My girl pug (confirmed Cushings & confirmed calcinosis cutis) / Tobey has passed

[Renee]

I still haven't increased the dose. We are doing another stim test on Monday, then go from there on the dosing.

I still feel like she could go up, but I want to see what the numbers show.

We finally have access to MRI/CAT imaging up here as of last week! Before last week, the MRI's could only be done in a human facility and the cost was prohibitive, but we just had a new MRI/CAT imaging facility for pets open up. I am giving serious thought to having it done on Tobey, rather than an ultrasound.

My vet will be calling the specialists to look into it. Does anyone have an opinion on CAT versus MRI?

[goldengirl88]

Renee:
You are doing the right thing waiting for the numbers. It's all a numbers game isn't it? I hope you get this straightened out. Blessings
Patti

[molly muffin]

I don't really know what is better MRI or CT, since I haven't had either done. However, Vicki, had Snuggles have an MRI on his adrenal tumor and that seems to give them more answers. I think we're still waiting on the written report but maybe she would have some insight into those options.

hugs,
sharlene and molly muffin

[goldengirl88]

Renee:
I have heard that the MRI is the gold standard, but don't personally know which is better. I think that is a question best left up to the Dr. I hope you find out what it is that is causing Tobey to be off. Blessings
Patti

[Renee]

Results from yesterday's ACTH

Pre 2.7
Post 7.5

So, now the decision on whether to increase or not.

Just for reference, Tobey is 19 pounds and currently taking 20mg am and 10mg pm. She has been on this same dose since mid-January.

I think her symptoms could be improved somewhat, but they aren't unmanageable where they are either. Her CC is healed very well, except a few new spots popped up recently. However, those spots are nowhere near as angry as the initial CC she had, and I feel it possible that these new spots are just preexisting ones that are working their way out.

The vet wants to increase to 20/20.

[lulusmom]

If I had a dog with calcinosis cutis and was treating with Vetoryl, I would want to see that post number closer to 5 ug/dl. If you are still seeing symptoms, no matter how easily managed, cortisol isn't being well controlled. That's my two cents worth.

[Renee]

If I had a dog with calcinosis cutis and was treating with Vetoryl, I would want to see that post number closer to 5 ug/dl. If you are still seeing symptoms, no matter how easily managed, cortisol isn't being well controlled. That's my two cents worth.

Thank you for this. I appreciate such a straight forward opinion.

I struggle with the increase / don't increase every time we do a stim test, because we are just outside of the controlled range I am looking for.

[molly muffin]

You could try it and if it brings the post down to just under 5. then you could stay there. Can you get say, 5mg in the compounded so you can just add that to the dosage giving presently? That way you could back off if you need to, but you do have maneuver room.

hugs
Sharlene and Molly muffin

[Renee]

The vet and I don't really want to go with compounded. If I increase, I will just add 10mg to the evening dose, bringing it to an even 20mg am and 20mg pm.

We are moving forward with the CT scan next week though (as long as I can convince the hubby that it is a worthwhile expense -- pray for me!).

[Harley PoMMom]

pray for me!).

Both you and Tobey will be in my thoughts and prayers.

You are doing an excellent job with Tobey!

[Arizona Boston]

I think lower is better … but that's just based on my one dog experience. Lucy is 17lbs and she was taking 40mg. It just didn't do it. I was thinking about going up to 50mg when we decided to change her to Lysodren.
Shelly

[molly muffin]

Definitely sending the good vibes your way. :)

I knew you didn't want to go with compounded completely, but some do both, majority vetroyl and then compounded to make up the in between dosages if needed.

hugs,
Sharlene and molly muffin

[goldengirl88]

Renee:
I am hoping Tobey is doing well? Are you going to change the dosage? If so, to
what? We are awaiting a super storm! Blessings
Patti

[Renee]

I did the dose increase last night, 20mg instead of 10mg. So far, so good. No adverse reactions. She still woke me up at 3 & 430 to eat and potty.

I expected her to have gained weight, as she has been looking heavier, but her weight is stable where it has been for the last 2 months. This leads me to believe her pot belly is getting worse.

[Dawn Anderson]

Thanks god a facility opened that performs imaging on pets. That in my opinion is the key to dealing with PDH, once you know just what is going on within the brain you can make better/educated desicion.
Butters first had a MRI that showed all the damage the tumor was creating and then a Cat Scan for the radiation therapy, the CT was used for demensional imaging of the tumor so that when the radiation laser was applied it hit the surfaces of the tumor and have minimal fall out to the surrounding brain tissue.
Keeping fingers & toes crossed that hubby dont buck to hard. I was lucky enough to not have to negotiate ANYTHING, it was my way or the highway.

Hope baby is having a good day

Dawn & Buttercup

[Renee]

Thanks Dawn! It will be my way or the highway.... but, it's so much nicer to have everyone in agreement, rather than having to flex my muscle. :)

At this point, I don't know if she has PDH or ADH, which is why I want the CT, and also because her pot belly has been increasing, and her random digestive symptoms. All in all, the CT is the biggest bang for our buck, and only about $500 above the cost of a high-tech ultrasound.

[Renee]

Just a little update on the girl.

So far, her dose increase has been going well. For reference, we upped the dose to 20mg am and 20mg pm, starting last Tuesday (3/11). Previous dose was 20mg am and 10mg pm.

She did throw up last night, so I withheld her vetoryl. It was just bile mostly, and I feel like she only threw up because she was hungry / had a cricky stomach. I still fed her dinner, and she did just fine. Breakfast was fine too, so she got her regular dose.

We are scheduled for her CT this upcoming Friday, and will be doing the pre-anesthetic blood work on Wed. I am very excited to see what the CT reveals, and fortunately, I got hubby's blessing too (whew!).

[labblab]

Renee, will the imaging be done of her head or will it be done of her abdominal area? I am a little confused as to which area you are focusing on.

Marianne

[Renee]

Renee, will the imaging be done of her head or will it be done of her abdominal area? I am a little confused as to which area you are focusing on.

Marianne

It will be the entire abdominal area. We are not imaging her head. The vet figures it is better to get a picture of all her organs / adrenal glands in one shot. If there is no adrenal tumor, then we will know she has PDH.

[labblab]

Makes sense. ;)

[Renee]

My vet is rather excited too, as this is all new technology for us in AK and will be her first patient getting imaging of this type.

:D Now, if only I could get a discount for the learning opportunity!

[Harley PoMMom]

The medications for Cushing's are known to cause gastric upset so many members use an antacid, or something like Pepsid AC. I have used slippery elm also for tummy upset.

[Renee]

Thank you for the suggestion, I'll pickup some Pepcid AC. We had a snow storm hit last night... so, I'm not sure I'll be headed out anytime soon.

[goldengirl88]

Renee:
If the Pepcid does not work try Slipperynelm or Manuka honey. Some of the dogs on here I have read can't go the Pepcid, and Tipper is one of them. It makes her even worse . Blessings
Patti

[Renee]

I just dropped off Tobey for the CT.

God, I am a wreck. I know it's not a big deal, but putting her under scares me, and of course these 'specialists' always assume the worst, so they were talking to me about cancer this and that, and generally just freaking me out.

[molly muffin]

Deep breathes!!

Hugs
Sharlene and Molly muffin

[goldengirl88]

Renee:
I am praying for you and precious Tobey. It's going to be alright. Big hugs to you both . Blessings
Patti

[goldengirl88]

Renee:
Just checking in to see how Tobey did with the CT scan. I am hoping all is well and you have a good report. Blessings
Patti

[molly muffin]

Hi Renee, checking in with you also. How did things go, what did you find out?
hugs
Sharlene and molly muffin

[Renee]

Hey ladies. Lord, I am sick. First time in years. I usually have a super strong immune system. Ugh.

The CT went good. No problems with anesthesia or anything. I have not gotten the results yet. :( After the radiologist reviews and notes their findings, the results get sent to my vet. And, I have not heard from my vet.

[goldengirl88]

Renee:
Feel better, we will be waiting for Tobey's results, fingers crossed and praying for good new. Blessings
Patti

[molly muffin]

Awww, Renee I hope you get to feeling better soon. This year has been a doozy for people getting sick. :(

hugs
sharlene and molly muffin

[Renee]

The CT results are finally back.

It is PDH. Her adrenals are enlarged at 8mm, but smooth and without tumor or nodule.

At least I know, but I am disappointed. If it had been an adrenal tumor, we would have been prepared to do surgery. No other tumors or nodules were noted in the abdominal cavity, which I am very grateful for.

[goldengirl88]

Renee:
I am thankful there was nothing else wrong with Tobey. This should give you some breathing room for a while. I am glad to hear some good news for once. Blessings
Patti

[molly muffin]

Hopefully it is just going to be a matter of finding the exact dose that will control Tobey the best through the day and night.

Then there are people who are on the same dose for years before having to tweak again, it's just a matter of finding it and then hoping it holds for the long term.

That is what the goal is anyway. :)

Hope you are feeling better.

hugs
Sharlene and molly muffin

[doxiesrock912]

I know how you feel Renee as surgery is not yet an option for PDH. Daisy has it too. I'm praying that the laser surgery performed in CA and the Netherlands works its way across the globe so that all of our babes can be helped.

[Renee]

I'm just so disappointed. I didn't realize how much I had set my heart on it being an adrenal tumor, and hoping to do surgery. :(

As far as how Tobey has been doing - I think I have found the right dose for her. Her symptoms are doing very well, and she only wakes me up once a night now. A lot of her fur has been growing back in. It's not exactly the same, but still coming back in. No new CC, and most of the lesions that are older than 2 months are healed up well. She still has maybe 6-7 spots on her lower back that popped up a while ago.

She's still troubling me on the food, seeming uninterested in her regular food, but quite excited for treats. I may go back to home cooking for her, just so I can have peace of mind. I hate not knowing if her appetite is down or if she's just being a picky-pants.

Her personality seems different to me too, but I cannot pinpoint it. I don't know. Cushings really has me down today. I hate this disease.

[goldengirl88]

Renee:
Several vets told me before I started Tipper on Vetoryl that it can change their personality. So for what it's worth that could be what you see. I never asked them what they meant, as I was more concerned about my dogs well being at the time. Hope you are feeling better. Blessings
Patti

[molly muffin]

There are a lot of ups and downs with cushings, not Just for the dogs but for the people too. Sometimes it can very depressing, others really good. You just have to hold on to the good and not let the downs over whelm you.

Okay, so no surgery, but as long as the tumor doesn't grow, then they can do good and life out a normal lifespan. Just hold onto that thought when the day seems depressing.

hugs
Sharlene and molly muffin

[goldengirl88]

Renee:
I am hoping everything is going well for you and Tobey. Hope you are feeling better? This is a tough road this Cushing's. Hang in there as that is all we can do. I am frustrated by Tipper's worsening of her tremors, and worried. Blessings
Patti

[Arizona Boston]

Darn the luck. I feel your disappointment. I like it when bad things can just be cut out of the body and be done with, rather than all this medicine tweaking up and down.
Hope you feel better.
In Phoenix, we are 10 degrees above normal and dust storming. I wish we could share some of this weather around the country to places that are so cold.

[Renee]

Popping in with an update.

Tobey is doing very well on her new dose. We are a little late on getting a stim test (should have done it last week), so I will be getting it done this week. That said, I am not worried in the least. She is up to waking me only once a night now, and her symptoms are as well controlled as ever. She has been more engaged, and even ran outside to play for a minute the other day. :)

My other pug, Ichiro, got to see the veterinary ophthalmologist this last week. He has a recurring ulcer on his eye and some PK. We got the appointment for free! My GP vet (the one managing Tobey's cushings) hooked us up. :) It was really fun watching him use all these little gadgets and tools to examine Ichiro's eyes. We have some new meds to use and recheck in two weeks. I was afraid we would have to sew Ichiro's third eyelid shut, but the vet said he was doing well and the new meds should really help.

