Poor Pitiful Pia - Pia has gone to heaven

[knitbunnie]

Pia is my nearly 8 year old French Bulldog who, for unknown reasons, had a stroke three years ago. She woke up from a nap and was paralyzed on her left side. She went through therapy, a whole lot of therapy, and acupuncture which really helped a lot, and recovered with a limp and some left-sided weakness. She's such a sweet girl, and I feel like it's not fair for her to have yet another major health crisis. Here she is:

http://farm9.staticflickr.com/8368/8418325021_f576d419a5_m.jpg

So on to the possible Cushings and the lead up to where we are now. She normally ate a diet of homemade food of beef, rice, fruits and veggies that was recommended by her actupuncturist/vet when she had a stroke. I supplemented with Merrick Cowboy Cookout dry to balance her diet. The company stopped making it, so about 3 weeks ago we switched her dry food to Fromm's Beef Frittata Dry. And that's when the problems started - bloating, gas, lethargy, excess thirst resulting in excess urination. I switched her to another Merrick product, and mostly fed her the homemade food. The bloating/gas have improved but not resolved, but the thirst is still there, and she's urinated in the house a few times this past week at night. This is completely uncharacteristic of Pia. Even when she had her stroke, she held her urine until we carried her out to the yard and helped her to stand with a sling.

I called the vet's office on Monday, and she was seen today. I collected some urine this morning - clean catch on a clean serving spoon. I honestly suspected diabetes, but her urine and blood glucose levels were completely within normal limits. She was needled at the vets for a sterile urine culture, so that's in the works. They suspect either pancreatitis or Cushing's or both.

Below are her "off" lab results and some input from the vet as to why on several of them.

ALT - 146 U/L (normal 10-100)

Lipase - 5660 U/L (normal 200-1800) Vet says this is suspicious for either Cushing's or pancreatitis along with the elevated ALT.

TT4 - 0.8 ug/dl (<1.0 ug/dl is low) Vet said it's because of the stress of being ill

Her lymphocytes are low (0.9) as are her eosinophils (0.01) and the vet also said this was a stress reaction.

For now, the vet has put her on Royal Canin Gastrointestinal TM Low Fat Canned Dog Food, and started Reglan for the bloating. We're to wait for the results of the urine culture (three days) and see how Pia does with the Reglan and diet change. If nothing changes, she recommends an ultrasound and a Low Dose Dex Snap Test.

With the over $300 expense of today's visit, I'm tapped out. The next round of testing is about $400. I can do it after the 1st of the month. Is this realistic?

Since Pia has been having night-time accidents, would it be awful to restrict her night-time water intake? I will do whatever I can for Pia, but if the expense of the tests can wait two weeks, it would be a relief. If not, I'll figure something out.

I thank you all for any and all input, good or bad. I'll listen to advice. That's why I came here.

[frijole]

Sorry you had to find us but glad you did. Cushing's doesn't just pop up after a diet change which is what you have described. Based on the lab results - the alt is a liver enzyme but it's alk phos that is usually in the THOUSANDS that is a sign of cushings. The lipase is not a sign of cushings but really tends to be present with pancreatitis. I would suspect that vs cushings and would not spend ONE DIME on cushings tests at this time. It could also be kidney issues which would explain the urination.

When kidneys are acting up they use up all the hydration and that is why dogs drink more - so NO do not restrict water as it is important Pia has as much water as her body needs. Sorry but the urination will continue until she is cured.

Again - if those are the only items that were high on the blood test I would not rush to test cushings. I'd check out the tummy issues. Pancreas issues are serious and painful so don't waste time. There is a specific sPec test you should have done and I pray Lori or someone else with experience sees this and can help you tonight.

Meanwhile you might want to switch to very easy foods to digest like white rice (overcook it so it is mushy and include some of the rice juice) and water, perhaps chicken breast if she can handle it.

Kim

[Simba's Mom]

Welcome to you and Pia, what a cutie! So glad you found this site, you will learn a lot, and get encouraged along the way. There is no question too big or too small, so settle in and get comfortable...

[molly muffin]

Hello and welcome. I agree with Kim, my first thought too with those test results and the symptoms you have described is pancreatis. Very small meals, several times of day, as bland and low fat as possible, as kim mentioined.
The Cple test is specific to pancreatic attacks and I would ask for one of those immediately based on these results.
Lori does have experience with this, so hopefully she'll be around soon.

Welcome to the forum by the way. Pancreatis or cushings, you're here, we adopt you :)

hugs,
Sharlene and Molly muffin

[knitbunnie]

Thank you all for some answers that give me hope for my sweet Pia. I'd rather she be completely healthy, but if I have a choice between a bout of pancreatitis and Cushings, it sounds like pancreatitis is the lesser of the evils.

We have had our share of dog woes at my house. Our other wonder-pup is Maggie, a nearly 15 year old Boston Terrier. After numerous surgeries and many medications in her eyes, she became totally blind at age 7. As old age crept up, her ever-present grade 1 heart murmur increased to a 3-4 with mitral valve regurg. She's on enalapril and Vetmedin. In January, she started to have seizures, and now she's on phenobarbitol as well. Did I mention that she's nearly deaf? We love her so much♥

If I sounded less than generous with my desire to put off further testing for a few weeks, I hope this helps people to understand why. We are of modest means, but we are responsible pet owners, and if you all recommended immediate testing, I'd whip out a credit card and do it, and worry about paying it off later.

Pia tried her first meal of Royal Canin Gastrointestinal TM Low Fat Canned Dog Food. She hadn't eaten much of anything today, so she had half a can. She really liked it. This is the first time in days that she has licked her bowl clean. She's to have 3 meals a day with Reglan half an hour before each meal, with feedings about every 8 hours. Tomorrow, I'm going to try a third of a can per meal. I don't want to starve her, but I don't want to stress her. The vet said to give her 1 to 1 1/2 cans per day.

[doxiesrock912]

It doesn't sound like Cushings. Honestly, I would spend the money with an IMS vet to determine what is truly going on.

General vets only know so much and certainly not enough about Cushings etc. Best to start where you know they have the knowledge in my opinion.

Don't restrict water intake as others have said because this is the dog's natural way of flushing out excess toxins or whatever is out of balance from their systems. In the case of Cushings dogs, they're trying to rid themselves of excess Cortisol.

I do understand completely about the money because I am unemployed and Daisy's diagnosis couldn't have come at a worst time. This is why I'm advising you to see an internal medicine specialist since in all likelihood your general vet will recommend one anyway if they can't figure out what is going on.

Please be aware that an infection can also hinder the accuracy of Cushings tests so it is important that that be cleared up or ruled out first.

Good luck.

[knitbunnie]

If Pia hasn't improved dramatically within the week, I'll look into an IMS. That would be a more than 200 mile round trip, to near Palo Alto, CA. Yes, I live in the boonies. But Pia's worth every mile.

Thank you for the suggestion.

[Harley PoMMom]

Hi and welcome to you and Pia,

Lipase, when elevated, can be indicator of pancreatitis but other things can make the lipase high, lipase is non-specific because there are many types of lipase. To really confirm if Pia has pancreatitis then I would ask your vet about having a spec cPL test done on her. A link with info about the spec cPL test: http://www.idexx.com/view/xhtml/en_us/smallanimal/reference-laboratories/testmenu/innovative-tests/spec-cpl.jsf?SSOTOKEN=0

If pancreatitis is suspected then a diet very low in fat is recommended. Also keeping her hydrated is important. Feeding several small meals through out the day helps a dog that has pancreatitis. Kim mentioned the mushy rice, which is good, and I would give, along with the rice, skinless, boneless, low in fat chicken breasts.

If this were me, I would have the spec cPL test done and if the results validate the diagnosis of pancreatitis I would not have any tests for Cushing's performed. Once the pancreatitis is under control and if symptoms continue then I would resume the testing for Cushing's.

Please know we are here for you and Pia so please do not hesitate to ask any and all questions.

Love and hugs,
Lori

[Squirt's Mom]

Hi and welcome to you and Pia! :)

I wanted to be sure you understand the seriousness of pancreatitis. This condition can be quickly serious while Cushing's takes years to get serious so don't let yourself feel that pancreatitis is preferred over Cushing's tho I do understand where you are coming from. I just want you to understand that pancreatitis needs attention now, today, but the Cushing's could wait for a while. ;)

The ALP is nothing to be concerned about at such low elevations. We have seen that value waay on up there - my own babies is off the chart often. So don't panic over that. It is the lipase and T4 (thyroid) that need further investigation. I wouldn't be happy with a thyroid level below 1 and would want a full thyroid panel run. Hypothyroidism mimics Cushing's, sharing many of the same signs, and it is so easy to treat. So if I were you, I would want that checked out and the pancreas checked out asap and forget about Cushing's right now - based on what we know so far, I would say that is the least of your concerns and may never be a concern. ;)

I'm glad you found us and look forward to hearing more about your sweet girl. Even if it turns out she does not have Cushing's, you are both family now and we will want to hear from you often.

Hugs,
Leslie and the gang

[knitbunnie]

Pia is having a generally quiet day. She's always been a rather stoic girl, uncomplaining and not given to fussiness at all, so it's hard to tell if she's in pain. She is so not interested in walking or playing. All she wants to do is eat her small portions of food, lap ridiculous amounts of water, and sleep. Even getting her to move her little rump outside for potty is a bit of a struggle. She had another accident in the house last night. My carpet machine is getting a workout!

I read somewhere on the net that sweet potatoes are a good snack for a dog on an ultra-low-fat diet. I microwaved one last night and cut it into small pieces. She likes it and is happy to take her Reglan wrapped up in a little piece of it.

Should I encourage activity? Or should I let her lay around? She has a couple things that drive her into a frenzy of activity - my talking through a paper towel roll or banging big sticks together. She perks up if I do either one, but I'm not sure if it's a good idea to get her excited. She has this thing for sticks that bang together. She even loves when I clank my knitting needles together. Sweet, silly girl!

[molly muffin]

Pia sounds adorable. I love her pictures. Awww, and a Maggie dog too. There is no need at this time to encourage activity especially if there is a possibility of pancreatis. She might just want to lay around until she feels better. She'll let you know when she feels like being playful again. :) No worries there. They may not talk but they have their ways of getting the message to us when needed. :)

hugs,
Sharlene and Molly Muffin

[knitbunnie]

It is the lipase and T4 (thyroid) that need further investigation. I wouldn't be happy with a thyroid level below 1 and would want a full thyroid panel run.

Thank you! I talked with the vet and she said that it could be because of the stress, but I'm going to request more complete thyroid testing once this crisis is over. It has me worried, too.

[knitbunnie]

There is no need at this time to encourage activity especially if there is a possibility of pancreatis. She might just want to lay around until she feels better. She'll let you know when she feels like being playful again. :) No worries there. They may not talk but they have their ways of getting the message to us when needed. :)

hugs,
Sharlene and Molly Muffin

Pia brought me a toy tonight and wanted to play tug. I was so excited that she initiated some play. She was so darned weak, and she only wanted to play for a minute or two, but it was really encouraging that she wanted some fun. I was very gentle and let her think she was her usual strong self. For a few minutes, she had a little of the sparkle back in her eyes.

[Squirt's Mom]

aahhhh....that little sparkle in their eyes is what we live for, huh? Nothing makes a day bright like that little sparkle, especially when it has been missing for a bit. I hope you start to see that sparkle more and more as the days go by.

Hugs,
Leslie and the gang

[molly muffin]

That is a really good sign of Pia wanting to play a bit and you letting her think she was the big strong dog still. :) Nothing like a little reassurance play.
Nothing wrong with having the thyroid checked out to see if it is still low or not.
You're doing great. :)

hugs,
Sharlene and Molly Muffin

[knitbunnie]

Pia had a very quiet day today, too quiet, so I called the vet, who was not in. The office said she'll call me tomorrow.

Pia's supposed to eat 3 times a day, and I had to hand feed her the first two times. She's decided she's tired of the Royal Canin low fat GI foood. She's still drinking a lot, and every time she eats anything she blows up like a balloon, despite taking Reglan. It's not like she's getting a lot of food - 1/3 of a can or 4 1/2 ounces with each meal, and she weighs 30 pounds.

Tonight, I was making something with leftover baked chicken, and she showed some real interest, so I tossed her a piece which she caught and looked for more. It was skinless chicken breast, so I tossed her a couple more pieces. and then she nearly scoured the kitchen floor looking for more. I saved out about an ounce of chicken from the food I was preparing and chopped it finely and added it to her last food of the day. I don't know if it was the chicken or a return of appetite, but she ate like a champ.

Because she has such terrible gas and bloating, I decided to put some probiotics in her food. I hope it helps. I had some from the health food store (I got Montezuma's revenge a while back from a trip to Mexico) and it helped me, so I opened a capsule and sprinkled about 1/4 of it onto her food.

I got the name of someone today who may be able to do acupuncture for Pia. She had it when she had her stroke and it helped immensely. If anyone has had experience with acupuncture for anything similar to Pia's issues, I am all ears. I'm trying to make up my mind on doing an ultrasound and a low dose dex snap test.

If anyone has any thoughts on other things to discuss with the vet, I am open to suggestions. I will ask her about the spec cPL test, too, and remind her of the low thyroid test, and further discuss the Cushings tests.

It's a comfort to know that all of you are here. I am so worried.

[molly muffin]

How is Pia this evening? I'd discuss the things you have already mentioned. Thyroid and cPL. Not sure if I'd pursue cushings till other things like pancreatic issues have been ruled out. Otherwise you could be throwing away money, since those can cause false readings on the cushings test. First things first. The not eating is Not cushings normal symptom. Cushings dogs can't get enough of anything usually.

Hang in there. I know you are worried sick. If anything appears to be too off, then head for the ER. You know Pia best.

hugs,
Sharlene and Molly Muffin

[knitbunnie]

I had a long conversation with the vet this afternoon and she said that they did the spec cPL test, so that was one thing off the list. I discussed Pia's constant bloating and she (the vet) said it would be ok to withhold water for one hour after each feeding, as this seems to contribute to it.

Last night at bedtime, I put Pia on our bed and massaged her belly. She's not usually a snuggle bunny, but she fell asleep, belly up, in the crook of my arm, and snored softly. When I massaged her, she had just the most foul-smelling gas from both ends. It was pretty disgusting.

This morning, Pia woke up with an appetite, and she looked a little more lively. I sprinkled some probiotics on her food and she happily ate. She had more awful gas, so I turned to the internet and, in desperation, gave her half a Tums. She seemed more comfortable after that, and didn't get so bloated. She and I took a little walk and she found sticks and chased lizards. It was a wonderful morning.

Lunch was a different story - we were back to hand feeding balls of sticky food, but she did eat. I gave her Reglan half an hour before lunch, put probiotics on her food, and gave her another half a Tums with her food. I also put her water up for an hour after she ate because it seems that as soon as she eats she heads for the water bowl and just guzzles water. I wonder if she has reflux.

Back to the vet. In addition to the water, I discussed with her the probiotics and the Tums. She was fine with all of it, as long as Pia has fresh water available the rest of the day.

Since Pia is making slow steps in the right direction, we're going to hold off on any further testing for another week. At that time, we'll reevaluate and decide what to do next. She also said we should wait on the T4 for now, but I'd like to get it rechecked as Pia improves. The vet thinks that's a good idea because Pia has shown some improvement. I sure hope it keeps going in the right direction.

[molly muffin]

It sounds like a fine day indeed with Pia. The walk and a bit of play is a good thing.
I'm glad you had a nice chat with your vet and that you two are on the same page.
Is she going to do any testing for any gastrointestinal issues? That gas sounds like it is very uncomfortable, so I wonder what is causing it.
I think it's good that you have a plan. A plan is a much admired thing around here as everyone always feels better once they have one. :)

hugs,
Sharlene and Molly Muffin

[Harley PoMMom]

What about GAS-X (Simethicone)? Here's a link with info about OTC meds and dosages:http://www.walkervalleyvet.com/otc-meds.htm

[knitbunnie]

I asked her bout the GI business and she wants to wait and see. I really pushed about the gas and the drinking right after eating and the possibility of reflux and she said it could all be from the pancreatitis except for the drinking, but I think if I was a dog and I had burning in the back of my throat I'd drink, too.

[knitbunnie]

GAS-X - what a good idea! Before I moved to California 2 years ago, to the middle of nowhere, I was a peds and neonatal ICU nurse, and I gave it to kids all the time. What on earth didn't I think of it? Harley PoMMom - thank you! I've bookmarked that page. What a good reference.

[molly muffin]

Sheez. I'm bookmarking it too! :)

Sharlene

[NoonelovesmelikeNorman]

Just stopping by to say welcome to you and Pia. Sound like you're getting answers. The forum is so knowledgeable...a pure blessing to all of us.

Take care,

Sharon, Norman (Cushings Doxie) and Millie (mini Yorkie-pooh)

[knitbunnie]

Pia continues to drink, drink, drink, and in looking over some of the recommended links on the board for more information on Cushings, I can see that Pia has some of the other signs - redistribution of fatty areas and muscle wasting especially in her rear legs, along with the pot-belly. I need to figure out what I can do next. The vet recommended the Low Dose Dex Snap Test and an ultrasound. Do I need to do both, or could we try for a diagnosis based on just the Dex test? Yes, money is an issue.

Because Pia had a stroke when she was 5 years old (she woke up from a mid-morning nap and was paralyzed on her left side), she already has some muscle wasting in her left hind quarter, but the right side is looking thinner, too.

[Budsters Mom]

Hello and welcome from me too, :)

You have come to the right place! There is a huge arsenal of K9Cushing's angels to help and stay with you every step of the way. They love details, test results, any information you can get your hands on. The more the better. It looks like you have already made a great start!

So again welcome to you and Pia

Kathy and Buddy

[knitbunnie]

Pia continues to not feel so great. Last night when she squatter to urinate, she couldn't maintain her balance. Yes, I cried a little bit. She's not terribly interested in food, and I cajole her and hand feed her. She'll be at the vet's office at 8 am for another round of testing. They're going to feed Pia at the office (I hope she eats for them!) and x-ray her afterward to get a good look at the bloating that's going on. Beyond that, I don't know what they have in store. And I don't care. I'm going to take a deep breath, pull out a credit card and have at it. I want her better! If any of you are the praying sort, please remember Pia in your prayers. She's asleep at my feet, snoring. I miss her silliness, and her happy face. I haven't seen that side of her in weeks.

[Harley PoMMom]

Sweet Pia will definetly be in my thoughts and prayers, sending huge and loving hugs to you both, Lori

[frijole]

Prayers being sent from me as well. For you and dear Pia. Kim

[molly muffin]

Oh dear, poor little Pia. I do hope that they can figure out what is going on with her.

I don't know which test is better to have, the LDDS or the ultrasound. One can show you her insides, and things like, liver, adrenal glands, kidneys, gall bladder, pancreas. That might be able to help, but then they would still want to do testing if some of those things are enlarged. (if any ultrasound is done, make sure they use high res equipment, capable of seeing everything). If you do the LDDS test, it will tell you, if she is able to suppress cortisol and maybe help to tell the difference between pituitary and adrenal gland cushings.

I know it is so hard to see them not themselves. It just hurts, so of course you do whatever you can to try and help that.

So they have ruled out pancreas issues? I'd ask about those Lipase levels if the cPL is negative, and see what else they think might be causing that.

Is she still interested in the chicken?

Our thoughts and prayers will be with you and Pia.

hugs,
Sharlene and Molly Muffin

[knitbunnie]

Pia has had terrible bloating all day. She ate two bites of food and turned into an absolute balloon. She didn't want to eat any more. It comes on so darned fast. She's been so unsteady it's pitiful, and then she wanted to play tug of war. I know she's trying to get better.

I looked over the lab reports again because the vet said they did a cPL, and finally found it. It was its own separate notation, and I didn't see it before. Result - abnormal. I seriously don't care if it is if it leads to a firm diagnosis and treatment. Thank you all for your prayers for Pia.

[Mel-Tia]

My heart breaks for you and your girlie reading her struggles

So hoping they figure it out soon

Sending prayers, hugs, positive vibes and kisses for all the fur babies

Mel
Xxxxxx

[doxiesrock912]

I hate to see the bloating. Honestly, mention fortiflora to the vet because Daisy hasn't bloated a single time since she's been on it!

[Squirt's Mom]

I looked over the lab reports again because the vet said they did a cPL, and finally found it. It was its own separate notation, and I didn't see it before. Result - abnormal.

This is critical in my mind and cannot for the life of me understand why it wasn't for her vet. :confused: If that credit card you pulled out has a little bit of weight behind it, I would be stomping my feet this morning and demanding an ultrasound - NOT xrays, an ultrasound on a high resolution machine and the results read by an expert radiologist.

