Pandy, 14 y/o border collie/aus shepherd mix - (Pandy has crossed Rainbow Bridge) [Archive] - Canine Cushing's Information and Support Forums

lucygoo

05-22-2009, 02:38 PM

Moderator Note: Gina is responding to a similar post, copied from the k9diabetes site:

I understand that this a forum for diabetic dogs--I registered with you when you were hosting the cushings forums temporarily. I've tried to register with that forum with no luck so I'm hoping that maybe someone here might be able to give me advice. My BC/Aussie mix is 14 and was diagnosed with Cushing's last month. She had been on a maintenance dose of lysodren for about 2 weeks and seemed to be doing relatively well--and then she stopped eating altogether about a week ago. Had a whole battery of blood tests done and found her cortisol levels were okay, kidney, liver function was normal. I don't think my vet knows what to do at this point--said maybe the pituatary tumor was causing her problems. She has weakness in her legs and is congested. She didn't want to even drink water but I've managed to coax her to. She was lethargic and seemed depressed-she seems to be a little better in that regard yesterday and today, but is still not eating. She's off all medications now--she was taking the lysodren, prednisone and eye drops because her eyes were pus-filled. She WAS doing real well prior to this and was amazingly healthy despite her age. I'm at a loss now as to what to do. Please let me know if any of you have any suggestions. Thanks so much.

Joan

Joan....
The symptoms you're describing sound very familiar to what my Lucy had. And hers indeed was a very large pituitary tumor that they just removed a week ago in a study. I would first get your dog at least back on prednisone immediately. Lucy was on 20 mg/day and it helped the swelling in her head, and even made her eat again. (She hadn't been eating at all) It will also make her feel much better, she'll just be drinking water and peeing nonstop. Is she showing any neurological signs as well? Lucy started having these weird spasms in her back, where she would hunch her back like a cat. She also got confused and was very lethargic.

Of course, they'll need to do an MRI to make certain it is a pituitary tumor, which is very expensive, and you'll have to make the decision whether you want to do that or not. My dog is only 11, so I went ahead and did it....now we're going through postop hell, and I've had to take off a huge amount of time from work. My other options were radiation or a drug from Canada that they're trying out to see if it shrinks tumors, or just palliative care for a few months (prednisone and tramadol.)
I know what you're going through now....Please at least call your vet and insist that she be given prednisone until you get to the bottom of this.

Gina and Lucy.

jayvee

05-22-2009, 02:38 PM

Hi, and thanks to all of you who helped me find my way from the diabetes forum to this one--I'm finally where I need to be! My situation is this--we have a 14 yr. old BC/Aussie mix who was diagnosed with Cushing's last month. After her loading dose of lysodren brought her cortisol numbers down, she was put on a maintenance dose, along with a small amount of prednisone. She seemed to be back to normal for about a week although the day after her twice a week dosage of lysodren, she was lethargic and refused to eat but she eventually bounced back.

After last Saturday's dose however, she didn't bounce back and hasn't eaten since. I have managed to get her to drink water and chew ice cubes, but not eat, even when she's offered her favorites. She was given a battery of tests on Tuesday and all her values looked good. The only numbers I have right now are cortisol levels(?) Pre: 3.6 and Post:3.9. Kidney and liver function were good. She's on no meds right now until we can figure out what's going on.

My vet's office is closed until Tuesday, so I can't supply you with any more test-related information right now. She also had really "goopy" eyes and was having breathing difficulties due to clogged nostrils, but with care, both of those symptoms seem to be under control. She has weakness in her limbs, but can walk, although she's fairly unsteady.

I've got fluids that I'm to give her subcutaneously over the weekend and am hoping that that will jump-start her appetite. Prior to this whole mess, her health was excellent and one would never know that she is 14. I hate to see her like this and really would appreciate some input. I'm not sure that my vet knows exactly where to proceed from here, and I'm sure lost! Anyway, sorry for such a long post--thanks for hanging in there with me.

Joan

k9diabetes

05-22-2009, 05:58 PM

Hi Joan,

Glad you found your way here!

I'll add a bit of detail you sent me in an email...

Her dosage of lysodren was 250 mg twice a week with 1/2 of a 5mg prednisone every other day for a week and then I'm was to stop giving the prednisone routinely. After she got sick on the loading dose of lysodren and we cut back on it, she seemed to be doing a lot better. Lately she only seems to be her normal self a couple of days after the lysodren dosage, but by then, it's time for another dose--so maybe you're right-- it may be too much lysodren( she weighs about 52 pounds).

Then I'll go and read what you posted here.

Natalie

k9diabetes

05-22-2009, 06:01 PM

Hi Joan,

Do you have phone access to your vet? Or is there an emergency clinic you can keep in touch with?

I'm worried that her cortisol now may be too low and she needs the prednisone.

I think I would give her a little pred - it shouldn't hurt and it could help....

Was there any worry that she might be sensitive to the prednisone?

If it was me, I'd feel a lot better if there was veterinary advice available at least by phone through the weekend. And if there's any way to get hold of your vet through a pager or something, ask about giving a little prednisone to prop up her cortisol and appetite through the weekend.

Natalie

gpgscott

05-22-2009, 06:03 PM

Joan,

Welcome to you and your pup,

it is hard to say without numbers from the diagnostic testing and more information concerning the loading and all but I am going out on a flyer here.

I really think you are overloaded, everything you post points to it.

It is Friday evening of a three day holiday here in the states. Do you have means to reach the Dr. treating your pup.

I really think you should suspend all treatment and give rescue cortisol. I would not give anymore Lysodren without the express direction of the treating Dr.

Please do not be concerned about the length of your post. The medical professional who has prescribed this treatment needs to be available to you whether it is a holiday or not.

Scott

k9diabetes

05-22-2009, 06:03 PM

A link to Joan's thread at the K9diabetes forum for reference...

http://www.k9diabetes.com/forum/showthread.php?t=945

k9diabetes

05-22-2009, 06:06 PM

I want to second Scott and make my statement a little stronger... unless there was some worry about her being sensitive or having problems with prednisone, which would be unusual, I think she needs some through the weekend.

If nothing else, it will likely stimulate her appetite even if her cortisol levels are okay.

What is available to you in terms of contact with the vet or a 24-hour hospital?

Natalie

AlisonandMia

05-22-2009, 06:22 PM

Hi Joan and welcome.

I'm sorry that you and poor pup are going through so much at the moment.

I see that you had an ACTH stim test done which showed a pre of 3.6 and a post of 3.9. It appears that she had been having prednisone from time to time and I'm wondering when she last had a dose of pred prior to that test being done? And also when they ran all those tests where her electrolytes checked. I'm guessing they were but could you confirm that and post the results?

I agree with the others with regards the predisone too.

Good luck and keep us posted.

Alison

jayvee

05-22-2009, 06:27 PM

Thanks to you all-- I think that I'll give her some prednisone--it can't hurt. It appears as if my vet was weaning her off of it, as she was only getting 1/2 of a 5mg tablet every other day til gone( which would have been about 10 days).She doesn't have a sensitivity to it as far as I know. Is it normal to give the lysodren without the prednisone once maintenance levels have been achieved? I really don't know what I'm doing here, and although I really like my vet, I wonder if he does. There's an emergency hospital about 10 minutes from here that I can use, if necessary. Tonight, I'll give her the subQ fluids. Sigh....

Joan

AlisonandMia

05-22-2009, 06:39 PM

Oh sorry - one more question to add to my questions above - when she had the ACTH stim test when had she had the last dose of Lysodren in relation to that test?

Make that two questions:p - also had she been given fluids prior to the tests being run?

Alison

gpgscott

05-22-2009, 06:54 PM

Tonight, I'll give her the subQ fluids. Sigh....

Joan

Joan,

Have you been told why you are giving the additional fluids. This is not usually a Cushing's treatment. It points more to a kidney issue.