[molly muffin]

Great new for both Tobey and Ichiro! Sounds like it's been a good week with positive news all around.
I bet Tobey's stim will look good too. Hope there isn't any reaction to the test this time. Last time was a doozy. LOL But if all is good, then you can go to more spaced out testing and stay on the same dose. Always a good step to reach, so crossing fingers for that!

hugs
Sharlene and molly muffin

[goldengirl88]

Renee:
I wish there was a better method for this testing, it is so hard on these babies that already have enough issues. Hope Tobey is still doing well on this dose. It is such as relief to finally get to that place where you aren't changing doses. I don'tknow if Tipper will get there anymore. She was OK for a year and now it hasall changed. Blessings
Patti

[Renee]

I have a question on the personality changes.

Symptom wise, Tobey is doing really well! She gets up just once a night (sometimes not at all!!) to potty, and her CC is controlled pretty good too without any new lesions. All her fur has filled back in, so she's not bald anymore.

That said, she still seems somewhat depressed. Could this just be the new her, could it be the meds, or could it be something else? She only ever gets excited for food, treats, or when I first get home. She does not care to go on walks, and she is not interested in playing either.

:confused:

[molly muffin]

Oh poor Tobey. :( I do hope that will improve eventually. You'll know more after the next ACTH test about how the numbers are. Then what you need to try to evaluate and remember is was she at a more playful activity level and when. It is such a balancing act. If not trying to get one thing right, then it's another to try and figure out. I swear we should all be detectives the way we try and figure so many things out. :)

hugs
sharlene and molly muffin

[goldengirl88]

Renee:
I think it is the Vetoryl. Several bets told me this would happen on this medication. Tipper has gone thru periods like this too. Blessings
Patti

[Renee]

Lord, this girl had me up three times last night. :rolleyes:

She just wants to eat. She doesn't need to potty, although I make her go out and go. She prances around and does a little dance for a treat. Brat!

Anyone else become a hawk watching all their dogs drink water? Every time one of my other pugs drink water, I start watching and thinking, 'how much is he drinking? is it too much?'. Haha!

Cushings make you crazy, I think!

[goldengirl88]

Renee:
When my Toby drinks I am monitoring his water too! This Cushing's can push you over the edge! Tipper pretends she has to go out just to get a treat. I just give her dog food nuggets for treats because I am watching her weight, too bad she is not! Blessings
Patti

[Renee]

Oh yes, cushings can push you over the edge for sure!

I bought some tiny treats, the kind made for very small dogs, and she gets one or two at a time. But, I will not give them to her unless she goes potty. Sure makes for a frustrating night when she goes out, doesn't pee, then runs right back in and prances for a treat!

[Iraklis]

.............

[Renee]

If it's any comfort...cushings is childs'play compared to a cushpup with a macroadenoma...
Wish no parent or pup has go through it ever again...!

Not really much of a comfort, because I don't really view this disease in terms of who has it worse or not. My girl doesn't have a macro, but I did go through treating a foster pug with a brain tumor, so I know well what that experience is like. I don't really appreciate being told my experience is child's play.

[Iraklis]

Ι am honestly sorry...I 'll delete my comment as i didn't mean in any way to offend you!

[molly muffin]

Renee, I bet that if you ask anyone on here they can tell you down to the ounze how much water their dog consumes. It is a constant worry, when they drink more, because what if the numbers are going up again, if they drink less, you worry if they are going too low. It will definitely drive you nuts trying to track it.
I watch molly's constantly to see if she is going to tip over into a cushing symptom of over drinking. Then there is the are they eating more today or less today, what does it mean. Nothing can be discounted.
I think that is one of the things about cushings that everyone can relate to who has ever encountered that prognosis.
You are in Excellent company.

hugs
Sharlene and molly muffin

[goldengirl88]

Oh gheez girls if Tipper burps I count how many!!! We are all statistitions! We have formed our lives around our babies every move, drink, poop, and food eaten. What would we do without all this fun??? Seriously I know what you mean as any one of these things could be a signal of something going wrong, and I above everything else surely realize this as I am Miss Proactive. Blessings
Patti

[Renee]

So, confession that I have broken with protocol and not done Tobey's latest stim test in the prescribed time frame. :o

She is finally and for sure on the schedule to have it done on Wednesday of next week, the day after tax day! This works perfectly for me, since I have worked every day since March, pretty much (I am an accountant), and I have the 16th off. Woo!

Her symptoms are doing well. She is still waking me at night to eat, but I am thinking that is as much her just being a brat as the cushings. She knows where the treats are, and she knows that I will give her one if she wakes me up. Ha! Last night, I told her no, and didn't get up, so she ran over to hubby's side and woke him up! Hahahaha, that was awesome! I think I'll say no again tonight, and let her wake him up again. :D

[Arizona Boston]

We measure water most days, but I can tell by the sound her collar charm makes when it his the pyrex water bowl as Lucy drinks how long she is at the bowl. Ding..Ding.. Ding.. It's kinda handy actually.

Golden Girl … your comment about the counting the burbs reminds me of an old nursing joke.
It seems that the new grad nurse was trying to be very detailed and exact in her charting and wrote…"Pt passed flatus three times…two long and one short"
(Sorry…hospital humor)
Shelly and Lucy

[molly muffin]

ROFL Shelly! Oh that was just the laugh I needed!!

Wow Renee, nothing like being caught in the busy season for you eh. :) Tobey seems to be doing just fine, I doubt that it will hurt anything to wait. She isn't actually showing signs of being too high or too low and I think Tobey Would react to either if it went too much out of comfort range for her. Not to mention you have that cc that tells you exactly when she is going too high.

I bet you'll be glad when April is over and spring is putting on a happy face and you can just get back to normal for a bit.

How many dogs do you have in the house now with Tobey? I know you have a couple and you do rescue too, so that must keep your door revolving quite a bit.

hugs
Sharlene and molly muffin

[Renee]

Hey Sharlene, I have three pugs total, Tobey and my two boys (Ichiro & Skeeter). I am still active in rescue, but have declined fostering since Tobey's problems started.

I will be so glad to get through the 15th! This year has been a real doozy for taxes.

Yes, the symptoms tell the story, and her CC is doing awesome. Still some spots, but so much better. Better than it has ever been. I'll be taking her in to groom Sunday, I think, then I'll get a better idea.

Two long and one short! Hahahahahaha :D

[goldengirl88]

Renee:
You sure have a busy life! Glad Tobey's CC is better. That stuff is the worst, and I
feel so sorry ffor the poor babies that get it. What part of Alaska are you in? What is the weather there now? Hope you get all your taxes done. Blessings
Patti

[Renee]

Weather is cold and clear, about 17 in the am, and hitting a little under 40 in the afternoon. The sun is out, which is nice. We don't really get true summer until May / June. :(

[Trish]

HI Renee, cold here too... have my socks on :D

[goldengirl88]

Renee:
Sounds a little chilly there yet. We are in the 70s today so the doggies are loving it. Blessings
Patti

[Trish]

Hey Renee! How are things going in Alaska, Tobey doing OK?? :)

[Renee]

Hey Trish! Thanks for checking in.

We are getting sun, but still cool weather. It was 30 degrees this morning at 7am.

She went in for an ACTH yesterday, but my vet hasn't called with results yet. She does have some type of infection on the skin of her belly. No idea what its from. It must not be contagious, because the other puggies don't have it. It looks like black spots, and one sore that is very much like a pimple. It hasn't spread beyond her belly skin, and I do not think it is the dreaded CC. :( She just can't catch a break I guess. Her existing CC is much better, not getting worse, but slowing down a bit on healing.

And, I am so upset - her weight is up again. 20.4 pounds. This is her heaviest in years. She should be 16-17 pounds. She is so lethargic most of the time, has no interest in walking more than a few feet, and she is a terrible beggar. Hubby gives her more pizza crusts than I would like to admit. His baby girl is sick.... so, he just gives her whatever she wants. I know the extra weight is bad for her, for a number of reasons. I have been cutting back her food, but obviously, she is making up for those calories by getting treats.

Boo. Sorry to make this post sound so whiny!

[Trish]

We are allowed to do whiny!! If you can't whine to us who can you whine too!! Flynn loves a pizza crust too!! But he does not get them anymore, BOO from him :D

Bugger about her tummy, are you putting anything on it? You must have a few different concoctions I am sure.

Maybe once that snow melts she will be a bit more keen on walking and getting a bit trimmer!

Fingers crossed for the results, always a hard time waiting... not many of us are the patient types!!

Have you got some videos of Tobey? We are sharing a few on Sharlene's thread so come on in and join the chat if you like!! Everyone welcome :D:D

[goldengirl88]

Renee:
I can't remember, has Tobey had a thyroid panel? That is when all Tipper's weight came on when her thyroid problems started. Blessings
Patti

[Renee]

Renee:
I can't remember, has Tobey had a thyroid panel? That is when all Tipper's weight came on when her thyroid problems started. Blessings
Patti

Yes, full panel was done before we moved onto the cushings testing.

[Renee]

Have you got some videos of Tobey? We are sharing a few on Sharlene's thread so come on in and join the chat if you like!! Everyone welcome :D:D

I think I missed the chat! I do have some video, but no idea how to get it on here?? Hmm. I'll have to do some work. :)

I have not put anything on her belly yet. Honestly, it kind of snuck up on me.

[Trish]

Yep they all gone to pub (Sharlene) bed (Tracy) and exercising (Addy), me I am still being lazy on my first day off and sitting here and drinking tea!

I have a cream called Neotopic that I use on Flynny, it clears up most things. Contains neomycin for antibiotic and lignocaine for local anaesthetic but also hydrocortisone which would not be ideal for cush pups. Hope it is nothing too much to worry about and clears up soon!

[Renee]

Results are in! Pre is 2.0 and post is 5.9.

I am happy enough with these numbers to wait another 30 days and retest. :) If they don't come down a bit more, and depending on symptoms, I may increase again, but at this point, I feel better waiting. My vet is in agreement too.

[Trish]

YAY! Sound pretty good to me too, certainly enough to stay at that dose to see what happens over the next month. Good girl Tobey!!

[Renee]

YAY! Sound pretty good to me too, certainly enough to stay at that dose to see what happens over the next month. Good girl Tobey!!

Thanks Trish! :)

[molly muffin]

That is really good for Tobey, for any dog really, the CC will be your guideline I'm sure as it is for most who have that dreaded stuff show up. If it doesn't heal up, then might need to come down by a point or two on the post, which likely wouldn't be much of an increase. You should know in the next month.

Did they do a skin scrapping on her belly to test and see what kind of infection it is? Likely will need some antibiotic to clear it up. Cushings makes it harder for their immune systems to fight the infections, so a bit of help there is likely needed.

Well, can't argue much with a daddy's girl. What she wants she gets. :) :)

hugs
Sharlene and molly muffin

[Renee]

Oh Sharlene - too true, what she wants, she gets!

Yes, they did a scrape and popped one of the little pustules and looked at that too. Nothing too scary, so they didn't send it off. We are doing a course of abx to see if that helps.

[molly muffin]

Oh good, the abx should help. Was just reading how tumericu with honey (manuka honey I'd think) can be a good combination to put onto skin, infected areas, to help it out. Interesting that eh. (course it is orange!!!)

hugs
Sharlene and molly muffin

[doxiesrock912]

Whooohoooo Renee!
Great news!