There is also a condition called GDV, commonly called "bloat", which can be quickly fatal. One of our dogs developed the gastric dialation but thankfully did not have the twist because we got her in quickly. While this is probably a remote possibility in Pia's case it is worth looking into. Here is some info on GDV -

https://www.addl.purdue.edu/newsletters/2005/Summer/canine-acd.htm

I would not waste money on any cushing's test right now with Pia not well. Whatever is causing her distress at the moment could easily skew those tests. So make them find out what is causing the things you are seeing first, then once she is better and back to her old self, you can think about the cushing's test. ;)

Prayers and healing white light are flying her way.
Hugs,
Leslie and the gang

[knitbunnie]

It's 7 am here in northern California, so we're getting ready to head to the vet's office pretty soon. Pia is looking sad and mopey. It's so obvious she doesn't feel well. The only reason she gets up is to drink more water. I can tell she's drinking even more.

Last night, she had the worst bloating after just about an ounce of food (I weigh what she eats). She took those few bites, stopped eating, turned into a balloon, and had the worst gas for about half an hour, then she wanted to eat the rest of her supper. I'm giving her a product for gas that's made for dogs - Prozyme - and it didn't seem to help.

I took pictures of Pia yesterday when she was bloated, so the vet can see just how swollen she gets. I think she (the vet) is really getting concerned about the constant bloating and that's why she wants to do an x-ray. My credit card is ready for whatever tests we need. My husband and I came to that agreement together, thank goodness.

Here are some pictures of Pia's belly - the first two are within minutes of eating and the third one is about an hour later. She stands, stock still, in this position, and does not want to move.

http://farm9.staticflickr.com/8259/8662250707_fd18c0779f_n.jpg

http://farm9.staticflickr.com/8252/8662253133_6cd30b1060_n.jpg

http://farm9.staticflickr.com/8264/8662251887_2f450c0da5_n.jpg

I hope you know how much I appreciate the support, love, prayers, and help. Thank you so very much.

[Boriss McCall]

Oh poor little girl.. :( I will be saying a prayer for Pia today. I hope the vet can get to the bottom of this & make your little girl feel better.
hugs..

[molly muffin]

Just a quick note as I am on my cell. But if the cPL is abnormal that is a specific test for pancreatis. This should have been notes by the vet. Perhaps one of the others can confirm but doesn't abnormal mean Pia has pancreatis?

Hugs
Sharlene

[doxiesrock912]

I would certainly ask about Pancreatitis or maybe a bacterial infection? Daisy looked exactly like Pia before the vet determined that she had an underlying systemic infection in addition to the Cushings. They put her on Baytril to clear the infection before we started Cushings treatment.

Also, I can't underestimate how much Fortiflora has helped her! She looks like she did before any of this started and doesn't bloat after eating anymore.

[Harley PoMMom]

Perhaps one of the others can confirm but doesn't abnormal mean Pia has pancreatis?

Hugs
Sharlene

Yes, Sharlene, you are correct. If this were me, I would still have a spec cPL test done to see how sever the pancreatitis is.

[knitbunnie]

Pia had a lifetime worth of x-rays today - 12 of them. She had barium, too, and nothing showed up. The vet was at lunch when we picked her up and she's supposed to call this afternoon. I have a list of questions. They were "impressed" with her immediate and obvious bloating after eating but couldn't find a cause. I've wondered if she doesn't have some sort of bacterial GI infection. I will mention that and ask about a course of Baytril.

She continues on her special food for the pancreatitis, but she won't eat unless I hand-feed her. They had to do that at the vet's this morning, too. She just won't eat if it's in a bowl, but she's a relatively eager eater if it's given by hand. She's never been a "spoiled brat" so it's completely not a normal behavior for her. Mention has been made of a GI scope, but darn it, I'm equally concerned about the endless water intake and very, very dilute urine.. It can't be doing anything good for Pia's electrolytes.

I'm not familiar with fortiflora, but I'll ask the vet. Pia is now getting probiotics and Prozyme, but it's not doing any good. I haven't been able to get to the drug store (25 mile trip) for Gas-X but that's on my list.

Pia has had one spec cPl which came back as "abnormal". Should she have another one? The vet said the treatment for the pancreatitis is the $3 a can dog food she's currently been prescribed. I plan to ask if I can switch her to plain chicken breast and rice for a while. There are too many ingredients in the Royal Canin low-fat gastro food!

Edited with vet's update - Our vet was pretty concerned that Pia is so unsteady. Yes, Pia had a stroke 2 1/2 years ago, but she has gotten so darned weak this past month or so. I asked her about a course of antibiotics, but she's hesitant since Pia already has such GI issues. She's going to think about it and call back. She could see how uncomfortable Pia was with the bloating, and she feels that that's a more pressing issue than the drinking/peeing. On reflection, she is reconsidering the thyroid as a possible issue since Pia's T4 was so low. They drew blood and are sending out a full thyroid panel. The vet is in complete agreement with the Gas-X and she said that the fortiflora is a probiotic and that the probiotics I'm giving Pia should cover the same thing. I asked about changing her diet to plain boiled chicken breast and rice and she said that was fine. While we were on the phone, Pia was in the midst of refusing lunch, and at this point we're going to be happy if she eats anything at all. I can really tell that the vet is very concerned about Pia and is really focusing on her problems and possible diagnoses. I wish something would ring a bell.

One more vet's update - Tomorrow morning, we're picking up antibiotics. Unfortunately, they called right before they closed, so I couldn't get there in time tonight, but I will be on their doorstep at 8 am. I don't know what's going to happen with my sweet Pia, but a course of antibiotics is an easy thing to try, and if it works - fabulous. If it doesn't at least I know we tried it. Chicken and rice are cooking on the stove!

Please know how much I value everyone here - for education, support, kindness, help, suggestions, and heart.

[Harley PoMMom]

Pia has had one spec cPl which came back as "abnormal". Should she have another one? The vet said the treatment for the pancreatitis is the $3 a can dog food she's currently been prescribed. I plan to ask if I can switch her to plain chicken breast and rice for a while. There are too many ingredients in the Royal Canin low-fat gastro food!

I believe Pia had the "snap" cPl test done which only shows results of normal or abnormal. The spec cPL test will show the results via a number. Harley's first spec cPL test came back with the result in the 500's (reference range 0-200). :eek::eek:

Besides the prescribed food, there are other things one can do. Feeding several small meals throughtout the day really helps, also making sure she stays hydrated is important. Here's a link to a dogaware article that has a lot of info regarding canine pancreatits: http://www.dogaware.com/articles/wdjpancreatitis.html

Hope this helps.

Love and hugs,
Lori

[molly muffin]

It is what many of the dogs who have a bout of pancreatitis have had recommended to them by vets. My own recommended it last March for Molly. You cook it with lots of water till the rice is the consistency of mush and then you feed them several very small meals a day instead of just a couple.
The flortifora is a probiotic. It is just one of the things that many of us have used with good results. My Molly loves it.
Cushing dogs are quite prone to getting pancreatitis, as they are to getting UTI's.

hugs,
Sharlene and Molly Muffin

[knitbunnie]

I believe Pia had the "snap" cPl test done which only shows results of normal or abnormal. The spec cPL test will show the results via a number. Harley's first spec cPL test came back with the result in the 500's (reference range 0-200). :eek::eek:

I see - I will discuss with the vet tomorrow morning when I pick up Pia's antibiotics. Thank you♥♥♥

The Pancreatitis website you posted is so informative. Thank you, again!!!

[knitbunnie]

I made the mushy rice with chicken and Pia love, love, loved it. I cooked a chicken breast in water, measured the chicken broth (2 1/2 cups) and added 2/3 cup rice. I finely chopped the chicken, put it back in with the rice and chicken broth and slowly cooked it for over an hour. I was surprised at how thick it got, so I added another 1/2 cup water. After she ate it, she farted and farted and farted, which is fine with me. I'd rather she let it out than have a belly that looks like a balloon. She didn't seem so miserable with gas after supper of the chicken and rice. I hope things keep going in such a positive way.

[Mel-Tia]

Let's hope all that trumping gives her some relief

Hoping the pills do the trick and she feels more comfortable soon

Mel
Xxxxxx

[molly muffin]

That is great. :) In this case, farts are very good. :)

Now remember though, not too big of a meal. Very small ones, several times a day. Even if she thinks she wants more at the time, just keep it small and give her a bit more later. 6 meals would probably work out. This is very important with pancreatitis, you don't want to over work the gastrointestinal system. I think that this will help Pia with her gas issue and the bloated looking.

hugs,
Sharlene and Molly Muffin

[knitbunnie]

Early morning - Pia got up at 6 am for "pit stop" - so much better than a wet spot on the new carpet! She had a few bites of her chicken and rice and then said "that's enough". She then went for the tennis ball!!! An hour or so later, I offered it again, and she ate the rest. I'm keeping the quantity low - about 4 ounces.

[Boriss McCall]

Ha... Pia sounds like my Boriss. He is a little gas machine. I don't think I have ever been around a Boston Terrier who wasn't tho. He especially likes to get under the covers & stink the place up!! My Bulldog is the same way sometimes. Glad she is getting some relief. :D

[knitbunnie]

Ha... Pia sounds like my Boriss. He is a little gas machine. I don't think I have ever been around a Boston Terrier who wasn't tho. He especially likes to get under the covers & stink the place up!! My Bulldog is the same way sometimes. Glad she is getting some relief. :D

I hear you on the "little gas machine". Our other pup (not exactly a pup at nearly 15), Maggie, is a Boston and she is quite the tooter. It's so funny when they hear their own noise and looks around in surprise. Pia used to be a champion "machine" but her ability to let loose seems to have gotten lost.

I've been admiring Boriss's picture in your avatar. What a pretty boy!

[knitbunnie]

The antibiotic the vet put Pia on is Doxycycline. She's had 3 doses so far (twice a day). She was super hungry this morning and eagerly ate chicken and rice, and then sneaked some dry food I'd put out for Maggie. I will have to be more careful. That was the last of the chicken and rice, so I put on a big crockpot of chicken and rice but it's not ready, so for her second meal I tried the canned stuff again. Two bites, and she was done. Our other girl, Maggie, then paid Pia back by eating the rest of what was in the bowl.

[Harley PoMMom]

I recall that some members that use rx'd canned food slice it up in 1/4 " pieces and bake it in the oven either until it is warm or crispy, and their dogs seem to want to eat it then.

[molly muffin]

It sounds like the antibiotic combined with the small meals of low fat, bland food so working for Pia!
Good job! Keep it up, it takes some time for their system to clear up and the pancreatic episode to calm down.

You're doing really well.

hugs,
Sharlene and Molly Muffin

[knitbunnie]

I recall that some members that use rx'd canned food slice it up in 1/4 " pieces and bake it in the oven either until it is warm or crispy, and their dogs seem to want to eat it then.

Wow! That's love:) Next time I have the oven on, I'll bake some. I still have about 15 cans, and I'm sure not going to waste them. It sounds like it could be good treats.

Today, I put 6 chicken breasts in the crockpot, filled it almost to the top with water and added some dry rice. I cooked it until it turned into porridge, then chopped up the chicken. It made 5 quart containers and a big bowl. Yes, my crockpot is a big one. My old girl, Maggie, thinks the new food is fabulous, and Pia doesn't mind sharing. I froze the 5 quarts.

I have to go out of town on Wednesday for a week, and I am dreading it. I'll write down all the instructions in great detail for my husband and call him, too, to check on things. Luckily, he works from home, and he's completely devoted to The Girls.

[knitbunnie]

It sounds like the antibiotic combined with the small meals of low fat, bland food so working for Pia!
Good job! Keep it up, it takes some time for their system to clear up and the pancreatic episode to calm down.

Thank you for your words of encouragement. It seems like Pia hasn't been herself in such a long while. I see a little progress every day, and even if she decides not to eat now and then, at least she's got more pep and wants to play a little tennis ball. She's still drinking up a storm and peeing a whole lot. I have a feeling we're going to be in for some more testing.

Molly Muffin looks like such a happy dog. Is she as sweet as she looks?

[Boriss McCall]

Thanks! Boriss is one spoiled boy & I love all smooshy face dogs. :)
We have a bull dog too. We are hoping one of these days we can add a frenchy to the mix. Pia is just so cute!

Glad Pia is feeling better!

[Simba's Mom]

Sending hugs to you and Pia, hope she feels better soon!!

[knitbunnie]

When Pia gets up in the morning, she's been pretty peppy compared to a week or two ago, but by evening, she's looking much less so and we can barely get her to move her butt to go outside. Since we're still considering Cushings (still haven't gotten the thyroid study results, and I called again today), does it affect dogs more in the evening than in the morning. Do any of you see a difference in your pups depending on the time of day?

[doxiesrock912]

Cortisol levels can change throughout the day so this is probably what you're saying.

[molly muffin]

Well don't forget that she is still trying to recover from her pancreatic episode too. That takes time and it's only been a few days really. We've seen dogs taking a month or longer to get full energy levels back.
If you are thinking cushings she would be very hungry, very thirsty, peeing everywhere, are those symptoms evident? I wouldn't even think of cushings until the pancrease is healed up and everything else eliminated. One day at a time :)
Just keep up with what you are doing, it is obviously helping Pia immensely. You're doing great.
hugs,
Sharlene and Molly Muffin

[knitbunnie]

Well don't forget that she is still trying to recover from her pancreatic episode too. That takes time and it's only been a few days really. We've seen dogs taking a month or longer to get full energy levels back.
If you are thinking cushings she would be very hungry, very thirsty, peeing everywhere, are those symptoms evident? I wouldn't even think of cushings until the pancrease is healed up and everything else eliminated. One day at a time :)

I honestly didn't know how long it took to recover from pancreatitis. Thank you - now I better know what to expect. Why didn't the vet tell me???

She is thirsty, thirsty, thirsty, and she pees like the proverbial racehorse. Now that she's feeling better, she's gotten improved bladder control. For a while, when she seemed so weak, besides the accidents in the house, she couldn't make it across the driveway to the "pee spot", and her pees were shorter and more frequent (I worry and I have no other way to keep track of output for comparison, so I count "1-one thousand, 2-one thousand, 3-one thousand"). She was doing about 7-one thousand every hour or two, but she's not as interested in going out as frequently, and sometimes we get up to 12-one thousand worth of peeing, but she is still drinking a whole lot of water. Her appetite has definitely picked up, and I worry that I'm not feeding her enough, although she still has a time at least once a day that she doesn't want anything.

My girl has a cast iron bladder, so it was such a complete shock when Pia started having accidents in the house. Even when she had her stroke, she didn't have one single accident in the house. It was a snowy northwest Ohio winter, and we used to literally prop her up in the snow to get her to do her business. When she had her stroke, we had her straight to the vet, and we saw a neurologist the next day. She went for about 28 hours without relieving herself. At the neurologist's office, the tech, the vet and I all tried to crede her bladder (I'm a retired peds ICU nurse, so I've done it a ton of times), and no matter, we could not get her to pee, and her bladder was super full. The neurologist was sure it was from her stroke. My husband carried her outside (she was semi-comatose) wrapped in a blanket and put her down on the back seat of the car. She knew she was outside, and she laid there and made a flood. We cheered her on as we cleaned it up.

I still haven't heard back from the vet on the in-depth thyroid testing, so I don't know where we'll go next with testing, but I definitely see more testing in our future. I have to go to Texas from tomorrow until Tuesday evening, so unless she gets worse, anything else will wait until I get back from my eldest daughter's baby shower. I'll be in touch with my husband A LOT!

Another question - the vet charges $20 for what I know is a urine dipstick test. I can get those same sticks at Amazon for $20 for a hundred, and they're really easy to read. Her urine specific gravity had been 1.001 which is super low. Maybe I'm trying too hard to be a nurse, but should I get some?

Again, my thanks to all of you♥♥♥ It would be so much harder without your support, advice, and knowledge.

[molly muffin]

Hi Bonnie. No idea why the vet wouldn't have mentioned that it all takes time. I know mainly because of seeing the dogs on the forum. You'll see improvements of course and I think you already are, but you know a couple weeks for real good over all and a couple more for energy levels, etc seems to not be abnormal. Some bounce back quicker, just depending on how bad the pancreatic issue was.
hmm, yes I do see your point, much easier to pay $20 for a hundred than $20 for one test. I am not positive that all dipsticks are created equal, so not sure if one type/brand is better for canines than another or not. Maybe one of the others knows this better.
Just leave your husband detailed instructions for Pia. I think Addy wrote a book for her husband when she was away for a weekend. :) :) :)
hugs,
Sharlene and Molly Muffin

[knitbunnie]

Back from Texas and after a week away from Pia, I saw changes, some good and some not so good. she is more interested in playing, but wow, she has lost what little stamina she had. She's interested in eating, but she's bloating up pretty badly. She's definitely weaker and her whole hind half just looks a bit more wasted.

My husband was home with Pia and said she wasn't looking so good. I called the vet while I was in Texas and made an appointment for an ultrasound. I got in to California at 10 last night, and Pia was at the vet's at 8 am. The vet just called and said Pia was pretty agreeable with the ultrasound except when she (the vet) tried to US Pia's right upper quadrant. Pia did not tolerate it, so the vet called me and asked permission to give her some sedation, which she really hadn't wanted to do, but considering that the other 3/4 of the ultrasound went so uneventfully, and Pia resisted that last quadrant so vigorously, I completely agreed with sedating her. I'll pick Pia up in about 4 hours, and we'll find out what's lurking in that painful RUQ. I hope there's an answer. Pia is, over all, going down hill, and I can hardly stand it.

[Mel-Tia]

Hi

Hang in there, this waiting in between is the worst, not knowing what is happening and waiting to know what they know.

Hopefully you will get some much needed answers when you pick her up and a round of something will clear it right up.

Big hug, post us when you can as we will all be worrying with you

Mel
Xxxx

[molly muffin]

Glad you made it home safe and sound and very sorry to hear that Pia is having problems still. I so hoped it would just all miraculously clear up while you were away.
The good thing is that they should be able to give you an idea today of what they found on the US. My IMS went over it right after it was done.
Ask to get a copy of it so you can review it at leisure.

Hope all is well with US
hugs,
Sharlene and Molly Muffin

[Boriss McCall]

we will be waiting for your results. I hope you get some clarity on what is going on with your sweet Pia.

[addy]

They should be able to go over everything that may be an issue. Sometimes it is overwhelming so maybe take notes because you will have questions later.

I know it is hard, Zoe just went through her US two weeks ago, we had not done once since 2010.

Hoping for good news for Pia and you.

have Zoe's US report in front of me, right upper quandrant/pancreas- maybe that is what is bothering Pia- her pancreas

[knitbunnie]

Nothing! Absolutely nothing abnormal showed up on ultrasound, but Pia is just plain worse than ever. She had to have a bit of sedation for the last part of the US, so I'm hoping some of it is residual effect, but she's wobbly and uncoordinated, and the vet is really at a loss. She and the rest of the vet group have discussed Pia endlessly, and they just don't know what to do, and truthfully, I don't have the resources to do much else. The vet has pretty much ruled out Cushings, especially since it all came on so suddenly, so she's thinking maybe it's aseptic meningitis, and we started Pia on a steroid burst.

She's willing to eat, and of course, drink, drink, drink, so getting her pills into her isn't an issue at this point. I am praying for a miracle for my little girl. I know crying won't do any good, but I keep crying. Pia is absolutely not interested in any sort of interaction right now, so I'm not letting her see it. She doesn't need to be comforting me.

[molly muffin]

Oh Bonnie, I am so sorry that Pia isn't any better. How did they come up with aseptic meningitis? They gave her steroids, which might make her actually drink and pee more. Has she had any course of anitibotics? Something like baytril, (not sure if I spelled that right or not) in case of a bacterial infection.

I hope that something will make a difference. It can take a bit to come out of even mild anthesia, so see how she is after 24 hours.

Hoping for all the best.
hugs,
Sharlene and Molly Muffin

[Squirt's Mom]

I'm so sorry they didn't find a cause for the way Pia is behaving - I so hoped they would say "here's the problem and we can fix that easy." :(

Was the blood work all normal as well? Is she peeing well - no chance there is some sort of urinary blockage?

Is she getting any feed or treats that are from China or have any connection to China?

Any chance she may have gotten into something like a poisonous plant or meds of some sort or bitten by something?

Just woolgathering, letting the old brain wander and ask questions.

I read this about aseptic meningitis in dogs -


In the vast majority of cases with this disease, the long term prognosis is very good. If you understand the symptoms, catch it early, have it treated and watch closely for relapses, your trusted friend will rapidly return to their normal self.

http://www.helium.com/items/1913121-aseptic-meningitis-in-dogs-cervical-rigidity?page=2

This article says the pred is the first line of defense so it sounds like the vet is on the right treatment path if this is what she has. I hope you are soon seeing improvements in your sweet girl.

Hugs,
Leslie and the gang

[molly muffin]

How is Pia today? How are YOU? Can't forget you are probably a bit of a wreck with all of this going on too.

hugs,
Sharlene and Molly Muffin

[Mel-Tia]

Just nipping in to give you a big hug too. Cant believe it didn't show anything but that is good news also as it means all her organs are ok.