Please tell us what breed, how long with the subQ and anything else.

Scott

jayvee

05-22-2009, 06:57 PM

Her last dose of Lysodren( 250 mg) prior to the test was 3 days before the test. She hadn't been given any fluids prior.

AlisonandMia

05-22-2009, 06:58 PM

When was the last dose of prednisone prior to the test? And do you know if her electrolytes were checked?

Alison

jayvee

05-22-2009, 07:02 PM

Scott,
Pandy is a border collie/australian shepherd mix. I've never given her subQ fluids before now--her blood test indicated that her kidneys were functioning okay. From what I understand, the fluids were prescribed due to the fact that she's drinking very little and eating nothing. I guess she needs electrolytes? I'm to give the fluids only this weekend.

StarDeb55

05-22-2009, 07:08 PM

I agree with what everyone else has said, it definitely appears that your pup has been overloaded. With numbers of 3.6 & 3.9 on her stim, this is what is usually termed a non-stimulatory response, meaning her adrenals are not functioning well enough to produce an adequate amount of cortisol. Frankly, if a dose a pred & the subQ fluid doesn't help within about an hour or so, I really think you will need to go to the emergency clinic.

Debbie

Squirt's Mom

05-22-2009, 07:12 PM

Hi Joan,

Glad you made it over here!

Unless something has changed, it is not standard protocol to use pred in combination with the Lyso either in loading or maintenance, tho some vets will do this. It is just that they are counteractive....the Lyso is lowering the cortisol and the pred is raising it. The objective is to lower the cortisol. Pred is typically used only as a rescue when the cortisol is too low.

I am a bit confused as to what happened when...can you put things in chronological order for me. Old brains need all the help they can get. :p:o What tests when, when Lyso treatment was started and the mgs she takes how often, when pred was started and how much how often, when reactions like not eating started, and so on. Also include any other meds, supplements, herbs that Pandy is on if any. Do we have her weight? When you get the copies of all the tests done to reach a diagnosis it would be great if you could post those, too, along with the units of measurement (ug/dl, mnol/L, etc) and the normal ranges.

Hugs,
Leslie and the girls

gpgscott

05-22-2009, 07:14 PM

Joan,

Debbie is right that emergency care might be necessary, you have to assess that and know when and how long it will take you to reach it.

A dog can survive for a long time without eating. They have to drink frequently, and if they are not you have an issue.

I would not wait out the weekend with the situation you are describing.

Scott

jayvee

05-22-2009, 07:16 PM

Debbie,
If you don't mind could you explain more fully? I was under the impression that her stim numbers were good and everything was in balance. Thanks

gpgscott

05-22-2009, 07:28 PM

Joan,

She should be eating and drinking, in fact she should be ravenous if she is a cushpup.

You have not posted testing confirming Cushing's.

I suspect the diagnosis.

I think you should stop treatment and adminster pred. She should perk up.

Then I would ask for additional diagnostics.

Scott

StarDeb55

05-22-2009, 07:36 PM

A Cushpup's adrenal glands are what you would call hyperactive because they are pumping out this excess cortisol constantly due to ACTH being released from the brain. When an ACTH test is done, the Cushpup, even with treatment, should show a distinct increase between the pre & post levels due to the release of the cortisol that the adrenals have in reserve. Pandy's numbers are basically identical which may indicate that she has no cortisol reserves in her adrenal gland, possibly indicating that too much of the adrenal cortex has been necrosed due to an overload. Yes, you want the numbers between 1-5, but not identical like you have posted. I have gone back & re-read your posts. Alison has asked when the last prednisone was administered prior to this ACTH being done. I can't see where you have specifically answered that question. This is extremely important because if pred was administered within 24 hours of the ACTH being done, the pred has been read as cortisol on the test which give you falsely elevated values. The results are likely much lower than what you have posted, if the pred was still in your pup's system. I truly feel you are in an overload situation. You need to administer prednisone ASAP. If you do not see improvement within about an hour or so, you need to go to the emergency clinic. I absolutely would not give any more lysodren until you get this sorted out.

Debbie

jayvee

05-22-2009, 07:37 PM

Again, thanks for all of your input. I fully did not realize how serious a disease this was when she was diagnosed--therefore, I didn't keep a journal or record of things...SO to the best of my knowledge,she was prescribed one 500mg tablet of lysodren for 10 days, then given her second stim test. Numbers were still not what the vet wanted, so she was put on 2 tablets daily and 5 days later wasn't eating, was vomiting, lethargic. At that time she was given another stim test, and her numbers were supposedly good enough to be put on a maintenance dose--at that time she was prescribed prednisone--one 5mg tablet once a day for 7 days and 1/2 tablet every other day after that. Prior to the tablet of pred that I just gave her, she hadn't had any since Monday, the 18th. I noticed Sunday night that she wasn't interested in food or water, so I had her re-tested Tuesday. The only other meds she was on were eye drops, that I have since discontinued since it was reacting apparently to the prednisone still in her system. I'm sorry that I can't be more specific about test numbers--I'll get them as soon as I can and post them. In the meantime, as soon as my husband gets home, we'll give her the subQ fluids and watch her carefully, taking her to the emergency vet if need be.

AlisonandMia

05-22-2009, 07:43 PM

So she had a pred tablet on Monday the 18th and had the stim test on Tuesday the 19th?

If that is the case then the result of that stim test read as being much higher than it should have been because the pred read as cortisol on the testing. This means that her cortisol is almost certainly now extremely low (more like maybe 0.1 on the pre and 0.9 on the post) and that she needs pred.

Was she getting prednisone with the Lysodren during the loading phase too?

Alison

StarDeb55

05-22-2009, 07:46 PM

I just want to make sure I understand the timing. You gave her pred on Mon., 5/18, had the ACTH done on Tues., 5/19, correct? If this is correct on the timing, the stim results are probably much lower as I said in my earlier post, & you are in an overload situation. If there is no distinct improvement after the pred & subQ fluids, please go to ER clinic, make sure that they check your pup's electrolytes as an overload can wreak havoc with the electrolytes.

Debbie

k9diabetes

05-22-2009, 08:12 PM

Just reposting some of the information as some basic questions have already been answered...
_________________________

14 yr. old Border Collie / Aussie mix
Weight: about 52 pounds
Diagnosed with Cushing's last month

Got sick on the loading dose of lysodren
After cut back on it, she seemed to be doing a lot better.

Her dosage of lysodren was 250 mg twice a week with 1/2 of a 5mg prednisone every other day for a week and then I was to stop giving the prednisone routinely.

She seemed to be back to normal for about a week although the day after her twice a week dosage of lysodren, she was lethargic and refused to eat but she eventually bounced back.

Lately she only seems to be her normal self a couple of days after the lysodren dosage, but by then, it's time for another dose).

After last Saturday's dose however, she didn't bounce back and hasn't eaten since.

Battery of tests on Tuesday
Cortisol levels
Pre: 3.6
Post:3.9
Kidney and liver function were good.

She's on no meds right now until we can figure out what's going on.

She also had really "goopy" eyes

And was having breathing difficulties due to clogged nostrils

With care, both of those symptoms seem to be under control.

She has weakness in her limbs, but can walk, although she's fairly unsteady.

I've got fluids that I'm to give her subcutaneously over the weekend and am hoping that that will jump-start her appetite.