[goldengirl88]

Renee:
Glad you are going to use the Manuka honey. Tipper takes it for acid reflux and it has really paid off according to the IMS. They do use it in burn units in hospitals too. Blessings
Patti

[Harley PoMMom]

I believe Egyptian physicians used honey as an antiseptic/antibiotic.

[Trish]

Hi Renee
I didn't realise you were going to use honey, the manuka type comes all the way from us here in New Zealand!! Manuka trees are native here and they flower with either little white or pink flowers which attracts the bees. I think it would be incredibly messy to use but whatever helps, here in NZ we are more inclined to put it on toast than any wounds :D

[Renee]

Hi Renee
I didn't realise you were going to use honey, the manuka type comes all the way from us here in New Zealand!! Manuka trees are native here and they flower with either little white or pink flowers which attracts the bees. I think it would be incredibly messy to use but whatever helps, here in NZ we are more inclined to put it on toast than any wounds :D

I don't think I am going to use the honey?? How did that get here? LOL. No, it would be too messy on her stomach. Someone recommended it, but I am going to stick with some ointment and the abx for now.

[Trish]

Hmmm dunno lol, confusion reigns... but what you said makes sense to me!! I wouldn't use it either and I have worked in wound care in the distant past and it was never real popular. I think if Flynn had honey on him he would do his level best to get those bandages off to lick it up!!

[Renee]

I got the girl out for a walk yesterday, as it is finally decent enough weather to get outside. She was panting after just 5 feet... but, she was motoring right along and seemed happy, so we kept going. Probably only a 15 minute walk... but it was good! The other puggies were very excited to be out and about as well.

[molly muffin]

Isn't it fabulous to have great weather to be out walking again I know the dogs love it and so do you. Good times hugs Sharlene and Molly muffin

[Trish]

Awww glad Tobey had such a nice walk, bit of fresh air does us all good!! Maybe she needs to build up here exercise tolerance a bit too, after all being inside for a lot of the time during winter, she may have lost some condition with that and being sick as well... pleased she loved it!! :)

[Renee]

Got another walk in today! She put the breaks on about 10 minutes in, but she did some fast trotting to start out. I must admit however, I have a love/hate relationship with nature. The bugs were zooming by me, and I was glad to get back home! LOL

[Renee]

Just posting an update on the girl.

Things are ... hmm .. hard to say. Not better, not worse, kind of just in limbo. Her infection/rash on her belly is no better or worse, so the abx don't seem to be doing anything. I am beginning to suspect a UTI or maybe even just a little vaginal infection, as my boy pugs are sniffing and sniffing her. :mad: (everyone is fixed, not to worry). Her drinking and peeing are completely normal though (YAY). I feel like a urinalysis would be a waste, so she probably needs a C&S.

Digestion is up and down. No throwing up or diarrhea, just the bloat and gassiness off and on. I want to switch foods, but I don't trust any food companies. Back to home-cooking, I think.

The dreaded CC appears to be in limbo too. It's definitely much better from where it was 5 months ago, but it has not changed in the past 4 weeks or so, and I thought it would heal up and go away with her cortisol finally getting fairly low. Her coat did grow back in and she looks like a puppy, lol! It's all undercoat and super fluffy.

In other news - our home inspection is done, nothing too terrible, so the process continues. I cannot wait to move! Hopefully this new house is the one we stay in for a very long time. Hubby is so excited to get a four car garage and man cave space! :D And, I'm excited for him too. Get his darn tools out of my way!

[molly muffin]

Yay for good home inspections. Very important!

Oh yea, a man cave and big garage is exactly what a guy needs to keep him busy and the tools out of your way. hahaha My hubby would love that! As it is, he has to settle for a 2 car in the city and the basement to man cave in. hahaha
I'm not telling him what your hubs is getting least he want to move, thinking that is what he needs too!!! nu huh, no like moving any more. Getting too old for all that stuff. hahaha

Okay, so at least Tobey isn't worse, which is good. Fluffy new hair is good sign too as skin and hair can be the longest and hardest to get cleared up.

hugs
Sharlene and molly muffin

[Renee]

Oh for sure, moving is no fun. I don't want to move again after this until we are ready to retire! We really put a lot of thought into the longevity of this home purchase. The house we have now was just a starter home for our young family. Now we have teenagers, we need something different.

We weren't actually looking for a 4 car garage. We knew we wanted 3, but we stumbled across this amazing 4 car and could not turn it down. I may just put a couch down there and never see the hubby! Hahahaha.

[Trish]

Hi Renee

Sounds like you will all be pleased to be in the new house with more space for everyone!! That's a pretty big man cave, he will love it!!

You think if Tobey has a UTI it is getting on her skin and causing a rash? Is that common in dogs? Haven't reread back far enough to see if a swab has been taken to confirm the bug?

I reckon that CC is getting ready to go away, Tobey been bothered by that long enough so hopefully you can wave goodbye to that soon, she deserves it with those good numbers xx

[Renee]

I talked with the vet about Tobey yesterday, and we aren't really sure what we want to do next, in regards to the possible UTI. Tobey isn't displaying any symptoms of the UTI, except for the other pugs being quite interested in her lady parts. I hate to put Tobey through a cysto if it's not necessary, especially with her skin being so thinned out and rashy right now.

Took her on another walk yesterday. I need to get this weight off of her that she has put on the last five months. She used to be 17 pounds, but she's up to 20 at the moment. :(

[molly muffin]

Have they checked glucose levels lately? Just to be sure that there isn't any extra sugar in the urine that the other dogs smell?

Just trying to think why else they might be sniffing her. Yeast maybe? hmm

hugs
Sharlene and molly muffin

[Renee]

Sharlene - I was thinking yeast too, especially with that rash on her stomach. Glucose is a good idea though too.

Maybe I'll just take in a urine sample for a quick UA and see?

I swear, it's one thing after another!!

[molly muffin]

One thing after another isn't it. :( Yep, I'd grab a morning sample and hmm, wonder if you can swab around her privates with a q tip, put it in a sealed bottle or jar or tuperware and ask them to check for yeast on the outside of her too. :)

Once you've caught urine sample in a ladle nothing seems beyond us to figure out.

hugs
Sharlene and molly muffin

[Renee]

Hahaha, oh yes, the ladle trick. That's a good one.

[Renee]

Buried back on page 3. :)

Update is: she's doing well! The possible UTI has squared itself away, so I opted to forgo the vet visit and UA. The boy pugs are leaving her alone for now and her potty habits are completely normal.

We did go on another long walk, and she was having a wonderful time. She overworked herself though, and hubby had to carry her back. :D

I believe her last stim test was mid-April, so I'll be scheduling another here in the next week or two. I am very, very happy with her current control, the last little thing I am really watching is the CC. It's still there, fairly stagnant. I wish it would go either way!

In other pug news, my Ichiro's eye is still not better! A month of abx drops, and the ulcer is still not filled in. Back to the ophthalmologist vet at the beginning of June. We are just keeping the drops going until then. I am wondering if he will need a corneal flap? All this eye issues have been going on for a year. He got his eye punctured by the evil sheba inu next door. :mad: It has never completely healed.

[molly muffin]

Gosh I hope that the eye will eventually heal, without need of surgery. Is June the earliest that the ophthalmologist could see him?

It sounds like Tobey is doing real well and whatever was going on has healed up.
That was funny about the walk as my molly has done that a time or two on a long walk. She just lays down and expects to either stay there or be carried back home. My and my hubby both have indulged her in the carrying department. LOL So I know exactly how that came about. :) hahaha

Glad to hear a good report on her. I've been buried on page 3 myself and even further. Sometimes it doesn't seem that anything of real note is happening with us and I just end up yakking on other members threads. I'm actually just fine with that as nothing of note is a pretty good thing. :)

hugs
Sharlene and molly muffin

[Renee]

I am so frustrated by Ichiro's eye. A year long we've been doing drops. I was taking him to my regular vet all that time, and we just kept getting more and more drops. It would seem to be healed for a while, then back to being red and not healed. The vet can see the blood vessels in there, so it's trying to heal up, it just can't quite get there. I should have seen the specialist long before now. We did see the specialist last month (for the first time), but he's not back into town until June now, so I have no choice but to wait. There are not a lot of specialists in Alaska, and the ones there are, usually have to travel a lot all over the state.

Looking back, I kind of wish I had sewn his third eyelid shut. Maybe it would have healed better, from the beginning.

Is it bad that one of my major motivations in moving is to get away from the evil neighbor dog?

[molly muffin]

Nope, not bad at all. I'd probably be considering the same exact thing. That along with the bonus man cave should settle it in fact. :) I don't know why I have heard a couple times now of a sheba inu attacking another dog. I read up on them and they are aggressive towards other animals or can be I should say, but if you know that going in when you get that breed, then proper training and socialization as a baby are very important, just like with any dog. I know you know all that already as involved in rescue as you are, but it sure is frustrating. I don't think there are bad dogs I think there are bad owners who don't take responsibility for their dogs actions and welfare.

Maybe it is that a combination of drops are needed. I remember when Zoe had her eye problems, Addy and hubby were putting drops in every couple hours and had I think, 3 different drops and did this until the problem cleared up. I think Zoe had an infection, but a puncture often leads to various infections which can be quite difficult to completely clear in the eyes.

hugs
sharlene and molly muffin

[addy]

Zoe has twelve different eye drops for three months:rolleyes::rolleyes: we had a chart and took off of work early- but we saved her eyes. If you can see an eye doctor it is best.

It started with an ulcer that did not heal then she developed secondary glaucoma, then dry eye disease and conjunctivitis, this list was endless. But once we got it under control she was down to 4-5 drops per day and she never got another ulcer- the eye has to stay moist too to prevent ulcers so she had over the counter Gentile Gel Severe- it has to be the severe, the others would not keep the eye wet enough- 3-4 times a day.

Shysie had a procedure done for her eye ulcers. That is on Stormee/Sky'es thread.

It is all way back on my thread in the spring and summer of 2012 I think:o:o:o The serum we received helped her eyes the most. It was a miracle serum. I can find the name f it if you want.

[molly muffin]

OMG, it was 12! See the mind rebels at such an overwhelming number of drop medications, I was obviously in denial.

I remember you talking about that miracle serum. That was some good stuff and was a real turning point if I remember correctly.

Hope you can get this turned around too Renee. It's so hard when you just want to fix them and they are being all contrary with progression to complete healing.

hugs
Sharlene and molly muffin

[Renee]

Ooh, please do share the name of the miracle serum! I'm willing to try anything at this point.

So far, it's just the ulcer and some mild PK. No dry eye yet.

[addy]

Aggressive antibiotics were needed for Zoe's eye as we started to see yellow ribbons indicating the start of infection. It was also important to keep her eyes moist. We had to treat the other non ulcer eye as well so a spontantous ulcer did not occur there also. Zoe also had secondary glaucoma in the ulcerated eye. Glaucoma in dogs is very painful.

Meds included:
Tacrolimus .02% solution for dry eye disease and to keep the eyes moist. Cyclosporine 2% solution was also used in the non ulcer eye. The cylocpsorine could not be used in the ulcered eye.

Flubiprofen was used for inflammation both eyes
EDTA 1% solution to break apart the crystals both eyes
Genteal Gel to keep eyes lubricated both eyes
Cefazolin and Oflxacin for infection ulcer eye only
Serum- ulcer eye only
Neo Poly Gram- for infection non ulcer eye only
Tropicamide- ulcer eye to dilate pupil, help with pain, help with glaucoma
Dorzolamide for eye pressure ulcer eye only for glaucoma

It was very, very important Zoe did not rub her eye and we could not miss one single eye drop. Some meds were 4 times a day, some 3 times a day, some twice a day. It was very important to control her pain which we did with Tramadol.

