Daisy Mae - our sweet Daisy has crossed The Bridge

[Trish]

Aww my condolences to you and your Dad at the loss of your Aunt. Sad times for the family. Your weekend away sounds like one of my trips where things always go wrong!! Hope your Dad picks up again soon, such a worry these parents.

That girl in the video needs to try the old coathanger in the zipper trick, lay down on the bed, suck it in and pull up on the coathanger lol

[doxiesrock912]

Trish, I'm surprised that she didn't try putting them on while in the bathtub trick too. :)

[molly muffin]

So, say you accomplish getting them on, what happens when you are out and about and have to go pee???

Just curious.

Sharlene and molly muffin
(molly is glad that her mom doesn't make her wear pants!!)

[doxiesrock912]

You're careful of what you drink or hold it for a very long time. :-)

[goldengirl88]

Valerie:
You are too funny girl. I was waiting for her to stabilize them like a a cartoon character and try to jump into them. She better not have anything to drink in those pants! Hope Daisy is doing well still on this dose. We have storms thru Thursday so we cannot wait until Friday. Blessings
Patti

[molly muffin]

No drink and no eat! LOL

Sharlene and molly muffin

[doxiesrock912]

Yeah, I forgot about food. :)

[goldengirl88]

Valerie:
Day three of the terrible n thunder and storms and now it is coming again soon! Tipper has about had it. She is so exhausted she is napping now. How is your dad doing? Hope all is well there. Have you been getting any storms? That is why I prefer winter for Tipper. Blessings
Patti

[Trixie]

Sorry for you and your Dad on the loss of your aunt.
Glad to hear Daisy did fine while you were away and how nice all her beds are spring time fresh!
Sounds like we have bad weather headed our way..hope we don't have too much thunder and lightning. :rolleyes:

Barbara

[doxiesrock912]

Thanks Barbara.
We've had rain for most of the day/night. No thunder or lightening though.

I volunteered to take photos at a dachshund race on Saturday :) I've never been to one.

[Trish]

Wow a dachshund race, that sounds awesome fun... have you entered Daisy?? Hope its a nice day for it, let us know if you post a photo!! x

[goldengirl88]

Valerie:
that sounds like a whole lot of fun. Hope you get some good pictures to show us. Too bad Daisy can't partake. Blessings
Patti

[molly muffin]

A dachshund race! Well I have never heard of this. We'll definitely want to see photos!

hugs
Sharlene and molly muffin

[flynnandian]

i've once seen dachshunds coursing on a real racecourse and they were fast! it was in a break during an agility contest.

[doxiesrock912]

I will certainly make an album as long as the race isn't rained out.

[goldengirl88]

Valerie:
That will be great to see and fun to watch. Tipper is better today, we just have showers coming no thunder expected. I am glad she is more relaxed this has been really hard on her. Are you taking Daisy to watch the races? Blessings
Patti

[doxiesrock912]

Here is the link to the album that I created. You do not have to belong to Facebook to access it. https://www.facebook.com/media/set/?set=a.792113357474263.1073741834.100000268197543&type=1&l=21d028b143

Daisy is not doing well. She's very sluggish and I didn't give her the Trilostane tonight. I don't think that it's working well enough for her. She doesn't have a pot belly, but her fur looks thin again and she's just not a happy girl so I'll be making another appointment with the IMS and discuss other options.

[goldengirl88]

Valerie:
Great job on the pictures thank you for posting them, and great picture of you and Chris. I am sorry Daisy is not well and could not go with you. When I think of all the things my Tipper used to do, I cry too so you are not alone. I think Tipper's harness came from Amazon. It does help her quite a bit. Hope Daisy gets on the mend. Blessings
Patti

[Woodydog]

Sorry Daisy isn,t feeling so good today, I hope you get some answers from the IMS.

Great pictures by the way :)

[molly muffin]

The pictures really make it look like fun Valerie.

How is Daisy today?

hugs
Sharlene and molly muffin

[doxiesrock912]

We went for 2 small walks and took a ride to Petsmart. Daisy liked that. Seems a bit better, but being picky about her food so I'll keep an eye on her.

[Trish]

Hey Valerie, glad Daisy is feeling better? What do you think is going on with her?

[doxiesrock912]

Could be arthritis and/or depression. She perked up today after I took her to Petsmart. Didn't finish dinner until I threw (literally) a few pieces on the floor. We used to play this game, I would scatter the food around the kitchen and she has a blast running to each piece and eating it. :-)

I'm sure that she senses the stress in the house with the crap that my sister is pulling too. A combo of all of the above.

[Trish]

Glad she liked shopping, one of Flynny's favourite things to do is go to the petstore! Spending time is great, shame she could not go to the doxie races. Is she on anything for her arthritis?

[doxiesrock912]

No, once she starts walking she seems a lot better. Could just be stiffness.

[Trish]

Might be worth getting it checked though next time you see the vet, those injections work really well for my boy. He is on Pentosan for his arthritis and I can really see the difference in him with them. Maybe adequan where you are? Plus I give him a glucosamine/chondroitin supplement. Last year I was giving him Tramadol but he does not need that anymore with the injections. He does not seem to need them so much in summer, but now it is colder he we have started them back up again and I really notice how much easier he is moving about now. Worth a chat to the vet about, if she is sore that might be making her depressed too?

[goldengirl88]

Valerie:
It does sound a lot like arthritis as I have it too and that is how I feel in the morning, all stiff and I hurt. Tipper does very well on the Adequan and she ahs no signs of distress in her legs or back while on this. Hope Daisy gets back to herself. Blessings
Patti

[doxiesrock912]

Daisy doesn't want to eat much at all. I'm thinking more than arthritis now.
She lays around all day but still runs to her bowl when I put it down.
This is so confusing! She has no pot belly at all so the Trilo is working but I'm thinking that it's working too well now.

Emailing the IMS tonight.

[flynnandian]

i am sorry that daisy gives you so much to worry about.
hope it is just a trilo thing and nothing else.
is daisy an old dog? then maybe her joints do hurt a bit.
because of the vetoryl?
hope she will get better soon.
p.s. i read in your first post that she is still a young lady at 10 years old......

[molly muffin]

Sorry to hear that Daisy isn't feeling so hot. Will anything entice her to eat?

Did you email the IMS the other day when she was off?

hugs
Sharlene and molly muffin

[doxiesrock912]

Daisy is eating and I know this because she drank water really quickly tonight and I made the mistake of picking her up. Well, up came the water and food and then she was fine...sigh.

I emailed the IMS and got an autoresponse that she is on maternity leave until SEPTEMBER!!! Nice to warn your patients!

[Trish]

Oh no, do they have another IMS you can see? Can your local vet to a stim just to check where she is? Then that is one thing you could rule out?

[molly muffin]

Yikes!!! I would definitely be calling to find out who has taken on her patients.

Glad daisy is eating though.

Hugs sharlene and Molly muffin

[goldengirl88]

Valerie:
Too bad about the IMS. I think maybe Daisy was just too full from the drink of water and the way you picked her up may have induced her vomiting. Sometimes when Tipper is full form eating and drinking she does not want you to pick her up and that is why, cause she will vomit. I know you have noticed Daisy being off, so I hope you can get in touch with the IMS that is substituting for yours. Blessings
Patti

[doxiesrock912]

I called Daisy's regular vet. I am sure that this is arthritis. She really holds her back legs straight and struggles to squat. I believe that the cushings is controlled or close to it because of the absence of clinical signs. She breathes harder when walking around, calms a lot while laying down, wiggles like mad to get out of bed - if it were her back, I don't think that she'd be able to wiggle. I now believe that the pain of arthritis has made her appetite iffy because it's not always off.

She had luxating patella surgery on one back leg in 2005 so I'm sure this is where the arthritis is. Waiting for a call back from the vet. Once we get this under control, I'll make an appointment with another IMS. I don't want to take the chance that bring in pain will skew the ACTH result.

On a good note, I bathed Daisy last night and her fur looks so shiny! Also, much less fur in the tub to rinse out.

[doxiesrock912]

I called the vet again and got through, Daisy has an appointment at noon today and Patti, he does adaquan shots!!!!

I read a lot about them last night and I'd prefer to do something like this to help her body naturally repair the damage rather than rely on pain meds which will only treat the symptoms.

Patti, did Tipper gradually show signs of arthritis and then when the cushings was more controlled, the arthritis was really bad? This seems to be the case with Daisy. She barely bends her back knees and both knees have some degree of luxating patella but only one required surgery.

I'm going to play the game of throwing the food around so that she'll eat and I didn't give her her the Trilo this morning since she was more comfortable laying in bed with me than eating breakfast.

I'll keep you posted.

[goldengirl88]

Valerie:
Exactly as you said. jack Russell's jump all the time and she had arthritis in her rears legs and some in her back. She feels so much better that she even starts jumping some days, and I have to stop her. They are 19.00 at my vets. You need a series of them in the beginning then just maintenance doses. This and the laser therapy have kept her walking thank goodness. It will only help Daisy so glad you are taking her.

[doxiesrock912]

Ok, in the scheme of things it could be worse.

Thankfully, Daisy doesn't have a damaged/ruptured disc. She has major arthritis with some degeneration on a good portion of her back. We are treating her with moloxicam (sp) which will hopefully be temporary until the adaquan shots kick in. Dr. Kimm charges $20.75 for the shots.

We're hoping that the adaquan will be enough to manage it and that it will also prevent the arthritis from spreading farther because it is heading upwards toward the spinal column nerve.

[goldengirl88]

Valerie:
Her leg will be sore it is done in the muscle. I had them alternate legs with Tipper. These shots are a tremendous help, and unlike some of the other things I have spent money on, these shots are cheap and invaluable to Tipper. This should get her moving around more and feeling better. Blessings
Patti

[doxiesrock912]

Patti, they gave her shot near the base of her neck. Her legs have no arthritis, it is her back.

One of the shots didn't like her. We brought her home to rest and dad and I went out for just over an hour. We came home to find that she had vomited the food and pumpkin that she ate earlier and also left a very loose present on the living room carpet. Thinking it's the meloxicam shot. Since then, she's had one tiny bit of diarrhea so I added unfloavored Pedialyte to her water and gave her some boiled chicken with a tiny bit of Tylan powder sprinkled on it.

The vet said that this is fine.
If she tolerates the chicken and hopefully no more problems, then we gradually resume normal diet. Sigh.....

[molly muffin]

I've had to do the throw food game with Molly at times to entice her to eat. One piece and she is usually good to eat at least some of her food. Maybe not all
I have to be careful though if I do that game too much, then she wants it all the time and will stand at her bowl and bark for someone to come throw food. Crazy kid. :)

Well, I'm glad you figured out where the problem might be and hopefully that is all that has been affecting her appetite. Crossing fingers that the med kicks in soon and she feels much better.

hugs
Sharlene and molly muffin

[goldengirl88]

Valerie:
The Adequan shot is not given where the arthritis is, it is just injected and goes all through their system. We alternated legs because intramuscular shots are hard on them they hurt. I hope we are talking about the same thing as this is not given in the neck??? Blessings

[doxiesrock912]

Patti, at the base of her neck in the muscle so it travels to her lower back where the arthritis is. She didn't even flinch so it obviously didn't bother her much.
Dr. Kimm did explain how it works to seek out inflammation in their bodies. He's been using adaquan for years and it can be used for different reasons in cats.
She gets another shot next week. Thankfully, he's only 10 minutes away.

She doesn't have arthritis in her legs which surprised me since she had luxating patella surgery in 2005. I thought for sure he'd tell me it was in her legs too.

He showed me on the xrays.

So far, she's kept the chicken down and no more messes in the house. She seems to be resting quietly on one of her many beds.

The IMS in on maternity leave and once Daisy is stabilized, I'll make an appointment for the ACTH. The IMS that I spoke to today agreed that we should wait and was fine with everything that Dr. Kimm is doing.

[goldengirl88]

Valerie:
It does travel all thru the body. It comes from a cows trachea. It is used in cats now that have bladder issues etc. I know it can cause liver and kidney changes if the dosage is too high, and platlet problems. I don't think Tipper would be as good as she is today without it. I hope this gets Daisy back to feeling better. Blessings
Patti

[doxiesrock912]

Patti, he did mention that he has a cat patient with chronic bladder issues that he uses adaquan for and also another dog with Cushing that had major allergy issues show up once the Cushings was controlled.

How long did it take to see improvement with Tipper? Did she have to take pain meds in the beginning until the adaquan built up in her body?

[goldengirl88]

Valerie:
It took Tipper about four weeks to feel better, as she started trying to jump again. I never used painkillers on Tipper. I kind of look at things differently than other people because of my previous work. I am so proactive my pic is beside it in the dictionary. I believe in stopping something before it gets started so when Tipper showed some signs of trachael problems I started with the Adequan because of that, and knew if she had any arthritis that would be showing up because of lower cortisol it would take care of that too. I can tell when her Adequan is wearing off as she starts with a lot of trachael noises etc. She gets her shots every two weeks now. She was doing every three weeks, but it was not enough because of the trachea. So this will definitely help Daisy. Just be cautious, and onlynhave them give the correct amount according to her weight as it can bring problems if too much is used it can cause bleeding issues. So this should fix up your girl soon. Blessings
Patti

[doxiesrock912]

Daisy is still off so I spoke with Cornell and I am not giving her Trilostane for the moment. Dr. Kimm, the gp who is giving the adaquan shots and I both think that it is possible that Daisy's cortisol was rising because of Cushings and to compensate for the pain of the arthritis so now that we're dealing with the arthritis, I truly think that the current dosage of Trilo is much too high.