Prior to this whole mess, her health was excellent and one would never know that she is 14.

jayvee

05-22-2009, 08:15 PM

Thank you... I missed the direct Q (Alison and your repeated here). She had 2.5 mg prednisone on 5/18 and her followup ACTH on 5/19. Vet specifically quoted no change in drug schedule so I did not fast or stop meds prior to the test which may have been slightly less than 24 hrs, yes. I'm hearing you all (THANK YOU) that she needs prednisone. So how much do we give her??? My pills are 5 (five) mg she is 52 lbs. I just got 1 x 5mg in her, but dont know what the expected dose for her weight is supposed to be. Im watching her now for reaction/improvement. Will go to emergency vet (but again is 5mg./52 lbs adequate to produce some level of expected response??) -- John (Joans husband)

Squirt's Mom

05-22-2009, 08:23 PM

Hi John and Joan,

The standard rescue dose of pred is 0.25mg/kg. To find her wieght in kg, divide the lbs by 2.2...then multiply that result (her weight in kg) by 0.25 and you will have the amount for her weight.

Might not hurt to give her some Pedialyte, plain flavor....a good home remedy for electrolytes. But not if you are going to the ER with her any time soon.

Hugs,
Leslie and the girls

jayvee

05-22-2009, 08:29 PM

Thank you :) so the 5 mg dose is close enough. We appreciate your fast reply.

StarDeb55

05-22-2009, 09:01 PM

Frankly, I would give her another 1/2 tab. Her rescue dose calculates to 5.9 mg., giving extra will not hurt in any way.

Debbie

Right now, you need to get her feeling better. Once she's feeling better, we can help you get this sorted out & understand what happened. Post all of Pandy's test results as soon as you're able. As several of us have already said, please DO NOT GIVE any more lysodren until this gets sorted out. IMO, & please remember none of us are vets, there is one of 2 things going on here, the Cushing's diagnosis is suspect, or concurrently loading with prednisone has lead to the overload. As Leslie has already mentioned, using pred during loading is not good practice as the pred is working against the effects of the lysodren. Lyso is used to selectively erode enough of the adrenal cortex to bring the circulating cortisol levels down to the 1-5 range. Pred simply acts like cortisol in the body, so you are simply masking the signs of loading you need to watch for, & very easily drop the cortisol much too low, leading to the pup getting very sick, very fast. Signs of this are just exactly what you have already described, inappetance to the point of anorexia, extreme lethargy, diarrhea, & vomiting.

AlisonandMia

05-22-2009, 09:07 PM

And, from what I've seen, when they have been low and feeling crummy for a while (ie for more than a few hours) they often benefit from having a bit more than the normal rescue dose. It is better to give a little more than necessary than too little, IMO.

Alison

jayvee

05-22-2009, 09:08 PM

Just wanted you to know... John just took Pandy to the emergency
vet. Thanks to all of you dear people for all your help. I've learned more from all of you in the last couple of hours than I have in the past month. I'll keep you posted.... Joan

frijole

05-22-2009, 09:31 PM

Joan,

Since you are in the "wait and worry" mode I just wanted you to know that with the prednisone Pandy will get relief before long. I am very glad you were able to find us and please know that with electrolytes she should be fine. That is why you needed to get to the vets' asap. You did the right thing and I'm glad you didn't wait the weekend. So hang in there and know you are doing everything right.

We are here.
Kim

jayvee

05-23-2009, 12:09 AM

Pandy just got back from the ER--she has a massive infection and was given antibiotics--also fluids with electrolytes. He doesn't suspect Addison's but couldn't give the acth test because of the prednisone. We're to watch her carefully and make sure she gets fluids, so I plan to be up all night. By the way, I guess I gave the impression that she was on Pred during the loading dose of Lysodren--she wasn't prescribed it until she started on the maintenance dose.
Is it normal to get infections associated with the cushing's or the medication? The doctor wasn't too optimistic on her prognosis, mostly due to her age. Again, thanks for all the concern and help. I'll keep you posted.
Joan

AlisonandMia

05-23-2009, 12:25 AM

Cushing's most certainly does predispose a dog to infections because high cortisol suppresses the immune system. Going very low on cortisol also suppresses the immune system and is generally pretty rough on the body so when she went low at the end of the loading period (overloaded) that probably didn't help either.

It isn't that unusual for a dog to go a bit low towards the end of the loading period and to need a little prednisone. However it is not usual to start maintenance while the dog is still needing prednisone.

The standard protocol for when a dog does go too low is to withhold Lysodren, give prednisone for a week or two, tapering it off while watching for signs of low cortisol. Once the dog is doing well off prednisone then another ACTH stim test is done and, if the cortisol is where it needs to be, then maintenance is begun. If you begin maintenance while the dog is still too low it will stop the adrenals regenerating that little bit they need to do to bring the cortisol up the correct level where there are no Cushing's symptoms and no need for prednisone either which is the goal of Lysodren treatment.

I hope Pandy can fight off the infection with the help of the antibiotics and fluids etc - sending healing thoughts in Pandy's direction.

Alison

StarDeb55

05-23-2009, 12:32 AM

I am so very glad you have gotten to the bottom of what has made Pandy so sick. I will totally agree with Alison about what she has told you about Cushpups pre-disposition to recurring infections. My Harley fought a non-healing corneal ulcer for nearly a year because of the immune suppression from his Cushing's. Did the vet say what type of infection, perhaps a UTI?

Please don't let the ER vet's comments about Pandy's prognosis due to her age alarm you. Harley was diagnosed a year ago at 13, is now 14, & is doing well. I think once you can get her over the infection, there is every likelihood that you can get the Cushing's controlled, & she can have a happy, healthy life for her remaining years. Being 14 years old is a testimony of the wonderful care she has gotten from your family, so don't give up. To give you a ray of hope, my 1st Cushpup, Barkley, was successfully treated with lysodren for nearly 8 years, crossing the bridge at 15.

Please keep us updated as to how Pandy is doing.

Debbie

Harley PoMMom

05-23-2009, 12:47 AM

Hi John and Joan,

Just wanted to welcome yous to our cush-family :)

Sending healing thoughts and prayers too.

lucygoo

05-23-2009, 12:47 AM

Hi Joan...

I'm just sending my good thoughts your way. I'm not nearly as knowledgeable as most of the wonderful people on here, but I'm just sending you good wishes, and hopefully all will be okay. Hang in there...

Gina and Lucy

gpgscott

05-23-2009, 10:50 AM

Hi Joan,

I am just seeing your thread since Pandy has returned from the ER.

I hope she had a comfortable night and the antibiotics are beginning to work in the infection. Did the ER Dr. characterize the type of infection?

Scott

Squirt's Mom

05-23-2009, 11:50 AM

Hi Joan,

I am so glad to hear that John took Pandy to the ER last nite and that the infection was found and treatment has started. Like Scott, I am curious as to what type of infection she has. I also wonder how long it has been brewing as a serious infection would quite possibly had an effect on the cushings testing causing skewed results from the get-go. In other words, is it possible that Pandy was otherwise sick when tested and doesn't have Cushing's after all. When we see the results of those tests and learn what type of infection maybe we can help you determine if this was a possibility or not.

Debbie and Alison are right about using the pred during maintenance. And the specialist was right about not being able to do the ACTH with it on board. It is unfortunate that your GP vet decided to approach maintenance in this manner.

As for the comment by the IMS, don't put too much stock in that. Unless her health is much worse overall than we are aware of, he has no way of knowing how she will respond to treatment. I believe vets will say this sort of thing based, one on their training, two on prior experiences where they mishandled the diagnosis and treatment, and three experiences with parents who couldn't or wouldn't do their part. They just ain't used to folks like us who will demand the very best from our vets and who are willing go to extreme lengths to learn and do anything possible for our babies. ;)

Hang in there. You and John are doing a wonderful job of watching Pandy so just keep up the good work!