In the beginning, prognosis was guarded and eye vet thought surgery would be needed.

Were you given a diagnosis of melting ulcerated cornea? Do you know how deep the ulcer is?

I credit the agressive antibioitcis and serum for helping save Zoe's eyes. It was a lot of work. We had a full time job of medicating her eyes and watching her like a hawk. We made sure she got a lot of rest. I used the tramadol to knock her out.



So I guess it was 11 not 12 eye drops:rolleyes::rolleyes: So far all I can find is that it is called "dog serum"

I'll keep looking;););)

[Renee]

Oh my gosh Addy! My head is spinning reading all that!

No melting ulcer, just the puncture wound that won't fill in. We were using neopolydex for a while, but then switched to gentimycin. The non-ulcerated eye is just fine. No dry eye, as we have tested for that numerous times.

I cannot see the specialist until June, as that is the first date he will be back in Anchorage.

[Trish]

Blinking heck Addy! Another example of why Zoe was lucky to have you.. us mere mortals would have messed that up for sure!! You saved her eye, you are truly amazing!!

Renee, I hope you get this eye problem finally sorted, sorry it has gone on so long, how frustrating for you both. Glad you are moving away from that devil dog... blardy shite of a thing! Does it bother him?

Hope Toby is doing well this week! x

[Renee]

His eye is looking pretty good, we're doing the drops 6-7 times a day. Of course, this is always how it goes. Looks really good for a few weeks, then back to being bad. :( I think the eye bothers him, because he squints it a lot. But, he is such an angel about getting the drops.

Tobey is doing great! Got some play action out of her yesterday and her stamina on the walks is getting better. I have also finally convinced hubby to quit giving her so much table food, so she can lose weight. I told him if her weight kept going up, I'd have to increase her dose in medication and it would cost even more! Hahahah. But, he's also quite motivated by all her new found energy and I think he is finally convinced she's not going to die from this.

[goldengirl88]

Renee;
So sorry you are having a baby with eye problems. I had a Himalayan cat many years ago that had the scratch on his retina and I spent many thousands of dollars saving his eye, or he would have lost it otherwise according to our eye Dr. It never did get back to the same way it was, but he could see out of it. Blessings
Patti

[Renee]

Oh Patti, I know! These eyes can get expensive. I don't think his eye will ever be 100% the way it was, but if he can maintain eye health and sight, then it is worth the time and effort. I wish we could see the specialist sooner.

[Trish]

Hey Renee

It mus be time for a Tobey Update!! Hope all going well with her and your other babies eye is doing good!! xx

[Iraklis]

Update?
How's Tobey doing? Eye(s) better?

[Renee]

Yikes, I have been away quite a while!!

I've mostly been off grid, as the move took up so much of my time, then prepping our old house for sale.. which we are finally done and it was posted to market this week. Whew! Never, ever moving again! ;) The new house is lovely though, and we absolutely made the right choice.

Update on my boy's eye - it is finally healing beautifully. The opthamologist had a second look, and using his most powerful magnification, he found a foreign object in the eye. A small black speck of something, which was causing all the swelling and cloudiness. He had to loosen and remove it with a needle, which I almost passed out watching him do. Since then, twice daily drops of neomycin and his eye is nearly completely healed.

Tobey goes in for a stim test tomorrow. Symptoms are returning somewhat, so I am expecting her cortisol to be up a bit. I am debating whether to have her tested for a UTI. She's not displaying symptoms... but, my boy pugs are doing so much sniffing around her girly parts (they are all fixed, not to worry!), that is makes me think she may have an infection or blood in her urine. Her hair is starting to fall out again, and some of her CC seems to be growing back a bit, but nothing like it was before treatment. Drinking is slightly increased, but peeing appears normal.

Anyway, so sorry for being absent. I am having to check in from work, as I still do not have my home office set up.

[Harley PoMMom]

Hey, glad to see ya back!! I, too, would have her urine checked for an UTI, and if her urine is diluted a regular urinalysis may not pick up the bacteria so an urine culture and sensitivity test should be done.

Please do keep us posted and sending healing and positive energy, Lori

[molly muffin]

Yay Renee, so glad to see you back online. Even if from work. Boy moving sure is a pain isn't it. In more ways than one. :) :) I thought that might be what you have been up to.

Excellent about the eye. Gosh, so glad they had that magnifier that could see the object. Good news that it is finally healing. Yep, I'd check for UTI via culture and sensitivity too.

Hope you get everything situated soon. It's a big job.

hugs
Sharlene and molly muffin

[Renee]

ACTH done. Results should be in tomorrow.

They weren't able to do a culture. :( The vet tech let her go pee outside (free catch for a UA), before she could be told to hold her for a cysto. So, they weren't able to collect the urine for a culture.

[molly muffin]

They can't do a culture from a free catch? I thought they could if they had enough, maybe I am thinking of the UPC though.
Crossing fingers on the ACTH. I know her symptoms have been back up a bit.

hugs
Sharlene and molly muffin

[Harley PoMMom]

Ideally a cystocentesis is the best way to get urine for an urine culture and sensitivity test, but free catch can also be used, one needs to catch the urine in midstream.

Hugs, Lori

[Renee]

Well, results are completely unexpected. Pre 2.5 and post 3.4. At these numbers, she should be perfectly controlled - and, yet, I see some recurrence of symptoms. I don't understand how the CC is not 100% cleared up, with numbers so good. And, why is her hair falling out again?

Her urine was too dilute (as expected, sigh) for the UA to pick anything up, so we will have to do a culture. I think we are going to start the abx anyway, ahead of the culture results.

Recheck ACTH in 30 days.

[Harley PoMMom]

Well, results are completely unexpected. Pre 2.5 and post 3.4. At these numbers, she should be perfectly controlled - and, yet, I see some recurrence of symptoms. I don't understand how the CC is not 100% cleared up, with numbers so good. And, why is her hair falling out again?

Those numbers are really good, exactly what symptoms are you starting to see coming back?



Her urine was too dilute (as expected, sigh) for the UA to pick anything up, so we will have to do a culture. I think we are going to start the abx anyway, ahead of the culture results.

Recheck ACTH in 30 days.

Is the culture being done on the free catch urine that was caught previously, before antibiotics are started, right?

[molly muffin]

Those numbers are good Renee. You said the CC is coming back and the drinking/peeing?

hugs
Sharlene and molly muffin

[Renee]

The symptoms that are coming back are: hair loss along the sides, CC, increased drinking, and hunger. I have not noticed an increase in peeing, but her urine is still dilute.

The culture will be done by cysto, then while we wait on results, we'll start abx. I know she can't take the abx until after the urine is drawn.

[Trish]

Hi Renee

Yay your back!! Wow house moving is never fun, well getting to the new one is but hate sorting out the old one!! What great numbers for Tobey, but that sucks her symptoms not totally gone, be interesting to see what the cysto shows. Did the vet have any ideas about why she has symptoms when the numbers are doing so good?? :confused: Hopefully your back online at home soon xx

[goldengirl88]

Renee:
Glad you got moved into your new house. That is a lot of work, I sure never want to do it again. Blessings
Patti

[Renee]

Update - everything is going good. The abx are doing their job, and the drinking has decreased and the boys are leaving her girly parts alone. We will recheck her urine in two weeks to see if the UTI is gone.

I have not checked her CC the past few days to see how it's doing, but I will tonight. Her hair is still coming out, but I am hoping it is just shedding the coat that grew in after she lost all her hair a few months ago.

I guess I am still frustrated that she even has CC lesions, when her numbers have been perfectly controlled for months. :mad: They are no where near like they were, and don't even bother her in the least. They don't bleed or crack open like they used to, but the little hard lesions still persist.

[Harley PoMMom]

That darn CC, fortunately I have never had to deal with CC but from reading about it here on the forum I see how very hard it is to deal with.

Renee, you are doing an excellent job with Tobey, and I am glad to read that the a/b's are working and that she is doing well.

Hugs, Lori

[molly muffin]

Maybe those hard ones are just calcium that was there and had to come up and out. I think that them not breaking and bleeding is a good sign. I agree with Lori, you've done an excellent job keeping this under some control. CC is awful! And in the midst of a move too! :)

Hang in there, keep up the good numbers Tobey!

hugs
Sharlene and molly muffin

[Trish]

Yep you certainly have had your hands full lately! You have totally done so well with Tobey, I 3rd Lori and Sharlene :Dyou are a treasure chest of info for newbies with CC, having been there and done it yourself! Such a bugger it takes so long for it to be totally gone, persistant blinking thing this CC... so pleased to read she is feeling well!! Hope you guys are all settled and you get a chance to relax and enjoy some summer!! xx

[Renee]

Aww, shucks. :o Thanks everyone for the votes of confidence. I am pleased that Tobey has been able to make so many improvements, with very little negative side affects. The guidance here, plus my amazing vet, has made such a big difference. I shudder to think how bad it could have been, had I not found this place and not had a vet that respects and listens to me!

I checked Tobey's CC last night. The lesions are still there, but dare I say, one of them feels a bit smaller? I am just so pleased they aren't busting through and cracking and bleeding like the old ones did! I think it could be possible a small secondary infection was setting in, which was aggravating them. With the abx clearing up her UTI, I think they could also be helping her skin too.

[Trish]

Well double bang for your buck with those antibiotics :D pleased to hear no new CC emerging on cute wee Tobey! I agree, cannot go wrong with a good vet and this forum, you have all the bases covered :) xx

[Renee]

Well, abx were finished this week, and we should be going in for another culture next week to make sure everything is all clear. :)

The drinking has subsided quite a bit, and other than the darn pesky CC, I am very pleased with symptom control! I think the increased drinking / peeing had to be from the UTI.

I am sure some of you can sympathize here - last night I took my (15 year old) daughter driving. :eek: I was trying to stay calm on the outside... but, freaking out on the inside!! Hahaha! She did pretty good though.

[molly muffin]

hahahaha, oh you poor dear! Driving with the kids when they first start out can be nerve wrecking!
My sister emailed me this morning saying she felt old, that her grandson is now driving (with an adult). He was going out on the freeway with his dad for the first time and I don't think she settled down a bit till they were back home safe and sound.

Glad she did well. That must make you feel good. I'm sure she will be fine. :)

Oh man, hope that UTI is a done deal. Can't believe how long you have been dealing with those things!

hugs
Sharlene and molly muffin

[Trish]

Hi Renee! So pleased to hear good Tobey news!! Finger's crossed that UTI has finally been kicked to the curb!

Oh no driving lessons, I had to do some with my nieces and nephew... :eek::eek: I wanted one of those cars with duel controls :D still no accidents and they all passed!! They seem so young at 15, so many nutters on the road to look out for, don't envy you there!!

[flynnandian]

in my country you must be 18 and can only take lessons at a driving school. those are very expensive!
15 sounds way to young for me.

[Renee]

in my country you must be 18 and can only take lessons at a driving school. those are very expensive!
15 sounds way to young for me.

Oh I know! 15 seems so young to me too! Teenagers can get their license at 16 in the states. I was driving at that age, but looking back, it scares me!

[molly muffin]

Gads yes, when I look back, I think the same. I bought my first car when I only had a learners permit at 15 and had my license on my birthday. (we took drivers ed in school Trish) Once you pass that, it was an anything goes and all us kids were on the roads.

Here in Canada you pay for a driving instructor and then have a graduated license. So, you might drive on local streets, but no highway until later age.

hugs
Sharlene and molly muffin

[Trish]

Yep it was 15 here too, I failed mine the first time. Stalled the hill start 3 times and the policeman had to get out and come around and start the car!! How embarrassing, I think it is a good idea to do it in school Sharlene.