I really hope you see some improvement from the streriods soon. Let us know how you are both doing when you can

Mel
Xxx

[knitbunnie]

Pia woke up this morning and seemed to have more energy, but as usual, she's worse as evening approaches. She's been more interested in food and today, during the day, she wasn't drinking so much, but it's 6 pm here, and she's starting to drink more, look wobbly and somewhat bloated.

She did a course of antibiotics before we started the prednisone, so I don't think it's some sort of infection. There was no change at all with the antibiotic.

Today, I spoke to a vet in another town and we reviewed Pia's tests, symptoms, and history over the phone. She suggested that we give the prednisone a week to see how it goes, and then she's going to look Pia over next Thursday and give a second opinion. This vet is both a traditional vet and a vet who does some non-traditional medicine and treatments, so part of the evaluation is to determine if she sees anything that could be helped by acupuncture. She also mentioned looking into Addison's as a diagnosis, and she said that the prednisone would help that, too.

When Pia had her stroke 2 1/2 years ago, acupuncture was like a miracle. After 3 weeks of being barely able to sit up, being carried in and out, syringing water into her mouth, and spoon feeding her a slurry of dog food and water, she came home from that first session and walked down the hall from the back door to the living room.

Pia looks pretty funny - they had to shave her belly for the ultrasound. I hope it doesn't itch when it grows out. She's got enough problems.

I wish I could hug each of you in gratitude for your support and help.

[Boriss McCall]

Hi,
I hate that you & Pia are going through so much. I hope she doesn't have meningitis. We had an English Bulldog 3 years ago that had it. It was so hard to watch. He had a spinal tap & that is how they found the problem. They could not figure out what was going on until we did that at the specialist. It was rough... He was on steroids for about 2 months & then ended up getting pneumonia. Since it was such a weird thing & I didn't have a forum like this it was so difficult. I didn't really know what all signs to look for while at home trying to treat/care for him. I really feel like we lowered his steroids too soon & he couldn't fight off everything that came his way. He also developed glaucoma. :(
But, I am not telling you all of that to scare you. Just too keep you aware. I have another friend with a Boston Terrier that has meningitis. He is actually recovering. He has been on steroids for about 6 months.
It is a long process & takes a watchful eye & skillful doctors.
I will only hope & pray that Pia's situation is something else & will be cured. Poor little girl deserves it after everything she has gone thru.

[Sabre's Mum]

Hi

I have tried to skim read over the last pages but just wanted to share my experience with meningitis. From our experience generally meningitis presents in the form of a very high fever and neck pain. Our Flynn had meningitis at 6 months old ... initially the vet had no idea of what it was and when we got home (we were on holiday at the time) our vet suspected meningitis. He was also "shy" of light and highly sensitive to touch ie would yelp! Flynn also looked a total zombie .... and he continued to be like this even with the high doses of pred. A spinal tap is the only way of confirming meningitis (this has to be done before any prednisone is given) but in our case it was between Christmas and New Year and we made the decision just to give steriods as he had been very sick for a couple of days. The doses of prednisone are very high ... if I recall he was on doses of 3-4mg/kg per day split into two doses. He also got IMHA after 5 weeks of pred treatment so we added in azathioprine and reduced the doses over about a 14 month period.

I hope Pia feels better soon.

Angela and Flynn

[knitbunnie]

Pia is no better, and maybe worse. She perked up for a few days with the prednisone pills, and I'm continuing to give them to her, but she's drinking even more water, seems weaker, and doesn't want to eat much. She is so bloated from all the water she keeps drinking, and her hind legs are looking skinnier than I can even believe. I can grab her skin on her hind legs and over her butt and it seems loose and baggy. I called the vet, but she's not in today. Pia will be seeing her "second opinion" vet on Thursday. Maybe that vet will see something Pia's regular vet hasn't seen. It's particularly hard because neither vet knows Pia and they see a dog with impaired neurological function, but they haven't lived with a dog who had a stroke 2 1/2 years ago. I know she's unsteady because she's so weak and wasted, not because of anything else. How do I make them understand and look past that aspect of Pia's condition?

Now that she's been on steroids, she can't be tested for Cushings until a month after we stop them. Does anyone know if the urine cortisol:creatinine test (which the vet hasn't mentioned) would also be affected by the prednisone dosing?

[Harley PoMMom]

Does anyone know if the urine cortisol:creatinine test (which the vet hasn't mentioned) would also be affected by the prednisone dosing?

I am so sorry to hear that Pia is not feeling well and you both will be in my thoughts and prayers.

Prednisone mimics cortisol in a dog's system and therefore the symptoms of increased drinking/urination are probably due to that. The UC:CR would not be accurate when a dog is taking prednisone.

Sending huge and loving hugs, Lori

[knitbunnie]

Lori, I was thinking the same thing, that the prednisone is doing more harm than good. I'm seeing another vet on Thursday, and I've contacted UC Davis about their Internal Medicine clinic. I discussed Pia with Davis IM department and they also thought I should take Pia to the second-opinion vet and then get a referral to have her seen at UC Davis is that vet has no concrete answers. I discussed finances with Davis, too, and I think I can manage to go there for some more diagnostics. I almost feel relieved that I at least have a plan. We discussed Pia's labs and tests, and the person at UC Davis was not impressed with the prednisone! I hope I haven't totally messed Pia up. The Davis staff member agreed that a recent history of bloat, excess water in and out, and muscle wasting is not neurological. Time to cry just a little bit:(

[Mel-Tia]

Thinking of you Both. Hoping they find that clue to get your girlie back on the road to recovery. A little cry is to be expected as you keep thinking you will get answers then get more questions.

Keep us posted. Am sending lots of positive mojo for you sweet pia

Mel
Xxxx

[Boriss McCall]

I am glad you have a plan. I know you feel like crying & are scared. but, remember you have a plan & help is on the way for your little Pia.
She has been thru too much not to come out on top this time. ;)

[molly muffin]

Oh Bonnie :( I wish Pia was doing better, and I hope this new vet can see something. Just say, look she had a stroke and these are the side effects of that, everything is a new symptom not stroke related. UC Davis does have a good reputation, so if possible and affordable, that might be my choice too.

Hang in there, I know you are doing everything you can and it's still breaking your heart.

hugs,
Sharlene and Molly Muffin

[knitbunnie]

I called my regular vet back this afternoon because Pia looked even more miserable than this morning, and with Pia's continued decline, between us, we decided that I shouldn't wait to take Pia to UC Davis. She's got an appointment at noon tomorrow. It's a 3 hour drive, but Pia usually likes car ride, so it shouldn't be so bad.

UC Davis also encouraged me to look into CareCredit for an 18 months same as cash option for vet bills. I found it online and got immediate approval, so that's one load off my mind.

Pia will not get prednisone in the morning, and she can't eat after midnight, not that she'll really care. I can give her water, thank goodness, because she is so thirsty so often. They told me to try not to let her pee before she got to the vet's. I laughed! They're quite happy with my taking along a clean container and a big serving spoon to catch it. I've done it more than once in the past, and it always makes me giggle.

[molly muffin]

Oh I'm glad you are going to tomorrow if she is declining today. Container and spoon works. A ladle was used by one of our mommas. That seemed to work really well too. :)
Hope you get some answers tomorrow and something that can help Pia
We will all be anxiously awaiting word.
So, everyone, Road Trip time!!

hugs,
Sharlene and Molly Muffin

[doxiesrock912]

I hope that Pia's appointment goes well and that you get some answers!

[Trish]

Pleased to hear you are taking her tomorrow, definitely have fingers crossed for some good news tomorrow and they can help Pia feel better. Good Luck! :)

[Mel-Tia]

Be thinking of you, good luck.

Big hug, kisses for Pia

Mel
Xxxx

[Squirt's Mom]

Best wishes go with you and Pia today. Know we are all right by your side as well. Let us know what you learn!

Hugs,
Leslie and the gang

[Mel-Tia]

Checking in, thinking of you both. Hope it's going ok

Mel
Xxxx

[Boriss McCall]

hope today is going good & you get some answers for Pia.

[knitbunnie]

Back from UC Davis - what a place! The vet took one look at Pia with her pot belly, massive thirst and urination, wasted-away rear legs and rump, and sad demeanor and quickly redid the ultrasound that my local vet had said was normal. IT WAS NOT!!! Pia's adrenals are quite large. Hmmmmm - think she has Cushings???

I snagged an early morning urine which they tested for creatinine/cortisol ratio and the cortisol was sky high. Their test is able to sort away the prednisone that my local vet STUPIDLY gave her, and which the UC Davis vet was pretty appalled that Pia had been given. We had a vet and a ready-to-graduate student vet, and they had quite a discussion on that topic. They asked me why she'd been put on steroids, and I told them that the local vet suspected aseptic meningitis. The vet's eyes bugged out and her jaw dropped. I said, "Wrong, eh?", and she high-fived me.

To be on the safe side, they had a neurologist check Pia out because my local vet was so utterly sure that Pia's problems were neurological. Like I already knew before I wasted yet another $80 on that consult, Pia's neurological status is completely consistent with having had a fibrocartilaginous embolism, the spinal stroke Pia had in December 2010.

Because the vet started Pia on steroids, the low dose dex test will have to wait a few weeks, so we'll be going back to UC Davis for that test on the 28th. We're going to do a quick steroid taper since Pia has only been on the prednisone less than a week. We'll halve the dose for three days and then stop.

Pia loves to ride in the car, and look out the windows, so she enjoyed the 110 mile trip to Davis. We started out at about 8 am for the trip. She is pretty intolerant of any heat lately, so her side of the car had the air conditioning set to 65 degrees because she was in the sun most of the time. It took 65 degrees to stop the panting. We were at UC Davis until a little after 5 pm, and I was sure Pia would sleep all the way home. She was so tired, she could barely walk to the car, but once it started moving, she was up and looking out the window. She hadn't eaten since the night before, so we stopped at Burger King and Pia had a plain broiled chicken sandwich and a big cup of water. She was ecstatic. After that, she curled up on the passenger seat and snored the rest of the way home.

What should I expect when we start medicine? Will Pia quickly return to her usual self or will it be a slow, gradual sort of thing or is what she is now be what she's like forever? I hope not, because she's pretty sad and not terrible interested in much of anything. Will she jump around and enjoy walks in the woods again? Will she lose her pot belly and gain back her meaty thighs and rump? Anyone know if bad side effects are common? Is the start of treatment a difficult time?

[doxiesrock912]

Every dog is different, but you should see improvements within the first 2 weeks of starting medication. Please review the links that are under the helpful resources for cushings dog owners. Especially the signs when cortisol has gone too low. Important to know because finding the right dosage depends as much on owner observation as it does test reesults.

A Cushins diagnosis is not bad news because it's quite treatable.

Stopping the sterids alone should bring about some improvement and thankfully you now have a proper treatment plan for Pia.

Please find a different vet sincethe original was so far off the mark! I changed 3 times before finding the right one.
Also failiarize yourself with the symptoms that indicate when cortisol falls too low. Correct treatment depends as much on owner observation as it does testing. There are many great links under the "helpful resources" section of this forum.

Learning about Cushings helped me to determine which vet was most knowledgeable and the best choice for Daisy.

I was shocked at how little the other vets knew about such a common condition.

[Trish]

Oh wow, what a long day for you and Pia. So pleased to hear you have a plan in place to get her back to good health!! I bet you are cursing your vet and I agree with Valerie it might be time for a change. Hope you have smoother sailing now that you have the IMS on board! :)

[molly muffin]

I'm really glad that you took Pia to UDavid. I've only heard good things about them and many of the top studies on cushings has come out of there. So, first depends on which drug they want to put Pia on. Vetoryl or Lysodren as to how things go. Getting the right dose is of course very important.

You should see a return of attitude and interest fairly soon and control of the urination and eating. Muscle wastage can be one of the last things to get better. Slow walks to build the muscles helps, but not over doing it. Some try every other day starting out for short distances. This is once you see things start to get better in the other areas.

Yes you need to be aware of signs for over dose, etc. It'll be okay though, just have to get things under control and of course you have us here to help too.

I'd see if UDavis might have a vet recommendation that will work with them in your area. So you can get things like tests done local, and results sent then to the IMS.

Whew, long day but does sound very positive. Not sure what on earth your vet was thinking, but my guess is they have little experience with cushings, so I would rely on them. It's really not abnormal for vets to not know. There seems to be a trend in jumping into a diganosis of cushings with some vets and then followed by not knowing how the medication works. Very frustrating for all and potential quite harmful. The other extreme is they don't even consider cushings and ignore the possibility, allowing for dogs like Pia to continue to deteriorate. Both of vets that while great maybe in some areas, just aren't the ones you need for treating.

Okay, have to get to work.
hugs,
Sharlene and Molly muffin

[knitbunnie]

I've thought about switching vets, and I can't decide. The thing is, the vet we've been seeing (the newest member of a 5-vet practice) is fresh out of vet school. I think what really threw her off was the fact that she doesn't know Pia and since Pia had a stroke a couple years ago, the vet just couldn't see past her deficits and was sure it was something neurological, even though on Pia's first visit, Cushings was considered, but then pushed way down the diagnostic tree.

I'm a nurse, and I remember being a new nurse and learning so much on the job. So, in retrospect, I'm going to forgive the vet this one. If she learns from this experience to be a better vet, it's all good. However, I'll be seeing her only for standard stuff like immunizations. I can take Pia back to UC Davis for anything else unless it's a life-and-death emergency. It's not the worst thing to make that long trip, and I know Pia will need ongoing monitoring of her condition and medication. Since I live in the middle of nowhere, I'll plan to do some shopping when we go there, especially on her long visit on the 28th. I love to knit and sew, so I'll be on the net looking for yarn shops and fabric stores.

We moved here in July of 2011, and I've already switched vets once. The first place was dirty, and the vet was rough with my Boston Terrier. He wanted to do surgery on Pia's ears, too, because she gets ear infections, and he was pretty huffy about the fact that I didn't want to do that. Pia gets yeast in her ears, and I told him so, but of course, without looking under a microscope at the goo in her ears, he gave her ear drops that weren't any good for yeast. That's when we changed vets. The current vet practice is clean and the three vets that we've seen have been kind and gentle with the girls. One of the vets has a blind Boston Terrier who is 16, so a year older than my Maggie. We're in a very rural county, so I don't have many choices.

I will definitely read over the links on medications and what to watch for as far as overdosing. That way, whatever they decide on for Pia, I'll be prepared.

As ever, I hope you all know how much I appreciate your support, your knowledge and your kindness. Thank you ♥♥♥

[molly muffin]

Yes, of course and you're right, maybe this vet will learn and what an opportunity to work with UDavis on Pia's case. It's not bad if they are willing to learn and work with you and can help others that come along later.
It is much harder when you are in a rural area that's for sure. I'm glad you didn't stick with the one with the dirty office. Yikes!

Ahh, shopping And vet, got it, good plan. :)

hugs,
Sharlene and Molly Muffin

[Boriss McCall]

yay.. I hope this will mean Pia is on her way to feeling better. I know you will be so happy to see her start perking up again.
Hopefully it won't be too long now before you can start the ball rolling once the other test are complete.
I saw an improvement in Boriss pretty quick. The accidents & panting pretty fast. It took a little bit longer for his back legs & jumping up on the bed to go to sleep.

[knitbunnie]

I'm so glad to hear that the accidents and the panting will improve pretty quickly. We sadly joke that Pia went from having meaty chicken legs to scrawny Cornish Game Hen legs. It happened so darned fast. I think that Pia's overeating on the new food we started in mid-March probably caused the pancreatitis, and threw her Cushings symptoms into overdrive. She seemed so normal before then. We had a houseful at Christmas, and she was as whacky as ever in December. No matter how much I look back on the early part of 2013, I cannot think of one single sign of illness.

Diet question - I've been feeding Pia 4-6 small meals a day of chicken and rice, and I've slowly started adding a few pieces of kibble to it to give her the vitamins and stuff that I figure she needs. Chicken and rice made with a whole lot of water are ok in the short term, but after 3 weeks of it, and with Pia looking so scrawny, it's time to get a little better nutrition. Any suggestions? Are there any special dietary needs for a dog with Cushings? Considering that she had pancreatitis, I'll need to watch the fat content. Anything else? I'd love to hear what some of you feed your babies.

[knitbunnie]

Question on appetite - Pia has so many signs of Cushings, including the high urine cortisol/creatinine ratio, enlarged adrenals on ultrasound, huge thirst and urination, pot belly, low energy, wasted muscle especially in the hind end, but she's not ravenously hungry. I have to sort of beg her to eat most of the time.

It's been about a month since she was diagnosed with pancreatitis, so would that be affecting her? Because the stoopid original vet gave her steroids, she won't be getting her low dose dex test at the new vet's until the 28th. I read somewhere on one of the websites listed on K9Cushings that medication for Cushings won't be started if the patient is not ravenous. Is this true? Have any of you had dogs that were Cushings but didn't eat like crazy?

[frijole]

Hunger is almost always present. That said pancreatitis would certainly make you not eat until it is resolved. I would not even think about treating cushings until the tummy is under control. I also wouldn't do the ldds test until that is resolved as it is prone to false positives when other issues are present.

It could be that she has cushings but there is no need to rush treatment unless the symptoms are impeding her lifestyle. What is the status of your stomach issues?

Kim

[knitbunnie]

I would so love to start treatment ASAP because Pia is so unsteady and weak. Having had a stroke three years ago at age five, she's already got a weak left side, and a left forepaw that doesn't work at all, and she's become more and more stumble-y. Plus, I'm still paying for the new carpet (hurray for 1 year same as cash) on which she continues to have accidents every few days. Her hind end looks pathetically wasted, and her spine is like a ridge.

She has bad days and so-so days, but no good days. A few months ago, she seemed completely fine. I have a black blood spot under my thumbnail from her leaping into the air to get bubble wrap on which I was popping bubbles. I was holding it at about 5 feet off the ground, and she leaped up and missed the bubble wrap and got my thumb. That wasn't so long ago, since the spot is only about half grown up my thumbnail. Now, there's no leaping, no jumping, and she pants and huffs at even small exertion. She used to sleep in my husband's easy chair, and now she can't manage to jump up there, and she was happily doing so 3 months ago.

Pia is and always has been a picky eater. Currently, she bloats as soon as she eats anything, and she continues to drink and drink, and I don't see how there's any room for food with all the water she consumes. She's incredibly gassy, too, and I give her Gas-X and Prozyme. They help. We have some Dick Van Patten Natural Balance food that comes in a tube that we use for giving our other dog her 5 pills a day pills, and it's fat is 6%. This morning, Pia ate a few bites - the last of it, so I'm going to get more today. She completely refused her chicken and rice. I made a 3-egg omelet with zucchini and tomatoes, and she ate about a a third of my omelet quite eagerly. I wonder if she's been uninterested in eating for so long that it's become a habit. I also wonder if she's just being "bulldog" obstinate and wants human food.

With her low dose dex test coming up in just over 2 weeks, I guess I'll feed her whatever she wants as long as it's low fat. I try small amounts of chicken and rice at least 4 times a day and when she doesn't eat that, I try other things. If she's not interested in the chicken/rice, once in a while she'll eat the canned Royal Canin Low Fat GI dog food or some dry kibble. Currently, I have Holistic Senior and Merrick Classic Beef dry.

My other dog thinks this is all absolutely wonderful. She cleans up all the leftovers.

[frijole]

My Annie was misdiagnosed with cushings - she had an enlarged tummy (because her organs were enlarged), NO appetite, hair loss and she had two false positives on that ldds test. She had an adrenal tumor (small) that is not the cushings kind. Can you get out the report from the ultrasound and describe what it says about the enlarged adrenal glands?

I almost think I'd do the acth test vs the ldds test because all the symptoms you describe COULD be caused by other illnesses. The reason why cush dogs drink so much is not because they are thirsty. Their kidneys are working overtime and use up the hydration and their bodies actually require more water... So they aren't peeing because they drink alot.. they drink alot because their kidneys are working overime.

I worry about Pia's appetite going away if you try to treat her for cushings. When Annie was diagnosed with cushings we started her on lysodren. Her numbers didn't go down but she lost her appetite forever. She too was never a huge eater but for the last 2 years of her life I opened on average 5 cans of dog food a day - I could tell she was starving but she was nauseous or something.

I'm just saying that I am not convinced Pia has cushings and I am concerned about trying the meds. If you feel you have no choice please go with trilostane and not lysodren. It is easier on the tummy. And start with a very very small dosage. Promise me so I don't worry myself silly. ;) Hang in there. Kim

[frijole]

I read your edited post and understand you want to treat but cushings does not come on suddenly. This is so strange. I assumed you have ruled out:

-diabetes mellitis
-diabetes insipidus
-hypothyroidism
-kidney disease

Kim

[knitbunnie]

I read your edited post and understand you want to treat but cushings does not come on suddenly. This is so strange. I assumed you have ruled out:

-diabetes mellitis
-diabetes insipidus
-hypothyroidism
-kidney disease

Kim

They've ruled out DM (negative urine glucose and serum glucose WNL), thyroid panel (full panel done beyond the basic T4), and kidney disease based on labs and exam. Her urine is super dilute and her creatinine/cortisol ratio on urine was "sky high" according to the vet. I joked about it being DI with the vet and asked if we should start DDAVP. She laughed and said it wasn't DI, but I don't know what tests ruled that out.