This is not at all like the other times when Daisy was off for one or two days following an adjustment and we recently increased the dosage considerably on March 28th plus allowing for Diamondback to fill and ship to us. Let's say that we actually started the 19mg twice a day in early May.

Daisy is very weak and unsteady on her feet and she wants to lay down almost off the time. She has a hard time getting comfortable on a flat surface like my bed. I've been carrying her inside and out and she finds her spot to go as quickly as possible and then is ready to go inside again. Regardless of the weather.

This happened gradually and then all of the sudden got much worse which prompted the vet visit yesterday. Dr. Kimm mentioned talking with Cornell about decreasing the Trilo dose. He treats other dogs with Cushings.

She ate tonight at 7pm and has kept the chicken down and she's drinking water with Pedialyte to ensure that her electrolytes don't go too low.

[molly muffin]

Oh sorry to hear that Daisy still isn't feeling very good. :(

hugs
sharlene and molly muffin

[goldengirl88]

Valerie:
I am so sorry Daisy is feeling so bad. You know something you said also applies to Tipper. She cannot get comfortable on a flat surface either. I keep special pillows on my bed for her and she only lays on them. It seems to help her when she has cushioning. I hope you get Daisy on the mend, she has to be miserable not wanting to move around. My vet told me not to use pedialyte because if the electrolytes have to be checked it would really skew the numbers, so maybe ask about that. Blessings
Patti

[doxiesrock912]

Oh crap. The gp vet and Cornell were ok with the Pedialyte since she's not eating much or drinking much. I'm starting to think about Addisions or damn close to it.

This last dose jump was a big one in comparison to all of the others.

[labblab]

If you have concerns at all about low cortisol having affected Daisy's electrolytes, I agree with Patti about using pedialyte only with caution. Dogs who have been overdosed with trilostane may have abnormally high levels of potassium due to oversuppression of aldosterone in addition to cortisol. Pedialyte has a lot of potassium in it and may worsen this problem which can trigger cardiac arrhythmia.

Pedialyte can be helpful to offset general cases of dehydration, but when Addisonian issues are suspected it is probably best to hold off on any mineral supplementation until the blood chemistries can be tested in order to assess the exact balance of sodium and potassium.

Marianne

[Tina]

Hi Valerie,

I'm sorry that Daisy is not feeling well. I was reading along on the posts and when I read that you were giving her pedialyte and then in the next sentence you said you were thinking about Addison's, I felt the anxiety knot in my stomach. Then I went to the next page and read Marianne's post, thank you Marianne!

If I were you, I would stop the pedialyte. You mentioned that you fed her and she kept chicken down. Has she been vomiting? And you said she isn't eating or drinking much. What does that mean exactly?

[doxiesrock912]

Thank you all so much.
I stopped the Pedialyte. She enthusiastically ate quite a bit of chicken from my hands tonight and drank just plain water.

We went outside and while she still isn't her perky self by any means, she urinated and decided to explore the neighbor's yard for awhile which she hasn't wanted to do in a few days then left a small, normal poop. I took the water away a few times and let her rest for a few minutes before drinking more. She drank approximately 1/2 the bowl (small, deep 5 oz bowl).

She's alert and follows my every move from her bed in the kitchen too. I have NOT given Trilostane since this morning and I'm not going to until she settles and then ACTH time.

She's still on the weak side but more steady on her feet than she has been.
I think that she's on the mend.

Neither the gp vet or the IMS at Cornell mentioned Addisons. Dr. Kimm, the gp believes that she was close I think because he mentioned advising Cornell to lower the dose. The IMS insist that even extensive arthritis impacts Cortisol minimally.

With all do respect and the timing of discovering the bad arthritis and giving adaquan along with the more frequent times that I skipped a dose since this most recent and largest increase of Trilostane, I absolutely disagree with him!

Tina, she vomited the other night after drinking water too quickly and I made the mistake of picking her up. After the gp visit where she was given an injection of Meloxicam and adaquan, she vomited the food that she'd eaten 1/2 prior to the visit so I'm guessing that an hour or more had gone by since she ate.

I'm reasonably sure that it was the Meloxicam that put her over the edge.
She kept dinner down last night, breakfast today, and dinner tonight. All of which were boiled chicken.

[Tina]

Oh ok, I read about the vomiting when she drank too much water the other day, I was just worried she was vomiting currently. She is keeping her food down for 3 meals, and a normal poop, that all sounds good. Just so you know, if she is ill and you suspect a possible addison's crisis, vomiting (repeated or continuous vomiting) is an emergency.

Hopefully she is on the mend now. :)

And by the way, the photos from the race are so cute! My BFF has a mini long haired black and tan puppy, and he is just adorable. His feet are just the best!

[doxiesrock912]

Thanks Tina!
I call those feet "boxing gloves".

Daisy's kind of look like them <3

I do think that she's on the mend. The Meloxicam took away the pain of the arthritis and I think that's when she crashed because her body no longer needed that excess cortisol which meant that the current dosage of Trilo is now too high.

That coupled with the fact that since this recent increase, I've had to back off several times and each time, the IMS reminded me that Daisy is always "off" for a day each time we change doses, but she wasn't comprehending when I said that this time was different from the others.

The IMS is out on maternity leave until September. I want someone else to see her before then and if I like this new IMS< I will switch. Which of these do you think are likely to be most qualitifed with Cushings? http://www.cuvs.org/doctors.php

[Tina]

Lol Valerie, that is a great way to describe those feet! I will have to tell my friend, she will laugh her butt off.

Ooh, that new Dr is cute!!!! And it looks like he is Canadian, can't beat that. I am a total hockey chick and was just watching the Stanley Cup game tonight. He enjoys hockey, goes without saying! :)

[doxiesrock912]

Down girl! LOL

Please look at the other docs and let me know which you think might be most qualified to deal with Cushings. I've lost a bit of confidence in Dr. Morgan after this latest turn of events to be honest.

[Tina]

Lol, I know, its a pitiful situation here Valerie!!! :D :D

Wow, they look like they have a lot of good specialists there. I will need to take an in depth look and read each of their bio's and I don't have time to do that right now. Can I let you know my thoughts in a day or two?

I understand about your loss of confidence, it really doesn't take much for me to start feeling that way. I feel like I am a completely different person than I was before Jasper's illness and all of his subsequent issues.

[doxiesrock912]

Me too Tina.
I hope to not have to bring Daisy there tomorrow but if you could give me your input as soon as possible and I'm sure that others will too.

Thank you so much. This was so scary and I was really worried that I'd have to make THE hard decision.

[Tina]

Oh gosh, I didn't realize you were thinking you might need to take Daisy tomorrow. Let me check out the internal medicine vets real quick. Dr Rousseau isn't listed under internal medicine, but it looks like he is board certified in internal med as well as emergency and critical care.

Aww, I know this has been scary, but Daisy doesn't sound like she is out of fight yet. I have been through hell fire and back with Jasper more than once, and he is still with me. ;)

Let me take a look at the Drs, brb.

[doxiesrock912]

By dachshund standards, Daisy is 10 yrs old which is more like middle age for that breed. Some live well into their teens and twenties!

Praying that Daisy gets finally regulated and healthy enough to enjoy her life again. I love her SO much more than words can say.

Thank you for all of your help Tina.

[Tina]

Jasper is 10 also. I don't think schnauzers live into their 20's, but teens for sure. I know what you mean, he is the best part of my life and I love him so much! I would do anything for him.

Ok, after reading, they are all very highly qualified. I think I like Dr Broussard or Dr Forman, mostly based on their background and expertise. Dr Broussard was recognized for excellence in clinical research in endocrinology, and while not specifically about Cushings, he has numerous publications on other endocrine issues. And he trained at the Animal Medical Center in NY, which is very reputable.

Dr Forman has lectured throughout the US on Cushings, among other things, and has lots of experience with pancreatitis and gastroenterology. He has some good publications and he trained at UC Davis and the Animal Medical Center in NY.

I don't mean to kick the cute guy to the curb, but I think I would lean toward one of these two, I don't think you could go wrong with either. :)

[doxiesrock912]

Ok ladies and gents.
I took Daisy out tonight for the last outside before sleepy time pee. She didn't have to go but seemed to start favoring one side, just super unsteady so we just made the trip to Cornell and they have her being seen by the IMS on call and I'm waiting for news.

I really don't believe that it's a back injury because she never does stairs, doesn't jump on or off anything, and can use her legs. So, I'm really thinking an Addison's crisis. She has kept both meals down today as well as water. Better to be safe than sorry.

ER doc said that orally administration of Pedialyte will only affect electrolytes minimally so she's testing those, potassium, and BP to rule out Addison's. If those are ok, she's going to test urine because apparently a urinary infection can cause hind end weakness in older dogs as it does in humans. We're already up to $570 at this point. If it's not Addison's, we can go home but we'll be going to Greenwich instead because I want to be close by in case one of the internists wants to see her tomorrow. Stay tuned.

ER vet mentioned that Daisy's records show low Aldesterol (sp?).
How can that be low and last ACTH still have high numbers?
Input please?

[doxiesrock912]

Doesn't appear to be Addison's. While here in the back, Daisy vomited again and had a small bought of diarrhea with blood in it. BP a bit high, 170 and calcium low. Keeping her overnight and Dr. Forman will see her in the morning.

[Trish]

HI Valerie

Oh no, alarmed to see you at Cornell at this time of the night. Gosh poor Daisy and poor you... so does not appear to be Addisons? Well that is good, hopefully it is just a bout of colitis and she will come right. Are they giving her fluids, anti nausea etc? I bet you are pleased you can stay close by. How fantastic to be able to see IMS on call. I hope they can get to the bottom of this, she has been off colour for a wee while now. You heading home now?
xx

[doxiesrock912]

Omg! They want to keep her overnight and the low estimate is $2550.75 which they want RIGHT NOW!!!!! The doc on call is not an IMS and this is pissing me off.

[Trish]

:eek::eek::eek::eek::eek: OMG how the heck are they justifying that??? Outrageous :mad:

[labblab]

ER vet mentioned that Daisy's records show low Aldesterol (sp?).
How can that be low and last ACTH still have high numbers?
Input please?

Val, Dr. Morgan noted and addressed this issue back in her January email to you, so this is probably what the Cornell team is referring to:


There was one bloodwork change which bothered me more than the others, which was the increased potassium level. This is suggestive of a low aldosterone level. One cause of a low aldosterone level is Addison's disease. However, Daisy Mae's high cholesterol [I bet Dr. Morgan instead meant "cortisol"] levels rule out Addison's disease. Therefore, this may be primary hypoaldosteronism (meaning that only the layer of the adrenal gland that produces Aldosterone is dysfunctional), or it may be a condition called hyporeninemic hypoaldosteronism, in which the low aldosterone levels are being caused by decreased production of a hormone called renin by the kidneys. I suspect that later differential, but certainly either is possible. Neither of these is a reported side effect of trilostane therapy, and neither is it a reported consequence of Cushing's disease. However, it may be that chronic protein loss through the kidneys (which can occur due to Cushing's) may be damaging the kidneys, resulting in low renin production and thus a low aldosterone level. The way for us to best diagnostically evaluate this problem would be to run an ACTH stimulation test looking at cortisol and aldosterone levels at the same time, and also to run a renin level. However, the other way would be to try to better control the Cushing's and re-evaluate the amount of protein loss through the kidneys and the electrolyte levels.
Did the ER vets note whether Daisy's kidney function seems to be normal right now? Since Addison's has again been ruled out, it looks as though one of these side issues possibly secondary to high cortisol may be causing her problems and it may be necessary to go forward with the additional testing that Dr. Morgan suggested.

Marianne

[doxiesrock912]

The ER vet had little experience with Cushings. Dr. Forman, the IMS working today will look over the notes and I'm to contact him today to see if he wants to see Daisy or not. I will show him the paragraph that you pointed out Marianne. This is way over my head so thank you for pointing it out.

Does either condition cause weakness and hind end weakness?

[molly muffin]

Oh no Valerie. How is daisy this morning?
Sending big hugs
Sharlene and Molly muffin

[labblab]

Does either condition cause weakness and hind end weakness?
When low aldosterone occurs in conjunction with Addison's, a dog can definitely experience these issues. However, since Addison's has been ruled out, I don't know about these other scenarios that Dr. Morgan noted. Actual renal failure certainly can also produce lethargy, but surely the ER docs would have told you about any serious acute kidney concerns.

I guess a main question right now is trying to sort out the difference between a possible new, acute problem for Daisy vs. the chronic wasting/changes associated with uncontrolled elevated cortisol. If she did not start her new trilo dosing until a couple of weeks ago, that means her cortisol still continued to run high up until at least that time, and in the absence of an ACTH, we don't know whether it has yet been lowered significantly. Did the ER docs perform any type of cortisol check in ruling out Addison's, or were they only looking at her electrolytes?