Hope you had a good week Renee, are you online at home yet? You must be just about sorted there. Hoping little Miss Tobey has had a good week too! x

[Renee]

Things are going fairly well. I am still waiting to see if Tobey will ever play again. :( I know, that sounds very sad... but, before cushings, she used to chase her brother and the ball all around the yard. She has not done this in a very long time.

I am bringing home a new foster pug tomorrow. It's been at least 10 months since I last fostered. I am excited, of course, but also a bit nervous. I don't want him to upset my pugs, especially Tobey. She can get bent out of shape easily with dogs she decides not to like, lol!

He's a 12 year old owner surrender. Name is Fritz. Pretty good health, but heading into the vet on Monday to have the 'boys' removed! Hehe.

[molly muffin]

Hi Renee, oh I do hope Tobey returns to playing too. That would be wonderful.

How exciting a new rescue!! I bet he's a cutie too. Hopefully no health problems and a new family will be found fast.

Molly doesn't always like to make new friends either. She seems to think she is fine with her old ones and why go out looking for new. LOL

hugs
Sharlene and molly muffin

[Renee]

Here I am, 3 pages back again. :)

Things are steady and controlled still, other than the slight personality changes. I sure wish I could either drop her dose down, or bump it up a bit, as we go through a box of 30ct 10mg every week, which is quite spendy, but she really seems to have hit her sweet spot.

The CC is stagnant, with a few small lesions still on her back. They aren't going anywhere, but they also aren't getting any worse. The abx for her UTI helped them clear somewhat, which just confirms to me that they are highly susceptible to secondary infection when exposed.

My old guy foster, Fritz, who is 12, had his neuter and dental. He sang the blues for a solid 2 days. :( I felt horrible for him. I've never had to neuter an old guy before, and I was not prepared for how bad he would take it. He's feeling much better now.

He's deaf as a doornail too, but so sweet and happy. :) Here is a link to his bio on our rescue page: http://polarpug.org/mrfritz.html

[molly muffin]

Well I could see why he'd want to sing the blues a bit. LOL Actually don't they then lose a bunch of testosterone production once neutered? He might feel yucky?

It sounds like Tobey is in a good spot with her cortisol. Be great if all those cc areas would just finally go away.

Hope you are enjoying your summer in the new house. :)

hugs
Sharlene and molly muffin

[Trish]

Hi Renee! Nice to see you!! So glad that the CC is behaving, but wish it would totally settle down, such a slow business. But you are on the money with managing it, hopefully any new people with CC come and read your thread! Poor guy Fritz, he must wonder where he has landed LOL sounds like he is on the mend though ;) xx

[Renee]

Okay, so I have not updated in over a month. Sorry about that! I just got through the corporate tax deadline yesterday. Been working non-stop for the last 4 weeks.

Cushings is very well controlled, with some random rebounding popping up. It seems her cortisol will spike for a few days, and I'll see recurring symptoms, but then, for whatever reason, it evens out again, and all is good.

Last ACTH was 2.5 and 3.4, so excellent numbers.

The CC persists, but very, very mildly. I think the last lingering lesions will either stay as they are, or get worse should her cortisol increase for an extended amount of time.

I hope everyone else has been doing well. I will try and catch up with everyone soon!

[Harley PoMMom]

So happy that Tobey is doing well on her treatment!! YAA!!

[molly muffin]

That's excellent news Renee. I wonder why she slips every once in awhile. I guess as long as she bounces back it is okay and might just be the nature of Tobey.

Sure hope one day that cc is all gone.

hugs
Sharlene and molly muffin

[Renee]

Yikes, it's been a month!

Can I get some experts to weigh in here?

I just dropped off Tobey for an ACTH this morning. My vet uses Dr. Peterson's dilution/freezing protocols for cortosyn. One final injection was left (in the freezer), but it expired a few weeks ago. We decided to go ahead and use it anyway. If her symptoms were questionable, or if we were not in the maintenance phase, I would not have risked it, but she is very well controlled and has been controlled for months now.

FYI - no ACTH performed in the last 3 months.

Any thoughts or advice?

[Renee]

Results are in.

Pre 1.3
Post 2.8

Very well controlled, but I am concerned about her dropping too low. This is about as low as I would want her to go.

As for the CC -- it was this time last year when she first got CC. It has taken an entire year, from start to finish, before I could honestly say she no longer has active CC. I do feel that some of the bigger spots have changed the texture of her hair and skin (scarring), but overall, she is very clear.

[labblab]

Hi Renee, and thanks so much for this update. I'm so glad it seems as though you've finally gotten a handle on the dreaded CC! But I agree with you that I'm a bit antsy about the way in which the ACTH has lowered. For a dog with CC, very tight control of cortisol is probably optimal, but still, you don't want to tip the scales too far. Tobey's "post" is down although still OK, but her "pre" is lower than most anybody would want it to be.

I might wonder whether the stimulating agent was not quite as effective due to its age, but since Tobey's baseline is also lower, it seems more likely to me that they are both accurate readings and they are both down. One "positive" is that if you are still giving two 10 mg. capsules twice daily, it would be easy to back off the dosing a bit simply by eliminating one of the two capsules you are giving at night.

Since all seems to be well right now, especially with the CC, I don't know whether you want to rock the boat quite yet. But her level does make me nervous and I wouldn't hesitate to lower the dose a bit if you start noticing anything at all that is "off." And sadly for your pocketbook, if you don't decrease the dose now, I don't think I'd wait a full three months to retest again since Tobey is right there at the borderline for her cortisol. Dr. Bruyette has told us in the past that, in his opinion, twice daily dosing holds a greater risk for more easily driving cortisol too low and therefore monitoring needs to be even more vigilant. If you don't lower the dose now, even without noticing negative changes, I would probably test again in a month to see where she's at.

Marianne

[Renee]

Marianne - thank you so much for weighing in.

I am 100% in agreement with you, and in fact emailed my vet last night to tell her that I want a retest in 4-6 weeks, and if the cortisol is still as low (or lower), I want to drop her dose back by 10mg.

I'm more concerned with her baseline being so low, because there is not much wiggle room for it to drop any lower.

So far, she has not exhibited any signs of low cortisol. In fact, if not for the daily pills she takes, I would never even know she has cushings. Maybe she will be one of the dogs that can eventually wean off vetoryl completely?

[molly muffin]

Sorry I am late to the party. :) :)

Tobey sounds like she is doing very well, if cutting it a bit close with those numbers. I totally am on board with the plan. I'd back off too if the numbers stay that low.

I have to give you a big congratulations though. CC is one of the most difficult symptoms to get any kind of control over and you've done amazing!!

hugs
Sharlene and molly muffin

[Jed's Mom]

Renee you give me hope!! :) My pup is also suffering with horrible CC and reading that your girl is winning the battle is amazing. Please share any tips/pointers. It would be greatly appreciated.

Thanks!
Lisa and Jed

[Renee]

Renee you give me hope!! :) My pup is also suffering with horrible CC and reading that your girl is winning the battle is amazing. Please share any tips/pointers. It would be greatly appreciated.

Thanks!
Lisa and Jed

Hi Lisa!

I sure hope this thread gives people some hope and reassurance that it can get better!!

The biggest and most important tip is to get that cortisol below 5, and keep it there for an extended amount of time. It takes months and months.

Unlike many people, I did NOT use DMSO, weekly medicated baths, or topical sprays. I would have used the topical spray, maybe, but her CC was mending fairly well by the time I heard about the spray. What I did do was to keep the sores dry, exposed (trim the hair, if it's long), kept her from scratching them, and watched closely for secondary infection. The secondary infections almost always set in at least a few times. We did occasional cycles of abx to keep the infection in check, and I put her on probiotics. Also, tramadol when the sores were especially bad, as I know it's painful. I never really picked at the sores, unless there was a big huge scab that needed to come off. The cycles of CC can be rather yucky, and difficult to watch. Check out Tobey's photo album to see documentation of the sores while they were active.

[Renee]

Just re-read my whole thread the other night. Talk about a trip. It was nearly surreal, especially reading the posts where I was clearly feeling discouraged.

I keep waffling back and forth on the low cortisol. When I went back and looked at all her ACTH's the last year, it appears her baselines have always been rather low. Highest was 3.9, but most hover in the 2-3 range. I am watching her like a hawk for any signs of low cortisol, but she's doing absolutely fine. In fact, last night she chugged a good bit of water, and I figured her cortisol might have spiked a bit.

I'm going to keep on with the current dose, but recheck numbers mid-november.

All that said - I sure do feel like Tobey could be considered a 'success' case, especially with the CC. I cannot thank my vet enough for her part in this journey. I really think I need to get her a gift and a card on the one year anniversary. And, of course, without the guidance of everyone here, we would not have been able to make such steady and safe progress. So, THANK YOU!

[molly muffin]

It is kind of wild going back and reading your own thread isn't it. :) :)
I think Tobey is a success too. That she is a success WITH the cc, is just down right phenomenal aka awesome!

Good idea on getting your vet a card and a little something. She sure has worked well with you as a team and that's pretty cool in and of itself.

But, I will always say, that you have played the biggest part in Tobey's success.

hugs Renee, and a job well done if I do say so
Sharlene and molly muffin

[Trish]

Hi Renee.... long time no see!! It is weird rereading your thread thought it would probably take me a couple of days to go through Flynny's now.

Tobey sure is a success because he has the Mama CC extraordinaire!!! I full heartedly agree with Sharlene, big pat on the back for you!! x

[Renee]

Oh yes, reading back through Flynn's thread would take a while! I can't believe how long some of these threads are. :) Talkative bunch around here, lol.

CC is so difficult. Mostly because a lot of people, vets included, really do not have good advice for managing it. No one knows what it looks like, how to treat it for short and long term, etc.

[scoora]

Renee, You did and are doing a fantastic job with Tobey.
I know how hard CC is.
Tobey is a very lucky girl to have you as her mom.

[Renee]

Tobey has thrown up 6 times in the past hour and a half. :(

She hasn't had an ACTH since the one in October. Before this, she has not displayed any symptoms of low cortisol at all. She should have gotten it tested this week, just to check, but with the holidays, it didn't work out. I had planned to get her cortisol tested next week.

I'm a little confused about whether she is throwing up because of low cortisol, or just over indulgence from Thanksgiving.

:(

[molly muffin]

Is just with hold the next trilostane dose. And maybe give her some
Pepcid and see if her stomach settles.

[labblab]

Renee, exactly what did Tobey overindulge in eating? Unfortunately, vets often refer to the Friday after Thanksgiving as "National Canine Pancreatitis Day" because of the uptick in cases due to overconsumption of fatty foods or foods that are unfamiliar to a dog's GI tract. Vomiting so frequently in such a short time is somewhat worrisome. If she keeps it up I would worry about dehydration. Does she seem to be in any pain?

Marianne

[Renee]

I'm not sure if she's in pain or not. She's being very quiet.

She had some turkey (white meat), mashed potatoes, and a few bites of coconut cream pie. :( But, the day before, my husband gave her some pizza crust too.

I just tried giving her some rice and broth, and she ate a bit of that. She did drink a bit of water too.

I'll definitely be withholding her vetoryl for a while.

[labblab]

After that much vomiting, you may want to hold off on feeding any solid food, even just rice, until later tomorrow. I would be afraid that anything more right now may continue to overstimulate her GI tract. The coconut cream pie was probably pretty rich and fatty, so it may be the culprit. I'm guessing it's more likely the food than the trilo that is causing this upset, but I understand why you'd want to temporarily discontinue the drug. I hope little girl feels better tomorrow!