[frijole]

It's the suddenness of the situation, the lack of appetite and the description you gave of how after she drinks she gets bloated. None of that is consistent with cushings. Cush dogs are ravenous. They don't even chew food - they inhale it. My cush dog started head butting huge trash cans to get whatever she could. It was unreal. My other dog had the large tummy and some hair loss. She had an enlarged adrenal gland but it was due to an adrenal tumor.

Originally I was convinced it was cushings - obviously I started her on the drugs. And her cortisol was high but it was because her body was fighting another battle not cushings. I share because I lived it and have seen other dogs go down this path. You mentioned not being convinced about your vet. Perhaps going to a specialist (if there is one near you) for a 2nd opinion would make sense. Bring copies of all tests already done so you save time and don't have to repeat everything.. re the high creatinine cortisol ratio:


http://www.vcahospitals.com/main/pet-health-information/article/animal-health/urine-cortisol/440
Does an increased urine cortisol/creatinine ratio always mean that Cushing's disease is present?

No, there are other causes of an increased urinary cortisol/creatinine ratio. Simple stress, such as a car ride or a visit to your veterinarian, may cause a mild increase in this ratio. The presence of other illnesses may also result in increased cortisol production by the adrenal glands and thereby increase this ratio.

However, if your pet has appropriate clinical signs and other initial screening tests (CBC, urinalysis, and biochemical profile) are supportive of Cushing's disease, then further confirmatory testing for Cushing's disease is indicated. Additional tests may include the ACTH stimulation test and/or the dexamethasone suppression test.

[knitbunnie]

My Annie was misdiagnosed with cushings - she had an enlarged tummy (because her organs were enlarged), NO appetite, hair loss and she had two false positives on that ldds test. She had an adrenal tumor (small) that is not the cushings kind. Can you get out the report from the ultrasound and describe what it says about the enlarged adrenal glands?

I almost think I'd do the acth test vs the ldds test because all the symptoms you describe COULD be caused by other illnesses. The reason why cush dogs drink so much is not because they are thirsty. Their kidneys are working overtime and use up the hydration and their bodies actually require more water... So they aren't peeing because they drink alot.. they drink alot because their kidneys are working overime.

I worry about Pia's appetite going away if you try to treat her for cushings. When Annie was diagnosed with cushings we started her on lysodren. Her numbers didn't go down but she lost her appetite forever. She too was never a huge eater but for the last 2 years of her life I opened on average 5 cans of dog food a day - I could tell she was starving but she was nauseous or something.

I'm just saying that I am not convinced Pia has cushings and I am concerned about trying the meds. If you feel you have no choice please go with trilostane and not lysodren. It is easier on the tummy. And start with a very very small dosage. Promise me so I don't worry myself silly. ;) Hang in there. Kim

Oh, no, poor Annie. That's terrible!

After reading over the links here on the various medications, I agree with you. One of the articles was on lysodren versus trilostane, including a way of dosing that was different from the manufacturer's dosing routine, and it was from UC Davis, where Pia is being seen. I don't have her ultrasound reports. Our vet said that the one adrenal she could visualize looked OK. UC Davis said that they saw both adrenal glands and that they were both enlarged. The first vet, our local vet, is so inexperienced that I have little faith in her ability to read anything on US. UC Davis had a full-fledged radiologist do her ultrasound.

When Pia gets up in the morning, she looks pretty slim, after a night of rest, and not eating/drinking. It's when she drinks a ton of water that she looks hugely pot-bellied. Every time she eats, no matter how wet the food, she heads for the water bowl and laps and laps. Every time she goes out to do her business, she comes in and drinks and drinks. Every time she does anything at all, the water bowl is her best friend. And then she looks like she swallowed a football sideways.

On a positive note, I cooked some new food for Pia after my last post because she was eager to eat my omelet this morning. I made chicken & rice with a lot more chicken and a lot less rice (two breasts, 1/2 cup rice and 2 1/2 cups water) and I scrambled 3 eggs and added them to the mix. Yowza - that went well. I hope it continues. I forgot to mix in Gas-X because I was so excited that she ate with gusto, so I put some in a little water, and she drank it right up. It was hard to only feed her a small amount because she did want more (yeah!!), but she doesn't need more problems, so we're sticking with several smaller meals a day.

I'm headed to the feed store this afternoon and I'm going to get an assortment of canned foods with lower fat contents and try rotating foods. I've read good things about some of the Blue Buffalo foods and they carry it. In the past, Pia has not had issues with eating a variety of foods. Her big job in life has always been to prewash the human plates, and she's eaten a combo of home-cooked and dry foods for many years with no issues, at least until the past few months.

Thank you for telling me about your Annie's story and for reinforcing the idea of trilostane over lysodren. I am so sorry for what happened to you and your Annie.

[knitbunnie]

You mentioned not being convinced about your vet. Perhaps going to a specialist (if there is one near you) for a 2nd opinion would make sense. Bring copies of all tests already done so you save time and don't have to repeat everything.. re the high creatinine cortisol ratio[/I]

I'm stuck with my local vet for all the regular stuff, and hopefully she can assist in monitoring Pia's progress if we start medication, but after a terrible day last Monday, I called UC Davis where she was seen on Tuesday. Their vet called me yesterday to check on how she's doing, since we can't do the low dose dex test for another two weeks due to Pia's being given steroids by the local vet. I told her that Pia isn't eating well, and that seemed to hit home with the UC Davis vet who is an Internal Medicine specialist. So I think the wheels are turning in that vet's brain for some possible alternative diagnoses.

If not for the support I've found here, I'm not sure I'd have sought out a second opinion. UC Davis is a 220 mile round trip, but Pia is worth it. I'm hoping that this will be a learning experience for our local vet, a recent vet school grad, and that UC Davis will work with her and educate her so she becomes a better vet and also so that I don't have to constantly make that 220 mile trip, but I will. She's nice enough and all that, just completely inexperienced, and as a nurse, I know that experience is a major part of a medical education.

[frijole]

I will sleep better tonight knowing UC Davis is on your case. :D I had to drive 5 hrs each way to the closest IMS. :eek: K State Univ is where I found my answers after a year of throwing money away and trying every vet in town.

Your local vet won't be able to help you with feedback when dosing begins but we sure can! :p We specialize in that. Don't worry about that but like I said lack of appetite is a big red flag to me and I'm glad the UC Davis vet caught that too. Better safe than sorry.

Kim

[frijole]

I will sleep better tonight knowing UC Davis is on your case. :D I had to drive 5 hrs each way to the closest IMS. :eek: K State Univ is where I found my answers after a year of throwing money away and trying every vet in town.

Your local vet won't be able to help you with feedback when dosing begins but we sure can! :p We specialize in that. Don't worry about that but like I said lack of appetite is a big red flag to me and I'm glad the UC Davis vet caught that too. Better safe than sorry.

It is so strange that your dog's tummy appears normal in the am and then bloats after drinking. That is not a cush dog. Our babes are always chubby in the tummy. If you can take photos before and after so we can see... and share them with the UC vets also.

Kim

[molly muffin]

I definitely have a lot of respect for the UDavis people. They have done awesome work in the field of cushings.
Good that Pia ate. The pancreatis probably has caused her to be "off" some food and a good meal is just what she needed. Tasty and the eggs a hit for a bit of something different. She might need that every once in awhile till she gets completely over the upset tummy issues. In the mean time, yea, the water intake and peeing will probably continue because of the cortisol levels. (which would go up with any kind of illness in additon to/ or rather than cushings, either way)

You're doing awesome!
happy mothers day
hugs,
Sharlene and Molly Muffin

[knitbunnie]

I will sleep better tonight knowing UC Davis is on your case. :D I had to drive 5 hrs each way to the closest IMS. :eek: K State Univ is where I found my answers after a year of throwing money away and trying every vet in town.
/snip/
If you can take photos before and after so we can see... and share them with the UC vets also.

Kim

Wow - I don't feel so bad with my 2-3 hour trip to UC Davis.

I actually did take pictures of Pia after she bloated up, gave them to my local vet, and also took copies along to UC Davis, but I never thought to take any morning beauty shots. I'll do that next time I catch Pia looking slim.

Here are a couple "bloat" photos that I gave to the vets:

http://farm9.staticflickr.com/8259/8662250707_fd18c0779f.jpg

http://farm9.staticflickr.com/8252/8662253133_6cd30b1060.jpg

Here's a picture of Pia from before she got sick:

http://farm4.staticflickr.com/3044/3003944169_41572b0e7d.jpg

[molly muffin]

Hi, thanks for the pictures, what is the time difference between the last picture and the first two pics? I do so a marked difference in the "bloat" around the stomach area. Did you take these to the vets at UDavis?
If not I would definitely do so the next time you go, so they can see for themselves what you are talking about. Describing it is one thing but the pictures really tell the story.

hugs,
Sharlene and Molly Muffin

[doxiesrock912]

PLEASE don't buy Blue Buffalo.
It's very high in protein and many dogs can't tolerate it. Daisy ended up in doggy ICU within a week of eating it.


$1,600 later and the manufacturer did not stand behind their product when I sent the the vet reports.

[knitbunnie]

what is the time difference between the last picture and the first two pics?

hugs,
Sharlene and Molly Muffin

I took the "bloat" pictures to the vet, but not the old one. That one's from about 3 years ago. I'm going to have to look around my computer and phone and ask my family, too, if any of them have pictures of Pia from a few months ago. Maybe it all came on gradually and I missed it until she got pancreatitis and got obviously ill.

[knitbunnie]

PLEASE don't buy Blue Buffalo.
It's very high in protein and many dogs can't tolerate it. Daisy ended up in doggy ICU within a week of eating it.


$1,600 later and the manufacturer did not stand behind their product when I sent the the vet reports.

Ouch, ouch, ouch! I looked over the fat content of everything I bought because that's what I've been worried about with Pia's hx pancreatitis. I didn't get any Blue Buffalo, but we're going to try 4 different kinds of Merrick cans, 2 varieties of Taste of the Wild cans, and a 2 1/2 pound tube of Natural Choice Beef. I picked the ones that were lowest in fat. I'll check the protein in them.

What did the BB cause that made Daisy so sick? For Pia, this all seemed to start, or at least to go into overdrive when I had to switch Pia's food in her self-feeder because her food was discontinued by the manufacturer. I put out Fromm's Beef Frittata, and she nearly ate herself into a stupor for a few days before I realized that the feeder contents was disappearing at an alarming rate. I contacted Fromm's about a week ago, asking them if they'd had any issues with the food or if they had any ideas, even allergic reactions. I was friendly and open-ended in my query, but I haven't heard back from them. Why am I not surprised?

Before Pia got sick, she always ate one 'real' meal a day of ground beef, rice, and fruits and veggies, all picked from a vet's diet sheet that had been tailored to her special needs after her stroke, and she had a self-feeder of dry beef-based dog food for snacking at will. I honestly have no idea how much canned food to expect her to eat. I need to do some googling. In case anyone knows off the top of their heads, she weighs 28 pounds.

Later - I used an online dog food calculator that says Pia should eat, based on 28 pounds as a senior, neutered, sedentary dog, 1 3/4 cans of dog food a day. Since she's ill, should I hold back or try to get her to eat more? I don't think she'll eat that much. The foods I just bought have around 340 calories per can, give or take a few calories. The calculator said she needs 606 calories per day.

[doxiesrock912]

Listless, bad diarrhea that went to straight blood and vomiting on the morning that we rushed her to the ER vet.

[Squirt's Mom]

Understand - just because a certain feed did not do well for one pup that does not mean the same feed will not work great for another. EACH pup is a unique biological system so each will react in their own way not only to feed but to meds, herbs, supplements, etc. We cannot generalize and extend our own experiences to all dogs. We CAN share our experiences and what happened to us/our babies so others are aware of the possibilities but we cannot say our experiences will be the same for all.

I have a friend who has fed Beneful to all her dogs for a long, long time. When the warnings about it started coming out, she switched to a much better brand - Royal Canin - and her baby got very ill. She tried several other brands with the same result. She put her baby back on Beneful and she is thriving again. Gives me the hibbie gibbies but I can't argue with the fact that her baby is better on Beneful than she is on anything else we tried. ;)

[knitbunnie]

Understand - just because a certain feed did not do well for one pup that does not mean the same feed will not work great for another. EACH pup is a unique biological system so each will react in their own way not only to feed but to meds, herbs, supplements, etc. We cannot generalize and extend our own experiences to all dogs. We CAN share our experiences and what happened to us/our babies so others are aware of the possibilities but we cannot say our experiences will be the same for all.

I have a friend who has fed Beneful to all her dogs for a long, long time. When the warnings about it started coming out, she switched to a much better brand - Royal Canin - and her baby got very ill. She tried several other brands with the same result. She put her baby back on Beneful and she is thriving again. Gives me the hibbie gibbies but I can't argue with the fact that her baby is better on Beneful than she is on anything else we tried. ;)

I sure do understand your friend's difficulty with the food switch. Pia had chronic loose stools for years until we found Merrick Cowboy Cookout a few years back. She did great on that, and I finally stopped having a roll of toilet paper inside the front door (we had to wipe her butt) with that food. Then they discontinued making it so we switched her to a Fromm's product. Within a couple weeks, she had raging pancreatitis and has been sick ever since. So, I've been searching for the right dog food, and luckily, Pia hasn't had much in the way of "poo" issues, but my older dog is having loose stools, and she threw up this morning right after her breakfast. She's going to be eating strictly Pia's homemade chicken and rice until she recovers. Pia, on the other hand, seems to be doing well with chicken & rice mixed with Precision Senior. I tried a different Merrick product, Classic Beef, and Pia doesn't like it. At this point, I'll give her anything that whets her appetite.

Last night, Pia ate about the best she's eaten in weeks - 10 ounces of chicken & rice & scrambled egg. This morning, she ate 6 ounces and 5 or 6 pieces of the Precision Senior. This is definitely the most she has eaten in quite a while.

Of course, she went straight toward the water bowl after she ate her breakfast. She bloats so badly when she drinks right after eating that I limit her water to 2 ounces for an hour after she eats. Her chicken and rice is very juice, so I don't see how she could possibly be thirsty. She gets Gas-X in her after-eating water, too. It seems to help her get out the burps. If she looks miserable, I usually sit her up in my lap or toss her over my shoulder and burp her like a baby. I'm sure we look pretty comical.

[doxiesrock912]

Someone mentioned to me that a lot of dogs have that problem with BB so why chance it when a dog already has issues?

Daisy was healthy when this happened and it was VERY scary then.

[Squirt's Mom]

Allow me to offer a voice from the other side - Brick developed diarrhea a while back that I couldn't get hold on. I switched his feed to several with no improvement. He is now eating Blue Wilderness, almost finished with the bag, and his stools are perfect, in fact better than they have ever been. So for Brick, Blue is good feed.;)

[knitbunnie]

I looked at BB dry at the store, and all they had was the huge bags. That, alone, prevented me from buying it, but the higher fat content was another deciding factor. For Pia, we're going to keep to the lower fat stuff.

When I bought the bag of Fromm's, the one that coincided with the start of Pia's issues, or at least exacerbated her symptoms if there was already an underlying condition, they had only big bags, so I bought one for $42.99. Luckily, they give a guarantee with dog food, so they took it back.

Once I find a food that agrees with Pia (and Maggie), I'll stick with it after this crisis is over. If their old food hadn't been discontinued, they'd still be eating it. Never again do I want to go through this puppy-dog misery.

Right now, all I want Pia to do is eat, and so far she's having another decent day with that. She just had a small lunch of Natural Balance. It comes in a 2 1/2 pound roll, and the wrapper has markings every half inch. For Pia's size, she's supposed to eat 2 1/2 inches a day. I sliced off a half inch slice, cut it into 10 wedges, and hand-fed them to her. I think she'd have eaten more, but I'm not going to push it.

Hopefully, there won't be any GI repercussions beyond the usual farts, but that's nothing new for Pia. She'll go back to chicken/rice/eggs for her next meal. She doesn't seem to want to eat the same thing twice in a row, and hand feeding keeps her interested. I'm sure some people will say I'm spoiling her, but to quote Rhett Butler, "Frankly, my dear, I don't give a damned."

[knitbunnie]

Time for another question. Do Cushings dogs have heat intolerance?

Yesterday, it got up to 80 degrees in our house which didn't bother me, but Pia was drinking and panting and restless. She was raised without central air in Ohio, so it never bothered her before. Our new house in California does have central air that we very rarely use, but I cranked it down to 74 anyway, and Pia seemed to rest better, eat better, and not drink so much.

Is this a "Cushings" thing? Or is she just getting used to the ways of California?

[Squirt's Mom]

Cush pups do better in the cool - they don't process heat as well as they used to before the cortisol made changes in their bodies and they will seek out cool places to lay / be - but the change in environments could sure be in play as well.

One of the feeds I tried with Squirt during her recent period of not eating was FreshPet - another that comes in a refrigerated tube. She liked it for a while as it came, then liked it even better for a while when I cut it into little 1/2" pieces and baked them. Then she stopped eating that, too, but MAN did the others in the house love those baked pieces as treats. Squirt did as well after a bit. Baking canned/wet foods changes the smell, texture and taste and sometimes that is just what our babies want so you might try baking a little of the Natural Balance if Pia decides she doesn't want it as is. ;)

[knitbunnie]

Cush pups do better in the cool - they don't process heat as well as they used to before the cortisol made changes in their bodies and they will seek out cool places to lay / be - but the change in environments could sure be in play as well.

I have so much to learn! As soon as I saw the temp climbing, I didn't wait for it to reach 80, because Pia has had a pretty good day so far today. The thermostat said 76, and I turned on the air. She seems comfortable at 74. Thank you so much♥

Pia just ate more chicken/rice/egg, about 6 ounces, and compared to the way she's been for the past month, it was the most eager she's been. I'm going to give her one more feeding (it's 4 pm where I am) at around 8 pm if she's interested. Never did I think I'd be so happy to see Pia eat.

[frijole]

Time for another question. Do Cushings dogs have heat intolerance?

Yesterday, it got up to 80 degrees in our house which didn't bother me, but Pia was drinking and panting and restless. She was raised without central air in Ohio, so it never bothered her before. Our new house in California does have central air that we very rarely use, but I cranked it down to 74 anyway, and Pia seemed to rest better, eat better, and not drink so much.

Is this a "Cushings" thing? Or is she just getting used to the ways of California?
Cushings thing for sure. Before my dog was diagnosed I couldn't figure out why she quit laying on the area rug and instead laid on the tile. That is why. Very common. Kim

[molly muffin]

I'm so happy to hear that Pia is eating more I think that this is a good sign, and you know every dog is different as to how long it will take to clear up something, like pancreatis. Pia might take longer is all. She has gone through so much, what a trooper you both are.

hugs,
Sharlene and Molly Muffin

[knitbunnie]

Pia had such a good day on Tuesday, but yesterday, she got up in the morning and threw up. Not a good way to start the day. She barely ate, she drank a lot, and she was pretty unhappy. Today, she won't eat and she seems completely miserable. And we have new symptoms - her one eye has the pink part sort of sticking out, and her face is swollen on the same side. We're going back to UC Davis tomorrow. 10 am cannot come soon enough.

[molly muffin]

oh dear. Okay, check her teeth out, make sure there isn't an abscess in there.
I swear, if it's not one thing it's another. Keep in mind too that any infection can throw off cushing test results like the ACTH, etc.

hugs,
sharlene and molly muffin

[frijole]

Glad you are going to UCD. Keep us posted and no more cushings meds until after you talk to them. Tell them the whole story and don't leave anything out. Sending huge hugs, Kim

[knitbunnie]

I wonder about some sort of abscess. I watch her every minute when she goes outside - I do the 1-one-thousand, 2-one-thousand count when she pees so I know if she's peeing more or less, and I watch her #2s, too, to be sure they're formed and normal, so I know she doesn't eat plants and hasn't been bitten by anything. I noticed the red tissue around the inner corner on her eye yesterday (either the conjunctiva or the third eyelid - not sure which, but it's red and puffy, but the white of her eye is not reddened) and put in some tobramycin drops from when she scratched her cornea a few months back. I even checked with "local vet" on this, and she said to go ahead.

Yesterday, she wasn't interested in holding a tennis ball in her mouth, so I looked in her mouth, which she did not like one little bit. A couple years ago I took my other dog to our old Ohio vet twice because I thought she had a tooth abscess and he said she didn't. Then, her face swelled up and she was in terrible pain and had 2 teeth extracted, so I know you can't always see a bad tooth. But Mama knew!