Marianne

[goldengirl88]

Valerie:
I am praying that you find out what is going on with Daisy. It seems something went wrong all of a sudden here in the last two weeks. I know she has been off before, but I don't ever remember something like this happening. Are you taking her in for an exam to the IMS? I will pray for you both. Blessings
patti

[labblab]

If you talk to the IMS today, pancreatitis is another possibility I'd want to discuss given Daisy's vomiting, diarrhea, and apparent discomfort. A specialized blood test is required to confirm or rule this out.

[molly muffin]

Hi Valerie, wondering what is going on today and how Daisy is??

hugs
Sharlene and molly muffin

[flynnandian]

i hope daisy is feeling better today.

[goldengirl88]

Hi Valerie:
Just thinking of you and Daisy. How is she doing, any better?
Patti

[doxiesrock912]

Ugh, we have had a long week.
Got to Cornell at 3:23am. Stabilized Daisy. She kept down all 3 meals of chicken except for 2 pieces that she vomited while at Cornell. She also had a small bought of diarrhea there too.

Saw IMS Dr. Forman http://www.cuvs.org/doctor-marnin-forman.php today.


He did an ACTH among other tests. Thinks that the shot of Meloxicm given the other day really threw Daisy over the edge. Other tests to rule out pancreatitis, adrenal necrosis etc. He believes that Daisy might have IVDD and she's to crate rest for 4 weeks.
He did an interesting test. Picked her up and moved her from side to side with her paws barely touching the ground. Her feet did not turn under so I'm hoping that we caught this early and won't have to do surgery.


Stopping Trilostane until further notice. Continue Urisidol along with 1/4 tab Pepcid AC every 12 hours, another drug which I can't spell for ulcers Metra- something for 2 weeks, traumadol, 3 times a day for 7 days, and something that coats the stomach so that the traumadol doesn't bother her.

I should have an emailed report by tomorrow and results of the ACTH and urinalysis early next week.

Already since yesterday, she's more steady on her feet. Will lay down in a normal position with her back pointing to the ceiling instead of alternating sides, actually lifts her head and is more alert overall. No more diarrhea or vomiting.

Once the back issue is resolved, I'm sticking with Dr. Forman to reevaluate Cushings and meds. I asked Dr. Forman about trying other treatments if he feels that the Trilo isn't doing it for Daisy before going to Lysodren. He's in complete agreement and prefers not to use Lysodren. I know that many of you have had success with it, but with Daisy's sensitivity I would prefer to try other avenues first. I did mention that each time Daisy had an increase she has difficulty and how this last time was different and I felt resistance from Dr. Morgan. He understood and I felt listened better overall. Plus he lives with a dachshund so how can we go wrong? :)

Not bad to look at either Tina!!! The picture online doesn't do him justice.

[goldengirl88]

Valerie:
I read up on your new guy. I think you hit the IMS jackpot. I like everything about him and how qualified he is. He's a keeper in my book, and the fact that he lives with a dashound puts him over the top. So glad you are finding out what is going on with your baby. I am also happy you said she is having some improvement. Everything just seemed to go bonkers at once. Such a scare for you, and you really don't need any more stress. I have faith this Dr. will get Daisy
fixed up. Blessings

[doxiesrock912]

I hope so Patti,
I really miss my happy girl!

[Trixie]

Just catching up here Val and boy was I surprised to hear what's going on with Daisy! I hope she's doing a bit better now.
Dr. Forman sounds fantastic and it seems like he will get to the bottom of this, it would make me feel great that he has his own Doxie too!
I hope Daisy is doing okay today and that this gets resolved with a good treatment plan going forward.

Barbara

[Trish]

He does sound fantastic. Poor Daisy with her sore back, hopefully the crate rest will see that right. Hope she does not get too bored in there, I guess she is allowed out to potty, then straight back in. Or are you allowed to keep her out if you are constantly with her? What about a baby pen for a bit more room? That Meloxicam must have really upset her gut... that metro drug could be metoclopramide, an anti-emetic aka reglan or maxolon? Anyway, I hope all of those things settle her tum.

Gosh, what a night for you. I hope you are sound asleep and catching up on your rest tonight and Daisy is resting comfortably too x x

[doxiesrock912]

Trish, I believe the drug is antidiarrhetic.
For the first time ever, I can't get Daisy to eat!

Chris had to put the traumadol way down her throat. Felt rotten doing it.
I wonder what the tests will show? This is not looking good.

[Trish]

Maybe it was the metronidazole then? Same as Flynn.

What you trying to feed her? Might be time to do some chicken and rice.

When I had to give Tramadol, I got it in drops formula. Much easier to get into him that forcing a pill down.

She has just had an acute flare though Valerie, going to take a bit of time for her to come right. Did they test for pancreatitis?

[goldengirl88]

Valerie:
just checking in today to see how Daisy did last nite? Hope she is on the mend. I know how worried you are and I am praying for you both to come thru this. Blessings
Patti

[doxiesrock912]

I called the vet this morning. The traumadol really has her looped
She stood up outside and flopped onto her side twice before being able to squat to pee.

I believe that they did also test for pancreatitis. I'm still waiting for the doctor's notes yo share with you. She's sleeping most of the time so that is good.

[goldengirl88]

Poor baby, I hope they find out what is going on as soon as possible. That must break your heart to see her flop over like that. Big hugs to you both
Patti

[doxiesrock912]

I think that the pain meds are part of the cause. At least I hope so. This sucks so horribly.

[goldengirl88]

Valerie:
I never gave Tipped pain meds so I am unfamiliar with their effects. It was sprinkling here if you can believe it. Daisy did good for so long now, I am praying
this is just a little bump in the road. Blessings
Patti

[Trish]

Be good when you get the report so we can see all the labs etc. What drugs and dose is she on? Tramadol does make some dogs go a bit funny, it did Flynn but when we lowered the dose it was fine.

[doxiesrock912]

The IMS just called. They want to hospitalized her for a bacterial kidney infection.

[Trish]

Oh dear, sounds similar to Jasper's problem and that has been a bugger to get rid of too. Still with her being a bit unstable at the moment it will be the best place for her... hate to think what the bill is going to be though considering how much is was the other night :eek:

[molly muffin]

I think Jasper is on clavamox for his kidney infection. I don't think he was hospitalized for this incident though. They must think they need to zap her with IV antibiotics?

hugs
Sharlene and molly muffin

[Woodydog]

Poor you and poor Daisy, but maybe hospital is the best place for her to get better. Fingers cross all goes well :)

[doxiesrock912]

Yes, IV antibiotics and fluids.

[goldengirl88]

We have our fingers and all paws crossed for Daisy. It's going to get better I know it is! Blessings
Patti

[molly muffin]

:( poor baby. She must feel pretty awful. :(

Hopefully she can kick this, but it can be tough as we are seeing with Jasper.

Hang in there, big hugs
Sharlene and molly muffin

[addy]

I am so sorry little Daisy is having problems. I have been following along and was hoping she would feel better.

We are here with you Valerie

[doxiesrock912]

OMG please pray for Daisy!
Dr. Forman called with the results of the tests this morning and advised us to admit Daisy because she has a serious kidney infection. We brought her back to Cornell tonight and the doctor on call said that the estimate of $1800 - $2550 was probably going to be low because her kidney and liver values have considerably worsened since the tests a few days ago.

I'm praying that the antibiotics will save her! I can't lose her now and am bit upset with Dr. Morgan for not insisting that we test when she noticed the values climbing.

[molly muffin]

Oh no Valerie. :( I'm so sorry Daisy has gotten worse. :( Did they tell you what the prognosis was? What is the plan?
Of course you can't lose her, we won't even think about that, just what do we need to do to help her get better.

prayers and love being sent your way,
Sharlene and molly muffin

[doxiesrock912]

Sharlene,
they can't guarantee that they can save her. She has a "tough uphill battle" according to the ER vet on call.

I'll do ANYTHING to save her!!!!!! I love her!

[molly muffin]

Oh Valerie. :( Hugs! This is such a tough spot to be in. She's a little fighter though, so you know that she'll do her best to get better and the personnel at the ER are going to do all they can to help her kick this too.
Are you at the hospital now or back home?

come on daisy girl you can do this!
We're all pulling for you.
Sharlene and molly muffin

[doxiesrock912]

In Greenwich which is 10 minutes from the hospital.
I can't stop crying.

When Dr. Forman called earlier, he said that this was serious and now the ER vet says that her numbers are off the charts.

[Budsters Mom]

I am so sorry to hear this Valerie.:o I have been following along with this too. I have been praying for you and Daisy Mae and will continue to do so. I can't figure out how our fur babies are ending up with such serious infections. First Jasper, now Daisy.

We are here for you Valerie. You have many angels fluttering around you and Daisy at this very minute. Sending healing energy, positive thoughts, prayers, hugs and much love.

Kathy

[doxiesrock912]

Thank you Kathy and everyone.
This happened within a matter of days. Just so scary and heartbreaking! I will exhaust my savings to save her.

[Budsters Mom]

Yes, it's all so expensive.:o I was still paying off Buddy's bills long after he had passed, but I'd do it all again for a chance to have him with me a little longer.

We do all we can, for as long as it takes, because we love them so much.

Daisy is where she needs to be for now. She is getting the best possible care. She's a fighter Valerie. She'll give it her all. xxxxxx

[doxiesrock912]

Aside from when mom was really struggling with Parkinson's and dad with cancer, I've never prayed so hard in my life!

Chris got the house that we've been waiting for the bank to short sale on and it is so unimportant right now. I just want my monkey home with me.

I called dad and he said that if she's not going to make it to bring her home so that she can spend the time with us. I can see his point and I hope that it doesn't come to this. I feel SO let down by Dr. Morgan. She's mentioned the change in values but did nothing to determine the cause and assumed that it was related to Cushings.

[Trish]

Hi Valerie, I am here for a few hours, not going out tonight so feel free to vent here!

I am wondering if those drugs she had the other day like the meloxicam have affected her kidneys and liver? Did they mention a bug??

[doxiesrock912]

Thanks Trish.
Bacterial infection of the kidneys.
The meloxicam was a small dose given by injection once. She was already weak by then and that's why we were thinking a back issue and the gp vet took xrays and saw a lot of arthritis. I suspect that the infection was present then but since he didn't do any bloodwork.

Thankfully I took her to Cornell the following evening. Praying that we got this in time but it is not looking good.

How is Jasper?

[Trish]

I hope you have too, I have had high liver and high renal tests periodically he has bounced back so fingers crossed Daisy does too! Was she alert when you took her in?

[doxiesrock912]

She was laying around A LOT and having more difficulty walking than usual and extremely lethargic. That is what prompted the visit to the gp. I wish that he'd done blood tests then but she was eating and drinking and the vomiting and diarrhea didn't start until after the adaquan and meloxicam shots.

She hasn't done more than take a few steps in order to find the right pee spot. Decreased need to urinate. Down to once or twice a day and not much of it.

They said that her liver and kidney numbers were off the charts tonight and that her white blood cells were low. The ER vet sounds extremely worried. High BP too which is new since her last visit to Dr. Morgan on 3/28.

She did seem more alert when I brought her in tonight. Instead of just watching us with her eyes, she was lifting and moving her head.

[Trish]

So what are they doing? I hope IV fluids to flush out her kidneys? Gosh I hope none of those things have poisoned her? Or do they think just infection? Would have thought she would have high white cells with infection? So many questions, sorry Valerie... is Chris up with you?

[doxiesrock912]

IV fluids and IV antibiotics. I knew about the heart mumur but didn't know that giving a lot of water can cause heart failure so this is truly a life threatening balancing act.

Chris went to bed hours ago. Poor guy got teary eyed too and he can only manage $500. The ER vet warned me that the bill will likely be considerably more than the $1800 - $2550 estimate.

I could be wrong about the white count. So much to try to process and I can't get past the "tough uphill battle" portion of the conversation.

The IMS hasn't emailed the paperwork from all of the visits since they've had technical difficulties or I would've share that by now.

She's been sluggish for a week but we thought it was just too hot for her outside and I am kicking myself for assuming.

[Trish]

Have they said she has heart failure too? Well they can get rid of fluid from the chest with diuretics, when can you go in and see her? tough uphill battle??... well we are all battlers here including our little Miss Daisy Mae and you have all of us keeping watch too!

[doxiesrock912]

They did not say heart failure but administering too much water can cause that with murmurs. One positive thing is that each time they checked her temp it was normal.

[Trish]

Yay we will take all the positives! Have they given you a number you can call through the night to check in?

[Trish]

They won't let her get heart failure with all their monitoring, I feel for your Dad as he loves her dearly too

[doxiesrock912]

Of course I have the number and have called once already. I'm thinking of trying to get some sleep. Praying that consistently not running a fever is a good sign.

Not sure about the high BP though. It's also hard to know how much of the lethargy is due to the suspected back issue and how much is from the infection itself.

She has never ever completely gone off her food for days and that scares me. Wouldn't touch chicken or peanut butter.

[Trish]

Yes we can hold on to all the good things, go get some sleep Valerie. I will be here a few hrs if you wake back up xx

[doxiesrock912]

Thank you Trish. HUGS for you and Jasper.

