep you and your little ones in my thoughts.

Julie & Hannah

[ShannonJ92]

Julie, you're too sweet. Thank you for checking on Pebbles and me. Her spell continued Thursday into Friday, seemed to get a bit better on Friday afternoon but then started again at night (just as our vet's office was closing). I called anyway just to see if I could at least get some advice but only the techs were there at that point. Got up early Saturday in case we'd have to take her (they're only open a couple hours on Saturdays) but the episode seemed to be clearing up. The vet called here to check on her at least. She seemed alert and perky today. What a rollercoaster. I just want what's best for her.

It does seem strange that others describe unusual behavior (the tongue thing for example). I'm inclined to think it's unrelated in Pebbles' case as she's had random spells prior to the Cushing's diagnosis, but maybe it flares it up again? Even the vets never seemed to know what it was or what caused it, which is/was frustrating.

I wish I could come to a confident decision about what to do about Lyso or Trilo but the sad reality is I just don't know. With differing opinions and underlying issues will it do more harm than good or help her or make things even more complicated or make it better... I realize I must sound like a broken record but I'm becoming more stressed that I can't figure out what to do. I'm in a watch and wait phase now, for lack of a better way of putting it.

So glad you say Hannah is doing well. I know what you mean though, cherish the ups, prepare for the downs, always on alert, staying on the rollercoaster. Thank you again for the thoughts and prayers, you'll remain in mine as well.

~Shannon

[Cyn719]

Shannon - Penny has not done the tounge thing lately but my vet said it was being in pain or having an upset stomach - really she doesnt know for sure- how is Pebbles this afternoon? Penny ate this am but still moving slow- its like a strange type of walking? Stiff - pain - both not sure -

[ShannonJ92]

Yeah, maybe it's connected to upset stomach. If only our pups could talk and tell us, if only. Pebbles seemed to be okay today, I always answer this tentatively not because I don't want to say she's doing alright but because in the past when I've done so then something happened. Superstition or coincidence I don't know but always hope and pray to not jinx her. Drinking a lot still. I hope Penny isn't in pain and that her stiffness gets better soon.

~Shannon

[ShannonJ92]

So the past few days Pebbles was practically eating the house down, today she's picking and picking. This is where some of my confusion comes into play. How would I even begin to know when the drug was doing its thing (hasn't started anything yet still, but...) if her appetite is so hit or miss? Too confused about this.

~Shannon

[addy]

Hi Shannon,

Making the decision is the hardest part. It took me a year to start treating Zoe because of her colitis. In the beginning it was more worrisome than her Cushings.

You have to be comfortable with whatever your choice is. For me it was which was the lesser of two evils when it came to the drugs, which would hurt Zoe more rather than help. My gut told me early on I could not load her without problems, an endocrinologist that I finally had a telephone conversation with helped clear thing ups for me and we finally moved forward.

When we have concurrent issues we worry more about the decision to make, I think. For me, I went back to my initial gut reaction. And it sure does not help us when even the experts disagree on what is the best route to go. No wonder we get frozen with fear and indecision:rolleyes:;):)

I know this is hard, but you will come to a decision and it will be the best decision you can make. We all understand how hard it can be.

Sending love and hugs and support,
addy

[ShannonJ92]

Thank you Addy. What you say makes sense and where my head is at, meaning trying to determine the lesser of two evils. Also you got it right when it's not made any easier by differing opinions from the vets themselves. Right now I don't know that I'd even be able to get the Lyso (or Trilo for that matter) administered properly with Pebbles' unpredictable appetite, and of course with all her other issues.

At one point, I guess it was about 5 years ago or so, they suspected one of my other dogs, Frosty, had Cushing's. The thing with her was she was 13 at the time and I just didn't feel it was necessary to put her through the testing at her age. Well she lived to be almost 17, now granted we'll never know if she had it or not but I'm certain her quality of life was excellent up until just before we helped her cross to the Bridge in April of 2010.

Today Pebbles seems to be hungry but doesn't want the K/D. We've always been limited in she's needed the low-fat diet due to the pancreatitis flares but now needs the diet for kidneys as well. I think I'll try some chicken and rice later and see how she does on that tonight.

She and Mireya are supposed to be seen on Tuesday for follow-ups. Will post an update after that when I can, he (the vet) may still be stumped too though.

~Shannon

[BestBuddy]

Hi Shannon,

My Phoebe (no cushings and since passed away) had kidney issues and we fed the kd.

I did google homemade kidney diets in the beginning and there were lots to pick from. I didn't have much luck getting her to eat them and I discovered Phoebe particually didn't like the texture of the kd. It is kind of rubbery!