Marianne

[Renee]

Thanks Marianne for always checking in. The rice was mostly floating in broth. My real motivation was to see if she would even eat at all, because if she refused food, we would be headed to emergency vet right now. She ate about 1/4 cup of rice and has been holding it down for the last 15 minutes. She does look miserable though and will not come out of her kennel. :(

I feel better about withholding the vetoryl for now, even if that is not the cause. Her cortisol has been at the low end of the acceptable range, so I keep wondering if it's going to drop too low one of these days, even though I need her on this tight control for the CC.

[Dixie'sMom]

I hope Toby is feeling better now. Its good that she ate something and I sure hope she kept it down. My noncush baby, Buttons has been eating grass all day long every time we go out. She's got the Thanksgiving tummy ache too. I forbid anyone to give Dixie anything but turkey so she's made it thru pretty good. We all have just been whipped today and slept a lot. I'd love to go back and read all of Toby's story. There are so many of the threads that are soooo long but I want to read them all. Especially for those that have been on the forum for a long time. I feel like I'm missing so much by not knowing about all the precious pups here.

Let us know how she is doing. I'll say a little prayer for your sweet girl.

[Renee]

Just had to leave her at pet emergency. :( She continued vomiting, is very dehydrated, and now I think it is more likely she's in addisonian crisis.

So here is my dilemma - It's saturday, meaning that if I run a stim test, I won't know results until Monday. Of course, I can't wait until Monday to decide if she needs prednisone or not. I just asked them to run a baseline cortisol check instead of the acth.

Thoughts? They are also running full blood panel, checking electrolytes and starting her on fluids right away.

[addy]

Renee I am sorry to read this. Won't the er give her the rescue dose without the acth test? Our ims gave Zoe the rescue dose at er without knowing. If it were me I would be giving the rescue dose.

[Renee]

Addy, they are pushing for the ACTH, but I told them I would decide on the rescue dose based on her baseline cortisol; that I did not want to wait on a stim test. They should be calling with those results any time. I at least wanted a baseline before giving the pred.

[addy]

Is it possible she is having pancreatitis?

[Renee]

Just spoke with the vet.

Results are strange.

The baseline cortisol is above 10, so more than the machine can read. Red blood cells, platelets, and lipase are high. I don't have figures, because this is not my regular vet and she didn't seem to want to give me specific numbers over the phone. BUN is low. Of course, ALT and AlkPhos in the normal high range, as expected in cush pups. Electrolytes do not support low cortisol.

So, no rescue dose of pred, given her high cortisol. They are keeping her on fluids for the next 12+ hours and we are treating this as pancreatitis.

I'll be going by later this afternoon, and I will get copies of all her results.

[Dixie'sMom]

Oh no! I was so hoping she would be feeling better today. I'm sending prayers your way.

[Squirt's Mom]

:( Let us know how she's doing, Renee.

[Trish]

Awwww Renee so sorry to hear Tobey is under the weather, poor wee girl. Hopefully the fluids will perk her back up, maybe get the to do a spec Cpl if they do more bloods to confirm the pancreatitis. I will be looking to read good news about her later on xxx

[judymaggie]

So sorry to read that Toby is in the hospital -- I know it was hard to leave her there. Will be sending good vibes that fluids will make her feel better!

[addy]

They should be able to do a snap test to diagnose pancreatitis, keep us in the loop ok?

[labblab]

Oh Renee, I'm so sorry to read this news. FWIW, I would guess that the high red cell and platelet counts are due to dehydration, and the high baseline cortisol can be due to the stress of this acute illness in conjunction with a lack of trilostane. So it seems as though the high lipase may be the most significant finding and that pancreatitis is indeed likely. Addy is exactly right, there is a snap test that can give you a quick "yes/no" answer (SNAP cPL test). But the tradeoff is that you don't get a specific number against which to gauge recuperative progress, as you do with the Spec cPL that takes longer to process. So each form of the test has pluses and minuses. It sounds as though Tobey is being treated as though she has pancreatitis, anyway, so the test results may not be urgently needed and you maybe can wait for the full numerical result.

I am so sorry she is having such a rough time!

[molly muffin]

Oh no. So sorry this has turned into an emergency room situation. Does sound like pancreatis. :(. Was hoping just an off day.

Hugs

[Renee]

Sorry I have been slow to check back in.

We are definitely treating it as pancreatitis, even without the snap or spec test. I'm not even sure if one or both of those tests was run. I stopped by earlier to talk with the doc and visit her, but they had a huge rush of emergencies and they sent me home. I went back a few hours ago, but could only visit. Saturday's are busy, because there are only two emergency vets in town.

I'll be checking back in around 8pm, and hopefully I will be able to talk with the doc then. When I did visit, Tobey still seems quite lethargic and disoriented. Seems the fluids are slow on helping her recover. I'm not sure what other treatment is done for pancreatitis?

I have since found that my husband gave her quite a few more than just one pizza crust. :mad: He feels bad about it now, since I have been warning this will happen. And, of course -- just wait until he gets the bill too. I hope lesson is learned for him, I'm just frustrated that Tobey is the one suffering.

[addy]

If I remember correctly, pain pills sometimes metronidazole are given.

I hope she gets better through the night. Don't be too hard on hubby, he must feel badly, CUsh pups are prone to pancreatitis, doesn't take much.

[molly muffin]

Oh poor baby. Yes I am sure hubby feels bad. Poor tobey. We have had many Cush dogs go through this. As addy said doesn't take much. I worry about it constantly too as the low protein kidney foods always have higher fat content and it's so easy for it to just come on seemingly out of nowhere. Some recover more easily than others. Hopefully she will be more herself tomorrow.
Boiled chicken and mushy rice gore a bit though as they can't tolerate much more than that.

Hang in there Renee. We are all pulling for you and Tobey.

[Renee]

The cortisol is not my main concern at the moment... but, I am still a bit worried about the baseline being over 10. It has never been that high, even before treatment. I am wondering how far back this will set her progress.

[labblab]

Renee, baseline cortisols can fluctuate a great deal from hour-to-hour and day-to-day, even in normal dogs. That is the reason why baselines are of absolutely no value as diagnostic tests for Cushing's. Extreme physical or emotional stress is virtually a guarantee for a temporary related increase. Just as soon as Tobey is physically stabilized and resumes her trilostane, I'll bet her cortisol will even out once again. I know you are especially worried about her skin, but I'm really hoping this short-term episode won't have that much effect on things.

Also, before you are too hard on hubby, unless the pizza crust had a lot of cheese left on it, I wouldn't think it was the primary problem since it is mainly just carbs in the form of flour with a little oil added. I'd be thinking the coconut cream pie or even the mashed potatoes would have been more fat-laden (I know our own Turkey Day taters were especially delicious because they were loaded with butter, heavy cream, and soft herbed cheese :eek:). Perhaps hubby was the culprit with those items, too. But I think that's where a lot of people get into trouble giving their dogs holiday treats from the table -- the treats seem innocuous, but the holiday ingredients are especially rich or flavorful with the addition of special fats or dangerous items like onions or onion powder. I don't think anybody at our table had a clue as to how rich the mashed potatoes were -- all they knew was that they tasted especially yummy :o.

Marianne

[labblab]

Checking in again first thing this morning and hoping for an update on Tobey. Continuing to send warm thoughts and healing hugs across the miles.

Marianne

[molly muffin]

Checking in this morning too.
Hope Tobey is better today

Hugs

[Squirt's Mom]

Me, too. Hoping she is much better today.

[Renee]

Hey everyone, thanks for checking in.

I brought her home yesterday. She was very quiet, slept a lot, and still seemed very weak. Would not eat at all, but did drink water and pee.

I was thinking I would have to take her back, but then she ate a bit of turkey around 8, and drank a bit more water. Funny, she would not eat, but when I put the turkey in front of her and invited my other pug to come over, she hurried up and ate it before he could!! LOL.

She ate a bit more this morning, some rice and boiled ground turkey, so I decided to let her stay home, rather than taking her back to the hospital. I was going to take her back, if she would not eat.

She has not had her vetoryl since Friday morning. I'm still not comfortable giving it to her, since she is barely eating. If I can get her to eat a full meal, then I will start dosing her again, although I am considering easing into it by doing a half dose for a week. I don't want her to have a huge drop, when I am guessing her cortisol may be pretty high by now.

She's definitely put the scare in all of us this weekend.

[Squirt's Mom]

Glad to hear she's home and stayed so far. I hope her appetite picks up more as the day goes on. Of course, you could keep making her think someone else will eat her share! :D

[labblab]

I'm so glad Tobey is home and eating at least a little bit. Such a relief that she is out of the hospital!!! Good job, Renee!

[molly muffin]

Good to hear that Tobey is home and eating at least a little bit.

hugs

[Renee]

Any ideas for bland food I can make the girl? She is still rejecting her rice / boiled ground turkey. She ate less than 1/4 cup of it this morning, but I can tell she is just not interested at all in it. This has been my go-to bland diet whenever one of the pugs is sick.

I'm thinking she is being turned off by the rice, because she ate some friday night when she was sick and then threw it all up. :( I guess just like people, she doesn't want to stomach something that just made her sick a few days before.

She did eat a slice of lunch meat when I went home at lunch to check, so she could get a pain pill. And, I had some canned wellness she ate at lunch too... but, I hesitate to do canned food. Could be too rich. I didn't let her eat very much at all.

[judymaggie]

Hi -- a few suggestions - one is Royal Canin Gastro-Intestinal Low Fat canned food. My vet prescribes this for post-surgery pups as it is a very palatable, easily digestible food. Abbie absolutely adores it -- it is what I use to wrap all of her pills and also add a spoonful to her dry food.

Another thought is canned tuna fish (in water). I personally hate the smell of it but my Maggie loved it when she was reluctant to eat. You could also try cooked, lean ground beef.

If you are worried about Tobey not getting enough nutrients, you could get some Nutrical. It is a high calorie, nutritional supplement. It is a paste and I gave it to Maggie on a tongue depressor -- she would just scrape it off with her teeth. The color is a bit off-putting (looks like poop ...) but at least our pups don't mind that!

Good luck!

[molly muffin]

I think that Judy just covered my ideas. Tina uses ground lean beef for her Jasper when he is off, I use chicken with molly as that is her thing, she also loves rice and thinks it some kind of treat she is getting, but I can see where Tobey would be off that if she threw it up. Did you try cooking the rice maybe in some turkey broth to get it some flavor, that might entice her.
The nutrical is a good idea, for a nutritional supplement if she not into eating. Whether she'll take it or not with an upset stomach is hard to say.

hugs

[labblab]

Hey Renee, you might want to take a look at this article by Mary Strauss. It was really helpful to me when my Peg had her episode of acute pancreatitis.

http://dogaware.com/articles/wdjpancreatitis.html

As you'll see, Mary recommends low fat, moderate protein, and high carbs when a dog is first recovering from an acute attack. She suggests that potato -- either white or sweet -- are reasonable substitutes for white rice. You'll find a link in this article to another one that focuses on low-fat dietary guidelines and menu suggestions. Hope this may help!

Marianne

[labblab]

Wanted to add that I'd actually be leery of Nutrical in this situation. I just looked at the nutritional description and it appears to be very high in fat. The basic ingredients are all sugars and fats, I guess to pile on the calories. As Mary Strauss says, balanced nutrition is really not a big issue during these first days of recovery -- what you are seeking is bland, easily digestible, and lowfat. So I wouldn't worry so much about the full array of vitamins and minerals, etc.

[Renee]

Thanks for posting the article Marianne! I thought for sure that she would like the rice and boiled turkey, but she just does not seem to want it. I was thinking she didn't have an appetite, but after observing her more, I think it is the rice that is turning her off. I did add some broth to it, and the ground turkey... so I know it's enticing, she's just not interested.