[Trish]

Wish you were here and I would feed you up! Just made dinner, mashed potato, coleslaw and steak with mushroom sauce. Hope you managed a little something to eat, need your strength!

[doxiesrock912]

Trish, are you part Italian? Chris is, always trying to feed me. Trust me, I'm not lacking in that dept. Just called to check on Daisy. She's sleeping and doesn't look uncomfortable so I'm praying hard.

[Tina]

Valerie, so sorry to read all of this, I am trying to get my head around all that is going on with Daisy.

First off, don't worry about the heart failure due to the fluids. That can happen to any dog, murmur or not, if too much fluid is given too fast. They won't let that happen, it is monitored very closely.

Did they say what bacteria they have identified? I am guessing they have cultured something from her urine, but I thought it takes at least 48 hrs to grow? I know with Jasper it took 72 hrs to grow.

Big hugs Valerie, I'm sorry this is happening and I know how scary it is.

[Spiceysmum]

Valerie,
So sorry to hear that Daisy is not well. Sending prayers for you both.
Linda

[Trish]

Haha, no Italian blood in me.... love all Italian food though!! :) I am a Kiwi-Scot! So pleased to hear she is resting comfortably, that means her little body will be fighting away these problems. So hoping she is better in the morning.

Hi Tina :)

[Tina]

Yes, good to read that she is sleeping and I hope you are able to get a bit of rest also. I will be checking for updates Valerie and keeping her in my prayers.

Hi Trish :) :)

[doxiesrock912]

They took the urine culture Wednesday night when I first brought her to Cornell and notified us late yesterday afternoon. Dr. Dormant probably did mention the name of the bacteria but I was shocked and can't remember. I will ask today when they call me. I believe that the IMS comes on duty at 8:30am.

Thank you all for helping me through this. I did manage to sleep a bit.

Just called to check an there's no change. She's still resting comfortably.

[Trish]

So pleased to hear she is resting well Valerie, I am off to bed as well now. Some of the others will be around soon so good you at least got a few winks, hope you find her better when you go in and I will be looking for an update in the morning x

[goldengirl88]

Valerie:
You have been through so much, this just is really not what you needed right now. I am so sorry this is happening to sweet Daisy, but you knew right away something was really wrong. Than God you are so observant and got her the help she needs. No one on here wants to hear of someone else's dog in distress as it is just like one of our own. Do you have your Care Credit? Could Chris also apply for one? What about your dad, could he apply for one. At least that would get you the money with low payments. I am praying for you and Daisy daily and at nite. Think positive and keep your chin up, you certainly deserve a miracle if anyone does. God Bless You All and give us updates on Daisy please.
Patti

[doxiesrock912]

Patti,
I'm unemployed so I haven't bothered applying for Care Credit.
Chris is saving for the house and work that needs to be done on it.

I will likely exhaust my savings on this, but at least I have that option.

[goldengirl88]

Valerie:
I thought you already had a care credit, sorry. I just thought if they got one you could make the payments on it. I pray she is going to be alright. Have you heard anything this morning? Blessings
Patti

[addy]

Just checking in on you and Daisy, hope you both got some sleep. It is good Daisy is resting comfortably

[molly muffin]

I'm checking in too. What is the word this morning? Hope her numbers are improving. Kidney infections can come on when least expected. I too would have expected high white cell count with an infection but that might be part of the problem if her body isn't fighting it like she needs it to. The antibiotics should help that.

Crossing fingers and sending prayers your way

Hugs
Sharlene and Molly muffin

[goldengirl88]

Valerie:
Just checking in to see if there is any new news on Daisy. Take care of yourself you are under a lot of stress. Blessings
Patti

[doxiesrock912]

No news yet.

[addy]

Ok, let us know if you ring them up or if they call you

hugs

[doxiesrock912]

Ok, the kidney values are now "not horribly high" so I am so grateful for that! Liver values are horrible but that is mostly due to me not being able to give Daisy's Trilo twice a day and then the vets advised me to stop so it will have been a week on Tuesday since Daisy has had her scheduled doses of Trilo. They don't see any evidence of adrenal necrosis or Addisons.


They are still waiting for the bacterial culture but are treating her with broad spectrum antibiotics.

The vet who called today mentioned the probability of http://www.petmd.com/dog/conditions/urinary/c_multi_pyelonephritis

She still looks sick but they want us to come and visit her today before 5pm. I called Chris who has been working at the new house all morning by himself, and he's coming home to shower and then we'll see the munchkin!!!!!

They want to keep her for a few more days. I think that I might check out Care Credit. No clue how much this is going to cost.

I asked if they thought that she was going to make it. The vet said that she doesn't see anything dangerous going on right now so she believes that she will!!!! HAPPY DANCE HAPPY DANCE!!!!!!!!

Definitely changing to Dr. Forman because I have now lost faith in Dr. Morgan since it is possible that the problems that Daisy had each time we changed doses are similar to ulcers and Daisy is also being treated for that now.

[Budsters Mom]

Whew! Sounds very promising! Go Daisy!!! :p xxxxx

[doxiesrock912]

We're going to visit her now. ♡♡♡♡♡♡

[Budsters Mom]

Give her kisses for us. :p xxxxxxxx

[Trish]

Hi Valerie

So pleased to wake up to this news, pleased she has been OK overnight, hopefully starting to feel a bit better today. Hope you have a nice visit and the IMS can ease some of your concerns x

[molly muffin]

Very happy to hear that she is improving.

hugs
Sharlene and molly muffin

[doxiesrock912]

I SAW MY BABY!!!!!!!!!!!!

She's doing better. ER doc believes that their is no longer immediate danger. She'll be there until at least Tuesday.

[Woodydog]

Yay fab news Valerie :D

[molly muffin]

Glad to hear she is doing better. :) I'm sure you feel better getting to finally see her too.

Wow, that is a long stay!! Are they keeping her on IV for the entire time?

hugs
Sharlene and molly muffin

[Tina]

That is fantastic news Valerie! So glad to hear she is doing better. What a huge relief for you. :)

[Trish]

Yipppeeeee!! What a relief! So pleased for you all!! Your Dad will be relieved too!! xx

[goldengirl88]

Valerie:
I am so thrilled to hear Daisy is out of danger. You can take a big deep breath now, and relax a little. I bet she was happy to see her mom!. Blessings
Patti

[doxiesrock912]

Poor girl is so stoned on pain meds that she only managed to move her head. IV fluids are being administored slowly because of her heart murmur.

[Trish]

Why is she so sore? Is it the infection? Or do they still think her back is giving her problems? Best she is sleeping and resting for now, giving her chance to recover

[doxiesrock912]

The ER doc is hoping that it's from the infection and not so much her back. She can barely stand up and doesn't want to walk around. Her abdomen is already getting the Cushings pot belly because she hasn't had Trilo since Tuesday. Her back is still arched a bit which is a sign of pain.

She's able to hold her head up now which is an improvement and she watches what is going on around her. No new news tonight. More blood work to be taken at 10am tomorrow.

[Tina]

Valerie, have they tested for and ruled out pancreatitis? An arched back can be a sign of pancreatitis, as well as the vomiting and diarrhea that she was having.

[doxiesrock912]

I believe so and the ER doc said something about where the pain is being associated with the kidneys. She also kept mentioning kidney failure which is something that I haven't heard anyone saying before this.

I'm worried about the not walking and all of that and hoping that this resolves and nothing is permanent.

http://www.merckmanuals.com/pethealth/dog_disorders_and_diseases/kidney_and_urinary_tract_disorders_of_dogs/infectious_diseases_of_the_urinary_system_in_dogs. html

[jxeno13]

Hi Valerie, I'm so happy to read that Daisy is getting better and that you got to see her!! I'm hoping that she'll just continue to get better and better each day. I know you'll rest easy once she's back home with you again!

Hugs, Jo Ann and Eli

[Tina]

The pain meds can really do a number on their ability to stand and walk. You mentioned that you felt she was pretty medicated, I would imagine that is definitely interfering there.

[doxiesrock912]

I hope so Tina, it's so hard to know.

[goldengirl88]

Valerie:
I am hoping today brings more improvement on Daisy. This has been a scary ordeal for all of you, and I hope Daisy rebounds back to her old self quickly. Blessings
Patti

[addy]

Valerie, when Zoe took just a few doses of Rimadyl, she could not walk and fell over. When Koko took the same dose it did not affect him that way. They were about the same weight.

When I would give Zoe Tramadol 1/2 tablet 2 times a day, she was totally out of it.

Point is, maybe some dogs are really knocked out by pain killers more so than others. It is hard to say with Daisy.

I hope she comes home soon, sweetie.

[doxiesrock912]

Thanks Addy, Daisy was already seriously lethargic before the pain meds. This was what prompted the visit to the go vet. I'm pissed that he didn't catch the kidney problem.

[molly muffin]

Good morning. Hope you were able to get some rest last night. When can you call and check how daisy is? Hope she had a good night and is doing better.

Jigs
Sharlene and Molly muffin

[doxiesrock912]

Daisy drank a little water today according to the nurse. I'm waiting for a report from the doctor which should come between 10 - 11am.

[doxiesrock912]

Just heard from the doctor. Daisy is still leaking bloody stool and even though she drank water, she said that she's still in critical condition and is "cautiously optimistic."

We can visit her at noon and they should have the most recent test results by then.

Has anyone been in this situation? I don't know whether or not cautiously optimistic is a good thing or wishful thinking.

[addy]

Val, what is the bloody stool from? Cautiously optimistic is better than guarded I think.

[Budsters Mom]

Regarding "cautiously optimistic"....

Daisy is not out of the woods yet. She still has some very serious issues to overcome, but the doctor sees improvement. That's what I think it means in Daisy's case.

I asked the neurosurgeon who was monitoring Buddy's treatment that exact question because she used it too. It was regarding adding Prednisone and whether it would help Buddy feel more himself for a little longer. In his case it meant that she felt that it would help at least temporarily, but was not a cure. Buddy was still terminal and the tumor would eventually take over. Xxxxxxxx

[doxiesrock912]

Yeah, that's what I think too and I hope that she can overcome this. Especially since her Cushings is most definitely not controlled having been off the meds since last Tuesday.

[goldengirl88]

Valerie:
I am getting the impression they do not have their finger on the exact problem or problems here and do not want to get your hopes up that everything is ok, that's my take on it anyway. I am praying for your sweet Daisy to come thru this, I know how you must be feeling, and we are all with you in this. You have Chris and he is your rock, so lean on him when you have to. Blessings
Patti

[doxiesrock912]

They should know what type of bacteria in a day or so and I hope that things will turn around more when they can target treatment specifically for that kind.

[goldengirl88]

Valerie:
You are doing a good job, hang in there I am hopeful things will get better. Blessings
Patti

[doxiesrock912]

When we saw her today she was able to keep her head up the whole time. We carried her to the waterfront and she looked all around. No more vomiting, drank a bit of water for them and kissed Chris on the nose.

[goldengirl88]

My heart just aches for you. You have had too much lately. Tipper and I will pray for Daisy tonite.
Patti

[doxiesrock912]

Thanks Patti. Hugs

[My sweet Ginger]

Oh Valerie, I'm praying hard for your sweet Daisy to come out of this awful situation as soon as possible and come home to you. I can only imagine what you must be going through. I'm so sorry this is happening to you and Daisy.
I know it's very hard for you to come here and give us updates on Daisy when you are in such distress but we all appreciate it very much as we'd be worried sick. Just do it when you can.
Hang in there, Valerie. You and Daisy are in everyone's prayer. Hugs, Song.

[flynnandian]

i hope we will hear some good news about daisy tomorrow!

[molly muffin]

That sounds like progress that she can keep her head up and take a drink of water. Both really good and I hope she continues to improve each and every day!

hugs
Sharlene and molly muffin

[doxiesrock912]

Thanks everyone. I can't stop crying.
She hasn't drank for them since last night though so I'm back to being worried.

[molly muffin]

Did you go visit her today? Maybe she needs you and Chris to be there for her to feel better, or maybe she tries for you and feels like things are more normal if you are there, so will drink, etc.

hugs
Sharlene and molly muffin

[doxiesrock912]

We absolutely visited her today. She drank for the nurse last night but not since. We can only spend 10 minutes with her because they don't want the IV fluids unhooked any longer than that.

I don't know what to think. They used the term kidney failure today and that we hadn't heard before this so now we're really scared.

The gp vet gave her a shot of Meloxicam and everything that I'm reading says that a dog with liver and/or heart problems should not be given this drug. She did not have diarrhea before the shot. Cornell believes that this contributed to how sick she is now and so do I. Meloxicam can cause ulcers, bleeding, and kidney failure.

I do think that Daisy had a kidney infection which was actually what was bothering her more than her back and the gp missed that completely.

I've made sure that anything Dr. Kimm does is sent to Cornell and vice versa so that each place has all of Daisy's medical information.

They let us take her outside so we carried her and walked to the water. She looked around at the boats and gave Chris a kiss.

[molly muffin]

Well drat I was hoping she was feeling just a bit depressed when you aren't there. :-(.
In what context did they use kidney failure terminology? As in she needs to be drinking on her own and producing urine? If I remember correctly with humans it is that they need to produce output on their own even when fluids are being given. Is she doing that?