Phoebe was a little thing too, about 3kg so food size was important. I used to put a can of kd through a little hand mincer and she ate it fine. It actually looked like a fine mince steak (dry).

One can lasted several days so I only had to get the mincer on duty every few days and it was a blessing.

Jenny

[Cyn719]

Hi shannon - just checking in on pebbles - sorry he doesnt want to eat his dog food today - penny is still on rice and chicken too - a whole week - maybe pebbles will eat some of that - - how is pebbles energy level these last few day? Yup these decisions are really awful for sure! Hope you get some answers soon! Xoxo

[ShannonJ92]

I haven't been on here in over a week so just checking in. No news to report, which actually is a good thing I think in that things seem to be okay for now. Pebbles is eating her K/D and has been pretty perky. No decisions made yet for med(s). As you all know it's all very much taking each day as it comes.

Best wishes to everyone,
~Shannon

[jmac]

Hi Shannon,
Just wanted to check in and see how Pebbles is doing. I hope things are going well!
Julie & Hannnah

[ShannonJ92]

I know it's been ages since I posted here. Things got bad for us and it's been a very rough couple months. My mom passed away in January and I'm still trying to come to grips with her loss. It still doesn't seem real.

As for Pebbles, she was doing pretty good until late May. She'd been perky, eating well and holding her own. All of a sudden things declined in every way and very quickly. After four days of hospitalization, we made the dreaded decision and allowed her to cross to Rainbow Bridge on June 4, just a few weeks shy of her 10th b-day :'(

I wish everyone here and their furkids the best possible and thank all those who offered advice, support and prayers for Pebbles. She was a gem and will forever be missed.

~Shannon

[lulusmom]

Shannon, I am so terribly sorry for the loss of your mother and Pebbles.

[Jenny & Judi in MN]

Shannon I'm so very sorry for your losses. hugs, Judi

[addy]

Shannon,

I am so sorry for such a loss. Please know our prayers are with you.

[Squirt's Mom]

Dear Shannon,

I am so sorry for the pain you have been dealing with. Losing your mom is tough and I offer my deepest condolences. My dad passed in '94 and I don't think I will ever adjust to his absence in my life. Even when we know it is coming, know it is for the best, it still hurts like mad.

On top of this to lose Pebbles. :( I can barely imagine the agony in your heart. Saying "I'm sorry" is so woefully inadequate. I have no doubts that you made the right decision. You gave Pebbles the best you could all her life, no reason to think you would have done any less for her when her need was the greatest.

Please know we are here if you ever need to talk about your mom or about Pebbles. We do understand your pain...

My sincerest sympathies for both your losses,
Leslie, Squirt, Trinket, Brick, Tasha, and our Angels, Ruby and Crystal


A Special Gift

They're a very special gift, to be cherished and loved;
You're chosen for each other by God Himself above.
It's a match made in heaven so it can't be wrong;
You're tied together by a bond that's oh so strong.

All they'll ever ask from you is to be loved and fed,
And at night make sure they have fresh water and a bed.
In return, for so little, the rewards are so great!
You'll get a companion for life with some very special traits.

When you are lost and the end seems so far away
They'll walk by your side, they'll help you find your way.
When life gets you down they can put a smile on your face
As they run you in circles with their fast pace.

You'll share the good with the bad, you'll be happy and sad;
And through it all you have a friend, the best you ever had.
You're time together will be special and unique;
It will be as priceless to you as a rare antique.

Then, before you know it, the day will arrive
When suddenly your life takes a steep dive.
The furry friend who's been with you for all of these years
Has now passed on and left you in tears.

As you sit and wonder what did I do?
Why is this all happening to you?
Into each of our lives a little rain must fall,
And you must be strong to answer the call.

Your little one's spirit has flown home on the wings of a dove,
To a special place that awaits them in heaven above.
St. Francis will meet them; when they get home
He will take them to a meadow where they're free to roam.

There in the meadows, down by the pond,
Your furry friend will remember his loving bond.
He'll look into the water, then you appear;
He can see you're frightened, he can feel your fear
He'll look into the water, then you appear;
He can see you're frightened, he can feel your fear
Through the bond that still ties you from heaven above
He looks down upon you, he sends you his love.

Through the bond that still ties you from heaven above
He looks down upon you, he sends you his love.
Because you loved him and because you care
Whenever you need him, he'll always be there.

There, in the meadows, they patiently wait for the day
When you will celebrate your life together, each and every day.
Waiting for that day; when you come walking back home
When together for an eternity through the meadows you'll roam.

Author Unknown

[Bo's Mom]

So sorry to read about Pebbles and your Mom. Texas sized hugs sent to you.