This morning, when Pia again refused to eat, and looked completely miserable, I called Davis and got her an appointment. She spent most of the day under the dining room table, so I wasn't interacting with her very much, but at around 3:30, I caught a look at her head-on, and she obviously had swelling. If you've ever seen someone with the mumps, that's what Pia looks like on the left side, under her jaw. I called Davis again, and they told me that if she has trouble breathing to take her to my local vet, and to try Benadryl in case it's a bite. I'm not sold on giving her Benadryl.

My husband has been working out of town for the past couple weeks, and I called him and told him about Pia. He's been terribly worried about her, and he got so upset that he cried. So did I. He's coming home on Friday, and the Sacramento airport is near Davis, so I told UC Davis that it would be ok for Pia to spend the night if they thought it was necessary, since I have to make the trip anyway.

[frijole]

Be careful with eyedrops that were used previously for other issues... I learned this when my Annie had the corneal ulcer. Her local vet was giving her drop (sorry can't remember the name) and she wasn't getting better and I finally started going to a specialist in Omaha and the first thing she told me was that those drops made things worse in this particular case. I about died. So don't assume they are all helpful. Luckily you'll be there tomorrow. Do keep us posted. How sweet that your hubbie cares as much as you do for her. That is awesome. Kim

[knitbunnie]

Be careful with eyedrops that were used previously for other issues... I learned this when my Annie had the corneal ulcer. Her local vet was giving her drop (sorry can't remember the name) and she wasn't getting better and I finally started going to a specialist in Omaha and the first thing she told me was that those drops made things worse in this particular case. I about died. So don't assume they are all helpful. Luckily you'll be there tomorrow. Do keep us posted. How sweet that your hubbie cares as much as you do for her. That is awesome. Kim

My other dog, Maggie, had something wrong with her eyes about 8 years ago and our vet repeatedly diagnosed it as an eye infection and gave us antibiotic eye drops. We finally asked for a referral to a veterinary ophthalmologist. Her buggy Boston eyes were looking buggier. She had terrible glaucoma. Talk about a wrong kind of eye drops!

I finally convinced Pia to eat a few bites of food, but it was hard going for her. I think she was so hunger that it didn't matter that it hurt to eat. I hand-fed her some soft chicken/rice/scrambled egg/sweet potato mush. Pia loves sweet potatoes, and before she got so sick she used to think chunks of cooked sweet potatoes were a fabulous treat. Now that she has a little food in her belly, she fell asleep in her bed (we have dog beds in every room of the house) and is snoring her sweet Pia snore.

I have this awful feeling that tomorrow is a make it or break it day for Pia. It's the worst feeling in the world.

[molly muffin]

We are right here with you. It sounds like a tooth to me and they can probably take that out. She was doing a bit better before yesterday. So I am hoping for the very best and I hope that the people at UDavis can help her. We'll be awaiting news! Angels on your shoulders!

hugs,
Sharlene and Molly Muffin

[frijole]

Ah, sending more hugs and strength for your day. You are going to the best place for care for Pia. We will all be with you in spirit. Kim

[Squirt's Mom]

I hope things go well with Pia today and I'm glad she ate a little bit. Bless her heart, nothing hurts quite like a toothache in humans so I can imagine what it feels like for our babies. :( Hopefully, UC Davis will be able to give her some relief and she will be feeling much better very soon.

Let us know how things are going and remember you are never alone.

Hugs,
Leslie and the gang

[Boriss McCall]

Good luck with Pia today at the vet. Hang in there. I hope help is on the way.

[Mel-Tia]

Thinking of you and little Pia, hope all is going ok

[frijole]

Me too!!!!!

[molly muffin]

Thinking of you here too!!
Sharlene and Molly Muffin

[knitbunnie]

Back from a long, long day at UC Davis. I am so glad I have them, even though they're 110 miles away over a mountain. Pia woke up this morning and looked pretty terrible, and now she looks even worse! She will certainly not win a beauty pageant after they shaved half her face to do an ultrasound.

Amazingly, the current problem is unrelated to the possible Cushings. The report says, "...we suspect that Pia's facial swelling is secondary to a migrating foreign body, like a foxtail or grass awn." They ultrasounded the affected side, found a pocket of fluid and were able to aspirate what looked like bloody pus (the vet showed it to me) that they're sending for culture and sensitivities. They fully anesthetized and intubated Pia for the ultrasound amd a dental exam at which time they found a draining tract behind her last left upper molar which they probed and flushed. They also x-rayed her teeth to make sure there were no abscessed teeth. They did not recommend surgical exploration at this time.

Pia is home on two oral antibiotics - Clavamox and Baytril, and pain meds. For three days she's getting 3-times-a-day subcutaneous injections of buprenorphine and after that, she'll start on Tramadol three times a day. When the cultures come back, the antibiotics may be changed, but she will probably be on them for 6 weeks.

Pia is possibly the most stoic dog I've ever met. She's uncomplaining, and it's hard to tell if she's in pain, ever. We've joked in the past that we could slam Pia's foot in a door, and she'd just stand there, unmoved. I just gave her a shot of pain med, so she's snoring peacefully. Tonight, all I had to give her was one dose of Clavamox. It was no small feat! She definitely did not want to eat, so I put some food in her cheek pocket on the "good" side, and then a little more and then more with the pill. I had to keep shoving everything back in there and pressing it through her teeth. It's a good thing she's not an aggressive dog.

We have no idea how long this has been going on - maybe this is why Pia hasn't wanted to eat so much. Earlier in this whole awful adventure, the local vet gave Pia antibiotics in case she had an infection going on with the pancreatitis (seemed like a reasonable place to start), which could have calmed things down if the infection was already present, and then Pia had over a week of steroids, which could have perked Pia up at first, but then because of the immunosupressive nature of steroids, could have pushed the infection forward to the rapidly progressing mess we have now. It's all supposition, but it's a real possibility.

[doxiesrock912]

Poor Pia!
I hope that she feels better soon!

[Trish]

Oh my gosh, that sounds painful. No wonder she has gone off her food. I hope that settles down real fast with the antibiotics. So glad to hear you are on the right track with Pia now, hope she starts to feel better and takes her pills like a good girl.
Trish :)

[addy]

I am so thankful you have the ability to go to U.C. Davis. Hope Pia is feeling better soon so you can catch a break off the roller coaster.

[Squirt's Mom]

My goodness, poor little Pia. :( But I am so glad they found the problem and have a plan of attack. Something you might consider while she is off her feed is NutriCal or something similar. It is a paste that comes in a tube that has all the vitamins and minerals she needs to sustain her for a while. It tastes good to most pups so they will take it easily. I've used NutriCal to nurse pups through Parvo in the past. ;) It is amazing stuff!

Keep in touch and let us know how that sweet girl is doing. I hope she is up and driving you nuts in no time at all!

Hugs,
Leslie and the gang

[molly muffin]

Oh my what a time Pia has had and yes I agree this could actually answer the not feeling good, not eating, not active if this is going on and then with the various treatments that have been tried for the other issues, she might have been up and down.
It does sound like a good plan they have for this so that is good. Hope you have a good weekend

hugs,
Sharlene and Molly Muffin

[frijole]

How is Pia doing today? Sending warm healing thoughts. Kim

[knitbunnie]

Poor little Pia is not having a fun time. She's on pain meds that I think are making her constipated, and she's having difficulty urinating, too. She had full anesthesia yesterday, so that doesn't help thing to move along.

She does not want to eat at all, so I am forcefeeding her small amounts of food. Her twice-a-day antibiotic needs to be taken with food. So I shoved some feed into the cheek pocket on the unaffected side, about 2 ounces total in small bites, and she swallowed some and pushed some out, including the pills a few times, but I had a plate under her chin, so I scooped it up and shoved it back in over and over again. It stayed down, thank goodness. If I don't get her started eating, she's going to have to spend a few days in the hospital. I'm feeding her 4 times a day.

Believe it or not, she's not drinking much, either, so using a bulb syringe, I've been squirting a couple ounces into her every so often. I am actually cheering when she makes urine. What a switch.

Last night, she tried and tried to do #2 and she couldn't. I didn't have any rubber gloves, so I used some plastic food wrap over my hand and gave her a baby suppository. It helped, and I had to do it again tonight.

Her face doesn't looks as swollen although it's still puffy, and her third eyelid has gone back to its normal position. She doesn't look nearly as scary without that big red eye.

I had to pick my husband up at the airport today (5 hour round trip) and I took Pia along. She was not exactly thrilled with it, but I absolutely did not want to leave her home unattended. My husband just about cried when he saw her.

Force feeding her and squirting water into her reminds me of the time Pia had her stroke. She was a full-time job for a few weeks when that happened. It makes me have hope, remembering how we thought we were going to lose her, when the neurologist told us to take her home, "she'll either live or die." because there was really nothing he could do for her. She recovered pretty darned well.

[frijole]

Bless you. Thanks for the update. Continued prayers from my house to yours. Keep the faith friend. Kim

[molly muffin]

You're doing an excellent job with Pia and I know it is a hand full at times. I had to do the syringe with water for my molly a couple times as she tends to not want to drink or eat when she feels bad too. That makes their electrolytes get out of whack which mean I was also using pedilyte with her for a bit to get those back in sync. If possible would she like a bit of pumpkin off a spoon? Plain pumpkin, not pie filling. It could help with the constipation.

hugs,
Sharlene and Molly Muffin

[knitbunnie]

If possible would she like a bit of pumpkin off a spoon? Plain pumpkin, not pie filling. It could help with the constipation.

hugs,
Sharlene and Molly Muffin

Good thought! I'm headed to the grocery store this afternoon and hopefully, they'll have plain, canned pumpkin. Or some pumpkin-type squash in the produce department. Neither Pia nor I enjoy the suppository.

One of my daughters came to visit for the weekend and brought along her dog, Posey. She and Pia normally run circles around each other and thoroughly enjoy playing together. I planned to put Pia in my bedroom if it was too much for her, but she perked up when Posey came charging in the door, and Posey was super gentle, as if she knew Pia was not feeling well, so it's working out well.

Pia still needs her pain medication, but I cut back a little on the dose because she's really in la-la land when I give it to her. Between a lower dose (0.3 ml instead of 0.4 ml) and some pumpkin, I hope "things" move along. Pia's face is less swollen today, so she's looking better, and she was much less resistant when I shoved food into her mouth.

[knitbunnie]

Something you might consider while she is off her feed is NutriCal or something similar. It is a paste that comes in a tube that has all the vitamins and minerals she needs to sustain her for a while. It tastes good to most pups so they will take it easily. I've used NutriCal to nurse pups through Parvo in the past. ;) It is amazing stuff!

Keep in touch and let us know how that sweet girl is doing. I hope she is up and driving you nuts in no time at all!

Hugs,
Leslie and the gang

I completely forgot about NutriCal. About 30 years ago, I nursed a very sick young cat back to health and I remember shoving it into her mouth for days on end. I'd put a fresh flea collar on her, and she got so sick that she went into liver failure. Her sister and her mother had the same collar with no ill effects, but Pansy was a mess. She recovered and lived for many more years.

Thank you for the memory jog. You're right - it's fabulous stuff. Pia's getting chicken/rice/sweet potatoes mooshed down her throat, but something more nutritious would be better for her, even if it was as a supplement to what she's already getting.

[knitbunnie]

Today, Pia drank all day without my having to syringe any water into her yeah!. But she will not eat, not at all. No matter what I use to try to tempt her - grilled chicken, raw burger, cooked burger, ham or dog treats that she usually loves, she turns her head away. I managed to get an entire can of Royal Canin Low Fat GI into her today in several sessions - in the morning with her pills, in the afternoon with no pills, and again in the evening with pills. I smoosh food into her mouth and hold her lips shut, and I cajole and apologize and tell her she's a good girl, but she is starting to give me the looks of hate, and when she sees me coming, she tries to get lost. I only have to give her one more injection before we start Tramadol in the morning for pain instead of the buprinorphine shots. Will Pia ever forgive me for all this?

[Trish]

So good to hear you got the food into her, thats going to give her more energy, and a big YAY to her drinking on her own! Good girl Pia! Those antibiotics will be kicking in and hopefully we will see continued improvement and then you can change your thread title when she is not feeling so pitiful anymore :D:D:D

[knitbunnie]

My wonderful UC Davis vet has sent me several emails inquiring about Pia. I am so glad she wants to communicate and keep abreast of Pia's progress, and that way, I have all her directions in writing. My biggest worry right now is that Pia is not eating. This group is so ahead of the game! Pia's vet wrote back pretty quickly with the suggestion to try Pepcid! I'll be driving into town later today and will get some. You are all so smart:) She agreed that the bupronorphine causes constipation and also said that some of the antibiotics could be upsetting Pia's tummy.

This morning, after getting all the pill pieces into her in little balls that I have to shove into her mouth and then hold her mouth shut (I don't have to forcefully do this, just keep her flews closed with very little pressure), instead of shoving the rest of the food into Pia's mouth in "meatballs", I rubbed food across the front of her mouth and she licked it off and swallowed it. It took forever, but I think it's less traumatic than opening her mouth, and it seems to be more imitative of real eating. What a mess, but if it gets things going it's worth it.

I've decided to stick with the Royal Canin lowfat GI food for now and consider some Nutrical if Pia loses weight. I think the RC is more balanced and has more calories than my homemade. I managed to get an entire 13 1/2 ounce can into Pia yesterday, and that's my goal for today, too. Pia's 28 pounds. Is that enough? If she continues to tolerate it, I may try some other canned foods to see if there's a flavor she likes better. I have some Merrick and some Taste of the Wild in 6 or 7 different flavors. I'd love to hear of any foods that any of your pups find absolutely irresistible. She rejected raw and cooked beef, chicken, cheese, bacon, and ham. I need something that's like doggie "crack".

Her drinking has really picked up, thank goodness. She's not drinking gallons like the past couple months, but she's drinking enough that she's urinating every 3-4 hours. Before all this started happening a few months ago, she wasn't much of a drinker at all, and she only peed 3-4 times a day, even if I took her outside more often than that.

[Barb]

So sorry to read of Pia's problems. Have you tried any baby food? Like the meat in the small jars? When one of mine refuses to eat he will always eat the baby food IF I feed him from a spoon. He will also eat canned chicken breast that I rinse off first. That also has to be hand fed.:D
When my previous little girl with Cushings was hot here in Fl. I found her a cool bed. She loved laying on that.
Hope Pia feels better soon.

[molly muffin]

I'm really glad to hear that Pia is drinking now. That is the most important thing. How is her eating today?

That is great that the UDavis vet is staying in contact. That is reassuring.

hugs,
Sharlene and Molly Muffin

[knitbunnie]

Pia had her first Pepcid about an hour ago with her mid-day force feeding. Since she wants to drink but seems to object to the smell of food, I put about 25% low sodium chicken broth in her water. One part of me feels like I'm being cruel to Pia but the other part of me wants her to live a long and happy life. I miss her craziness so much.

Oh, oh - she just went to her bowl and drank, drank, drank. If she keeps drinking it, I'll increase the percent of chicken broth tomorrow.

I'll definitely give baby food a try, and canned chicken. I'll try anything, anything at all, if it gets Pia to eating.

[molly muffin]

Make sure that there isn't any onion or anything else except Broth in the chicken broth. Sometimes they add stuff to the broth. You want plain chicken broth. It could be that with the infection that her teeth still bother her and that her sense of smell is not working so great at the moment. You're doing great!

hugs,
Sharlene and Molly Muffin

[Boriss McCall]

Hope Pia is eating more today. It is good that she is drinking again. It is baby steps of improvement!! ;) You are a good mama.

[knitbunnie]

Pia is making slow but steady steps toward feeling better. She is now on Tramadol, Baytril, pumpkin (works like a charm for that pain med-induced constipation - thank you for that suggestion!), probiotics, Pepcid (another group member suggestion with which the vet completely agreed), Gas-X, and Prozyme.

She's eating 3 times a day, but not a whole lot. The vet said to be sure to keep her to low-fat stuff which is hard because she's refusing both chicken and rice and Royal Canin Lowfat GI. I looked at all the foods on the pet store shelf and found a few canned foods that are 3% fat and bought them. She likes them better and has eaten a few bites here and there.

What she really went for today was my hamburger, including the bun. I get my burger custom ground at a butcher. It's extremely low fat, and I know it's fresh. I get it made up in quantity when lean cuts are on sale and then I freeze it. I was surprised at how eager she was to eat my hamburger, and even the bun. I just sent my husband to the store for lowfat cottage cheese. She likes the 4% stuff we have in the refrigerator, but we want to minimize the fats so she doesn't get pancreatitis again. She likes eggs and is willing to eat just the whites. Plain chicken breast is also agreeable to her, and bites of steak. My baby seems to know what all the good stuff is.

Her appetite is picking up very, very slowly, but it improves each day. I force fed her for 6 days before she was willing to eat so much as one bite, and it took 3 or 4 days for her to drink on her own. I know her jaw was sore from the exploration, but I wonder if it wasn't also sore from being held open for a long time for the exam and procedure. She could barely open her mouth, and until yesterday, no matter how hard she tried, she couldn't open it far enough for a tennis ball, and if you've ever seen a Frenchie open its mouth you know they have huge, cavernous mouths.

Pia is back to drinking and drinking and drinking and she bloats right up like a balloon, so there's still something else going on. She needs six weeks of antibiotics, and as soon as the culture and sensitivity from her aspirate from her jaw is completed, she'll be on another antibiotic in addition to the Baytril. After all that, we can test for Cushings.

I hope this isn't against guidelines, but I had to get some Baytril at my local vet's office - $7.09 a pill. I tracked it down at California Pet Pharmacy online for $2.99 a pill, same strength, and my other dog is on Vetmedin, and that place has good prices on it, too. I don't know about their prices for Trilostane or Lysodren. What I do know is that they were very nice on the phone and quick to ship. They are willing to contact the vet, and they even called me back with a question about my order.

[Boriss McCall]

I am so glad you are seeing things on the up turn. Slowly but surely..

[molly muffin]

Glad to hear that Pia is doing so much better. She has good taste in food. LOL
We always like to know of new places to get medications at a good price. Thanks for letting us know what you found.

hugs,
Sharlene and Molly Muffin

[Tina]

Hi, just checking in to see how Pia is doing. I have been following along with your story and have been in tears on many occasions. I have been praying that she continues to eat and that things are continuing to improve. She has been through so much, bless her heart.

Love and hugs,
Tina and Jasper

[Trish]

Hoping Pia is making steady progress and is still improving each day... lots of belly rubs for her and hugs for you too!! :)

[knitbunnie]

Pia will be going back to UC Davis in a week and a half. She's still not eating enough - she seems to have a good day and a bad day. I force fed her 4 ounces of Roy Canin last night in desperation. She's drinking more than ever, and she seems to drink so much that it hurts. I wish I had better news. She is so sad and unhappy, and so am I. The vet said not to hold back water, so I don't. It seems like a vicious circle - she drinks and she won't eat, and she drinks some more, and she looks like she's in pain.

[molly muffin]

Oh poor you and poor Pia. Hopefully UDavis can come up with some answers. It's just not right that she went downhill so fast and then all these added problems on top of it. :(

Hang in there.
hugs,
Sharlene and Molly Muffin

[Trish]

Aww Pia, I wonder if her mouth is still hurting and stopping her from eating. Is she on pain relief for that?? I hope so, she needs her food to heal and you are doing a fab job making sure she gets it. Hope it is a better day today, that week and half before your next IMS can't go quick enough! Could you ring and tell them there is little improvement to get her reviewed quicker?
Trish :)

[knitbunnie]

So sorry to read of Pia's problems. Have you tried any baby food? Like the meat in the small jars? When one of mine refuses to eat he will always eat the baby food IF I feed him from a spoon. He will also eat canned chicken breast that I rinse off first. That also has to be hand fed.:D
When my previous little girl with Cushings was hot here in Fl. I found her a cool bed. She loved laying on that.
Hope Pia feels better soon.

I haven't tried the baby food, but wowza, did Pia ever LOVE the canned chicken breast. I confess, I didn't rinse it off. She was in the kitchen when I opened the can, and I didn't want to miss an opportunity, so I held a chunk in front of Picky-Picky Pia's nose and she took it so eagerly that I fed her another and another and another until there was nothing in the can but a few scraps and the juice. I was afraid to stop. This morning, once again, she's not interested in food, but it really seems like she drinks so much that she feels crappy and there's no room for food. Last night, when she ate the chicken, she'd just woken up from a long, drink-free nap and was headed for the water bowl, when I lured her away with the chicken. I know I can't withhold water, but I'm going to try to be more aware of her patterns of drinking and napping so maybe I can "catch" her more often.

The other things Pia has been interested in are pork chops (very lean and baked with homemade shake & bake), and hot dogs. I had a pack of organic, nitrate-free, preservative-free hot dogs in the freezer, and I gave them a try - that was another success. Today, I'm cooking chicken breast and oatmeal with some pumpkin for Pia.