Sending belly rubs, prayers and healing thoughts to Pandy.
Hugs,
Leslie and the girls

jayvee

05-23-2009, 12:39 PM

Hi All,
Pandy update: She had a quiet and seemingly peaceful night. She hasn't however, shown signs of improvement ( I thought that the antibiotics would have made a substantial difference by now). Don't know what kind of infection she has, just that the white blood cell count was extremely elevated. All the testing at the ER was going to approach $4,000. and regrettably, we just don't have that kind of money--thus, right now, we can just treat what we know is wrong with her--and that is the infection and low electrolytes. We just gave her more SubQ fluids. She doesn't appear to be in any pain or discomfort--she just wants to sleep. If she hangs in there like we're praying she will do, I plan to have another acth test done asap. How soon after her last dose of prednisone should the test be done? It's funny(not ha-ha funny), but when the vet mentioned possible cushings and before the battery of tests, I found your forum and was going to ask questions and get some guidance then. The next day, I tried to find you again and of course, you had disappeared (thanks, Hackers). I tried to get as much info about cushing's as I could, but what I found was mostly generic and non-specific. Her symptoms were; increase thirst( she would suck down two bowls of water in a matter of minutes) and increased urination that was clear. She also gained 5 pounds in a matter of days--her appetite was voracious). I've used my current vet for the past 9 years and had been extremely pleased with him, but am beginning to think that maybe his experience with cushing's has been minimal. I live in a relatively small town, so he probably hasn't seen too many cases. If she can pull through this, I'll try to find someone else who is more versed in this disease. In the meantime, any and all suggestions are so much appreciated. I can't begin to tell you how much your support has meant to us. Thanks so much.

Joan

frijole

05-23-2009, 02:34 PM

Joan

Sending some caring vibes your way. So we are all clear - can you tell us exactly what meds and dosages and frequency the emergency vet has Pandy on? You mentioned antibiotics and the fluids. Are you still giving prednisone? How often?

Did they tell you what tests they wanted to do that amounted to $4000? I agree that getting a feel for her cortisol level would be helpful. I believe (not sure) it's 24 hrs that you want between the last prednisone and an acth but hopefully someone can confirm or correct that.

With the infection the results might be scued as well. I am sure Debbie will check in later and have thoughts on this. In the meantime, keep us posted and know we all have your family and dear Pandy in our thoughts and prayers.

Kim

PS I had just moved to a small town when my dog was diagnosed (3 yrs ago) and the first vet was unfamiliar with cushings. I switched to a wonderful guy who might not have a ton of experience (hard in a small town to have alot of experience) but at least is very willing to read and research prior to making recommendations. So you aren't alone. Take your time - right now lets get her feeling better.

jayvee

05-23-2009, 03:41 PM

Hi Kim,
Right now, the only thing that the ER vet has her on is cephalexin 500mg twice a day. he wouldn't prescribe prednisone because he wasn't able to do the acth test and didn't know if the pred was needed. I have 2 tablets left and was considering giving one to her today--couldn't hurt, right (or could it?). I'm so tired of having to figure things out on my own( and of course with all this forum's much-appreciated help). I've already spent hundreds of dollars in the last month. Don't get me wrong, Pandy is more than worth it-- she's my little canine soul mate. I guess I'm just resenting that there's a very good possibility that I've wasted money on procedures and medications that weren't properly prescribed. The ER clinic's estimate (and I don't have a copy--so I'll try to remember what they told John) included x-rays, ultrasound, fluids and hospitalization--most of it, he admitted, to confirm what we already suspect. If money weren't an issue, I could have gone ahead but since it is, I have to try to make decisions as to what things are absolutely necessary and spend my money on those things( hope that made sense--I'm extremely tired:) ). Right now, she seems to be resting comfortably and I don't get the sense that were in any eminent danger of losing her, but I could be wrong. I'm still giving her subQ fluids (we learned how to do this with my 12yr. old sheltie who had kidney failure-we were able to extend her life a full year, bless her). I'm also giving Pandy clear pedialyte(thank you, for whoever recommended it here!) and nutri-cal.

frijole

05-23-2009, 04:18 PM

It is tough because the ER vet had no way of knowing everything going on with Pandy since they didn't treat her. One of the signs of an overload is extreme lethargy which you seem to be describing since you say she is sleeping non stop. Catch 22 - they didn't do the ACTH test due to the prednisone however her body (if her cortisol is too low) requires cortisol. It might perk her up and make her feel better. Yet giving it delays being able to do the test.

If she is resting comfortably I think I'd let her sleep. If you feel there is distress I would not hesitate to give her another prednisone. That is why you have the pills - emergency. Not sure I was much help but that is what I would do.

When you meet next with your vet or the ER vet (whichever you elect to see for the ACTH test) I would refer to Debbie's post regarding the previous test. (2 numbers being identical and a sign of overloading) Print it out if you have to but to me that was when they should have known the dog had too much lysodren. And frankly that's perhaps why they all of a sudden told you to give prednisone. But they should have instructed you to hold off on giving more lysodren until they could retest.

Please continue to post and give us updates - don't be afraid to ask questions. We were all new to this at one point. Hang in there and big hugs to Pandy.

Kim

frijole

05-23-2009, 05:23 PM

Joan

We never got to start at the beginning! Some time when you are up to it - please tell us a little about the original symptoms that Pandy had. I thought some of these links on our site might be helpful...

For additional information on cushings you might start with this thread: http://www.k9cushings.com/forum/showthread.php?t=180

the protocol for giving lysodren with instructions is here:
http://www.k9cushings.com/forum/showthread.php?t=181

Kim

StarDeb55

05-23-2009, 06:21 PM

Joan, in regards to how long Pandy has to be off pred before an ACTH can be done, it's 24 hours. There is an alternative which is a dexamethasone injection, the dex will not read as cortisol on an ACTH. Do you have any idea what type of infection, UTI, pneumonia, kidney infection? Do you have the results of the tests that were done at the ER clinic? I'm a medical lab technologist with 29 years experience, so I can help you to interpret those test results. Not to sound repetitive, but if you have any doubt whatsoever, please give the pred, it will not hurt Pandy at all.

Debbie

k9diabetes

05-23-2009, 08:55 PM

Hi Joan and John,

I just wanted to check in and see how you all are doing. If you can get safely through the weekend, then things can get sorted out once you have access to all of the tests.

I sure wish the ER vets had said where they think this raging infection is...

If you aren't psychotic from lack of sleep, you might ask the ER vet for the test results and their notes - that would probably help sort things out. You're entitled to the records - shouldn't be a problem for them to give them to you and I'm sure your regular vet would want to see a copy too if that's where you're going back to.

I'm glad she's getting in some calories.

Will be checking in often to see how you are doing.

Natalie

jayvee

05-23-2009, 09:29 PM

Natalie,
Thanks for checking on us--just got a faxed copy of the test results from the ER vet but, not being familiar with the terms, can't make any sense out of it. I do know that Pandy has nasal congestion but her lungs seem clear and she's breathing nicely. The vet said is was bacterial and not viral in nature. She seems to be a little more alert, but still won't move from her spot in the bathroom. I take some comfort in the fact that her condition doesn't seem to be worsening at least. Aside from Pandy, there's a lot of other stuff we're having to deal with. Among other things, John goes in for foot surgery on Tuesday. Funny how life tends to just keep throwing things at you. We're strong though--we'll get through this. What do they say--what doesn't kill you, makes you stronger?
Thanks again!
Joan

AlisonandMia

05-23-2009, 09:35 PM

Hi Joan,

I just wanted to second what Debbie said about dexamethasone. It is a corticosteroid like prednisone and works as a cortisol-replacement in the body but it has the incredible advantage of not "reading" on as cortisol on testing which most (maybe all) other corticosteroids do.

In fact what is done when a dog (or human) is suspected of having naturally-occurring Addison's Disease is that (amongst other things to do with electrolytes, fluids etc) dexamethasone is given urgently to stabilize the patient and then and ACTH stim test is done to look at adrenal function. Other more commonly used steroids like cortisone and pred are not used in this situation because they mess up the testing but dexamethasone doesn't cause this problem so is the preferred med.