I am going to try some sweet potato I think. Or maybe some pasta. The boys will sure be happy to take care of her rejected rice and turkey, lol. Figures I made a huge batch of it too.

I'm not too concerned about complete nutrition, and if I was, I have plenty of supplements on hand from when I was homecooking.

[addy]

Glad she is home and I know she will continue to get better with your loving care.

[Renee]

Okay, she LOVES the plain pasta and chopped boiled chicken. I let her have three small meals of it yesterday and she ate it right up. She ate it very well this morning too, so I gave her a half dose of her vetoryl (10mg). I can tell her cortisol has climbed, because she is back to drinking a lot of water, including getting up at night to drink.

If I had the money to waste, I would have liked to run a stim test, just to see how quickly her cortisol rebounded without treatment... but, after paying for a day and a half of emergency care and knowing she will need a stim in the next few weeks, I figured I better save the money.

[molly muffin]

Sounds like it was the rice that was putting her off. Just like us humans, we don't like what comes back up. LOL So glad you have found something that she likes and can tolerate. Awesome.

I know exactly what you mean. I tend to want to do tests to find out what is going on with molly but I've learned that I can't do that continuously. I have to pick and choose the best time to do what when. Frustrating! You know she isn't low, so that is the main thing. Hopefully she'll rebound to where she should be quickly.

hugs

[Renee]

Well, someone did not want to eat this morning. :(

She had a meal of noodles and chicken yesterday morning, so she got a half dose of vetoryl. Last night she ate noodles, chicken, and half normal food, so again, I gave her a half dose of vetoryl.

This morning - she would not touch the regular food, and only ate a bit of the noodles and chicken.

Water consumption is at full force unfortunately.

[labblab]

If you can possibly swing it schedule-wise, you may want to try giving smaller amounts of food at intervals throughout the day, rather than consolidating the food in two main meals. When recovering from pancreatitis, apparently it is easier on the organ's functioning if it isn't trying to process bigger meals. Dunno that you can arrange to do this, or if it will help with the appetite issues. But if Tobey is having an upset tummy again, temporarily easing the workload of the pancreas maybe will help a bit.

Marianne

[Renee]

Yes, I did give her some smaller meals throughout the day, but I am trying to get a full, or close to full, meal into her so that she can start back on her vetoryl.

I think I'll ditch the regular food and just go back to only bland for a bit. See if that entices her.

[Jed's Mom]

Your Tobey sounds like my Jed with her finicky appetite. What works one day will not work the next. Try grilling the chicken or a lean piece of beef and chopping it small. I find that sweet potato works better than rice. Jed used to love plain pasta but now he spits it out. Same with brown rice. Jed is also a competition eater so if he thinks my other V wants it or a cat, he is quicker to eat it.

I also find that that if I put it in his bowl he wont eat but he will eat it off of the floor of out of my hand. Sometimes I just feed him from the dinner table and he thinks he is getting my food. Its hard to believe he used to eat anything/everything..

[Renee]

Well, this morning she did eat chopped chicken and baby cereal (oatmeal). I should probably try sweet potato, but I have not made it to the store. I really just want her to get back on her regular food. :(

I am picking up some more pain pills for her today. I'm not sure if she's still in pain, but I wonder if that is what is causing her to not want to eat? She gets excited for the food, and looks like she wants to eat, but once I put it down, she only takes a few bites and then backs away. I can tell she's hungry though.

[molly muffin]

Does she eat if you feed her from a higher position? Sometimes the head down position works against them for food when they aren't feeling so well.
That's just a thought I had.

hugs,

[Jed's Mom]

Renee, Jed does the same thing! Wakes me up at all hours of the morning to eat and then a few bites, if that, and then walks away. I think he is holding out for something more tasty.

I give his pills with grilled chicken and some treats around 5am and I send him with a lunch to daycare. Some days he only eats half. For dinner we go through the same thing..he eats about half and then I mix in something else before bed to get him to finish. So instead of two meals a day he get 3-4.

[Renee]

Sharlene - we have always used elevated bowls, so I don't think that's the issue.

Not eating is not normal for Tobey. She loves to eat. Now, she won't gorge herself (the boys will :rolleyes: ), but she won't. It's weird seeing her not eating much or not being enthusiastic about it.

She did eat some canned meat and baby cereal for dinner, so I am glad about that. I have gone to doing a half dose of vetoryl, so that would be 10mg am and 10mg pm for her.

[Trish]

There's nothing wrong with her mouth is there Renee? Remember once Flynn looked like wanting to eat, but not keen and he had ulcer in there. Be worth taking a look. My other tip, if she can handle milk ok is to mix in a raw egg and warm it up... Flynn loves that when he is feeling poorly and laps it up. Hope Tobey finds her mojo and appetite soon!! xxxx

[labblab]

I know we are all assuming pancreatitis is the culprit, but perhaps there is something else that was the main cause or is also contributing. If Tobey doesn't perk up, you still may want to consider one of those cPL tests in order to get a more definitive diagnosis, or to have a measuring stick by which to judge her recovery. My Peg has had several done, so I can check the pricing and get back with you about that.

If it was/is pancreatitis, it can take a great deal longer than a week for gastric function to normalize. And "acute" pancreatitis can transition into "chronic" pancreatitis which can smolder in the background. So unfortunately, this may not be an issue from which Tobey has a quick turn-around. It may take time and some dietary tinkering to work things out. And even though most prescription foods seem to be made from horrible ingredients, in the short run, you may want to give one of the canned gastro-intestinal foods a try. Judy had written earlier that she has had good luck with the Royal Canin Lowfat GI canned food. Amazingly, sometimes the Rx foods are very appealing to dogs.

Marianne

[Renee]

Ugh. She threw up last night again. It was not food, just lots of thick watery fluid (like saliva). I could tell she was not feeling good. :( She only threw up that once and was restless for half the night. She is drinking a lot of water, thanks cushings! So, no dehydration going on. She was perked up this morning and ate more baby cereal.

Yes, the diet is an issue, because she wants to eat, but does not seem to like anything.

Marianne, I was just thinking I would maybe pickup some of the GI food, much as I shudder to think of feeding my babies science diet.

Sadly, her regular vet is on vacation until next Thursday, but I am taking her in at 9 to see another vet in the clinic.

[Renee]

Okay, left her at the vet. They are going to repeat bloodwork, run a cPL, and take abdominal xrays. Of course, when we arrived, she immediately acted all perky. :rolleyes: Whatever, she keeps getting sick, so I don't care if she acts fine now. She's not leaving until I have some better answers!!

[Squirt's Mom]

Tasha would do that, too! Act like she could hardly lift her head til we walked into the vet's office then she was as perky as could be! Of course, she loved them there. ;)

[Trish]

Oh yes, I have had that happen too... ring up all worried and make the appointment only to have him go all perky on arrival, does not usually last long though when they under the weather. Gosh, hopefully these tests lets you know what is going on with Tobey... feel better girl! xxx

[molly muffin]

Oh gosh, I hope they have some answers for you at the end of the day. I remember we had one of our cushing pups on the forum that got pancreatis and I think it took at least a month for her to get back to normal. She was also off cushings meds during that time. That must have been a year or two ago.

No, you're right if you are already using elevated bowls then that likely isn't the issue.

hugs

[Jed's Mom]

How's Tobey doing, Renee? Did the vet give you any answers?

[Dixie'sMom]

I popped in also to see how she was doing. I hope she is improving.

[labblab]

Me, too!!!

[Squirt's Mom]

Here, too!

[Renee]

Hey everyone!

She's actually taken a really good turn for the better, after spending the day with the vet on Friday.

Her lipase came down into the higher end of normal. Other bloodwork was unremarkable, much the same as before.

Xrays did show some inflammation of the intestinal tract, and a huge amount of bloat / gas. And, the stones are still in her kidneys (she's had them for years, although we have not been certain if they are stones or tumors). The vet decided to run a UA (I sure wish she had done a culture). The free catch of her urine had a good amount of blood in it, so she is thinking the acute pain from Thursday night is because one of the stones may have broken off and passed through, assuming they are stones. Otherwise, just a painful UTI. Tobey had bladder stones removed a few years ago, but vets won't cut into kidneys to remove stones. Sadly, the CT I paid for earlier this year was not focused on her kidneys.... but I am going to email the radiologist and see if she can re-examine the scans.

Anyway, she's taking pepcid (vet said pepcid AC was okay? I thought it was not?), tramadol as needed, and some abx. I will run a culture a few days after she finishes the abx. Also, she said not to start the vetoryl back until tomorrow. Boy, the cushings symptoms are back in full force. :( Panting, water consumption, peeing, nervous licking behavior, overheating.

[Squirt's Mom]

If memory serves, the AC is the only form of Pepcid that is alright for dogs. But please note that beginning phrase concerning memory. ;)

[Renee]

I can never remember if it's Pepcid or Pepcid AC that is recommended for dogs... but, either way, she's getting Pepcid AC.

[Renee]

Also, just emailed the radiologist in regards to her CT scan from earlier this year. I sure hope they can pull the slides and do some in-depth looking at her kidney's. I'd be tempted to do another scan... but, not sure I could convince hubby to pay for a second one!

[judymaggie]

Renee -- the box of generic Pepcid that I have for Abbie says:


compare to active ingredient in Original Strength Pepcid AC.

I always get the generic, famotidine, as it is much less expensive.

[Harley PoMMom]

Hi Renee,

I've not been around here much and just now getting caught up, I am so sorry to hear that Tobey has not been feeling well, that darn pancreatitis can be a bugger to calm down.

Famotidine is the active ingredient in Pepcid AC and like Judy, I always used the generic form. In time, though, my boy, Harley, started to get nauseated from the famotidine and I switched to slippery elm bark, which I really liked.

Hoping Tobey is feeling much better soon.

Hugs, Lori

[labblab]

I'm so happy to hear Tobey's doing better, and that there was nothing out of whack with her labs now that the lipase has returned to normal range. Obviously, something has shifted in a positive direction for the lipase to come back down again. However, just to file away for reference purposes, dogs can suffer from pancreatitis even without elevations in lipase. When my Peg's spec cPL was sky-high (confirming the acute pancreatitis diagnosis), her lipase was still in normal range. So if Tobey has future episodes like this, I believe I'd push for the cPL testing regardless of the status of the lipase. At this point, it probably makes little difference because she is improving and you've been treating her as though she had pancreatitis, anyway. But I think a lot of vets will automatically rule out pancreatitis as a diagnosis if the lipase is normal, and that's why the cPL testing is so valuable -- it can reveal another side to the story.

I'm really hoping that things will keep on improving from this point onward!

Marianne

[molly muffin]

Great to hear that Tobey is doing better.

Molly has kidney stones too. The only thing my IMS said could be done is a type of ultrasound to break them up and only a few places do them. No one in Canada where I am it does it. She mentioned a couple universities in the states. :(

Hopefully this will be behind Tobey and You now.

hugs

[Renee]

I am going to start back to her vetoryl tomorrow night. For reference - her dosing before this mess started was 20mg am and 20mg pm. I'm afraid to hit her all at once with the full dose, since I am certain her cortisol is high now and I don't want to make her crash.

I was thinking of doing 10mg am/pm for a week, then 20/10 am/pm for a week, then up to the full dose.

Has anyone done this, without benefit of ACTH in between each increase? I'm not sure how this works, since it seems most people only stop the meds for a day or two... and she's been off since 11/28. I already have planned to get her stimmed once she's been back to her full dose for 2 weeks, but given my planned dosing schedule, that would put her stim test 5 weeks out.