Hang in there.
We're all pulling as hard as possible for daisy to best this !
Hugs
Sharlene and Molly muffin

[doxiesrock912]

I asked that Sharlene, and they said that she is producing urine.
They still don't have the bacteria culture back yet. I told the vet that they needed to add a growth hormone to it already.

If they actually determine the type of bacteria, can they target it better by using certain antibiotics?

I can't stop crying. Chris has been wonderful thank God.
Daisy gave him a kiss today. <3

[Trish]

Hi Valerie

I am kinda confused about what is going on with Daisy. Started with kidney infection but it taking ages to get a result?? Now renal failure maybe started off with nasty UTI, how bad is the renal failure? Do you have any numbers? Liver tests high? So do they think the meloxicam has caused the worsening renal failure and kidney dysfunction? Plus bloody diarrhea, also due to meloxicam? Hopefully you have a better idea of what is going on than I do! So they are treating her with IV fluids and antibiotics for now?

Valerie, I wonder if Daisy is not drinking because of the IV fluids, I know when Flynn was sick and getting IV he would not drink much because the IV was hydrating him so he just did not feel thirsty. I found when his IV fluids were reduced/stopped then his thirst came back and he would drink.

That's a shame you only get 10mins, won't they let you sit with her while the IV is going? Still nice you got to take her outside and she is giving out kisses so that has to be good. Hang in there Valerie because Daisy is!!!! xx

[Woodydog]

Oh Valerie what a rollercoaster you are on right now.

Keeping everything crossed for daisy you and Chris x

[goldengirl88]

Valerie:
What a terrible time you have been having. Those words kidney failure would scare the crap out of me too. So they are thinking that shot did all of this? Had you told Dr. Kimm that she should not have this Meloxicam according to what you read? If so what did he say about it? I am praying for you both. Are you able to take a toy or her blanket to be with her while you are not there, or don't they allow that? Blessings
Patti

[addy]

Hope things are better today.

I do believe Trish's thinking that dogs tend to drink less on their own when given IV fluids is correct. At least that has been my experience as well over the years.

Oh Val, hang in there. I hope today bring good news.

[goldengirl88]

I know when any of my animals have had an IV they drank less too.

[molly muffin]

Well, that makes sense and if her kidneys are putting out urine, then what exactly is it that is making say/think kidney failure? Protein loss? or something else? Is she concentrating, over conentrating? I'm confused too.

Yes, I'd think when they know what bacteria, then they could specifically target it, if they need to.

hugs
Sharlene and molly muffin

[goldengirl88]

Valerie:
Just checking in on you. Hope you are holding up. When you feel like it give us an update on Daisy. Blessings
Patti

[doxiesrock912]

Still waiting on the exact bacteria, and she hasn't eaten yet. Step Dad (Chris) is going to bring her chicken tonight to see if she'll eat that.
This is something that she hasn't done since Tuesday.

L:):)K!!!!!!!!!!!!

https://www.youtube.com/watch?v=vrZz1EHughk


Just heard from Chris. Daisy ate the dinner from the vet, wet canned food and 3 handfuls of chicken!!!

[goldengirl88]

YeahhhhhhhhhhhhhhhhhhhhhhhhhhhhhDaisyyyyyyyyyyyyyy yyyyyy
way to go girl Tipper and I saw you video, and you look like you are on the mend. Great idea with the video Valerie, it made me feel so much better being able to really see her. I am so happy she is up and about and ate her canned food plus chicken, Daisy is really a rock star!! Blessings
patti

[molly muffin]

Excellent news Valerie! So glad she ate something. That will help her to get her strength back too. :)

What a great video. All I could do was give a great big smile. I'm so happy for her and you and Chris and your dad that she is improving.

hugs
Sharlene and molly muffin

[My sweet Ginger]

Oh Valerie, that video made me cry with a lump in my throat because I know how hard her little body had to fight whatever it is going on inside of her in a strange place with strange faces for days and days away from home all alone. It is just so wonderful to see her doing this well after worrying about her all day today. I'm sooo happy she is doing better. Hopefully she will be home soon enough to you and Chris. It's just wonderful and thank you for giving us this happy update. She looks incredibly cute, Valerie. Hugs, Song.

[doxiesrock912]

Everyone :) :) :)

Daisy's new IMS is back tomorrow and hopefully he'll have a much better clue of exactly what happened here. I do believe that Dr. Morgan dropped the ball because in her reports she kept mentioning concerns but did not do any other tests or suggest that we should. What makes me say this is that Dr. Forman mentioned that the Cushings is NOT at all controlled and Daisy's back has been hunched a bit for quite some time and that should've been of concern to someone besides me in my opinion.

I am not a suit happy person, but something big was missed and Dr. Kimm's shot of Meloxicam definitely threw her into kidney failure. When I brought Daisy to his office, she was extremely lethergic and weak. He took xrays and mentioned that there is a lot of arthritis and that he thought this was a back problem. Dachshunds are prone to it...yada yada. Then the shot of Meloxicam and adaquan. Those were given between 12:30pm - 12:50pm on Tuesday.

Brought her home and dad and I went out for a sandwhich while she rested. We came home to find that she'd vomited the meal that she had at 11:30am and very dark diarrhea. Prior to going to Dr. Kimm, she had only vomited water once and had kept 3 meals down. No diarrhea until after the Meloxicam shot.

On Wednesday, she barely walked and actually fell over on her side late that night so at 1:45am I threw my clothes back on and drove the 2 hours to Cornell. During the drive, Daisy cried out twice! She NEVER cries!!!!

Of course, I drove faster praying that I didn't get stopped because I would've asked for a police escort! At 3:23am we were walking through the door at Cornell.

By then she was not eating or drinking at all, unable to even hold her head up, and they said that she kept "leaking small amounts of black diarrhea". I knew then that it was BAD!!!!!!!


Dr. Kimm has not contacted me since Wednesday night. His is a small office and they were not open at all since Friday. I called on Friday saying that it was urgent that he call me back, he didn't. Probably off for the long holiday weekend.

So far I have spent $3500 and that's not up to date. I DO expect that if Dr. Kimm has any conscience once he sees the report that he'll offer to reimburse me for most of this since it was 100% due to the Meloxicam shot.

If he's the kind of person that my good friend Lamont says that he is, he will. I'm going to call on Wednesday and maybe go there in person since Daisy was supposed to get another adaquan shot and Gracie cat was to have her yearly physical that day too.

I had ALL of Dr. Morgan's notes printed and with me when we went to Dr. Kimm's office that day and he looked through them while we were there BEFORE giving Daisy the Meloxicam.

I've exhausted almost all of my savings on this and I would do it again, BUT if this is truly because of the shot then I expect reimbursement.

Wish me luck on that one.

Daisy lost a lof weight for her small size. She went from 11.5lbs to 10.5lbs at Dr. Kimm's and down to 9.9lbs at Cornell today.

It was funny, she decided to walk out into the hall and waiting area and stepped on the floor scale and stood perfectly still! She never stands still for that so I called to the tech "Craig! Hurry up! Daisy is standing still on the scale and you can actually get an accurate reading!" Smart man came running and we both had a laugh. Then Daisy walked to another section and FULLY squated which is something that she hasn't done in a long time and peed a gallon I(mostly clear) I swear.

I could tell that she was getting tired so I scooped her up, washed her feet and butt in the nearest sink and brought her back to the room where we waited for the ER doc to come and give an update. Little stinker wouldn't eat for me AT ALL. I really think that she remembers me giving those nasty antbiotics and doesn't trust me now. Poo.

Obviously Dr. Kimm did not intentionally harm Daisy and I can see his love for all animals, but a grave error was made and I'm hoping that somehow he helps to make it right.

Update from Cornell tonight at 12:34am. Daisy went out for a walk and ate 1/4 can of ED? The tech said that amount is right on target for what they want her caloric intake to be. I'm guessing that they consider her appetite to be normal or close to it.
I can't believe that she went for a WALK!!!!

[goldengirl88]

Valerie:
When we were going over the information for the Adequan shots I wanted to say this but didn't as I know you said Dr. Kimm had a lot of experience. If you look up Adequan you will find it is not approved to be used in joints. That is why I kept saying about Tipper getting the shot in her rear legs. I would not let him give her another shot of this like he did the last one. You need to make sure he is giving no more that the proper dose for her weight to as that can bring on bleeding problems, which correct me if I am wrong you said blood in the stool?? I researched this subject thoroughly before deciding to let Tipper have the shots. I am glad the regular IMS is back and you will get this straightened out I know. I was thrilled to see her walking around on the video. Hope she is home soon, and I hope htat Dr. helps you with the bill. Blessings
Patti

[labblab]

Well, that makes sense and if her kidneys are putting out urine, then what exactly is it that is making say/think kidney failure? Protein loss? or something else? Is she concentrating, over conentrating? I'm confused too.

Generally, kidney failure means that the kidneys are not properly filtering out toxins and waste products from the bloodstream and transferring them to urine so as to be excreted and eliminated from the body. A patient may still be producing urine, but the urine may be little more than water. In other words, it does not contain the wastes that the kidneys normally filter out of the bloodstream.

The most specific diagnostic markers of kidney failure are blood values of creatinine (CR) and BUN. If these levels are elevating, it means the wastes are collecting in the bloodstream instead of being eliminated in the urine. Protein in the urine can accompany kidney failure, but it is a different kind of marker. Instead of indicating that waste products are not being filtered, urinary protein can be a marker that protein is inappropriately leaking through kidney membranes and into the urine. So it can be a signal of particular types of kidney damage, but it is different marker from the elevations of creatinine and BUN. In humans, when the kidneys reach a certain point of irreversible failure in terms of clearing toxins and wastes, doctors either must turn to alternative artificial means of purifying the bloodstream (kidney dialysis) or transplant.

So we will find out, but I suspect that Daisy's creatinine and BUN were highly elevated during her crisis. Hopefully, those numbers are now resolving.

Marianne

[doxiesrock912]

Thanks Marianne,
I was told yesterday that her Creatinine was normal but it had been high. Praying that the damage isn't permanent.

More to the saga of Dr. Kimm.
Apparently, his ex-wife in Arizona is dying from cancer and he is there now. I feel badly, but he shouldn't have been treating animals with this looming over his head.

The person who answered the phone today when I called to cancel Daisy's and Gracie's appointment tomorrow told me all of this and she's going to have one of the other doctor's call me back to discuss the matter.

I want nothing less than full reimbursement and I'm praying that no lasting damage was done. I think that is fair.

I don't doubt that he's a great vet, but he had his records and all of the records from Dr. Morgan right in front of him and he looked through them.

Am I wrong to expect this?

[labblab]

Val, the Meloxicam/Adequan may indeed have been a very poor choice given Daisy's history and clinical signs. However, Daisy was obviously already ill prior to the injections since her abnormal behavior was the reason why you took her in to see Dr. Kimm in the first place. I'll defer to your IMS in this regard, but I am guessing it will be hard to establish that the injection was the sole cause of her emergency even though it may have made a bad situation worsen quickly.

You yourself were anticipating an arthritic issue when you decided to take Daisy in. So I don't know whether or not you and Dr. Kimm discussed blood testing for other problems at that time. Perhaps he should have pressed for that, regardless. So that may be another issue you can discuss with the IMS -- whether Dr. Kimm missed the boat entirely or whether it was reasonable for him to assume that the problem was arthritic at the time and leave it at that.

[doxiesrock912]

I feel that this is misdiagnosis. Dr. Kimm did not touch her abdomen, only her back and behind where he saw it bending upward. He said "we're not going to do bloodwork at this time."

I didn't think arthritis until Dr. Kimm mentioned it and then he took xrays.
I spoke at length with Dr. Shapiro and after I explained everything, she conceded that it is possible that he misdiagnosed Daisy. In either case, the ER doc found the abdomen pain immediately and Dr. Kimm didn't even check there.

[labblab]

I feel that this is misdiagnosis. Dr. Kimm did not touch her abdomen, only her back and behind where he saw it bending upward. He said "we're not going to do bloodwork at this time."

I didn't think arthritis until Dr. Kimm mentioned it and then he took xrays.
I spoke at length with Dr. Shapiro and after I explained everything, she conceded that it is possible that he misdiagnosed Daisy. In either case, the ER doc found the abdomen pain immediately and Dr. Kimm didn't even check there.
Val, I'm really confused now. Before you received the call back or later saw Dr. Kimm, this is what you wrote on the morning of the day after you picked Daisy up and she vomited:


I called Daisy's regular vet. I am sure that this is arthritis. She really holds her back legs straight and struggles to squat. I believe that the cushings is controlled or close to it because of the absence of clinical signs. She breathes harder when walking around, calms a lot while laying down, wiggles like mad to get out of bed - if it were her back, I don't think that she'd be able to wiggle. I now believe that the pain of arthritis has made her appetite iffy because it's not always off.

She had luxating patella surgery on one back leg in 2005 so I'm sure this is where the arthritis is. Waiting for a call back from the vet. Once we get this under control, I'll make an appointment with another IMS. I don't want to take the chance that bring in pain will skew the ACTH result.