The other thing is that in Pandy's situation, as a treated Cushing's dog and being so sick with an infection, even if her cortisol was exactly where you want it normally she would be needing a little extra corticosteroid to help her body cope with the stress it is under. When a normal dog (or person) is under stress of some kind, their body automatically signals to the adrenal glands to pump out more cortisol - sometimes up the 3X the normal amount I believe. Because with a Cushing's dog the cortisol production by the adrenal glands has to be artificially curbed to keep it at a level that is ideal and healthy for every-day functioning it is sometimes necessary to artificially supplement the cortisol by giving pred (or if you are wanting to do a stim test, dexamethasone) to mimic the increase in cortisol production in response to stress that would normally occur and which is necessary support the increased metabolic activity that happens with any significant stress like injury, infection, surgery or even, for some, a trip to the groomer.

Alison

k9diabetes

05-23-2009, 09:41 PM

Hi Joan,

If you want, you can fax them to me and I'll post the numbers.

My fax is 916.372-7161.

Alison makes a good point. Under this much stress, she probably needs cortisol even more. Perhaps you could relay to the ER doc that she had that ACTH test while being given some prednisone and came up with no stimulation - give the pertinent dates and readings, including when pred was last given and when lysodren was last given - and see if that would be enough information for them to recommend giving some pred.

I imagine the infection plays into the decision but as I understand it, being in a low cortisol condition is a really really miserable feeling. I know people who have been hospitalized because of an Addisonian crisis. So maybe a little pred would not limit the immune system too much but would help her feel better.

Just a thought.

Natalie

jayvee

05-23-2009, 10:06 PM

Natalie,
The ER faxed the test results to John's Blackberry--we don't have a fax machine to send it to you. Thanks anyway. John gave the ER vet the info regarding the last acth test and he agreed that due to the prednisone, the results probably weren't accurate. He did say that based on observation (her infection, if that makes sense), she wasn't Addisonian. I went out on a limb, and just gave her a pred. tablet. In the last hour, she has seemed to be more alert and responsive--hope it continues and isn't just a fluke.

Joan

k9diabetes

05-23-2009, 10:12 PM

Oh Joan, I hope it makes her feel better!!

My border collie Jack sends a big hug and get well wish to Pandy!!

Natalie

frijole

05-23-2009, 10:18 PM

Joan,

I can't blame you. If I saw my poor baby sitting in the bathroom all day not moving and knew I couldn't do testing til Tuesday earliest... I hope she is up and giving you hugs very shortly.

Hang in there -
Kim
PS When you go to the vets for the test make sure you talk to them about the dexamethasone. You will need to have that OR the prednisone on hand at all times. If I counted right you have ONE pill left right? Dogs on lysodren have to have this on hand at all times just in case. And as Alison said, during times of stress... we help them out a bit.

jayvee

05-23-2009, 11:38 PM

The fax report from the ER vet is extremely hard to read--will try to go tomorrow and get a clear one and post results. Pandy's looking a little better!
Thanks to all and have a good night.
Joan

jayvee

05-24-2009, 04:23 AM

Pandy just woke me up struggling to get up--first time she's tried since Friday. She wanted to go outside--her gait is extremely wobbly and she kept falling over sideways, but with a lot of help, she made it outside to poop. I had to carry her back in. She has such dignity--I'm afraid that my two, 3yr. old rough collie boys would have just pooped in the house in her situation! I've been briefly looking at other posts and see that the weakness isn't abnormal, right? My daughter has a fabric sling I need to borrow. I plan to study the back-posts here more carefully tomorrow(well actually, later today). Can't process much right now. It's late(early?). Briefly though, does the muscle weakness ever improve? Is there any predominate cause for it, or can it be due to different factors?
Thanks,
Joan

AlisonandMia

05-24-2009, 04:41 AM

High cortisol levels cause the muscles to weaken over time and Pandy probably has some degree of weakness from this.

Low cortisol can cause really profound and sudden weakness which usually reverses pretty quickly with prednisone but it seems to hang around a bit longer if the cortisol has been low for a while (like several days).

Being ill - having an infection- can make anyone weak of course as can lying down and not moving for a prolonged period.

I would suspect that Pandy is weak now for a combination some of these reasons and possibly all of them. But to answer your question - yes the muscle weakness related to Cushing's can be expected to improve although it seems the older and larger the dog the longer it can take. Many, many dogs regain all their pre-Cushing's muscle strength in time.

She sounds like a real fighter.

Alison

Sabre's Mum

05-24-2009, 04:49 AM

Hi Joan

Sabre - our Hungarian Vizsla - was diagnosed with cushings March 2008. With regards to the muscle weakness .... it does improve. Sabre was incredibly weak in his rear hinds just before diagnosis and lost a heap of muscle. He has regained his strength ... although his muscle is not to his pre cushing days but he bounces around like a puppy on his great days!

I just wanted to add a comment with regards to Debbie's post re "non-stimulatory stim" results. Sabre went low (ie <1 post stim) late last year and 2 months later had a non-stimulatory ACTH. He still was pretty low on energy. This is likely to be adding to the infection that Pandy is fighting.

Take care
Angela and Sabre

frijole

05-24-2009, 11:56 AM

Joan

It might not seem like it but Pandy wanting to get up and go outside to poop is indeed progress. Wobbly or not. As Alison said there could be multiple reasons for the weakness - all of which are normal. The lab reports will perhaps help us better understand. Getting an ACTH test done will also be very telling.

You are doing great!
Kim

Squirt's Mom

05-24-2009, 12:13 PM

Hi Joan,

Just popping in to check on ya'll. Sounds like Pandy is starting to rally a bit! :D That is good! Pooping is a good sign! :p

Since she was better soon after the dose of pred, that tells me her cortisol is still a bit low and that she needs it now. The antibiotics have been on board long enough now to start really having an effect, too.

You and John are doing a great job! Pandy is lucky to have parents like you.

Hugs,
Leslie and the girls

jayvee

05-24-2009, 01:41 PM

Hi to all,
We really appreciate all your kind words and encouragement. Just got home ( John was pup-sitting while I was gone) and Pandy wiggled her little butt when she saw me(being that she's an aussie mix, she has no tail to wag) :) I can't tell you how thrilled I was to finally get a reaction like that from her! I have to agree that the antibiotics and prednisone are working their magic. I have 1 pred tablet left, so I plan to give her half today and half tomorrow. Is that good? Will pick up more on Tuesday. I'm assuming that I shouldn't have another acth test done until her infection is cleared up? We were given a week's worth of antibiotics.
Picked up the test results--here are the numbers( they mean nothing to me, so any help interpreting would be much-appreciated!)
HEMATOLOGY
wbc--32.63K/ul
mono--3.25K/ul
neu--27.20K/ul
mchc29.7g/dl
The rest of the values were in the normal range

CHEMISTRY
alkp--1241. u/l
alt--109. u/l
ca--13.0 mg/dl
chol--98. mg/dl
crea--7.2 mg/dl
ph(VEN)--7.29
hc03(ven)--9.3mmol/L
pc02(ven)--21.0 mmol/L
tC02(ven)--9.9 mmol/L
cl--141.0 mmol/L
All the rest were within normal limits
--whew--
Please let me know if there are any other numbers that you need.
Thanks--I'm firmly convinced that by all of your collective effort, you save Pandy's life.

Joan

k9diabetes

05-24-2009, 02:50 PM

This is great news!!

Given the perkup she's gotten from the pred, I'd ask the emergency clinic to give you some to get through the weekend. They might be willing having seen what it's done for her.

jayvee

05-24-2009, 04:16 PM

I thought that it was a wonderful idea to ask at the emergency vet. I called, and he won't prescribe any pred. because he only teated her for the infection and nothing else. If you remember, he wanted to do a whole battery of tests to the tune of a few thousand dollars, which we declined. I'd like to think that he's just being cautious and conservative, but .... Oh well. I guess I'll just have to be content with one pill until Tuesday.
On a happier note(YAYYY!!!)-- Pandy got up from the bathroom floor, sauntered over to me in another room, and asked to go outside. Then she proceeded to walk all the way to the door, hopped down a step and went ouside to do her business. She came back in, hopped UP the step, and finally laid down. She didn't stumble or falter once. I was amazed. It definitely took a few beats to process. Just when you think things have settled down to normal, a new(and in this case, great) normal comes along. I know that things may change for her, but I'm rejoicing for the time being in the little miracles that happen.

Roxee's Dad

05-24-2009, 04:24 PM

Hi Joan,
The good news keeps adding up:) Very happy to see that Pandy is continuing to immprove:D:D:D

RE: Your vet, sometimes they have an answering service and you can leave a message. Your vet may be willing to call in a prescription before the day is out. My vet's office always has someone on call for these kinds of situations.

Carol G

05-24-2009, 04:43 PM

That is so great to hear Pandy is doing better.

Carol, McGill, Atty Cat & Winnie (always)

jayvee

05-24-2009, 05:07 PM

Thanks!
I called my vet's number and was referred to the emergency vet--the same one that didn't want to prescribe the pred without seeing her again. The good news is, I called them back and tried again, and was able to get 3 pills from them, which should get me by until Tuesday! Can anyone tell me if there is an optimum time to give the pred,i.e. is it better to take in the evenings, morning, or doesn't it matter?

k9diabetes

05-24-2009, 05:09 PM

I can't answer your question... just wanted to say YAY!!! about the extra doses of pred! :)

Natalie

jayvee

05-24-2009, 05:16 PM

Thanks! I tried to call my vet and the phone message referred me to the same ER clinic that refused to prescribe the pred. without seeing her again. I was finally able to convince them to give me a couple of pills to get us by until my regular vet was back in his office. I plan on giving her one 5mg pill daily--is there any special time of the day to administer that's better than another(ex. A.M. vs. P.M.?). She was just walking around again--she has some problems getting to her feet, but once she's up, she's good to go :)

jayvee

05-24-2009, 05:19 PM

Sorry for the almost identical posts--I didn't think the first one went through and I'm not computer literate enough to cancel one of them!

frijole

05-24-2009, 06:03 PM

Great news. I am relieved. You might not need to use them but boy you want them just in case.

You asked when the best time to give it is... When was the last time you gave Pandy prednisone and how much? How much did you give the day before that?

You want to be careful to use it only as needed. (grrr I wish we had the acth results so we knew how low her cortisol got!) But you want to use it if she is distressed.

Let's see if i can explain this in layman's terms: Pandy was taking lysodren because she was producing too much cortisol (the cushings). Lysodren erodes the adrenals to REDUCE cortisol production. The reason you have to monitor during loading is that you want the adrenals to produce SOME cortisol because it is needed to live! (that is where the goal of an acth level between 1 and 5 comes in)

When a dog goes too low you give prednisone because it acts just like cortisol and gives the body what it is lacking. It makes the dog feel better.

You only give it til it is no longer required. Remember you don't want the adrenals to grow back and overproduce cortisol and land you back where you started. That is why it is best if you can get the acth test done as soon as possible so you can tell where her real cortisol level is.

As others pointed out the first day you posted - the test results you had done are HIGHER due to the fact that Pandy had taken prednisone. So she was lower and perhaps too low. And that is why it is important to redo the test - 24 hrs after the last prednisone was given.

It is hard to answer your question about dosing simply because we don't know how low Pandy got. You have to be the judge based on how she is acting. If she is improving I would hold off giving it unless she appears to take a step backward. I hope this helps!

Kim

jayvee

05-24-2009, 06:41 PM

Kim,
I gave her 5mg. of pred. yesterday, early evening. Prior to that, she hadn't had any since Monday, May 18. Your explanation makes perfect sense to me. Is it wiser however, to wait until her infection is completely cleared up to have another acth done? I could ask my vet, of course, but if he wasn't aware or forgot to tell me that pred. could skew the results, I don't want to pay for another test that may be invalid I don't mind paying the pricey cost, but not if the test results prove to be inaccurate.(Did that make sense?--these sleepless nights are starting to get to me!). She seems SO much better than she has been for , I'd say, about a week. She still has no interest in eating, though, which is bothersome. Along with the subQ fluids, we give her little doses of Pedialyte and nutrical throughout the day.
Last week, both my vet and the ER vet indicated that it was probably her time to go,and we were to basically keep her as comfortable as possible until that happened. When you've lived with a dog for 14 years, though, I think you can develop a second sense as to whether it is time. Sadly, her two "sisters" died within 10 months of each other--one of cancer and one from complete kidney failure. They, like Pandy, were advanced in age. I said that I'd never get dogs that were that close to each other in age again, because it was back-to-back sorrow for us. Of course, I didn't listen to myself--I have two 3 year old collies.
They have been such a comfort to us though, throughout this whole mess with Pandy. Don't know what I'd do without them!
Pandy just came in here now to keep me company as I type this. I'm so thankful, that at least for today, I have my old girl back.

Joan

StarDeb55

05-24-2009, 06:51 PM

Joan, you definitely want to wait until the infection is cleared up. Pandy is under stress right now, so in all likelihood, her cortisol is already elevated because of the stress.

Thanks for posting those test results. Before I can give you meaningful input, I need the normal range posted for each of those tests.

Thanks,
Debbie

gpgscott

05-24-2009, 07:19 PM

Very good Joan that she is trying to assert herself.

Hope it all continues to go well until you can see her regular. Dr.

Scott

Squirt's Mom

05-24-2009, 08:09 PM

Hi Joan,

Like Debbie said, let her get over the infection before you have the ACTH. Any stress can cause the cortisol to rise as a natural response and an infection is certainly a stress on her body. You want the result of the ACTH to based on her normal state of being - healthy as possible, no pred or similar drug in her system, with her as stress free as you can make her.

I am so glad you got some more pred! Good for you for standing up for Pandy! :D You are being a wonderful advocate on her behalf.

You might try some egg, cooked or raw, or some cottage cheese, or liver, or baked/fried chicken skin. Is she drinking on her own at all? If so, you might try just some home made chicken broth. At this point, anything she will eat, let her have. Get creative and make it stinky! ;) The NutriCal will help her for sure, it has been a life-saver for me in the past, but if she will take some nourishment on her own, that is always better. Sometimes antibiotics can make you feel kinda bad, too, even nauseous. You might check and see if she can have some sort of belly aid like Pepcid AC; that might help her eat.

Hang in there!
Hugs,
Leslie and the girls

jayvee

05-24-2009, 08:56 PM

Hi Debbie,
These test results are like a foreign language, but here goes.
The following are all the Normal range numbers:
wbc...5.50-16.90
mono...0.30-2.00
neu...2.00-12.00
mchc...30.0-37.5

alkp...23.-212.
alt...10.-100.
ca...7.9-12.0
chol..110.-320.
crea...0.5-1.8
pH...7.31-7.42
hc03..20.0-29.0
pc02...32.0-49.0
tCO2...21.0-31.0
cl...109.0-122.0

Hope this does it, if not, let me know!--thanks for looking it over and translating.
By the way, I'm kind of a medically-needy dog magnet, also. They have a way of finding us, don't they? My rescue sheltie who died in December had one health issue after another, and one of my current collie boys has a seizure disorder--and then of course, there's Miss Pandy :)

StarDeb55

05-24-2009, 09:32 PM

Joan, the 2 important points on the CBC result (complete blood count), are the total WBC, & total neutrophil count (neu), both are severely elevated. Neutrophils are a specific type of WBC that are geared toward fighting bacterial infections, so those 2 things right there tell me that this is probably bacterial. The one thing that REALLY ALARMS me is the creatinine (crea) result. Creat is the main blood test to monitor kidney function. Pandy's is almost 6x normal. Did the ER vet say anything about renal failure? Is this why you are giving the subQ fluids to support her kidneys? How long were you instructed to give fluids? This is absolutely the most important value on what you have posted. Make sure you point this out to your vet ASAP on Tues. because Pandy's kidney function needs to be re-checked, then, & closely monitored. The 3 results labelled hco3, pco2, tco2 (ven), could you check to see if those results are from a test called a blood gas? Was Pandy placed in an oxygen kennel or anything like that while she was at the ER clinic? These 3 results may also be very important assuming they are results from a blood gas.

Waiting to here from you.
Debbie

jayvee

05-24-2009, 09:38 PM

Leslie,
I appreciate the food suggestions--tried boiled chicken, but it was a no-go. Will try cottage cheese or egg next. She actually can take pepcid ac--will get some tomorrow. She's not drinking on her own yet, but has shown some interest in the bowl of water. She laps a little water out of my cupped hands, too, occasionally. Small steps, but at this point, I'll take what I can get!

Joan

StarDeb55

05-24-2009, 09:43 PM

I just now remembered, dog's in renal failure have tendency to be very nauseated, so please use the Pepcid as soon as you can. This could be why she is not eating very well.

Debbie

gpgscott

05-24-2009, 09:53 PM

I just now remembered, dog's in renal failure have tendency to be very nauseated, so please use the Pepcid as soon as you can. This could be why she is not eating very well.

Debbie

This is very right,

Moria, is in early stage renal failure and since we started giving her ranantidine every morning she is eating fine. A dog that feels sick will not eat.

Scott

jayvee

05-25-2009, 01:58 PM

Hi-
Just gave Pandy some Pepcid--the tests at the ER didn't indicate renal failure, but I know from my sheltie that it can come on fast, so I'll be vigilant. She drank from her water bowl this morning and is showing some interest in food, so hopefully, before long... Except for wobbly starts when she gets to her feet, and some accidental peeing,she seems to be back to normal. She's even locking her jaws (typical Pandy-style) when I try to give her her pills--didn't have the strength to fight it before! we're making progress.

gpgscott

05-25-2009, 02:24 PM

we're making progress.

One day at a time Joan, I am glad to hear Pandy is feeling better today.

Scott

frijole

05-25-2009, 02:40 PM

Thanks for the update - glad to see some progress. You are doing great. Try to enjoy the holiday too! Kim

labblab

05-25-2009, 02:45 PM

Hi-
Just gave Pandy some Pepcid--the tests at the ER vet didn't indicate renal failure, but I know from my sheltie that it can come on fast, so I'll be vigilant.
Joan, I think the point that Debbie is making in her previous reply to you is that the tests at the ER vet DO indicate renal problems: Pandy's "creatinine"(a key indicator of renal function) is really elevated. Pandy's result was 7.2 when the normal reference range is 0.5 - 1.8. Has Pandy been diagnosed with any kidney problems in the past? I agree with Debbie -- I really think you need to pursue this abnormal lab value with your vet ASAP.

Marianne

Squirt's Mom

05-25-2009, 02:48 PM

Hi Joan,

Little steps are wonderful! I am so glad Pandy is showing some strong signs of feeling better. :D Interest in food and water is a great sign!

I'm sorry the chicken didn't work for her. Maybe she will take the egg. If I have any other ideas, I will pass them on asap.

Keep up the good work!
Hugs,
Leslie and the girls

jayvee

05-25-2009, 03:55 PM

Hi,
I somehow missed your post,last night, Debbie, re: interpretation of the test results. I was actually confused as to why I was given subQ fluids to give her--thought it was to keep her hydrated--nothing was mentioned about renal failure.
I was to give her fluids through the long weekend and check back with my primary vet on Tuesday. I'll give him test results from ER--I put in a call to the ER about what type of blood test was given, Debbie, haven't heard back from them yet. She hasn't ever been diagnosed with kidney failure in the past--she does have some of the same symptoms of my sheltie, Shelby, that did have reduced kidney function. The ER vet did tell John that he was puzzled by the discrepancy between Bun and creatine levels? I have one bag of subQ fluid left--will give her some now.

jayvee

05-25-2009, 04:08 PM

Debbie,
The ER vet's office just called--it was a blood gas test. She wasn't placed in an oxygen kennel while there.

StarDeb55

05-25-2009, 05:23 PM

Even though the ER vet said nothing about renal failure, the creat value clearly indicates that Pandy has some type of renal issue in play, Joan. Please, please bring this to your vet's attention tomorrow without fail. The creatinine is the main lab test that docs & vets use to follow kidney function in both humans & our canine companions. I've seen humans be put on dialysis for a creatinine value less than what Pandy has.

Thanks for indicating that those values were, indeed, from a blood gas. A blood gas checks to see how well the lungs are functioning & oxygenating the blood. The values you posted clearly indicate that Pandy was pretty badly hypoxic ( low oxygen level in her blood) at that time which may be an indication of pneumonia. I would strongly suggest that you ask your vet about doing a chest x-ray, even though Pandy has been on antibiotics the past several days. If this was pneumonia, the prudent thing to do would be the chest x-ray to make sure her lungs are clearing up. The kidney problem may have been brought on by the infection.

I'm very happy to hear she is feeling better today. Perhaps the Pepcid is helping with nausea & her appetite is showing signs of improving.

Please remember that I'm not a vet, but based on the lab values you have posted, I have very strong suspicions as to what is going on. Those suspicions are why I strongly encourage you to follow-up with your vet about the severely elevated creatinine, & a chest x-ray.

Please keep us posted.
Debbie

jayvee

05-25-2009, 05:47 PM

Thanks Debbie,
I plan to get her to the vet first thing tomorrow. She is indeed now showing the same signs that my Shelby showed when she was in renal distress--especially since her condition improves some with the subQ fluids. John is having surgery tomorrow , so I'm busy trying to coordinate things for both him and Pandy--we think we have it figured out. Nothing's simple. Thanks to all of you who helped determine probable kidney problems. I thought all her symptoms had to do with either the medications, her cortisol levels, the infection.. But, I guess everything is probably tied together somehow.
Joan

frijole

05-25-2009, 05:50 PM

Joan are you going back to the original vet? Just trying to keep it straight. You do have your hands full. Give John a hug for us too. :p

Kim

Squirt's Mom

05-25-2009, 05:54 PM

Hi Joan,

Keeping you, Pandy, and John in my thoughts and prayers for the best for all.

Hugs,
Leslie and the girls

jayvee

05-25-2009, 06:45 PM

Thanks, we need all the good vibes and prayers we can get--we're doing okay, considering, although it would be SOOOO nice if things could settle down a bit. I love to read and when things get stressful, I read multiple books at once (well, not at the same time of course, although that would be a neat trick if I could do it!). Anyway, I can usually tell how stressful things have gotten by the number of books I'm reading--just counted eight--so I guess stress levels are pretty high! I am going back to my original vet tomorrow--if I don't like what I hear with regard to this mess, I'll try to find another. Don't know where to start though. I've found that pretty much they'll all lead you to believe that they know what they're doing whether they do or not. I worked briefly for a very well-respected veterinary clinic and have some real horror stories.
Thanks again for caring--I'll keep you posted.
By the way, I got Pandy some little diaper bloomers as sometimes when she struggles to get up, she pees. She looks at me like she can't believe I'm making her deal with such an indignity! :)

Joan

MiniSchnauzerMom

05-25-2009, 09:28 PM

Hi Joan,

I've been following your thread but had not posted yet. Just wanted to let you know that you, your hubby and Pandy are also inclulded in my prayers. I'm glad Pandy is feeling and doing a bit better. Hope you will be able to find a vet who is able to sort things out and help.

Give Pandy some extra pets from me. Although she may be giving you "the eye" about her new apparel, I'll bet she looks cute in her bloomers!

Louise

frijole

05-25-2009, 09:35 PM

Joan

Wishing you lots of luck tomorrow. We are all rooting for John, Pandy and you! Kim

frijole

05-26-2009, 08:35 PM

I know it had to be a long day but I'm checking in to see how it went. Hugs and continued prayers. Kim

MiniSchnauzerMom

05-26-2009, 09:02 PM

Ditto what Kim said!!

Prayers & Hugs,

Louise

jayvee

05-27-2009, 02:09 AM

Everyone on this board understands what is important in life. All of you here have been so completely selfless and caring. Extending kindness, encouragement, support, help, friendship, and sincere concern for our girl Pandy (and us) need words of gratitude from us - that have no words really adequate enough to say it. Perhaps right now a simple thank you will find all of you.

Thank you.

Several months ago we wrote to my friend Steve, himself faced with the imminent decision for his Dalmatian baby girl Sasha who was suffering terminal bone cancer. Ourselves still mourning the loss of our Shelby Sue at the time; I think the words of encouragement directed at him were in essence words of encouragement for us as well. Excerpts of that letter are here - unsure of what exactly to write here tonight, yet needing to say… something.

*****
Steve my friend, I don't know what to say. I'll attempt a few words of "encouragement". I had to say goodbye to two of my girls in the past year. Anyone who ever had or has dogs and doesn't know the extremes of both the joy or the pain of letting go - will never really understand much of anything.

They give unconditionally and ask for nothing in return. Period.

A dog understands only one self-serving concept: to please. They live to please. Their existence is founded on pleasing us and not themselves.

We joke around that their exchange for affection is based on on really good treats or toys. Of course it is a joking remark... the desire to be loved and for our affection is their real need. I'll wager anyone that a dog would forgo a treat in favor of a whisker noogie or ear scratch or belly rub any day.

Myself included, I've never known anyone forgiven for a mistake or an error in judgment as quickly as the forgiveness from their dog.

It is said that they can't speak, yet how come they do so - very clearly. My dogs talk to me. The most important things they have to say are usually the same... thank you (for letting me please you!)

Who are your best friends? No thought needed there. Why? Because you are theirs.

It is true: training a dog teaches us to be better humans. We become better [people] because we learn so much about ourselves through our interactions with them. It's not about patience or constraints or expectations or behavior or rules or do this and not that. It's about understanding what is really important in life through the relationship and the teachings about love and affection and how WE should behave... by our dogs.

*** *** ***

"So why do I have to decide?" You don't brother. They let you know when it's time.

"They are so simple. They ask for nothing! They just love you no matter what!" When we adopt them we promise them love, affection, safety and sustenance. We also promise them they'll always live with dignity and honor.

"So why do I have to make this decision?" You don't. She will let you know.

"Some times it's easy! She is so happy! Other times I just don't know." You will never really be sure my friend. She will be. She will tell you.

"You take a simple decision to adopt an animal and give then a better life, but then they get sick and you can not always make it better for them!" Don't forget the most important point - you HAVE made it better. She has had the best life imaginable thanks to you. She will never forget and she won't be sad or resent anything of life. She had you, she had it all.

"The big problem is that you come home and they so happy to see you no matter how bad they feel!" They don't hold grudges or even understand why they don't feel well - but one look or tail thump reminds you they have all that they need when you arrive.

"They are so worried about you!" Every moment of every day man! If you are safe and near them all is right with the world.

"This just sucks! So who decided that she needed to get sick? It's just not fair!" No it isn't fair. Not in any way is it fair. I myself have said over and over again - NO MORE. I will NOT do this again. But, I do. 1. Denial, 2. Anger, 3. Guilt, 4. Depression, 5. Acceptance... ... ...crap... all of it. It's my dog, my friend, my love. Nothing else matters.
*** *** ***

Our girl Pandy crossed the Rainbow Bridge tonight. It was her time. She let us know it was her time. We kissed her goodbye - she left us in peace. She did not suffer and she did not lose her dignity. She is in a better place now. We will remind ourselves that this really isn't "goodbye" it's just a different kind of "hello". She joins Elly Marie, Shelby Sue and Woodie (generations of the best of friends). She was loved. We were loved. We miss her. Good night baby.

(Joan will be back to write when she feels a little better, she just needs a little time.)

k9diabetes

05-27-2009, 02:28 AM

I'm so very very sorry to hear this... Godspeed to Pandy.

Natalie

BestBuddy

05-27-2009, 03:50 AM

Joan,
My heart goes out to you. Any decisions made for Pandy were made with love as was this final one. I will be thinking of you.
Godspeed Pandy.
Jenny

Carol G

05-27-2009, 03:53 AM

I am so sorry. My thoughts are with you.

Carol

Spiceysmum

05-27-2009, 04:02 AM

Thinking of you both on the loss of your beloved Pandy. What a lovely letter you wrote to your friend.

Linda and Spicey

StarDeb55

05-27-2009, 07:14 AM

Joan, I'm so terribly sorry for your loss. There are no words that will make it better, but just know that you & your hubby gave Pandy a wonderful life, & you did everything you could for her in these past several days.

Debbie

mytil

05-27-2009, 07:33 AM

Hi Joan,

I am so very sorry to read about Pandy's passing. The letter you and your family wrote to your friend had me in tears and at the same time made me smile in that we are better because of them and they are only here for such a short time...

We will always remember your Pandy here in our very special honor list Remembering All Who Have Left Us (http://k9cushings.com/forum/showthread.php?t=132).

I would bet that Pandy has already found my Mytilda (aussie shepherd too) and these two are already getting things into order at the Bridge.

Take care and please stay with us - we are all here for you.
((((((hugs))))))
Terry

frijole

05-27-2009, 08:19 AM

Joan and John,

I am so very saddened to hear this. That letter was so beautiful - thanks for sharing. Rest in Peace dear sweet Pandy. Know you were loved.

Kim

Harley PoMMom

05-27-2009, 08:24 AM

Joan and John,

I am so, so sorry for the loss of your beloved Pandy.

The letter you wrote to your friend Steve, was indeed, a beautiful one.

Your Pandy was a special girl, and I'm glad she had found such special people like you both, to love her.

With Heartfelt Sympathy,
Lori and Harley

forscooter

05-27-2009, 08:28 AM

Hi.

I didn't have a chance to post to you before but I wanted to send my deepest sympathy out to you both. I lost my Scoobie 5 months ago and the pain is still raw for me....I found your letter to be very beautiful and am going to come back and read it more later when the tears won't matter as much...I am getting ready for work. I do think we know when it is time, when the time comes that letting go is a gift we must somehow be brave enough to give them.

Sweet peace, Pandy and many hugs going out to you both this morning...
Beth, Bailey and always Scooter

labblab

05-27-2009, 09:33 AM

Dear Joan and John,

I am so very sorry for the pain of your loss. Your letter is beautiful, and I hope that the words you offered so lovingly to your friend will be a source of comfort for you both, as well. After all the joyful years that you shared with Pandy, it was your final gift to release her spirit at the time that her body was failing. Through the final moment, you cared for her with all your hearts. And now, I believe her spirit will return to your hearts ~ never to be forgotten or lost again.

Please know that we will welcome you at any time should you wish to start a memorial thread for Pandy on our special forum: "In Loving Memory. (http://www.k9cushings.com/forum/forumdisplay.php?f=8)" It will be our privilege to share anything that you might wish to write there -- whether it be a tribute, or some special stories, or just your thoughts and feelings about your sweet girl (and also your other beloved companions who were awaiting Pandy at the Bridge).

In the meantime, I send you both many (((hugs))) in honor of Pandy and all that you will always mean to one another ~
Marianne (forever Barkis' and Peg's and Luna's mom)