The Tramadol continues, and so does the constipation. I've decreased it to twice a day. Baytril - those pills are huge. And she's still getting Pepcid, Prozyme, Gas-X, and probiotics. As long as she's making progress, no matter how small, I'm not going to vary much from the routine, and truthfully, if there's something Pia will eat, I'll give it to her. The only think I'm pretty firm on is keeping it lowfat. May she never, ever get pancreatitis again!

We'll be back at UC Davis in a week for a check-up on her infected jaw. I will do everything I can between now and then to improve my Pia's health. It's been cool here in northern California this past week, but we're supposed to have a scorcher of a weekend. Normally, I'm not an air-conditioning kind of person unless it's really, really hot, but the air is set at 74, and if it runs, it runs, because the heat has bothered Pia so much in the past.

[molly muffin]

Awww, Pia. Well at least she ate something. I understand not wanting to rock the boat either. You just do what you can and hopefully, each day will see some improvement. :)
paws up!
hugs,
Sharlene and Molly Muffin

[knitbunnie]

paws up!
hugs,
Sharlene and Molly Muffin

That is soooo sweet. Thank you, and paws up right back at you!

[Boriss McCall]

How is Pia doing?

[doxiesrock912]

I hope that she keeps eating!

[knitbunnie]

We may soon have some answers. Pia and I revisited UC Davis yesterday. She got weighed on arrival and had dropped from 13 kilos to 12.3 kilos in three weeks and she's gotten weaker. It's obvious that she's lost even more muscle mass, too. It was a dry weight, same as last time we went, and as soon as she got weighed, we gave her water. She drank and drank and we reweighed her - she'd drank half a kilo (just over 16 ounces) of water and looked, once again, like a balloon. I showed them a picture of Pia from this fall, when she looked like a normal dog.

At that point, my vet (remember - this is a teaching hospital) said she wanted to discuss Pia with her faculty (our vet's a chief resident and her adviser is Dr. Feldman who is apparently a King of Cushings in the veterinary world). They spent at least 20 minutes in conference, going over all things Pia. They decided that she couldn't have the low-dose dex test because of her previous steroid intake, and that it shouldn't be done for at least 8 weeks after the last dose, but on looking at Pia, they all agreed that they couldn't wait for that.

Sooo - we're going back on Tuesday with morning urines from Sunday and Monday. They're going to keep Pia for the day and do more extensive blood work and another urine culture. I wasn't told of this before, but they said that her liver is grossly enlarged and could be so big that it's contributing to her not feeling hungry because it's pressing on her stomach. The vet said this liver enlargement is very consistent with Cushings and that if she's treated it should shrink. They offered up two other possible reasons for the lack of appetite - a macro-tumor or an infection. She's on week three of a six-week course of Baytril, so I would be very surprised if she had any sort of infection.

The plan, if the work-up is consistent with Cushings, is to start her on Trilostane on a very low dose and recheck in 10 days, readjust dosage, recheck - you all know the drill. This is all slightly complicated by the fact that my husband is working out of town and I have to go to Texas on June 28th for 10 days. (my eldest daughter is having her first baby and she needs me!) He'll be home while I'm gone (I'm flying out about 2 hours before he flies in), but with Pia not eating, I'm worried that he won't be able to spot signs of trouble with medication adjustments. Staff at UC Davis said we can work around my schedule. They said that we'll monitor Pia as best we can by her activity level and general demeanor.

They gave Pia some Zofran (anti-nausea medication) to take at home with the hope that it will help her appetite. Right now, she's eating a few bites of meatloaf here and there, but not much at all. Drinking is increasing to the point that she looks like she's going to explode. Then she seems so very uncomfortable, and she can barely get up if she's laying on the hardwood.

Since it looks like we're going to be doing trilostane, it's time for me to ask the money questions. I don't know what does Pia will be on, but I was wondering if these prices were good prices or if I should look elsewhere. These prices are for 30 capsules of Vetoryl in the following dosages:

10 mg - $42.50, 30 mg - $53.50, 60 mg - $68.50, 120 mg - $117.50. That's from California Pet Pharmacy. I don't know what it costs anyplace else, so if there's someplace better to get it, I'd love to hear.

And a question on follow-up testing - ACTH stim tests at UC Davis are $150.00. Is that in line with other places? I'm waiting for a price quote from my local vet since UC Davis is so darned far away. Davis has kept my local vet updated. I have not been happy with them, but if Pia gets in trouble with her trilostane, I want the local vet to know what's going on in case of an emergency.

[molly muffin]

A grossly enlarged liver could very well be consistent with her not eating and pressure on the stomach.
As far as a macro tumor, are you seeing any sort of neurological issues, such as stumbling, legs not working right, etc, standing staring at corners, not acknowledging outside stimuli ? This would be other than the symptoms that were left from the stroke that you would be very familiar with already.

I am glad you have a plan in place going forward. Sorry that it is falling right in the middle of your grandchild being born though. I understand that makes it much harder to monitor, so you're going to have to leave an instruction booklet for your husband. What to watch out for, when to give meds, what to give and how to try and feed Pia. (Addy is queen of the instruction manual and can probably give you tips) :)

I'd put the meds into a weekly pill container, filled up so he'll know what to give when and if he has done it or not. Did they think you could wait on starting the trilostane until after your return since there is constant monitoring required when you first start?

Hang in there! You're doing great! I know if anyone can get this figured out for Pia it is you. :) yay for meatloaf eh. No onions in it right? :)

hugs,
Sharlene and Molly Muffin

[knitbunnie]

Pia stumbles a lot, but it seems more related to her left-sided weakness from her stroke and her being so weak than anything else. She has trouble on the hardwood floor - sometimes she can't get a foothold, but she looks pretty ok on carpet and on the concrete driveway. She ignores me sometimes when I talk to her, but if I get stern, she pays attention. Pia is a typically stubborn bulldog, If she doesn't want to be bothered, she just does not want to be bothered, but if I bounce the tennis ball, she perks right up. She still loves her tennis ball and she wants to play, even though she's so darned weak.

I don't know anything about macro-tumors. Do you know if trilostane helps if a dog has one?

I think we're going to start the trilostane on Tuesday then go back in 10 days for the follow-up testing, and if things are ok for an increase in dosage, we'll wait until I get back from Texas to do that, but we're all eager to get her into treatment. I'll have a little over two weeks at home with her for monitoring before I leave.

[molly muffin]

If a macro tumor is ever confirmed and it isn't at this point without any neurological symptoms, or an MRI or CT to say for sure, then it's a fine balancing act, with trilostane for cushing symptoms and maybe some prednisone to relieve swelling. You'd be guided by your specialist at UDavis if that was ever determined.

Yes I see what your plan is. Good you have the first couple weeks with her while she starts treatment as that is the most critical point, when trying to get the dosage correct.

hugs,
Sharlene and Molly Muffin

[knitbunnie]

When we were at Davis on Friday, there was a darling dog in the waiting room who looked so much like your Molly Muffin. Without even thinking, I called the pup "Muffin". She was a he named George, and George was as sweet as anything.

[molly muffin]

ROFL! Now That is funny!! Maybe I should ask Molly if she sometimes goes by George and skates off to California when I'm not looking :) I wonder if his owner now looks at George and wonders if he looks like a muffin hehehehehe Sharlene and molly muffin

[Trish]

Hope Pia is feeling better and all goes well with starting the Trilostane, tomorrow is it? Gosh you have a lot on with a grandbaby on the way as well, hope all goes well with that too :D

I do that too when I am out and about now, think oh there is one that looks like Molly or Zoe etc! Funny how all the babies on here worm there way into our hearts and we not only worry about our own babies we care about all the others and there is nothing better than celebrating good news so hope we get some soon for Pia :)

[knitbunnie]

Yesterday was quite the day - left the house at 5 am, got to Davis around 7:45, and didn't leave until nearly 7 pm, so home by 9:30 pm. Pia was exhausted, but she seems to love going to Davis. She actually gets energetic and lively when we get there.

I had two morning urine samples on ice from Sunday and Monday for creatinine:cortisol ratios and both tested "sky high". Pia had extensive bloodwork - only real issue was some liver values that were not normal, but vet said they were what one would expect with Cushings and a grossly enlarged liver. They did a urine culture "just to be sure", too.

Apparently, after we left Davis last week, they had more discussions on Pia and decided that it would be ok to do the low-dose dex test. She failed (or passed, depending on ones point of view). At 4 hours she wasn't suppressing (don't know the number) and at 8 hours, she was at 7. I need to look up what that "7" means, but what it does mean is that we're going to start trilostane.

Pia's eating has been slowly improving, and the vets at Davis would like me to offer her food a couple times a day, find the one time she's actually hungry, and then start the trilostane when we've better established some dietary patterns. They want me to work on this for 2-3 days and get Pia over her "I'm a spoiled little pupster" routine, because she ate for them like a champ! They GAVE (yes, for free!) me a case of Science Diet low fat foot and a big bag of the dry kibble. With her history of pancreatitis, for now we're not taking any chances, and they said that it wouldn't be the end of the world if she didn't eat much for a couple days while we get back to a regular pattern of eating.

So - Pia now weighs 12.2 kilos. The dose of trilostane we're starting with is 10 mg twice a day. Pia won't be starting that for a couple days, so I thought I'd ask the experts here what you think of that dose? Is it low enough? I don't want her to be taking too much, so I'd rather it not be enough for now than too much. Yes, I'm scared for my Pia.

One more question on giving the trilostane - the vet said it didn't matter if it was given with or without food, but I noticed on the Vetoryl information site (http://www.dechra-us.com/Cushings-Syndrome/Veterinarians/Prescribing-VETORYL-1.aspx) that it says, "VETORYL Capsules should be administered orally once daily in the morning with food. Administration with food will significantly increase the rate and extent of absorption of VETORYL." I know that Davis prefers the twice-a-day dosing scheme from reading some things here at K9Cushings, so I'm good with that, but do you experienced Cush moms & dads usually give trilostane with food?

[Harley PoMMom]

For Pia's weight of 12.2kg (26.8 lbs), I believe that a starting dose of Trilostane at 10mg BID is very appropriate. Trilostane is a fat-soluble drug so it's important to give each dose with food.

If this were me, I would not start the Trilostane until Pia's appetite normalizes even if this would take longer than a few days.

Wishing you both the best of luck, Lori

[knitbunnie]

For Pia's weight of 12.2kg (26.8 lbs), I believe that a starting dose of Trilostane at 10mg BID is very appropriate. Trilostane is a fat-soluble drug so it's important to give each dose with food.

If this were me, I would not start the Trilostane until Pia's appetite normalizes even if this would take longer than a few days.

Wishing you both the best of luck, Lori

Thank you! I'm glad to hear that it is an appropriate dose. I was surprised when the vet said it didn't matter if it was taken with food or not. Your answer makes complete sense to me, so Pia will get it with food.

Today, I offered her food this morning and she ate about a third of a regular-sized can of food. I've decided to not offer her food again until this evening when our other dog eats. I've been so worried about her not eating that I realize she's been grazing every couple hours instead of eating meal. I need to get her on an eating schedule that's appropriate for giving the triostane and to have a measurable baseline for her food intake.

[molly muffin]

You're doing a wonderful job. :) I think Pia will do better getting set meals too. The grazing makes it easy for her to not be hungry when you are trying to give her the meds. I think this will work better in that regard and getting her back onto a schedule will help all of you to feel like life is getting back to normal.
Sure it takes time, but baby steps and I think you're going to get there in the end. :)

hugs,
Sharlene and Molly Muffin

[knitbunnie]

Our new adventure began this morning. Pia ate a little food and took a little trilostane. The next 10 days will be devoted to watching her like a hawk. I'm making a baby blanket, so I'll be sitting on the sofa, watching HGTV home andd knitting, knitting, knitting while Pia sleeps at my feet.

She's beginning to get the idea that she's not going to get chicken breast and steak for every meal. She's ok with the Science Diet canned food, and she likes Paul Newman's beef. I'm offering it twice a day at "pill" times. For the past couple days she's eaten a little in the morning and a little more in the evening, and so we decided to start her medication. We're happy for and and all good thoughts, prayers, and warm fuzzies you can send our way.

[Budsters Mom]

Bonnie,
You certainly have you hands full. You babes are so lucky to have you fighting for them. Starting any new meds is always scary. You are prepared and know what to watch for, so you are ahead of the game. Definitely give Pia her Trilostane with food! That is the only way it can be properly absorbed. I dosed Buddy for a week on an empty stomach per vet's instructions. He had horrible stomach issues because of it. We all live and learn. Neurological symptoms are usually the first indication of a macro-tumor. Front legs giving out resulting in face plants, wobbly run or walk, or failing neuro tests done by your vet or neurologist. The best judge is you. You will know if Pia moves differently or unevenly. Quite often one side will be more affected than the other.
Hugs,
Kathy

[knitbunnie]

Bonnie,
You certainly have you hands full. You babes are so lucky to have you fighting for them. Starting any new meds is always scary. You are prepared and know what to watch for, so you are ahead of the game. Definitely give Pia her Trilostane with food! That is the only way it can be properly absorbed. I dosed Buddy for a week on an empty stomach per vet's instructions. He had horrible stomach issues because of it. We all live and learn. Neurological symptoms are usually the first indication of a macro-tumor. Front legs giving out resulting in face plants, wobbly run or walk, or failing neuro tests done by your vet or neurologist. The best judge is you. You will know if Pia moves differently or unevenly. Quite often one side will be more affected than the other.
Hugs,
Kathy

Pia just hasn't been a big eater since she had pancreatitis, so it's extra scary for me to be giving her trilostane. She ate about 2 ounces of Paul Newman's Organic canned food this morning and has been asleep (as usual) ever since.

Do you know if giving her Pepcid along with the trilostane would help if she has stomach issues? What sorts of issues did Buddy have? What should I look for?

Pia continues on Baytril which I give before bed, and the vet had said to give her Pepcid if she had any issues with that. She did at first but has been pretty ok with the Baytril for the past week or so. She has two more weeks of those gigantic pills, and we will both be very happy when that's finished. They're supposed to be chewable tablets, but there's not a chance Pia will eat them on her own. I have to split them into quarters so it's like giving four pills instead of one.

The only change in Pia's face-plants and wobbliness (which she's had for two and a half years since her stroke) is that it's worse because she's so darned weak. She got sick with "something" about a year and a half ago and looked the same as she does now in the "wobblies" department. She'd been to the dog park and the next day she was falling down, wouldn't eat, could barely walk. The vet couldn't figure out what was wrong with her, but later I heard that there's been some sort of poison at the dog park. We haven't been there since. It took her about a month to get back to her normal self.

Her left side is the weak side, so when we play, if she does fast left turns she often winds up on the ground, so we try to be careful to ensure that there are a lot of right turns. She's much better with those. The neurologist at UC Davis has seen her twice and our IM vet at Davis seems to be really cautious and pays attention to looking for neuro changes because she knows Pia has some already built in.

[Harley PoMMom]

Do you know if giving her Pepcid along with the trilostane would help if she has stomach issues? What sorts of issues did Buddy have? What should I look for?



The Pepcid AC should be given 20-30 minutes before the dose of Trilostane.

My boy, Harley, had pancreatitis and Pepcid AC is what I initially used first but after a while it seemed to cause nausea in him so I switched to (SEB) Slippery elm bark, just love that SEB.

[Budsters Mom]

Hi Bonnie,
Yes, Pepcid is fine with trilostane. I would check with your doctor to be sure.
Buddy takes pepcid about a half hour before his breakfast in the morning. He has his trilo with breakfast. He also takes Benadryl for allergies and Prednisone at that time also. He takes a second dose of pepcid in the evening about an hour or so after dinner. Buddy tummy trouble since starting trilo is what led me to the forum in the first place. You might want to visit my thread and read the first message or two. That will give you complete details. Please don't panic when you read that prednisone is listed with trilo. We are trying to manage neuro symptoms due to a macro tumor.

Hugs,
Kathy

[Budsters Mom]

Sorry Bonnie,
I am at work and had to cut the last message short. Check out the beginning of my thread and then I will add more later and answer any questions you may have.

Hugs,
Kathy

[knitbunnie]

Sorry Bonnie,
I am at work and had to cut the last message short. Check out the beginning of my thread and then I will add more later and answer any questions you may have.

Hugs,
Kathy

I just read through Buddy's entire thread- skimmed a lot, and read just about everything you've written. Your journey has certainly had its ups and downs. This forum is so amazing, so helpful, and like you, I don't know what I'd have done without it.

My IM vet suggested giving Pia Pepcid when she started 6 weeks of Baytril and a week of Clavamox, so I'm going to go ahead and give it to her before tonight's dose of trilostane. Pia's been sleeping most of the day, with visits to the water bowl and going outside for potty. She's been burping every time she drinks, which isn't normal for her, so based on that, I think that tummy issues are happening.

I hope Buddy's having a good day. I'm so glad for you and Buddy that summer's here and you'll be home with him. When does your summer break start? Thursday?

Glad to hear that the car repair wasn't as bad as it could have been.

On prednisone - at one point in the whole train of events, Pia was put on prednisone because our local vet thought she had aseptic meningitis. She seemed to perk up for about two days, and then she got so much worse that that's when I first called UC Davis. I think she was on prednisone for a total of 8 days including a quick taper, but it totally delayed getting her low-dose dex test done. I've done some reading on the macro-tumors, though because it was one of the possible diagnoses for Pia, so I understand why Buddy is on it. With Pia's neuro history, I watch her a lot for any subtle signs and symptoms.

On ATCH test - my vet wants $320 to do it locally, but at UC Davis it's $150, so I'll make that 230 mile round trip and know that they're doing it right. Luckily, my car gets close to 40 mpg, so even with the cost of gas I'm still saving close to $150.

One other thing on prednisone - it raises blood glucose levels. Maybe it will help Buddy with his hypoglycemic episodes.

[Budsters Mom]

Oh Bonnie,
I didn't mean for you to read my entire thread, just the first few messages. :o. It cost me just under $300 to get an ACTH test done for Buddy here. That is for just the test, not an exam or anything!:(I would suggest that you give Pia the Pepcid at least 30 minutes before her Trilostane dosage with food. I think that's the only thing that has saved Buddy's poor little tummy. Feel free to pop into my thread and ask me about any concerns you may have. We are all here to help each other. Please know that many others are more more knowledgeable than I am, but I will tell you if I just don't know. By posting your questions, someone will have the information you seek. Sending hugs and healing energy to you and your precious babies.

Kathy

[molly muffin]

That is very awesome that UCDavis does the ACTH so much cheaper than the local vet. Especially because then the specialist can see Pia and judge how she is doing.

Crossing fingers here!
hugs,
Sharlene and Molly Muffin

[knitbunnie]

That is very awesome that UCDavis does the ACTH so much cheaper than the local vet. Especially because then the specialist can see Pia and judge how she is doing.

Crossing fingers here!
hugs,
Sharlene and Molly Muffin

I think they do so many that they max out the usage of their bottles of ACTH. I hope that's what they really do charge. It's what the vet told me at our last visit.

On Pia's last visit to UC Davis we were charged as follows:

Vetoryl - $75.40
Cortisol pretest - 44.00
Complete blood panel - 102.00
Cort:Creat urine X 2 - $68 X 2 = 138.00
Urine C & S - 75.00
Cort 4h & 8h lowdose stim - $16 X 2 = 32.00
Office visit - 68.00
All-day boarding - 16.50

Total - $548.90

I don't know how those prices compare with others, but my local vet's estimate for less than that was about $800.00.

I keep in touch with my Davis IM vet by email, and I've asked her about day-of-testing preparation (dosage and meal timing), mentioned the Dechra information about giving Vetoryl with food, and asked about getting Pia's trilostane compounded from Diamondback. I sent them an inquiry and got the most current prices - wow - one third the price of Vetoryl.

Here are their current prices:

We can definitely compound Trilostane, but have to be slightly different strengths from the proprietary strengths available;
9 or 11mg vs 10mg - #60, $31.50 each
28 or 32mg vs 30mg - #60, $35.28 and $37.80
57 or 63mg vs 60mg - #60, $71.82 and 75.60

We can also provide the brand vetoryl caps;
10mg #60 $97.34
30mg #60 $126.00
60mg #60 $173.25

I hope I don't sound like I'm all about being worried about money, but it is a concern.

[Budsters Mom]

Bonnie,
Your prices are way cheap compared to what I pay for Buddy. Money is huge issue for a lot of us. Many of us struggle with the constant onslaught of vet bills. Do not be afraid to voice your money concerns. We often have ways we've found to cut costs by a few dollars here and there. We gladly share that information with all. We are here to help each other. I'm glad that you are able to go to UCDavis for Pia's treatment. You are getting the best! We want that for all our babies.
Hugs,
Kathy

[Trish]

Gosh pays to shop around doesn't it, what a difference!! Well done you for sorting it out.