On a good note, I bathed Daisy last night and her fur looks so shiny! Also, much less fur in the tub to rinse out.
Based on that reply, before you had directly spoken to Dr. Kimm, it sounded to me as though you were pretty convinced that Daisy's issues at that time were related to pain from arthritis, and that you were planning to discuss that with him later in the day when you took Daisy in to see him. After taking the x-rays, it then sounded as though he agreed with you and hence the injections which, unfortunately, apparently turned out to be a regrettable decision. But I guess I may be misunderstanding what you had written.

As for the abdominal pain, what have the specialists told you is the source for that? Do they think it is being caused by the possible kidney infection or instead maybe an ulcer had developed? I am still not clear as to the cause of either the blood in the stool and the abdominal pain. Have they provided you with any answers for that yet?

Marianne

[doxiesrock912]

Marianne,
I thought arthritis as a possibility and that is what he said when he saw the xrays. The abdominal pain was a combination of the kidney infection and ulcers caused by the Meloxicam.

Prior to our visit to Dr. Kimm, Daisy's stools were fine and a few hours after the shots, all hell broke loose and they were black tar which I have never seen from her before. If she had blood in her stool, it was minimal and always bright red. That hasn't happened in quite some time.

Dr. Kimm focused on her lower back and legs from the moment that we got there and I didn't think to question him. He did not examine the front half of her at all and I believe if he had, he would've noticed the abdominal pain. On the way to Cornell she cried several times and she has never done that before, not even when her knee popped out before the luxating patella surgery.

She also flinched hard when the ER vet touched her abdomen where the kidneys are.

[labblab]

I just want to come back to say that it may seem as though I am nit-picking as far as what transpired with Dr. Kimm. But if you are serious about trying to press him for reimbursement, I want to prepare you that there are various questions that he might choose to bring up in his defense including what did you, as the owner, report in terms of your observations of Daisy's behavior and symptoms, and what you yourself thought was wrong. Obviously, you are not a vet and it is his job to make his own professional assessment and examination. But the direction of any examination will be affected by the owner's description of the behavior that is abnormal, and their concerns based on their own experience with their pet. I am afraid there may be a lot of money that ends up being involved here, and Dr. Kimm may or may not be willing to accept sole responsibility for what ended up being a complicated situation.

[doxiesrock912]

I told Dr. Kimm that Daisy had been extremely lethargic, vomited water the night before and that her appetite had not been normal for her for the past few days. I also told him that she was extremely weak and fell over easily while outside. She was very reluctant to walk and when she did, it was at a snails pace.

I gave him every printout from Dr. Morgan even though I knew that Cornell had been sending Dr. Kimm all of the reports and he thumbed through them. I had them in order from the most recent visit on the top of the pile. On March 28th Dr. Morgan indicated that Daisy's Cushings was not controlled and she expressed concern over some of the kidney values.

He said "I think that she's in more pain than she's letting you know and dachshunds are prone to back problems so we're going to take xrays and no bloodwork at this time."

[molly muffin]

How is Daisy doing today? Did the IMS get a chance to talk to you and tell you what is going on with her at this point?

Hope for a good report

hugs
sharlene and molly muffin

[doxiesrock912]

Her creatinine is within the normal range. It was super high when she first came in. The bacteria didn't grow sufficiently in order to identify it. She's still leaking small amounts of tarry diarrhea but Dr. Forman feels that it's safe enough for her to come home tomorrow unless something changes tonight.

The bacteria doesn't account for the bleeding so he's attributing that to ulcers from the Meloxicam. Some dogs are really sensitive to NSAIDS he said. I asked him what I read about not giving Meloxicam to dogs with heart problems, kidney, or liver problems. Then I said "correct me if I'm wrong but being that Daisy's Cushings is not at all controlled according to the numbers and she's known to have a heart murmur, doesn't this put her in that criteria for dogs with heart, kidney, or liver issues? He agreed.

[labblab]

Since the bacteria didn't grow, what are they thinking was the actual problem that caused Daisy's original illness prior to the addition of the Meloxicam/ulcers? Are they still thinking a kidney infection was the root of her other symptoms during these last couple of weeks? Are they going to be keeping her on an antibiotic?

[doxiesrock912]

Still thinking a kidney infection. He said something about they have the ability to grow bacteria under a certain condition and that not all of them grow under that condition. Since the antibiotics seem to be working very well, that's what we're going to keep her on.

I'm sure that I'll have all of the information tomorrow at discharge time.

[goldengirl88]

Valerie:
I hope all goes well and Daisy is able to come home tomorrow. Will you have to use doggy diapers on her until the leaking stops? Does the Dr. feel that will resolve? You knew something was really wrong, and you were so right. Blessings
Patti

[doxiesrock912]

Thanks Patti,
I'm not sure of all the details yet. I'm sure that they'll tell us tomorrow.

[labblab]

That will definitely be good to get all the info organized at the time of discharge. I'll especially be interested to hear the recommendation regarding resumption of the trilostane. Setting aside the Meloxicam disaster, it seems likely that Daisy's ongoing uncontrolled Cushing's increased her vulnerability to the initial development of the kidney infection in the first place, and will continue to place her at risk for other infections/problems as well. It sounds as though she was not actually on the higher dose of trilo very consistently for any length of time, though, so it will be hard to know whether or not it was an improvement. But I wonder whether they may consider switching to Lysodren in order to finally achieve a rapid decrease in cortisol.

[goldengirl88]

I was wondering about the trilostane too, what the plan is??

[doxiesrock912]

Dr. Forman doesn't use Lysodren and he doesn't plan on treating her Cushings until she's fully recovered from the infection and ulcers. Interestingly enough, she's been off the Trilo since Tuesday and the only symptom that has returned so far is that her fur is thinning and dull. She could also really use a bath :)

I agree and I wonder now if the pot belly that recently appeared was due more to the bacteria than Cushings because that was not a symptom that Daisy had until recently.

If I recall, the visit prior to the one in March, Dr. Morgan indicated that Daisy's numbers went up instead of down which I was shocked to learn. I wonder if that is related too?

[goldengirl88]

She is so cute, and sweet in her avatar!! Get better Daisy girl!

[doxiesrock912]

Thank you Patti, they have a dark purple towel to match her leg bandage too :)
She ate again for them tonight but hasn't had an actual poop aside from the leaky, tar smudge that they call diarrhea.

[Junior's Mom]

I'm so glad to hear Daisy is improving, and will get to come home.
I'm curious if they thought the long term tysan she has been on, is making her more antibiotic resistant?

[doxiesrock912]

That subject didn't even come up! I'll ask about that tomorrow. Thank you!

[goldengirl88]

Valerie:
I hope the baby girl is coming home today?? I am sure you will post and tell us the game plan from here on. Hope you all have a good day. Blessings
Patti

[Trixie]

Val..I just caught up on all this distressing stuff you've been going through! Awwwww poor Daisy!! I can't imagine how you got through this all..especially the crying in car.
I hope that things are improving and that Daisy can come home which I'm sure will help her feel better! That avatar photo is so cute...awww..her little leg bandage! It's so hard having the dog go through all this, you must be completely exhausted.
Hoping the worst of this is all over now for Daisy! When Trixie was sick last March she was off her Vetoryl for over a week, I did not see symptoms come back either. We started back once we were sure that she was 100% back to normal eating etc.
Keeping you and Daisy in my thoughts!

Barbara

[doxiesrock912]

Hello everyone!
SHE"S HOME WITH ME!!!! SHE"S HOOOOOME!
Ate 1/4 can of EN food with her pills mixed in (thank God), I think she's still pissed at me for giving her the other antibiotics :) I had to make her eat them and I felt really bad doing it.

Here is the letter that the ER doc sent to Dr. Kimm.

5/24/2014
Date of presentation: 5/23/2014 8:13:15PM

Dear Colleague,
The following is an update on Daisy Mae, who is currently hospitalized at CUVS, attached below is a summary of today’s physical examination, findings, assessment, and plan. As always, all medical records, lab work and images are viewable on our PartnerPortal.

All evidence point to pyelonephritis, suggested by the elevated renal parameters. Bacteruria, left-shift neutrophilia and pan. Urine culture is pending.
The patient was very dehydrated on presentation. Fluid therapy has been somewhat conservative due to her heart murmur; she has gained fluid weight and hydration has improved, but she is still significantly dehydrated. The extreme malaise is likely a combination of the pyelonephritis, pain, azotemia, dehydration +/- GI ulceration. Hyperadrenocorticism is currently uncontrolled. This may have predisposed to UTI and pyelonephritis.
Thank you again for allowing us to participate in Daisy Mae’s care.
Best regards,
Susan Hackner, BVS, MRCVS< DACVIM< DACVECC

Daily SOAP
Daisy was presented for hospitalization on 5/23/14 based on a presumptive diagnosis of pyelonephritis at CUVS on 5/22/14.
Daisy Mae has a history of Hyperadrenocorticism (suspect pituitary dependent, on Trilostane), increased hepatobiliary enzymes, gallbladder distension and sludge, hyperkalemia, azotemia, left-sided sialocele, low grade heart murmur, and Tylosan-responsive diarrhea.
Recently, she has had a progressive lethargy and decreased appetite. Saw RDVM 5/20 – suspected LS pain; received adaquan and meloxicam. She vomited thereafter, and developed melena. She has been anorexic since 5/21. (As a result, owner has not been able to reliably dose Trilostane, and she has not had any since 5/21.)
Bloodwork submitted on 5/22 revealed: BUN 225, Crea 2.9, phos 20.7, ALP 2222, ALT 210, GGT 173, glob 4.4, a neutrophilic left shift (neutrphil 15050, band 175), increase in basophils 875, and platelets 969,000. Her ACTH stim revealed uncontrolled hyperadrenocorticism (17.9/25.9) Her UA revealed a USG of 1.015 with proteinuria and bacteria but no pyuria. Urine culture is pending.
Medications: trilostane (not recently), urisidol, metronidazole, carafate, famotidine
PHYSICAL EXAM:
• Body weight (kgs) 4.85 (+5% since admission)
• Temperature (F) 99.2
• Heart rate (bpm) 72
• Respiratory rate (bpm) 50
• General habitis: depressed, but responsive
• Mucous membrane color, pink, tacky
• Capillary refill time (secs): 1
• Body condition score (out of 9): 3 with mild muscle wasting
• Hydration statues: estimated 7% dehydrated
• EENT: Clean corneas with lenticular sclerosis OU. Severe dental calculus. No nasal discharge.
• Cervical region: Marked fluctuant left sided submancibular swelling, no pain on manipulation of the swelling. Swelling is not warm to the touch
• Peripheral lymph nodes: within normal limits
• Cardiovascular: Normal sinus rhythm, grade II-III/VI left apical systolic murmur ausculted. Pulses strong and synchronous
• Respiratory: Mild tachypnea and increased respiratory effoft: lungs clear on auscultation, no cracles/wheezes/abnormal BV sounds
• Abdomen: Pain on craniodorsa palpitation. Cranial organomegaly, pot-bellied
• Rectal examination: Normal rectal structures. Melena.
• Musculoskeletal: Will stand and walk. Stands with hunched back. No pain on palpitation or manipulation of neck. No pain on thoracolumbar palpitation. Generalized muscle wasting. Grade II/IV left MPL with crepitus on ROM of both stifles; pain and crepitus on extension of both hips.
• Integument: Mild diffuse, patchy alopecia, with few remaining foci of alopecia on dorsum (ongoing alopecia on ventral abdomen and tail base). Diffusely thin skin. Moderate to marked scaling. No pustules seen. Coarse hair coat.
• Neurologic: Depressed but appropriate. Weakly ambulatory x 4. Intact cranial nerves. No head tilt.
DIAGNOSTICS:
• BP: 157/88 (114)
• PCV 50%; TS 8.8 g/dl
• StatLytes: pH 7.29, HCO3 21.7, Na 153.6, K 4.48, glc 98 mg/dll, lactate 1.17
• BUN 237 mg/dll: Creatinine 3.7 mg/dll
• Serum creatinine submitted to Idexx: pending
PROBLEM LIST:
• Renal failure – elevated creatinine, BUN, hyperphosphatemia
• Bacteruria
• Left-shirt neutrophilia
• Metabolic acidosis
• Dehydration, hemoconcentration – correcting
• Abdominal pain -? Renal vs TL
• Melena
• Vomited 1X
• Lethargy
• Anorexia
• HS hyperadrenococtricism – presently uncontrolled
• Hs elevated hepatic enzymes, ALkP>>>AlT – r/o hyperadrenococorticism vs hepatobiliary dz
• Hs hypertension?
• Hs heart murmur
• Hs gallbladder changes (distension and sludging)
• Chronic sialocele, left
ASSESSMENT:
Pyelonephritis is suggested by the elevated renal parameters, bacteruria, left-shirt neutrophilia and pain. Urine culture is pending.
Patient was very dehydrated on presentation. Fluid therapy has been somewhat conservative due to her heart murmur: she has gained fluid weight and hydration is improved, but she is still significantly dehydrated. According to in-house values: creatinine was 2.3 mg/dll last night and 3.7 mg/dll this afternoon. I am concerned that one of these is not accurate. Given clinical and hydration improvement, possible that creatinine on presentation was higher.
Melena likely due to NSAID therapy: differentials include GI ulceration, neoplasia. The extreme malaise is likely a combination of pyelonephritis, pain, azotemia, dehydration +/- melena. Hyperadrenococorticism is currently incontrolled. This may have predisposed to UTI and pyelonephritis.
PLAN:
• Increase IVF to 30 ml/hr
• Close monitoring of fluid balance including physical assessment, body weight: adjust fluids accordingly
• Auscult thorax q4h
• Unasyn 100 mg IV q8h
• Sucralfate 250 mg q8
• Famotidine 2.5mg q8
• Buprenorphine 0.05 mg IV q8h prn; monitor comfort
• Pending serum creatinine verification (Idexx)
• Pending urine C+S

[labblab]

YAY, this is wonderful that Daisy is home!!! :) :) :) :)

Val, thanks so much for this ER summary. By any chance, can you give us today's Discharge Summary as well? That will really help us get a handle on the path forward for Daisy.

Marianne

[doxiesrock912]

I've been working on that. No scanner where I am so I'm typing it all.

Here it is!

5/28/2014
Date of presentation: 5/23/2014 8:13:15PM

Dear Colleague,
The following is an update on Daisy Mae, who is currently hospitalized at CUVS, attached below is a summary of today’s physical examination, findings, assessment, and plan. As always, all medical records, lab work and images are viewable on our PartnerPortal and a full report will be sent at discharge.
Thank you again for allowing us to participate in Daisy Mae’s care.
Best regards,
Marnin Forman, DVM, DACVIM
Daily SOAP
Daisy was presented for hospitalization on 5/23/14 based on a presumptive diagnosis of pyelonephritis at CUVS on 5/22/14.
Daisy Mae has a history of Hyperadrenocorticism (suspect pituitary dependent, on Trilostane) which has been managed by Dr. Megan Morgan. Additional medical history included hepatobiliary enzyme increased, gallbladder distension and sludge, heperkalemia, increased BUN and right sided pyelectasia, left-sided sialocele, low grade heart murmur, and Tylosan-responsive diarrhea.
Daisy Mae’s dose of Trilostane was increased from 15mg to 19mg BID in early April 2014 due to inadequate control of hyperadrenococorticism based on ACTH stimulation testing. Since that time her owner feels like she has been lethargic and had a decreased appetite. Daisy has shown these signs with increases of her Trilostane dose previously, however they have resolved in short periods of time after the increase.
Over the past few days, Daisy’s lethargy and inappetence has worsened. She was evaluated by her primary care veterinarian on 5/20/14, at which time spinal pain was found and radiographs revealed evidence of spinal osteoarthritis. Daisy was administered injections of meloxicam and adequan at that time. That day she vomited once and had an episode of dark-colored diarrhea and vomiting. She did eat chicken well during the day on 5/21/2014.
Daisy Mae’s thirst and urination (PD/PU) and pot belly have reduced with Trilostane treatment. She is also less polyphagic. She has lost weight. On 5/22/2014 the following was noted: BP; 175mmHg. (Doppler 2cm cuff, right thorac limb), PCV/TS 56% and 8.2g/dL, Lytes: acid/base unremarkeable. Na 140.8mmol/L, K 4.98mmol/L, (Na:K 28.27), CA 0.85mmol/L, c 96mmol/L, AG 26.7mmol/L, Glu 106mg/dL, Lac 1.68mmol/L, urinalysis and urine culture and sensitivity to Idexx (negative to date).
On 5/24/2014 Daisy Mae’s labwork (complete blood count, biochemical panel, ACTH stimulation test) revealed an increase in ALP 2222, ALT 210, CK 231, GGT 173, glob 4.4, BUN 225, Crea 2.9, phos 20.7, Na 154, Mg 4, AG 47, and decrease in CI 92 with a neutrophilic left shift (neutrophil 15050, band 175), increase in basophils 875, and platelets 969,000. Her ACTH stim revealed 17.9/25.9. Her UA revealed a USG of 1.015 with proteinuria and bacteria but no WBCs. In-house labwork revealed BUN 237, Crea 3.7 on 5/24/2014.
SUBJECTIVE:
Ate with no vomiting
OBJECTIVE:
a. Body weight (kgs) 4.69
b. Body weight (lbs) 10.31
c. Temperature degrees F 99.8
d. Heart rate (bpm) 140
e. Respiratory rate (bpm) 24
f. Body condition score (1-9) 3
g. Muscle condition score (1-4) 2
h. Capillary refill time (sec) 1
i. Pulse quality (0-4) 2
• Quiet to dull, responsive, and hydrated with weak but improved ambulation in all 4 limbs. I noted pink color to the mucous membranes, moderate dental calculus and gingivitis with no nasal, ocular or other abnormalities in the mouth. I noted age related eye changes (NSIA OU). Kidney palpitation was normal but limited. I noted mild left-sided mandibular sweeling without pain. Abdominal palpitation was tense but non-painful with no mass detected but generalized hepatomegaly. On auscultation of the chest I noted a heart murmur (grade II/IV LSHM-A) with no gallop heart sounds, arrhythmias, problems breathing or abnormal lung sounds. All peripheral lymph nodes were normal in size. On rectal examination I noted no abnormalities except for soft, dark stools. I noted mild, diffuse, patchy alopecia, with few remaining foci of alopecia on dorsum (ongoing alopecia on ventral abdomen and tail base) with diffusely thin skin and moderate to marked scaling. I noted CO deficits in both the RTL and RPL and mild cervical discomfort.
PROBLEM LIST:
• Hs elevated hepatic enzymes, ALkP>>>AlT – r/o hyperadrenococorticism vs hepatobiliary dz
• Hs hypertension
• Hs heart murmur
• Hs gallbladder changes (distension and sludging)
• Chronic sialocele, left
• Thrombocytosis
• Pyelonephritis
• Acute kidney insult – elevated Creatinine, BUN, hyperphosphatemia
• Bacteriuria
• Left-shift neutrophilia
• Hypertension
• Metabolic alkalosis
• Dehydration, hemoconcentration
• Abdominal pain
• Melena
• Vomited 1X
• Lethargy – improved
• Anorexia

ASSESSMENT:
Daisy Mae has chronically managed Cushing’s disease (pituitary dependent hyperadrenocorticism). On 5/20.14 Daisy Mae was treated for spinal pain, likely secondary to intervertebral disc disease with injectable Metacam and Adaquan. She then developed dark-colored diarrhea (consistent with melena) with our primary differential being gastric ulcers however primary gastrointestional disease (including cancer) is possible.

On 5/22/14 Daisy Mae was diagnosed with a Acute Kidney Insult with bacteria in her urine however urine culture did not detect aerobic bacteria growth. She previously had evidence of low grade chronic kidney disease with right-sided pyelectasia. We have been treating Daisy Mae for likely pylonephritis however NSAID toxicity is possible.

PLAN:
• CLIENT COMMUNICATIONS: discussed case in full.
• Renal panel: Bun 104, Crea 1.6, P 6.8, K 3,
MAF

[goldengirl88]

Valerie:
I am so happy Daisy is home! These summaries will take me a while to decipher!! Daisy was a very sick girl, I am so glad you had good care for her. I hope she has a good first nite home. Blessings
Patti

[doxiesrock912]

Thanks Patti,

I know that she was! What a scare I had over there!

I was in the waiting room with another woman who started talking with me. Both of us were waiting for our 10 yr old female, black and tan, smooth dachshunds to be brought out for us to take home. What are the chances of that?! Her dog has chronic health issues and pneumonia and I think something else wrong with her lungs.

They called her into a room first and apparently when Dr. Forman was preparing to bring her dog to the room for the discharge consultation, the poor thing "crashed"!

Someone came out and told me what was happening and asked if I minded waiting longer. Of course I said "OMG. Not at all, in fact you can call me and I can come back later." They tried resuscitating her 3 times and then had to make the dreaded decision. I felt so bad for her and told the techs to ask her if she needed a ride home. They told me that he husband was coming. I can't imagine how traumatized they must be! Coming to pick up your dog and then she suddenly dies!

While they were all hands on deck trying to help this poor dog, I was alone in the waiting room and a man came in with a clipboard saying that he was there to pick up Daisy Mae. I didn't realize what he was there for and I walked up to him and I said "my dog is Daisy Mae". He said "Oh, I'm so sorry!"

My brain flipped once I realized that he was there to pick up a dog who had passed and I'd wondered if it wasn't the other woman's dog but my DAISY crashing and I almost had a heart attack on the spot and I said "there has to be some mistake.....I'm picking up my dog to go home". Still on the verge of panic.

One of the techs came out from behind a wall and said that there were 3 Daisy Mae's admitted to the hospital over the weekend. Cornell is the only 24/7 emergency vet within quite a distance and they had 22 dogs come in over the holiday. I really thought that they'd confused 2 smooth, female, black and tan doxies and that Daisy was the one in trouble.

I just gave our princess her midday meds and she us napping in the egg crate heated bed that Chris bought for her.

[goldengirl88]

Valerie:
Well that says it all, you passed the heart attack test!! What are chances of all these dogs named Daisy Mae?? Unbelievable!! Too many coincidences going on I would say. Chris is the best, he knows what to do right all the time? He's a keeper. I am so very happy this turned out to have a good ending. Now just to keep Daisy well will be the new order of business! She deserves a heated egg crate and more after what she has been thru? Hey you haven't exactly had a great time either. Where is your heated egg crate??? Blessings
Patti

[doxiesrock912]

After all of this, we can't afford 2 heated egg crates but I'll settle for a cork because OMGGGGG Daisy's farts are worse than ever before! Gag gag gag.....

Must be the plumbing healing, but oh it is NASTY and too cold to leave the front door open.

[doxiesrock912]

Here are the actual discharge notes.

Discharge Instructions for Daisy Mae – 5/28/2014
Daisy Mae was presented to Cornell University Veterinary Specialists on 5/23/2014 at 8:13:15PM. This report summarizes our findings and recommendations. A complete medical report will be sent to your primary care veterinarian.
• VISIT SUMMARY
Daisy Mae was treated for spinal pain, likely secondary to intervertebral disc disease, with injectible Metacam and Adaquan. She then developed dark-colored diarrhea (consistent with melena) with out primary differential being gastric ulcers however primary gastrointestinal disease (including cancer) is possible.
On 5/22/14 Daisy Mae was diagnosed with a Acute Kidney Insult with bacteria in her urine however urine culture did not detect aerobic bacteria growth. She previously had evidence of low grade chronic kidney disease (with right sided-pyelectasia). We have been treating Daisy Mae for likely kidney infection (pyelonephritis) however NSAID renal toxicity is possible.
RECOMMENDATIONS FOR HOME CARE:
1. MEDICATIONS:
Newly prescribed or Modifications of Current medications.
2 x daily – 1.5 tablet of Clavamox (62.5mg) with food (possible side effects: vomiting, diarrhea, inappetence.)
¼ tablet once a day - Mirtazapine 15mg ( uncommon side effects of excitement)
½ tablet once a day – Cerenia 16mg (possible side effects hypersalivsation and rarely vomiting and diarrhea).
CURRENT MEDICATIONS:
¼ tablet in 3ml (cc) of water x 3 times day - Carafate 1gr
¼ tablet x 3 daily - Tramadol 50mg
¼ tablet x 2 daily – Famotadine (Pepcid AC)
1ml x 1 daily until finished – Metronidazole
Urosodial: finish
Tylan powder: finish
NO Trilostane until further notice.
Continue flea, tick and heartworm preventative.
2. Diet recommendations: Please temp Daisy Mae to eat and feed the original diet you have been giving. If she does not want to eat your original diet, you can try tasty, high protein & colorie diets termed recovery diets. Examples of these diets include Hill’s A/D diet or Iams MaxCal diet. These diets can be mixed with your pet’s food or syringed into your pet’s mouth if needed. Although it is safe to feed these diets, in many cases, this is not an ideal long term diet for pets with liver, kidney, and certain intestinal diseases. In addition, you may warm up this diet, or any wet diet, to increase the scent of the diet which may stimulate your pet’s appetite. Also some pets prefer sweet foods like honey, applesauce, ice cream, etc or cold/frozen food, or even feeding on a human plate.
3. Activity recommendations: no changes at this time. If you have any questions concerning how much or what type of activity your pet should have please ask.
4. Other recommendations:
*Please call if your pet:
-Does not eat for greater than 1 day, vomits more than 3 times, or has diarrhea for more than 2 days.
-Is very lethargic, is having problems breathing, or you are worried.
-Please do not hesitate to call if your pet is having any problems.
*If Dr. Forman, Dr. Morgan or Dr. Broussard or his technicians are not available, our emergency/critical care service is available 24 hours a day.

It was a pleasure to see you and your pet. Thank you up entrusting us with your pet’s care. Please do not hesitate to contact CUVS at 203-595-2777 with any questions or concerns.

[flynnandian]

i am glad that daisy is home with you and i hope she will be better soon!

[doxiesrock912]

Thank you :)

[molly muffin]

Very happy to hear that Daisy is home and working on her recovery. That is a lot of medication, how is she going to be taking all that? I'd be having a hard time with Molly for sure.

Hopefully she will get over this completely and quickly.

I do wonder since they didn't get any bacteria growth if the NSAID renal toxicity is a real possibility. Did you ask the IMS what the odds were that with no bacteria growing that it was toxicity? I think I would just to know. That one shot is the only NSAID she had right? So, I wonder if that means that she is super sensitive to NSAID's. Has she ever had any before for inflammation?

Get some rest. This has been a long haul for you and Chris too.

hugs
Sharlene and molly muffin

[doxiesrock912]

She's never had NSAIDs but I read the warnings and it clearly states not to give to a dog with kidney, liver, or heart problems.

Dr. Kimm has been getting all documentation from Cornell throughout Daisy's Cushing's treatment so he knows her history along with the fact that I printed ALL summaries from Dr. Morgan and gave them to him to look over at Daisy's appointment that day and he still gave her the shot.

I truly believe that the shot is what caused this. Her symptoms worsened within a few hours of the shot and she didn't have any diarrhea before that either, let alone black tarry diarrhea. She's never had that before.

I don't mean to sound insensitive, apparently Dr. Kimm is going through some personal issues with his daughter in Arizona, but this shouldn't have happened.

[labblab]

It does indeed sound as though Cornell now also suspects that the Meloxicam was the culprit in terms of the acute crisis. A big part of the remaining puzzle for me, though, is what do they think caused the initial problems that prompted you to consult with Dr. Kimm in the first place, before the Meloxicam was given?


I told Dr. Kimm that Daisy had been extremely lethargic, vomited water the night before and that her appetite had not been normal for her for the past few days. I also told him that she was extremely weak and fell over easily while outside. She was very reluctant to walk and when she did, it was at a snails pace.

Clearly, something was already going on prior to the Meloxicam although neither the ER nor Cornell vets make specific note of that in their summaries other than to comment on the arthritic/disc changes that prompted the injections. What did Cornell tell you about Daisy's initial symptoms? If they are no longer strongly suspecting pyelonephritis, do they think the initial problems were indeed related to severe arthritic pain or instead to something else that was festering? They mention the possibility of primary gastrointestinal disease, and I am wondering whether they talked with you about that in any detail.

It just seems to me that this is a significant question in terms of Daisy's ultimate recovery. There now seems little doubt but that the Meloxicam made a bad situation acutely worse. But what was/is the underlying problem that first set the wheels in motion, and has that yet been identified and remedied?

Marianne

[addy]

Hey Val,

I am so glad your little girl is home and I hope this can all be sorted out. I wonder too, like Marianne, what caused the initial symptoms.

Give Daisy a big hug and smooches from me. Try to get some rest too.

Big hugs

[goldengirl88]

Valerie:
I am so glad things are moving along and Daisy is eating. She just melted my heart in that video of her from the hospital. She is certainly strong willed to go thru all this, so I am hopeful things will work out in time. Blessings
Patti

[doxiesrock912]

I don't think that Trilo is a good fit for Daisy, especially seeing her as she is despite the recent hospitalization having not been on Trilo for a week. I think that the Trilo was slowly causing issues for her because she's a completely different dog!

I'd been going back and forth with Dr. Morgan about this latest increase and how Daisy wasn't bouncing back like she usually does. SHe kept pushing back with "this happens every time we change doses" but she wasn't understanding that this was not the same.

Daisy has no pot belly right now, her fur looks shiny for the first time since starting trilostane, and already she seems less depressed.

[goldengirl88]

Valerie:
Do you think you are going to have to have a discussion about Lysodren with the new Dr.?

[doxiesrock912]

Dr. Forman is not sure that Lysodren would be a good fit for Daisy being how sensitive she is. He said that there are other options but is not concerned with resuming treatment until Daisy is fully well again.

[doxiesrock912]

Look at this! http://www.petpoisonhelpline.com/poison/nsaids/

Daisy had all symptoms except for the bloody vomitus and seizures. Now I an positive that it was the Meloxicam. No doubt in my mind.

Patti, I posted what Dr. Forman had to say about the congestion on your thread.

[goldengirl88]

Valerie:
Thank you for asking. I am going to go over this with my IMS and my vet. Hope all is going well with Daisy. Blessings
Patti

[doxiesrock912]

No problem Patti.
We help each other and I think that this bacterial infection is low grade and doesn't grow by the usual means that they use to grow bacteria in a lab. This is my guess and Dr. Forman was also perplexed as to why the bacteria didn't grow.

That would explain a lot I think and once we start Daisy on another Cushings med, if those symptoms don't return that we know that it was likely what they saw in the urine sample and not due to meds.

I would have your IMS look for bacteria in the urine and if it doesn't grow in the lab, I would really try the Clavamox because that's what appears to have done the trick for Daisy.

[labblab]

Val, if Dr. Forman is not going to use either trilostane or Lysodren when he restarts Cushing's treatment, can you ask him what medication he has in mind for lowering Daisy's cortisol?

Marianne

[doxiesrock912]

Absolutely. I imagine this conversation is a month or so down the road to make sure that she's well and the trilo is completely out of her system.

I will keep everyone posted.

[labblab]

Wow, if we have to wait a whole month to find out, the suspense is gonna kill me! :o

The thing is, trilo and Lyso are currently the only two meds of which we are aware that are recognized as being generally suitable/effective across a broad patient population. If Dr. Forman has something new or different up his sleeve, it's going to be a bombshell for us here. If you can, see if you can't get an earlier preview of what he has in mind, OK?

[doxiesrock912]

I understand and I feel the same way but I know that he's super busy and without reexamining Daisy, there's really no point to this conversation.

I think that he plans on wiping the slate clean and starting from scratch with her now that we know how sensitive she is.

I will share everything that I find out believe me :)

[doxiesrock912]

Another symptom that has resolved ironically is that Daisy is showing true interest in me again. I am THRILLED! So I will also ask Dr. Forman about this as well. I know that it's a sign of Cushings but also wonder if it's also a side effect of trilostane. Either way, it's weird that she's not getting any Cushings meds and this has gone away.

Daisy Mae mystery dog.

[goldengirl88]

Valerie:
I too will be real interested in this new treatment because of Tipper's side effects to trilostane. Personality change is one of the side effects so your are right about Daisy's interest in you. So if the IMS says it is usually an underlying bacterial infection causing the congestion, would that not have caused Daisy's instead of the trilostane?? I am going to have my vet see if Tipper has a sinus infection Wednesday as that could cause it. He breath has been really bad and I think it is due to mucous or whatever is going on in her throat. Hope Daisy is doing well, and you are taking it easy. I bet your dad was so glad to see that little munchkin! Blessings
Patti

[doxiesrock912]

Patti, breath smelling worse than usual is often a sign of infection. Smart to see the vet. The only place they found bacteria was in Daisy's urine.


Daisy pooped for the first time since her hospitalization. Less awful farting too so I believe that we're on the mend.

[Trish]

So pleased she is home!! Fantastic to read this morning! I bet you, Chris and Dad are very happy!!

Time for recovery and then I guess look at what next steps to take. I still wonder what came first... she was sick before the meloxicam.... ?arthritis ?something in gut ?kidney infection but I would have thought if that infection was that bad it would definitely show up on the testing. I would be wanting a scan of abdomen to see what the heck was going on in there. Jeepers that is real scary that one dose of Meloxicam can tip her into renal and liver failure like that. The dose was not too big was it?? But the vets have never really had her cushings controlled properly so I guess that did not help matters either.

Still a few things up in the air for our Daisy, but I am so pleased she is back in your arms and eating and pooping too!! :D:D xx

[doxiesrock912]

I still believe that Daisy has not been right since the most recent increase in trilostane. That I believe was the start of this so and I've read that trilo continues to work so that you must be very careful. That was the start and it is possible that she had an underlying bacterial infection since Cushings dogs are prone to those and UTIs according to the IMS, Dr. Forman.

I tried to email Dr. Morgan when Daisy still wasn't herself and got an email stating that she was out on maternity leave until September. That's when I made the appointment with Dr Kimm for Tuesday and expressed my concerns about lethargy, decreasing appetite, once incidence of vomiting water the night before and overall weakness.

Without doing any bloodwork, he surmised that Addisons wasn't the issue and that he believed that Daisy was in severe pain from arthritis and possibly a slipped disc in her mid/lower back. That's when he mentioned the Meloxicam shot and Adaquen shots assuring me that he's been using them for years and I agreed to try them.

Boom. That's when Daisy's health tanked an hour or two after the shots dad and I came home to find that she'd vomited her 11:30am meal, and left a pile of black, tarry diarrhea in the living room. Until this point, her stools had been fine.

The weakness progressed into Wednesday to the point where she literally fell over on her side when I brought her outside late that night which prompted me to jump in the car at 1:45am after having left messages for Dr. Kimm to call me back during the day (he did not), I drove her to Cornell.

During the ride to Cornell, Daisy cried out several times in pain . She's never done that :( They ruled out Addisons with an ACTH, found bacteria in her urine which they sent out for a culture and it wouldn't grow for them, determined that she was anorexic and dehydrated, started IV fluids and antibiotics because at that time they were thinking bacterial kidney infection. Black tarry diarrhea continued almost non stop and that is when things really changed and she started with the kidney failure and ulcers.

They believe that the Meloxicam caused both of these issues and I have no doubt because her symptoms got bad within a day after the shot.

I have spoken to another vet at Dr. Kimm's practice and Cornell has sent them all of the information including a letter that states that NSAID toxocity is a possibiiity.

So far, I have not heard from him which is really pissing me off.

[Trish]

Well NSAID toxicity could well be the problem, it is always worse if the patient is dehydrated and unwell. That can really knock the kidneys. I did not realise it can cause bloody poops in like 2 hrs?? Seems unusual to me, especially after an injection... not tablet form. I have seen GI bleed from NSAIDs but never that fast, gastric irritation is a common side effect with the tablets which is why it should always be given with food. I would still want to have an ultrasound to see if there is anything else going on in her gut causing these problems. But I guess if she goes totally back to normal now that might not be needed, but if she did have further trouble I think that is what I would do.

Blood in the poop sure has a distinctive smell, it is terrible!! I bet that is what was causing the foul smell you were noticing with her toots! I presume they would have done a faecal sample to make sure that there was no bacteria in the bowel causing all those problems. It does concern me that no bacteria grew in her urine. Daisy was symptomatic and I believe needed antibiotics but I am really against their indiscriminate use with no positive culture or definite sign of infection. That is just bad medicine when they just "pick" one to use hoping it will match the suspected bug. This is the reason we are seeing global resistance increasing with clinicians handing out antibiotics willy nilly... it is dangerous and should be avoided! It won't be too much longer and antibiotics will not work at all!!

[labblab]

Val, I know you are convinced that the trilo increase exaggerated Daisy's most recent problems. However, I am going to throw out an alternative explanation, especially since you had not been consistently giving her the higher dose for very long and the ACTH testing done at the ER showed that Daisy's cortisol is still way too high. I think it is possible that Daisy's symptoms prior to the Meloxicam injection may be linked to underlying issues resulting from months of uncontrolled Cushing's, and may yet reappear once again in the future, especially now that she is receiving no Cushing's treatment at all.

Yes, it may be the case that the trilo, itself, is causing some side effects. But I don't think you can discount the effects of her ongoing underlying disease. Throughout this entire year of treatment, you have understandably fretted about the possibility of Addison's. But the reality is that we have never had evidence that Daisy's cortisol has ever been even remotely low. In fact, it is quite the opposite.

I know you are focused right now on the likely ill effects from the NSAID injection, and that is understandable given the immense worry and cost involved. But I hope the issues surrounding the injection do not blind you to the still very unresolved issues relating to possible ongoing damage associated with Daisy's high cortisol. These are the issues that Dr. Morgan has written to you about, and that is why I am urging you to find out how Dr. Forman intends to address the Cushing's once treatment resumes.

I am surely glad that Daisy seems to be feeling better. And as for the future, it may be the case that Lysodren, for instance, could be a better treatment choice for her than the trilostane has been. But I hope you will not now lose sight of the forest for the trees by focusing solely on the potential damage done by the Meloxicam. Daisy was ill before she ever got the injection, and whether or not the cause was in fact a kidney infection this time around, that is yet another vulnerability that will remain unchanged until her cortisol comes under control.

[doxiesrock912]

I agree and so design Dr. Dormant. Daisy goes for a recheck in 2 weeks. Already she's so much better. Getting stronger every day. I think that the underlying cause helped the NSAID toxicity rear its head though.

Now I have a new problem with my 2011 Chevy Cruze and if anyone knows someone high up at GM I would really appreciate some help fast. http://www.lemonlawamerica.com/blog/2014/03/20/chevrolet-cruze-coolant-leak-causes-bad-smell-drivers

[goldengirl88]

Valerie:
Maybe you posted this and I do not remember, but how long did your Dr. say it would be before he used something new to get her cortisol down? I am glad she is feeling stronger and doing well, what are the poops like now, and is she still leaking or has it quit? Blessings
Patti

[doxiesrock912]

She's rarely leaking but when she does it's got a green tinge. Dr. Forman says that's great and means she's healing. She's still weak and has to build up her stamina but even that has improved.

I'm sure that we'll discuss what is next in 2 weeks.

[goldengirl88]

Valerie:
I am anxious to see what he has up his sleeve that could possibly help others on here too. I guess green is the new black! Blessings
Patti