[labblab]

Renee, I think your plan sounds fine since all you are doing is gradually increasing her back to her original dose. I think you are approaching this very conservatively and I would not feel the need to perform any interim ACTH testing.

Marianne

[Renee]

Well, well, well you guys. Do I have some news for you!!

I had the radiologist pull Tobey's CT scan from earlier this year. When she had the scan, we were primarily focused on the adrenals, so there was not much detail into the rest of her abdomen. I asked them to reexamine the slides, specifically looking at the kidney's and bladder.

Here is what they wrote back:

There are two areas of focal calcification, caudolateral to the right kidney and lateral to the left kidney. There are also areas of minute calcification in the dorsal skin, sublumbar muscles, and blood vessels around the tarsi. There is a single 1mm calcified focus in the left ventral dependent urinary bladder wall, or less likely, the lumen. Multifocal mineralization soft tissues as described, likely calcinosis cutis related to cushings.

Does this mean... Tobey has CC internally around the kidneys?? What appear to be kidney stones on the xrays (which have been there for a few years) are in fact CC lesions?? This could be why all the UTI's etc, because CC is highly susceptible to secondary infection. Dang, I just don't know! I really wish I knew if she had kidney stones or if these are actually CC?

[Renee]

Vet appt tomorrow to get a culture done, discuss the updated CT results, and just general chatting. Tobey is up to her full dose on vetoryl (20mg x 2 per day), but symptoms have not fully resolved. She just started the full dose a few days ago though, so I don't expect immediate results. Will probably run an ACTH in a few weeks.

I am sad to say that some of her CC has erupted. Nothing like when she was uncontrolled, but I noticed that it came up and seemed a bit more inflamed than it was before. Amazing how sensitive her body is to cortisol in relation to the CC.

[molly muffin]

I wonder if it is a case of once sensitive to the possibility of cc then always sensitive to it.

It probably will take a bit of time to get the symptoms controlled again, but it's not like it was at the beginning and this time you know exactly how she reacts when to what levels.

I do hope everything is cleared up on the culture!

hugs

[Renee]

Update on the vet visit.

Tobey was all hyper (cushings) and running around, lol. Did the urine culture, which is being sent to the lab today. Hope to have results next week, but based on the free catch they did (after doing a cysto), she probably still has an infection. :(

ACTH scheduled for 1/2/15, which should put her at 3 solid weeks back on her regular dose.

Then my vet talked with me about a vet conference she just got back from. Seems that cushings was one of the panel discussions, and Tobey's case was discussed quite a bit, especially her CC. A few of the topics that came up:

1. Overwhelmingly, vetoryl is being used over lysodren, and compounding is becoming quite regular too, in order to cut cost. Most vets are still going with 2mg/1lb dosing. I made certain to tell my vet about Dechra's new updated protocols, and she said that when presenting Tobey's case, she discussed how we did the dosing. One of the vets asked her why we don't compound, but I don't feel good about that, so I am sticking with the brandname vetoryl.
2. The LDDS is the preferred method to diagnose. She said the panel was surprised when she told them that I opted for both the LDDS and the ACTH, as most people just don't do both. But I do feel that having a baseline stim test done before starting treatment is very helpful.
3. Vets still don't have a lot of experience treating cushings, because so many people are put off by the expense and opt not to treat. A lot of vets said they have patients that they suspect have cushings, but owners won't test.
4. Not one vet on the panel had heard about diluting and freezing the cortrosyn. Meaning, they are still injecting the dog with the entire bottle.

All of this just reinforces how very vital it is that we pet parents educate ourselves!! The vet's just don't know!

[labblab]

Very interesting, Renee. Thanks so much for sharing!!!

[Jed's Mom]

Hi Renee

after I overdosed Jed last week I decided to go the compounded route because Jed is on 50mg and rather than worry about screwing it up again I just thought one pill would be easier. I never thought that it would make a difference. Is there a downside to compounded vs vetoryl?

[Renee]

I think the downside is concerns that it is not as effective, especially if the pharmacy used is not compounding correctly. I believe a study was conducted that showed many compounded medications were not as effective.

Of course, a lot of people use the compounded trilostane with success. It seems there are a few trusted pharmacies (diamondback and wedgewood are the only two I see on here a lot).

My vet is personally not a fan of compounding either, unless absolutely necessary. If cost ever became a big factor for me, since Tobey goes through a box of 10mg per week, then I would need to look into compounded. But, for now, I am sticking with what is working!

[Jed's Mom]

Good to know. I have a local pharm where I get it from and it is actually more expensive than getting through Valley Vet but I hate shoving so many pills down Jed's throat and it alleviated the risk of me giving him the wrong amount.

Jed goes for next ACTH tomorrow so I will see what that shows but he has not been great for the last 2 weeks..appetite is not there but he also hurt his foot/toe so I was thinking it was more because he was in pain.

I will prob just go back to the vetoryl. I will tell you the two days after I gave him the wrong dose and we stopped his meds he was acting like old Jed. Lots of energy and eating great. These meds are really affecting him. I wish I could stop them but then I worry about his CC getting worse.

[Renee]

The price of cortrosyn has come down!

I'll be buying a 1ml bottle next week. It's $322.67 for the entire bottle. I'll get 4-5 doses out of that. :) I feel like it was much more expensive last time I purchased a bottle.

[Trish]

MERRY CHRISTMAS RENEE!!! Of anyone maybe you will have the white Christmas up in Alaska??! Hope you and Tobey and the gang have a lovely time xxxxxxx

[molly muffin]

Merry Christmas Renee and Tobey!!

Hope you are having wonderful holidays

hugs

[Renee]

I hope everyone had a wonderful Christmas! We had a very nice day, quiet and stayed home.

That said - 2 not so good things happened. Tobey had an isolated grand mal seizure on Christmas Eve. She recovered fine and is acting perfectly normal.

Then, her medicine (vetoryl) must have arrived after I checked the mail on Wednesday, because I just pulled the box out of the mailbox last night. That means her vetoryl was outside in 20-ish degree weather for 24 hours. Ugh. I tried calling Dechra, but they are closed until next monday. The box clearly says temperature sensitive on it too! I'll be contacting the post office, but I don't have high hopes they will care at all.

[Trish]

Hi Renee

Wonder what that seizure was all about, not related to her being unwell recently? Hopefully just a one-off that we see occasionally.

Frozen Vetoryl, hard to trust it after that happens if it is so temperature sensitive, do you have enough of old stock to last till you can contact Dechra to see if it is OK to use it? x

[molly muffin]

Crud I do hope that was a one off with the seizure. Don't want to get those going. She's never had one before?
Fooey on the meds in the cold. Hope it wouldn't hurt them as is the cold and not the heat. Cross fingers for that one

We had a quiet holiday at home too for Christmas Day, must say was nice after the hussle and bussle of the season.

hugs

[Dixie'sMom]

I'm glad you had a nice Christmas. It was so chaotic at my house I was ready to take the pups and go sit in the car. LOL. I hate that about the seizure tho. I hope everything is still ok now and you don't get any repeat performances. The meds... I never realized that there could be an issue with the temps. That's good information for us all to know. It will be interesting to see what Dechra says.

Hugs to you and Tobey. :)

[Renee]

Well, I caught my postman yesterday and asked him about the medication. Since it's marked temperature sensitive, fragile, and urgent - I asked why he didn't bring it to the door. Of course he said that since it's so busy from the holidays, they don't really look at the packaging or read anything other than delivery address. If the warnings on the box had been in bright red or something else (just black lettering is on the package) he may have noticed it. I can try making a claim at the post office, but I have to prove damage. He also said it's likely the medicine is outdoors at the airport while it's being transported anyway.... so, it was probably subjected to cold temps before it even made it to my mailbox.

UGH.

Then, to top this all off, Tobey broke off a tooth last night. :( I'm guessing a dental is going to be needed.

Bah humbug!

[Trish]

Well I wonder what happens to everyones drugs over winter as I would imagine they would all spend a bit of time in the cold in transit, be interesting to hear what Dechra say about it when you can get hold of them after the holidays.

Oh no, a cracked tooth, poor Tobey she has had enough on her plate lately without this new problem!! I remember ages back when Flynny cracked one they did not need to take it out unless more than a 1/3 (???I think) was broken off or if it was obviously exposing a nerve and causing pain. x

[molly muffin]

Molly has a chipped tooth at the back, we're just watching it, but doesn't look like anything exposed. If the area were to turn red and look angry then would have to do something but just a bit cracked off it looks like. It's been that way for awhile.

I Think heat would be more of a danger to drugs than cold but I don't know, so I too will be interested to see what they say.

[Renee]

Dropped Tobey off for her stim test today. Lord, she was hyper. :rolleyes:

I wasn't able to talk with the vet when I dropped off, so I will catch her when I pick back up. I need to talk about the broken tooth and her seizure.

Then, I was reviewing the bill estimate, and for the first time ever, they are charging me $26 for a 'hospitalization' for her stim testing. Really? I spend so much money there; not only for my dogs, but nearly 100 rescues a year as well. I am cranky to say the least about that.

[judymaggie]

Renee -- I totally share your dismay about the "hospitalization charge". My vet charges me $29 for a "half-day" --- wonder how two hours translates into a half day ... I haven't questioned it but it does bother me. Between Abbie and Maggie's medical issues, I have definitely paid for a couple of years of college for one of his kids. I hope Tobey's test results are good!

[Renee]

We found which tooth was broken off, and it's one of the front ones on top. The tooth looked pretty dead anyway and does not appear painful or anything. Given what's been going on with Tobey the past month, my vet is not comfortable doing a dental anyways, unless it was an emergency. We are going to re-evaluate in 6 weeks. Nothing to do about the seizure, so we just recorded it in her file and will continue to monitor. I know seizures can happen randomly, but I'm also watching for any signs of her tumor becoming a macro.

I did say something about the hospitalization fee, and they waived it. I don't know if they will in the future, but it irritates me that I was charged $26 for her to be there an hour. Damn, the freaking acth alone is $265 -- can't they eat the cost of cleaning her kennel?

So, I bought the entire bottle of cortrosyn today, and my vet followed the dilution protocols to get 5 doses out of the bottle. It's good for 6 months. Unless I get a stim test every 6 weeks, I will be wasting at least some of those doses. I am so frustrated by this stuff right now. :mad: My vet does not have any other cushings patients, so I can't share the cost of it either.

Boo. 2015 is not starting off very well!

[molly muffin]

What did Dechra say about the medication being in the cold?

I know that is frustrating. There is always something it seems and definitely times when it is so frustrating to look and see additional charges tacked on to the bill, which is already so high. :(
I've been looking for ways to try and keep the costs down too, but it's not easy when there are some things that have to be done, like the tests. :(

I figure the whole industry, from the vets, specialists, pharmacuticals are making a fortune off pet owners who are just trying to do their best for their animals.

There was an article in our local paper the other day about how much would you spend on your pet and for what kind of things. The majority of people will spend thousands on their pet's health and accessories from pet stores for them. So, if you figure the majority will if they can, and it's an unregulated industry, in that they can charge whatever they want, then most probably do so.

Not the way I want to start out the year either. Molly has a back tooth that is chipped that we are keeping an eye on. It doesn't seem to bother her, but they don't want to put her under anesthesia if not absolutely required either.

Hoping to hear good results on the tests!

[Renee]

Stim results are perfect!!

Pre 2.3
Post 4.0

I'm very happy!

[Squirt's Mom]

Good news!

[labblab]

Renee, that is SUPER good news!! :) :)

Hope it helps make up for some of the aggravation you've been saddled with!

Marianne

[Harley PoMMom]

Oh Renee!! Those ACTH stim numbers are great!!