[mytil]

I too am so very sorry about Pebbles and your mom's passing too :(

My heart is with you.
((((hugs))))
Terry

[molly muffin]

Shannon, I'm very sorry to hear of both the loss of your mom and of your darlin pebbles.

Hugs!
Sharlene

[jmac]

Shannon,

I am so sorry to hear about Pebbles, as well as your mom. I can't imagine how difficult it's been.

Julie & Hannah

[Cocker's Mom in FL]

So sorry to hear about your Losses Shannon!

Curious though, you posted 12 pages about your little Pebbles. Do you have any idea what made her finally go downhill and pass away?

I have a sweet cocker spaniel that I suspect Cushings, but I can't afford to spend nearly the amount of money you must have spent on your puppy. Did the low dex-meth suppression test and it came back negative, but the other results from her blood tests led the Dr. to believe she has Cushings. At this point she is 11 1/2, and I wouldn't go surgery route anyway so I am living with the issues. She has a few other issues in addition to this, so it is a wait and see. You sure went through a lot!

[Sugar]

I know it's been ages since I posted here. Things got bad for us and it's been a very rough couple months. My mom passed away in January and I'm still trying to come to grips with her loss. It still doesn't seem real.

As for Pebbles, she was doing pretty good until late May. She'd been perky, eating well and holding her own. All of a sudden things declined in every way and very quickly. After four days of hospitalization, we made the dreaded decision and allowed her to cross to Rainbow Bridge on June 4, just a few weeks shy of her 10th b-day :'(

I wish everyone here and their fur kids the best possible and thank all those who offered advice, support and prayers for Pebbles. She was a gem and will forever be missed.

~Shannon

Hi Shannon
So sorry to hear that you lost your Mom in Jan and your dear Pebbles in Jun. I know what you are going through and feel your pain. My Mom died 2 yrs ago in Apr and it was her wishes to have her body donated to medical research. My precious Sugar died in Feb this year and was buried on 24th Feb, the exact same day my Mom was cremated. I am still trying to find a way to live without them.

[Sabre's Mum]

Shannon ... I am so sorry to hear of your losses. My thoughts are with you.

Take care
Angela and Flynn

[ShannonJ92]

Thank you everyone for your kind words and support. It's been very surreal for quite some time now.

Cocker's Mom in FL - to answer your question about what made Pebbles go downhill so fast, I don't know with certainty. My suspicion is during her regular blood test and check-up in late May (she was drinking soooo much which is why I wanted her blood checked again sooner rather than later) indicated high BUN but normal Creatinine. Our regular vet was away that week and a different vet did a urine test without asking us first. Our regular vet opted to not do the test via the needle in the abdomen given her extensive health history (chronic pancreatitis most of her life, the Cushings since the fall, then most recently the kidney issues)- many things that were generally safe for "normal" dogs were not appropriate for Pebbles and potentially could cause more problems (we would've declined that method of testing had we been informed). She had been doing well, even that morning prior to her appt., she was okay. I can still picture her perky and bouncing down the steps. After that needle urine test she started walking hunched once home and seemed disoriented. Things settled slightly that night a bit then got very bad the next morning and she went back in and was put on IV's that Thursday. We visited with her Friday, she was not quite herself still but holding her own and ate for us, perked up with our company. We'd gotten a couple updates over the weekend, then all of a sudden the call came early Monday that she wasn't doing good at all. We rushed over, when they brought her in the room, it was hard to believe how bad she was. I just cried and cried. She was in respiratory distress (possibly pneumonia), her numbers in her blood were very bad, Creatinine shot up, so much was either very high or very low.

Maybe it was coincidence, maybe it would've happened regardless, but I just wish I had known that other vet was going to use such poor judgement. I think it was too coincidental to not have had it play a role. I felt and still feel guilty... had I only waited but I thought I was doing the right thing rather than wait for our regular, most trusted, vet to get back. We'll never know if the outcome would've been the same regardless but, again, my suspicion is a strong one. I do not blame the entire office, we've been going there for over a decade, but the other vet took a chance and Pebbles and we paid the ultimate price.

She was a tremendous little fighter, and she'll live forever in my heart with all my other furkids (both those here and the ones at the Bridge).

I'm certain I'll see my mom and Pebbles again, but we've endured four losses in just over a two year span and wow it's been incredibly tough. I was in shock and depression for a long time, now I'm not sure what state I'm in. Just still trying to grasp and accept everything I think.

May all of you fight the good fight with your dogs and best of luck.

~Shannon

[bgdavis]

I'm so sorry for both the loss of your mother and of dear, little Pebbles.

Bonnie and Angel Criss Ann

[k9diabetes]

I'm sorry to learn of Pebbles' passing. It is hard enough to lose a beloved dog and then for it to happen suddenly is just such a shock.

Natalie