Hope she is going well with the trilostane and she eats ok for you!!! Paw''s up Pia!!!!! :)

[knitbunnie]

Pia seems to be eating a little better, and I'm able to get her to eat a small breakfast and then a so-so supper. Last night, she ate 6 ounces of canned dog food, which is a record for her as of late. She didn't want any more of it and turned her nose away when I tried to hand-feed her another bite or two, but then she decided to eat 3 pieces of pork chop that I offered her from my supper. Such a prima donna!

She's still awfully weak and shaky, and she gets tired so easily, but as my husband said, "She seems to have a better attitude." She's still drinking up a storm, and you can tell that when she's been at the water bowl and gotten all bloated up, she doesn't feel so great. I know I can't withhold water, but my dear Pia, who is not the sharpest tool in the shed, doesn't realize that she's making herself feel bad. Last night at supper, she'd been to the water and was completely uninterested in eating, so I picked up the water for an hour or so and then fed her. That's when she ate 6 ounces of food. (I weigh her food before and after she eats what she wants. I'm a nurse, so I feel like I have to quantify things.)

She doesn't mind taking the trilostane or the Pepcid - I hide them in a ball of Natural Balance Dog Food Roll, and she eats them right up, but the darned Baytril is a no-go, even in a ball of food. I still have to shove them down her throat after cutting them into quarters, and she gives me the look of doom every time I do it. We have to do Baytril for a little over two more weeks. It will be a relief to both of us when that time has passed.

[Budsters Mom]

Yay for 6 ounces! We celebrate these baby steps! With our babies, these things are huge! Way to go Pia!!:D I hope that she continues to eat and her meds do what they are meant to do without causing other issues. Pia knows you're trying to help her and she loves you for it! You're doing a great job mom! Hugs to you both and Happy Father's Day to Pia's dad!:)
Hugs,
Kathy

[knitbunnie]

Yay for 6 ounces! We celebrate these baby steps! With our babies, these things are huge! Way to go Pia!!:D I hope that she continues to eat and her meds do what they are meant to do without causing other issues. Pia knows you're trying to help her and she loves you for it! You're doing a great job mom! Hugs to you both and Happy Father's Day to Pia's dad!:)
Hugs,
Kathy

I'm watching her like a hawk! When she makes noise during her naps, I worry. When she doesn't make noise (she's a snorer) I worry. Every time she burps I worry. Every time she poops, I'm checking it (so far, so firm!). We are probably creating a small monster, but we celebrate every bite of food Pia eats, every dog snack she chomps, every time she looks interested in a toy, and every hour she's not at the water bowl.

Thank you all so much for your support and encouragement. It helps A LOT!

[frijole]

My Annie wouldn't eat food of any kind and so I couldn't hide meds in anything and it was just awful. Obviously it depends on the pill but my vet had me crumble the pill in some chicken broth (hardly any) and I put it in a liquid dispensor like you give to kids. It's plastic and easy to use. Annie had a space behind her canine teeth that was big enough that even with her teeth totally clamped down I could slide it in and squirt it real hard to the back of her throat and she'd swallow it. Just a thought. Kim

[Jeanne]

My little Harley Girl has Cushings disease & diabetic for 3 yrs. I give her meds with Organic Pumpkin by putting in the back of her mouth and she's so good about it. Also, since she can't eat any meat and very low protein diet, she is on a high fiber soft food from the vet & I give her Morning Side, Vege Hot dog cut up on top. It's only 7g of protein & the vege chicken patty is 8g. Our vet wants her to stay under 18g of protein a day. Once in awhile she will eat the hard food, but not always. Harley is 12 1/2 yrs old. :)

[knitbunnie]

My little Harley Girl has Cushings disease & diabetic for 3 yrs. I give her meds with Organic Pumpkin by putting in the back of her mouth and she's so good about it. Also, since she can't eat any meat and very low protein diet, she is on a high fiber soft food from the vet & I give her Morning Side, Vege Hot dog cut up on top. It's only 7g of protein & the vege chicken patty is 8g. Our vet wants her to stay under 18g of protein a day. Once in awhile she will eat the hard food, but not always. Harley is 12 1/2 yrs old. :)

Wow! You are really faced with dietary challenges. What kind of dog is Harley Girl?

[Budsters Mom]

Hi Bonnie,
Just popping in to check on you and your precious babies.:) How's the eating thing going today? Is Pia cooperating, or do I need to have a chat with her. Hugs to all,
Kathy

[knitbunnie]

Hi Bonnie,
Just popping in to check on you and your precious babies.:) How's the eating thing going today? Is Pia cooperating, or do I need to have a chat with her. Hugs to all,
Kathy

I think Pia needs a chat! She threw up a little bit of her supper two nights ago and had one very loose bowel movement yesterday. The thing is, my other dog did the same thing, so I have my doubts that it's from the trilostane. Pia's being picky about what she eats today, and I don't want to go experimenting with new foods because of the loose stool.

Plus, she had a regular urination this morning and then turned back around and kept squatting, probably 5 more times. She hasn't done it since then, but it was weird, almost like marking behavior. Pia's been spayed since she was quite young, but I think I read that trilostane can mess up hormones. She's been on Baytril for about a month for her jaw infection, so with all that antibiotic, it would be hard to fathom her having a UTI, plus she had a urine C & S last week before starting her medication.

On the plus side - two things. She has brought me toys this afternoon and wanted to play. And her bloated belly still gets all puffed out, but it's definitely less in size, and it's softer than it was a week ago. It used to get almost drum-tight and huge, but it definitely looks better even though she's drinking just as much.

I just found one more reason to be glad for this forum. Pia needs to continue on the Baytril (which she and I both hate to make her take), and I couldn't remember exactly when she'd started. It occurred to me that I'd posted about it here, and sure enough, there it was - May 16th. That means we can stop the gigantic horse pills June 27th!!! Yippee, the end is in sight.

I made an appointment today for Pia's ATCH stim test - we'll be in Davis at 9 am on Monday the 24th for it. When scheduling, I asked about pre-testing food and medication because I want to be sure to do it according to their protocol, but the right person wasn't in today. She's supposed to call me back in the morning. I wonder if there's anything else I should ask her.

[Budsters Mom]

Tell Pia that I'll be right over! ;) Well, if they both have it, that a bit weird. That could indicate a virus or something like that. Have your babies been playing with other dogs lately. If so, you might want to check and see if they are sick too? Now the playing thing is good. She can't be feeling too bad if she still wants to play. A smaller, softer tummy is also a good sign. It looks like she is still able to keep some food down. Did she have any diarrhea today? I know you are worried. Sometimes taking it day by day is all we can do. Hugs to you all.
Kathy

[Squirt's Mom]

Hi sweetie,

I'm so glad Pia is feeling better and so hope the trend continues. Getting out toys again! What wonderful feeling that is, huh?


...I asked about pre-testing food and medication because I want to be sure to do it according to their protocol, but the right person wasn't in today.

With Trilostane (Vetoryl) it doesn't matter what your vet's protocol is - Trilostane (Vetoryl) MUST be taken with food for the ACTH to be valid. If the ACTH is given after food is withheld, the results will not be accurate. Pia must eat a meal and take her med as usual then be tested within 4-6 hours after her latest dose. ;)

Hugs,
Leslie and the gang

[knitbunnie]

Pia must eat a meal and take her med as usual then be tested within 4-6 hours after her latest dose. ;)

Hugs,
Leslie and the gang

That's what I thought, but when I wrote to my vet (we email back and forth), she said, "You do not need to schedule the ACTH stimulation test 4-6 hours after the pill. We actually try to run the test 2-4 hours after Trilostane administration" And this confused the crap out of me. So, I'm going to speak to the lab people today, and if they give me the same answer, I'll be sure Pia's trilostane is given 4 hours before the test.

Pia has had no more diarrhea and no more emesis - yeah! This morning she was interested in eating. I give her a little snack with her Pepcid and then give her the trilostane an hour later with food. It seems to be working out well.

I don't know how the dogs pick up any sort of illness. They're not around any other dogs, but they often seem to get sick at the same time, just like with the diarrhea and vomiting of a couple days ago. We live in an area with a lot of wild animals, and there are times when they go outside and sniff and sniff and sniff, and I've always figured that they're sniffing where one of the wild critters came to visit.. They are never unsupervised because we don't have a fenced yard, so one of us is always with them. I wonder if they could pick things up from wild animals (we have turkey vultures, deer, foxes, coyotes, wild turkeys, and the neighbor has seen mountain lions). My dogs are, of course, up to date on immunizations.

The only other thing I can think of that might make them sick is that we've been trying a lot of different dog foods, hoping to find something that Pia will eat. She seems to like one thing one day and then rejects it the next, so we've been moving through Science Diet low fat, Royal Canin low fat, Fromm's, Taste of the Wild, and Paul Newman's Organic. They had Fromm's chicken before they got sick, so that's going out of the food rotation.

[Harley PoMMom]

Unfortunately there are different protocols that vets follow when performing an ACTH stim test.

Dechra, makers of Vetoryl, recommend that an ACTH stim test be done 4-6 hours after the dose of Trilostane.

UC Davis' protocol is to have the ACTH stim test done 3-5 hours after the dose of Trilostane.

What is important is to have the stim tests done within the same time-frame. So if your vet wants Pia to have the ACTH stim test done 2-4 hours after her dose of Trilostane, then the additional monitoring tests should always be done in that fashion, so one can compare apples to apples so to say.

Love and hugs, Lori

[knitbunnie]

I haven't heard back from Davis, but I'm going to definitely get a clarification on the timing. Yes - having it always done the same would be very important. I think that the day we go to Davis, I'll document the whole process so I can do it the same next time. I'll probably write it down here in the forum.

Pia seems to pretty consistently have a good day then a not-so-good day, then a good day again and another not-so-good day. Today has started off well - she ate about as much for breakfast as she's eaten in ages - half a can and some small dog treats. Yeah! Then she and I walked the half a block to our mailbox, and I don't remember the last time we did that walk without her stumbling and falling at least once or twice. With her weak left side, she's got to wear a small boot on her left front foot, which makes her even less coordinated that she already is, but today, there was not one roll-over, not one face-plant. It made me so darned happy.

Her stool is back to normal, and she's definitely not at the water bowl as much. I do a one-one-thousand, two-one-thousand count with every urination (we nurses have to quantify!), and she used to get up to 10 or 11 or even 12 in the morning. Today was a 7, and her other daytime urinations had usually been 7 or 8 and we're down to 5s and 6s.

She lays around a lot, but when I bounce the tennis ball she perks right up and is ready to go. The sparkle is definitely finding its way back into her eyes. I won't let her overdo, and I'm always the one to stop the tug-of-war with the hedgehog and the tennis ball play.

As she gets better, I'm thinking of asking one of my daughters if I can borrow her dog for a few weeks. Pia loves to play with Posey, an energetic two-year-old Australian shepherd mix. Before her recent illness, Pia could keep right up with Posey and they'd play and play and play. Pia made up in strength what she lacked in speed, so she and Posey were pretty evenly matched. It might get Pia up and moving and building up her strength and endurance. If it doesn't work out, my daughter is 3 hours away, so I could take Posey home.

[Harley PoMMom]

UC Davis' protocol can be found in our Resource Thread here, on page 3 : Comparing therapies for canine hyperadrenocorticism (http://veterinarynews.dvm360.com/dvm/article/articleDetail.jsp?id=460965&sk=&date=&pageID=1)

If you could get a recent copy of their protocol for Trilostane treatment and post what it is that would so wonderful!!

Wishing you both the best of luck, and sending huge loving hugs, Lori

[Budsters Mom]

Just popping in give hugs to you and your sweet babies. :) I would definitely go to UC Davis if I have the opportunity.;) A normal stool and drinking less water is good and I love the sparkle returning to her eyes. It is awesome that she still wants to play. Borrowing a playmate, now that's a new one! Love it!:D
Hugs,
Kathy

[knitbunnie]

UC Davis' protocol can be found in our Resource Thread here, on page 3 : Comparing therapies for canine hyperadrenocorticism (http://veterinarynews.dvm360.com/dvm/article/articleDetail.jsp?id=460965&sk=&date=&pageID=1)

If you could get a recent copy of their protocol for Trilostane treatment and post what it is that would so wonderful!!

Wishing you both the best of luck, and sending huge loving hugs, Lori

Thank you for posting the link with the UC Davis information, Lori. It talks about doing a UCCR along with the ACTH, but my vet didn't mention that. I want to be fully prepared for Pia's testing, so I'll ask about it when they call back, which they didn't do today. I'll give them a call tomorrow if I don't hear from them early in the day, and will ask if they have a written protocol for trilostane administration and testing.

[Boriss McCall]

I don't know if they want this. but, on the days Boriss has to do the stim test the morning of his test I go outside with him & catch the first urine of the day. The vet likes me to bring this along to test the urine as well as do the ACTH test.

[molly muffin]

Great to hear that Pia is doing better. That is very good news!!!

hugs,
Sharlene and Molly Muffin

[Trish]

I am hoping the number of good days keep on increasing for Pia :D Must be such a relief for you to see her eating!! YAY go Pia!! :)

[Budsters Mom]

Bonnie,
How are you all doing today? Yes, switching food a lot can upset sensitive babies tummies. But, what can you do when Pia won't eat. You have to try lots of things to entice her. It is such a sensitive vicious circle!:rolleyes: Why does it always have to be so hard?
Hugs,
Kathy

[Tina]

Very happy to read that Pia is eating better! I hope that is continuing to improve since your last post and that she continues to feel better each day. I do the one-one-thousand, two-one-thousand count also every time Jasper is peeing too!! :rolleyes: He still drinks lots more than he should, so sometimes his pees get up to 30 or even 45 count, which is so discouraging, but I think that is the way it is going to be for him due to his kidney issues.

I hope you and your pups are having a good weekend.

Hugs,
Tina and Jasper

[Simba's Mom]

Just checking in on you and your little Pia, hope she continues to eat well for you, enjoy the weekend...

[knitbunnie]

Question - do dogs every have a rebound of their symptoms? Pia's been on Vetoryl for 9 1/2 days, and yesterday and this morning she hasn't been interested in eating much at all (what else is new!), seems more stumbly, and is drinking/peeing more again. She'a 12.2 kg and is getting 10 mg morning and night with food, even if I have to make her eat just a few bites. She goes back to UC Davis tomorrow morning for her first ACTH stim test. Any and all thoughts and suggestions are appreciated. Thank you.

[doxiesrock912]

I had to stop Daisy's Vetoryl for a time because she had horrible diarrhea. Her symptoms did return quicky, but now that we've resolved that problem her symptoms are improving already.

They may need to increase the dosage or something else is going on with Pia. Could be a UTI? Cushdogs are prone to things like that.

Keep us posted. I'm glad that she has an appointment to check this out.

[knitbunnie]

I don't think she has a UTI, since she's been on Baytril for 5 weeks. Her stool is normal, her urine looks clear, but she looks more bloated and is drinking more, has almost no appetite, and she's weaker and uninterested in much at all. It's just about as bad as before she started on Vetoryl. She was slowly improving before the last couple days. I hope Davis has some answers, because life is getting harder and harder for Pia.

[Budsters Mom]

I am so sorry to hear this Bonnie. Life shouldn't be so hard for a little babes. To answer your question,yes,many of our Cush pups have rebounds of symptoms. Particularly if they're not stabilized on the perfect dose yet. Pia was only on Vetoryl for 9 1/2 days. Our pups are not considered stable until they hit the 30 day mark at least, with no changes needed and good numbers. The guidelines say to have the first ACTH test 7 to 10 days after starting Vetoryl, and the second one at the 30 day mark. Up until that point, they are still in the adjustment period. Yes, UC Davis is the best place to go to get all this sorted it out. ;) Pia will be an excellent hands! Please post when you know more.Sending love, hugs and prayers your way.
Kathy

[knitbunnie]

I'm going to have to have a discussion with Davis and write a book of instructions for my husband. Pia is going to Davis tomorrow for her test on day 10 of medication, and I'm leaving for Texas on Friday.

My new grandson, Graham, was born on Thursday, a bit early, but at 8' 14", it's probably a good thing he came when he did. My husband is in Wyoming, and coming back on Friday. I'm driving to the airport, parking the car, texting my husband its location and he'll be flying in about 2 hours after I leave, so I won't be home to go over things with him.

I'll be in Texas for a little over a week, coming back on the 8th of July. I have real concerns about making dosage adjustments while I'm gone, but I think my husband is just going to have to put on his big-boy britches and deal with it. If Pia needs a higher dose of Vetoryl, he's going to have to watch her like a hawk. I don't care how many times he calls me, but he's going to have to shove those pills down her throat and figure out how to get her to eat, even if it means some smearing of food across her front teeth or on the roof of her mouth. Sometimes that gets her interested, and she'll eat a couple ounces of food.

He's going to have to monitor her ins and outs, too. When Pia started drinking more water, he was in complete denial. I was too busy having a gall bladder attack and the aftermath to deal with it for a couple weeks (yep, I was one sick pup, myself in mid-March). Since then, he's been out of town a lot for work, so he hasn't been through much of this, at least not yet.

What should he watch for? Here's my list so far:

1. Bowel movement consistency
2. Water/urine in and out
3. Food intake, and is it staying down
4. Activity level
5. General mental attitude.
6. Change in strength/weakness/coordination

What else? What's most important? He needs to know if/when to call our local vet or the Davis vet.

[Harley PoMMom]

Hi Bonnie,

A new grandson!! Congratulations to you and your family!!

It really looks like your list for things to watch for is complete, if Pia would stop eating/drinking, and/or start vomiting or have diarrhea, the Vetoryl should be stopped and a vet visit is needed.

Hubby can post to the forum, with your login, if he wants to. ;) We are here to help in any way we can.

Have a safe trip and have fun with your new grandson, Graham.

Love and hugs, Lori

[doxiesrock912]

Bonnie,
that's probably a good idea for hubby to touch base with us if he's not familiar with what to watch our for:)

We don't mind at all.

[knitbunnie]

Home from Davis and Pia's first ATCH stim test. We won't know results until tomorrow, so for now we're still on the 10 mg BID dosing. Pia LOVES going to Davis. She was so peppy and enthusiastic when we got there, and she walked down the sidewalk to the building like she was a pup. The day exhausted her and she came home and slept and slept and slept.

I was quoted a price of $150 for the test, but it turns out the vet was wrong. It was $170.00, but still a lot less than at the local bonehead vet's office.

I spoke with the vet tech about ordering compounded trilostane, and she said a lot of their clients did that. She recommended Grandpa's Compounding Pharmacy. I'm going to have to do a little investigating here in the forum to see if anyone has had any dealings with that particular pharmacy. I'd been planning to use Diamondback because people seem to be pretty satisfied with their medication. If anyone has any thoughts, please let me know.

Weird thing happened tonight. As usual, Pia turned up her nose at her supper. Who knows why, but I barked at her. I barked and she put her face in the bowl and ate. She stopped eating, I barked, and she went back to eating. Have I discovered a new thing? We did this three times, and she ate about twice as much as usual, which is still not enough. Pia's weight was down again, but just one tenth of a kilo.

I cannot imagine my husband barking at Pia while I'm gone, although if he knew how much we've spent on all this he might start howling at the moon.

I don't know if Pia is developing an attitude or what. When we got to Davis, she absolutely trotted the half block to the office, no problems, no falling, no balance issues. But at home she acts like she can barely make it to the pee-spot in the yard. Late this afternoon, we walked to the mailbox after she'd come home and taken a nap. The mailbox is half a block away, and you'd have thought she was half dead the way she stumbled around and actually flopped over a couple times. And then she spotted a stick. Suddenly, she was capable of not only walking, but carrying a stick at the same time.

Only four more days of Baytril! I hate those huge honking pills as much as she does.

I asked about a written protocol that the community rep said she'd look into for me. No luck. She wasn't around today, so I'll have to call her and see what's up.

[Budsters Mom]

Yes, Diamondback all the way!!!!!!!! I use them, I love them, they are wonderful! If you call with the milligrams ahead of time, they will tell you the cheapest route to go. I order 60 count 20 mg Trilostane at a time. It costs only four dollars more to get 60 than it does to order 30. If you know this ahead of time, you can tell your vet. That way, they can call in the prescription for the larger amount.. Diamondback's service is phenomenal! You get your prescription within two or three days of ordering. I did a lot of research before I went with them. They have many awards,certifications, and excellent service. They are also the most affordable.

PS. I don't buy any meds from my vet. They are far more expensive! If it's a regular prescription like an antibiotic or something like that, I get written script and take it to Walmart or Costco. Walmart and Costco do not carry Trilostane as of yet.

Hugs,
Kathy
__________________

[Squirt's Mom]

I used a local pharmacy to compound Anipryl for Squirt when we lived in TN and I was very pleased with them. They were small and Josh, the pharmacist, always had time to explain everything I ever asked. He told me where the mixes came from, what they were, how they were mixed and I was welcome to watch if it made me feel better. I liked the personal touch and knowing Josh was just a phone call and short drive away.

I haven't found a pharmacy around here that compounds yet so I would have to choose someone like Diamondback and I would be very comfortable using them - just not as comfortable as I was knowing Josh was close. ;)

[knitbunnie]

Frustration has set in for several reasons. Pia seems like she's never taken any medication - back to drinking and peeing like crazy, including peeing in the house. She's not interested in eating. She's weaker and more stumbly. She looks sad beyond sad.

AND - no one has called me back from Davis. Our vet, Dr. B, is off for two weeks, so yesterday the vet tech said we'd hear from Dr. Y. today. Dr. Y's name is on Pia's prescription (we got another box of 10 mg caps of Vetoryl so we'd have medication regardless of dosage change), so I know this is who it's supposed to be. I didn't hear anything so at about 4 pm, I called UC Davis to check on her status. They told me that a completely different vet, Dr. P, was in charge of Pia while Dr. B is on vacation. They put me through to her voicemail, and I left a message. I still haven't heard anything. and it's 8:30 at night.

Question - How long does it take to get ACTH stim test results? I honestly thought we'd have the results at yesterday's visit.

I'm going to call back in the morning because Pia has done a complete backslide. Today has been bad.

[knitbunnie]

The vet, who has never met Pia, called at 9:45 pm. She said that Pia's numbers looked good on the ACTH stim test and we shouldn't change the dose. We discussed all sorts of things, and I'm going to try feeding Pia absolutely anything within reason that she is willing to eat.

I hate having a different vet. Telling me that a decrease in appetite would be a signal to hold trilostane does me absolutely no good. I can't seem to get through to her that PIA DOES NOT WANT TO EAT and hasn't wanted to eat for several months. Not having an appetite has nothing to do with her medication. If Pia was vomiting or having diarrhea or if she suddenly stopped drinking, I'd worry, but the not-eating thing is a worry for a completely different reason than too much trilostane.

Frustration continues. Maybe tomorrow will be a good day for Pia. I can only hope.

[knitbunnie]

Another night, another puddle on the floor :(

Pia got up this morning and ate two little chunks of Natural Balance food, got her Pepcid and an hour later, she had her trilostane and ate 3 ounces of cooked burger. And drank and drank! She was interested in playing tennis ball and squeaky toy, but she panted and got tired quickly. At least she played. An couple hours later, she went outside again and when she came in she ate 5 or 6 Alpo Variety Snaps. I don't know what it is about them but she likes them, and I'm back to not caring what she eats, as long as she eats and it's low fat.

The burger that she ate was some that I'd made into patties, seasoned and cooked for myself. It was low-fat burger and it had seasoning. Pia definitely has a preference for people food. I'm going to try some baked chicken next. I don't know how my husband is going to deal with this when I'm out of town, but deal he must.

Pia hasn't been walking a lot, but the pads on her front feet look kind of raw. Is it possible that this has anything to do with Cushings? We have no grass where we live - it's too dry, and water is too expensive to use to irrigate a lawn, so our back yard is a big, weedy, dry, steep slope that no one walks on (it's the same for all the neighbors, too, so it's just the ordinary way here), and our front is a landscaped terrace above a retaining wall. Pia's pee-spot is about 20 feet from the front door, across a concrete driveway and below the retaining wall. It's a gravel area, and I think she's become uncomfortable walking on the gravel. I've stopped trying to get her to walk to the mailbox, and I put some antibiotic ointment on her foot pads where they look raw. It seems like there's just one thing after another. She's really been stumbly when she's walked out onto the gravel, but there's no place else for her to do her business.

[Harley PoMMom]

Oh Bonnie, So sorry to hear that Pia's appetite has not improved and I understand how worrisome that can be. Has the vet mentioned an appetite stimulant, such as mirtazapine (Remeron), for Pia?


The vet, who has never met Pia, called at 9:45 pm. She said that Pia's numbers looked good on the ACTH stim test and we shouldn't change the dose. We discussed all sorts of things, and I'm going to try feeding Pia absolutely anything within reason that she is willing to eat.
Could you get copies of those recent ACTH stim results and post them here?


The burger that she ate was some that I'd made into patties, seasoned and cooked for myself. It was low-fat burger and it had seasoning. Pia definitely has a preference for people food. I'm going to try some baked chicken next. I don't know how my husband is going to deal with this when I'm out of town, but deal he must

Since Pia will eat the hamburger and chicken maybe you could make some extra up and freeze it into individual servings for Pia, that way all your Hubby has to do is thaw it out and serve it to Pia, what do you think?

Sending you all super huge hugs and love, Lori

[molly muffin]

That is a great idea Lori, about making ahead and freezing. Maybe that could work!

Could she have gotten a UTI? and that caused her backslide if her ACTH numbers are good?

It would be great to see those numbers though.

just thoughts,
hugs,
Sharlene and molly muffin

[Budsters Mom]

So sorry to hear that Pia is not eating well. Freezing individual portions to use while you're away is a great idea. I have a friend that does that because she has a dog with IBD. We are all anxious to see those ACTH scores. Yes, You must go see your new grandson, just so you can get your mitts on him! ;) Graham is one lucky baby!:)
Big Hugs,
Kathy

[knitbunnie]

Great idea on cook and freeze for husband to feed Pia! My brain is so scrambled. I don't know why I didn't think of it.

If Pia's appetite doesn't pick up, I will ask the vet about an appetite stimulant. That's such a good idea.

I don't think she has a UTI. Her urine is clear, it smells ok (how sad that I know that!), and she's not spotting in little dribs and drabs. She's just plain peeing big puddles. This afternoon, she was hanging out in my sewing room , and right in front of me just made a huge puddle. No matter how sorry I feel for her, that is unacceptable. She got scolded, and she's still moping around. After 5 1/2 weeks of Baytril, could it even be possible to have a UTI? I just don't know.

My daughter and I have done FaceTime so I've seen Graham awake and asleep and doing the baby squirmies. He's so cute. I get several pictures a day on my phone and on Facebook, too. When they brought Graham home from the hospital, the first picture they sent out was of Graham being greeted by Lucy, their yellow lab. They love their Lucy Dog, and their ancient Natty Cat, so they completely understand why I haven't been able to hop on a plane and rush right down to Texas.

[knitbunnie]

I'm trying to get Pia's ACTH results. The front desk staff at Davis cannot give it to me over the phone. What's that about???? They're mailing it to me. I put in a voicemail to the vet of record for Pia's last visit (Not our usual because she's on vacation) asking her to let me know what the numbers were. Hopefully, I'll hear back from her soon.

I've decided I have nothing to lose, because Pia is getting worse and weaker and continues to lose weight, and she just won't eat, even the chicken and the burger, so I'm going to force feed her again. Yesterday was one terrible day. So my new plan is to feed her the lowfat canned stuff (don't want pancreatitis to happen again), half a can three times a day. As long as it stays down, that's what she's getting, whether she wants to eat or not. She's easy to feed by smearing half an ounce or so at a time on the roof of her mouth. I did it yesterday and this morning she seemed a little more bright-eyed. But she can barely support herself to squat, so it's time to get more food/energy into her. I don't know what else to do.

[Simba's Mom]

Sending healing prayers for little Pia, hope she starts eating better soon, sending hugs too for you!!

[knitbunnie]

OK - finally talked with someone at Davis who was willing to give me results - whew!

Cortisol Pretest - 4.4
Cortisol 1 hour - 5.3

If someone could help me with those results, I'd be grateful.

[labblab]

Well, Pia's ACTH results are great. So it doesn't seem as though uncontrolled cortisol is likely to be the source of her problems. Something else -- and something serious -- must be going on, and I will be very disappointed in UC Davis if they don't pursue Pia's issues further.

As far as a possible UTI, was a urine culture and sensitivity test performed before she started on the Baytril? If not, it is always possible that her infection is one that Baytril does not address and no matter how long she takes the drug, it will not clear the infection or resolve the symptoms. It breaks my heart to hear about Pia's uncontrolled urination in the house. For a dog who was previously house-trained, this uncontrolled urination is as unnatural to her as it is upsetting to you since it is totally counter her natural instincts not to soil her "den." It doesn't sound as though it is anything that she can consciously contain. Poor you, and poor Pia. And since this is not a behavior that she would do willingly, I think it is another signal that something is seriously wrong especially in conjunction with her lack of appetite and general overall decline.

I don't recall, but has it been determined whether or not Pia has pituitary vs. adrenal Cushing's? If she has the pituitary form of the disease, I'm afraid there is always the possibility that her tumor may be enlarging and placing pressure in other areas of her brain. If so, this could account for things like the inappetance, lack of coordination, and also the loss of former inhibitions such as urinating freely in the house. But this is just an idea to throw out there -- that may not be what is going on at all.

But Pia's situation is so perplexing and unsatisfactory that I do believe UC Davis needs to do more digging to get to the bottom of things. IMO, this is too disturbing to you and too uncomfortable for Pia for them to allow things to continue with no answers. In the meantime, might you consider using some doggie diapers with her? As I say, it doesn't sound as though she is able to have any conscious control over her urination right now. Maybe the diapers might relieve some of the stress on you both for the time being. :(

Marianne

[molly muffin]

oh dear, it did sort of hope that it was just the cortisol was too high, but that isn't looking like it is the case.
I agree with Marianne, it would be disheartening if UDavis didn't pursue further investigation. Have they said anything about what else might be going on? When was her last blood test? Davis did an ultrasound right?

hang in there. When are you leaving? Friday?

hugs,
Sharlene and Molly Muffin

[knitbunnie]

UTI - Pia had a UA C&S before Baytril at our local vet and also when she started trilostane at UC Davis. At that point she'd been on Baytril for about 3 weeks.

I feel so bad for Pia when she has an accident, but yesterday it was like she was mad at me - she looked right at me and squatted down. I can understand her having accidents at night, but this was almost an attitude kind of thing.

My poor pup has had several ultrasounds. I have seriously considered that she may have a macrotumor, but I absolutely cannot justify having her sedated for an MRI and then go through repeated anesthesia for radiation treatments to buy 6 months time. It's not just the money, although that does factor into it, but I absolutely won't put Pia through all that for a few months extra time with the same thing happening all over again at the end. With Pia and her history of a stroke at age 5, it's hard to tell if she's wobbly and stumbly from being weak or if it's from some other neurological compromise.

One thing that's kind of odd with her unsteadiness is that when she really wants something, like the tennis ball or an empty paper towel tube (she goes wild for those things), she manages to get pretty darned excited and can move pretty decently, but when she has to go outside to pee, she's like a falling-down drunk, especially on the gravel area where she goes to the bathroom. She's definitely worse when she first wakes up, too.

On her last bloodwork, about two and a half weeks ago, her liver enzymes were high but not terrible. The vet said they were right in line with a dog that had Cushings, and after we started the trilostane, it seemed like her bloating which was partially from a grossly enlarged liver, looked much better. Her abdomen, especially under her rib cage, looks big again and she's all bloated up again and farting like crazy. She doesn't look jaundiced, so I'm going to assume that even if it's big, her liver is functioning, but at Davis they thought her inappetence was partly because her liver was so darned big. And also because she probably felt like crap from having that huge liver.

The vet who has seen Pia consistently since we started going there will be back from vacation by the time I return from Texas. I will be so glad!

[labblab]

I am really glad that your vet will be back, too.

I totally understand your thoughts re: the potential for a macrotumor. I lost my own Cushpup to what we assume was an enlarging tumor, but we did not opt for confirmatory imaging or radiation treatment, either. It is is really a tough position to be in, no doubt about it.

So I'll keep my fingers crossed that some answers will be forthcoming once your original vet is back on the case.

Marianne

[knitbunnie]

I am really glad that your vet will be back, too.

I totally understand your thoughts re: the potential for a macrotumor. I lost my own Cushpup to what we assume was an enlarging tumor, but we did not opt for confirmatory imaging or radiation treatment, either. It is is really a tough position to be in, no doubt about it.

So I'll keep my fingers crossed that some answers will be forthcoming once your original vet is back on the case.

Marianne

Thank you, Marianne, for understanding and sharing your experience with a possible macrotumor. I am so sorry that you and your dear dog had to go through it.

I just got off the phone with my husband. He'll be back from Wyoming tomorrow evening, and the neighbor is going to watch Pia for the 8-9 hours that no one will be home. I'll be headed to Texas to see my new grandson, and there's absolutely no way I can cancel. My daughter had to have a c-section, and she needs me.

No matter how often I tell my husband what's going on with Pia, he seems to tune out the bad stuff. I wound up crying my eyes out on the phone trying to make him understand what Pia's going through and to prepare him for whatever may transpire while I'm gone. He's been away for two weeks, so he needs to understand how much she has declined.

[Budsters Mom]

Oh Bonnie,
As you know, I am dealing with a probable macro-tumor with Buddy. We have a neurosurgeon managing his case through Buddy's vet. She was the one that originally did his neural consultation. She lectures all over the world and works at a specialty hospital that I can't afford to go to. Thankfully, she has agreed to stay on and manage Buddy's case through my vet. They are working together to provide the best possible care for Buddy. The docs are as sure as they can be, without advanced imaging that Buddy has a Pituitary macro-tumor or a brain tumor. Buddy is now being treated as if a tumor is a certainty. My point being that I know what you are feeling now. I know the thoughts that are going through your mind and the fears that you can't escape from. My heart goes out to you and your sweet babies. The not knowing is really hard, because you can't move forward with any kind of a plan. We are here to stay with you and support you in any decision that you make, whatever the diagnosis is.
Sending you tons of hugs,
Kathy

[knitbunnie]

Oh Bonnie,
As you know, I am dealing with a probable macro-tumor with Buddy. We have a neurosurgeon managing his case through Buddy's vet. She was the one that originally did his neural consultation. She lectures all over the world and works at a specialty hospital that I can't afford to go to. Thankfully, she has agreed to stay on and manage Buddy's case through my vet. They are working together to provide the best possible care for Buddy. The docs are as sure as they can be, without advanced imaging that Buddy has a Pituitary macro-tumor or a brain tumor. Buddy is now being treated as if a tumor is a certainty. My point being that I know what you are feeling now. I know the thoughts that are going through your mind and the fears that you can't escape from. My heart goes out to you and your sweet babies. The not knowing is really hard, because you can't move forward with any kind of a plan. We are here to stay with you and support you in any decision that you make, whatever the diagnosis is.
Sending you tons of hugs,
Kathy

Thank you, Kathy! When I get back from Texas, I'm going to talk to Davis about trying the approach you're taking. It's worth a try.

I talked with my husband again because Pia decided to stare at me while I was eating a piece of chicken, and she actually took some and ate it. How can such a small thing make my heart feel such joy? I think he understands a little better the dire state that Pia is in, and that he has to stick with "the program" - 3 feedings a day on schedule with fresh water, medication, lowfat foods, no going for walks on the freshly surfaced road that has already made Pia's feet sore, lots of rest, and a little quiet play to keep her spirits up.

Pia's front pads look sore and reddened and then, just this evening, I found out from a neighbor that her dog's feet are sore, too. What on earth did they put on the road?

I wrote out a full schedule, all sorts of directions, phone numbers, etc. He knows I will NEVER be without my cell phone, day or night, 24/7.

[Trish]

I hope your trip goes ok and enjoy your time with your family and new grandbaby! Congrats!

I am sure your hubby will take A++ care of Pia and hope she is feeling ok and eats some more, so hard to tempt them when they don't want it, they don't want it and you try and will them to eat more, I have had to force feed Flynn with water a few times and he was pretty good but you hate doing it to them eh.

Fingers crossed all is going smoothly for you all xx

[Budsters Mom]

Please update us on your trip when you get back. We would love to hear all about your brand new grandson. I hope Pia has been eating well. Big hugs,
Kathy

PS I just realized that this is my one thousandth post! That is mind blowing! :D:eek:

[knitbunnie]

When I came back from Texas and clicked on Pia's thread, my heart sank when I saw Kathy's post signature. It was devastating to know that Buddy had crossed the bridge, and my heart is heavy. Hopefully, Rosie will continue her puppy-pad success and bring much joy to Kathy's life.

While I was in Texas, my husband followed my instructions to the letter. It's hard to see small progress on a daily basis, but after being gone for 10 days, I could tell that Pia was stronger, more co-ordinated, and more energetic, although she still sleeps a lot and falls over. She's still not interested in eating, although I cooked chicken and rice for her yesterday and she voluntarily ate some. Poor husband was hand-feeding her 3 times a day, which in our Pia-world means smearing food a tablespoon or so at a time onto the roof of her mouth and holding her lips shut until she swallows, not just holding out food for her to take from your hand.

Pia is still drinking and peeing and peeing and drinking up a storm. When she's asleep, sometimes she quivers, but it stops when I talk to her and she comes awake. I'm watching her now, and she quivers with every inhale but stops with each exhale. Anyone else ever see this? Any thoughts?

I was reading Dr. Feldman's paper on Vetoryl dosing in JAMVA, and he suggested that, even with an ACTH stim test result less than 5.6, if symptoms were not satisfactorily improved, the dose could be increased to 3 times a day. I emailed Pia's vet and cited the paper (Dr. Feldman is her adviser at UC Davis!). She wrote back and said we'd consider it after seeing Pia's next test results. I just hope we're able to do the test on Monday. There are some potential issues related to Monday's testing.

I am currently a bit annoyed with UC Davis! On our last visit, they gave me Vetoryl, but when I got home I realized it wasn't quite enough to last until our next visit which is on Monday, the 15th. Our regular vet was on vacation and another vet dealt with Pia's last test results, so I called her and left a voicemail that I needed a prescription. I can get Vetoryl, even the branded Vetoryl, for a whole lot less at Diamondback and I wanted to do that instead of paying the UC Davis price. Two envelopes came from Davis while I was gone so I figured that I'd deal with it when I got home from Texas. Neither one had a prescription! I called Davis on Tuesday and they said that they'd have their pharmacy send me more Vetoryl AND charge me $10 to mail it. So, that 15 day supply is going to cost me $82!. At Diamondback, I could get a month's worth for only $10 more.

I hope they sent it out, because Pia will run out of Vetoryl capsules on Saturday, and she's scheduled for an ACTH stim test Monday morning. Pia's regular Davis vet is back from vacation, so she can figure out what to do next if the Vetoryl doesn't get here by Saturday. My local vet doesn't stock it, so I can't even get a couple days worth locally. I need to make a back-up plan so this never happens again.

My new grandson is, of course, an absolute sweetie. I had a nice time in Texas, but there's no place like home.

[molly muffin]

Oh I bet your grandson is a darlin. You're right though, as great as they are, nothing like home. :)

Your husband is a real keeper, hand feeding Pia like that and not just a bit of hand feeding but the whole making her swallow too.

I'm glad that you can see a change for the better. Hopefully it will continue to get even better.

You're definitely going to need to tell Davis that you want a prescription that you can then buy elsewhere, that you aren't made of gold and need to save money where you can to be able to continue treatment. Hopefully that will make them understand. Or just say straight out, you can buy vetoryl cheaper elsewhere at a pharmacy. :)

Gosh that isn't very good management on their part and I wonder if it is because your main vet has been away and the stand in just isn't as diligent or didn't realize what the time frame was.

Welcome Home! We're glad to see you back. I know it's a hard one to see Buddy is gone. We've all felt his loss. He's our lizard hunter in the heavens now.

hugs,
Sharlene and Molly Muffin

[Budsters Mom]

Thrilled that Pia is doing better and your husband stepped up and did his job! What a guy!:D Welcome home!:D I bet it was hard to leave that cute little grandson! I know that getting home to your baby is a relief. Big hugs,

[doxiesrock912]

I'm so glad that hubby "gets it".
It took ages for my father to realize that this is serious business.

I hope that you can get the Vetyrol! Otherwise, I would reschedule the test.

[Trish]

Good on your hubby! He is a treasure looking after Pia so well, must have been a relief to you during your time away to know he was in such good and caring hands. Pleased to hear she is eating with the encouragement, how is her mouth now... still sounds like it is a bit sore. I know my boy when he had mouth ulcers recently was reluctant to eat at time and his problem was nowhere near as bad as Tia's, is she due for another checkup on that? Good luck sourcing the meds... nice to see you back and glad you had a nice time with your family and new grandson in Texas! :)

[knitbunnie]

Aaaaarrrrgggghhh!!! Pia had a great weekend. We had company, including two friendly dogs, and Pia was playful and in good spirits. Everyone left at around noon and things were fine with Pia, but at around 6 pm, she went outside and squirted pee about 5 times, and when she came in I touched a tissue to her bottom and her urine had a pink tinge. Since then, she's been going in and out and squirting little bits, and of course, she's had an accident in the house, too. It's just about bedtime and I hated to do it, but I put her in a bathroom with food and fresh water (it's a big bathroom) and covered the floor with old throw rugs. She has a vets appointment in the morning for an ACTH stim test so they're going to have to deal with her urinary tract infection, too. I don't know if they'll be able to do the ACTH stim test since she's obviously got a UTI. I feel like every time we make a little progress, something else goes wrong. Saturday was such a good day for Pia - she ate on her own and it's the best she's been in weeks and weeks, and now this happens:confused: