View Full Version : Pheobe 11 year old Shar Pei in Moscow, Russia - Phoebe has passed away
camaeljax
12-29-2013, 11:42 AM
My name is Mark. I am a 39 year old American citizen and navy vet living with my wife (a Russian citizen) in Moscow, Russia for 12 years.
We have a 12 year old female Shar Pei, named Pheobe. She is an excellent and intelligent dog, very loving, very obedient, and has never had any significant health problems till now. We have been blessed, I guess.
About a year ago she started to put on weight and lose a little hair. While we thought it just might be old age setting in, I did a little research on the internet, and though it might be Cushings. Last April we took her to the vet. The bloodwork came back negative for Cushings, so the vet started us on a 3 month course of medicine for hyperthyroidism - which had no response.
After that we frankly neglected her. We got caught up in our lives, I forgot about the Cushings I had read about, and just justified away the symptoms as 'old age' and that there was 'little we could do'. Retrospectively, the symptoms started building up slowly but steadily over the last half a year.
She started out at about 21kg and is now heavy, pot bellied and at 30 kg. She has lost some hair on her belly and shoulder blades (I explained it away as the harness we used in place of a collar for her). The rest of her coat is now dull with frequent dandruff and some slight scaling on the legs. Over the last about three months she has had a voracious appetite. For the last month and a half she has been drinking water excessively (explained away as due to the typical Russian overheated apartment in the winter which makes me dry and thirsty as well). For the last half a year she has been slowing down (explained away as old age) and no longer able to go on hikes outside our neighborhood. For the last couple of months she started to be reluctant to go on our normal neighborhood circuit walk (explained away as combination of old age and Russian winter - who wants to be outside much?).
Then very suddenly just ten days ago her rear legs stopped holding out and she couldn't walk. It was so sudden. One day fairly ok. Next she couldn't walk - and hasn't since. Her belly skin is also now suddenly very fragile and carrying her up and down the three flights of steps to go to the bathroom outside has given her some skin tears that aren't healing very well. I thought at first that she had torn an ACL ligament from jumping off the bed.
Two days later we were able to get her to the vet and the bloodwork did come back positive for Cushings this time, of course. The bloodwork results were not extremely bad however the vet said. Ultrasound said it was of the pituitary sort rather than the adrenal.
We started her on a course of Trilostane capsules on Tuesday evening (five days ago) - 1 capsule twice a day for the introductory week. We also discussed that after a month of treatment we would likely begin a course of radiation treatment for the pituitary gland.
Three days ago, she started to lose fine control of her front legs as well. She no longer sits up at all, can only lie flat.
She still does not urinate or defecate in the house at all. She is a very good dog and would be horrified and doing that in the house. She holds it until we take her outside and releases it right away, lying flat. Meanwhile I am lugging a 30 kg shar pei up and down three flights of steps 4 times a day, trying not to injure her skin in the process. She still wags her tail energetically whenever she sees us and responds to our treatment of her belly skin tears, almost purring in the throat the way she does to show contentment. Poor thing, its breaking our hearts.
Last night we noticed that she definitely has diarrhea. Last night for the first time she was also reluctant to eat and this morning didn't eat at all. She is still drinking water. We will contact the vet today and see if we should take her off the Trilostane because of the negative side effects or bring her in for more bloodwork.
We were so hoping that somehow the course of Trilostane and then the radiation treatment might somehow rejuvenate her and she might start to walk again and live another couple of years. I haven't found any discussion of that on the net, however.
We have at this point lost hope and I am afraid we are going to lose her. She has always been a very dignified dog, who loved to run and scout, and would go trekking with us all over the world. I keep hoping she might respond - but don't want to keep her alive undignified as a vegetable as she loses the will to live.
goldengirl88
12-29-2013, 12:02 PM
Welcome to the forum. Please do not lose hope as that is all Cushings parents have to keep going. First off any time your dog is sick, stop immediately giving the trilostane. I am concerned your dogs cortisol had dropped to low. What milligram are you giving and how many a day? You would want to get your dogs electrolytes checked if the cortisol went to low do you have any prednisone to give? If not you need to get your dog seen at the vets. Sometimes dogs have a reaction to too much trilostane. That is why you should start out low and be careful. No more than 1mg per pound. The symptoms you described to me are overdose symptoms so again you need to get your dog seen asap. As far as the skin on the belly tearing open this could be CC. You can read about it on here, as many of the dogs suffer from it. Dawn and Buttercup on here have a lot of documented pictures in their album for you to look at. My dog does not have it, but from what I understand you need to address it asap. I am hoping you can get a Dr. in over there and have your dog seen. His cortisol has probably dropped to low and he cannot get up or stand. This can become an emergency situation so please take your dog to the vet. As far as the hind leg weakness many dogs on here experience it because the high cortisol wastes muscle. Once your dog gets on the correct dosage these symptoms should start to correct themselves. Do not give any more trilostane when the dog is not eating, vomiting, can't get up, diarrhea, lethargy. The best rule is do not give a sick dog trilostane. I admire your courage in trying to help your dog. We will guide you on what to do, so please do not feel alone in this anymore. We are here to help you get through this. Blessings
Patti
labblab
12-29-2013, 12:05 PM
Dear Mark,
Welcome to you, your wife, and Phoebe! Although I am so sorry to hear about Phoebe's problems, I am really glad you've found us. It does sound as though you are at somewhat of a crisis point, so I surely understand your worries and your urgency re: obtaining some answers.
Right now, one of the biggest challenges likely will be trying to sort out whether her new immediate issues are medication side effects vs. symptoms of disease progression. My first question for you is, what dose of trilostane is she taking? The extreme immobility, diarrhea, and loss of appetite could all result from a cortisol level that has dropped too low, even after only five days on the trilostane. Since this poses a life-threatening risk, you will likely be instructed to wihhold any more trilostane until monitoring blood testing can be performed (ACTH stimulation test and basic blood chemistries -- most importantly, potassium and sodium levels). Not only does trilostane lower cortisol, but it can also lower aldosterone which regulates the appropriate balance of potassium and sodium in the body.
If it turns out that the trilostane dose is too high, then it is possible that she will respond more postively once an optimal dose is determined. And it can be amazing to see the improvement that can be achieved in many dogs once cortisol levels are consistently maintained within a therapeutic range.
However, if Pheobe suffers from a pituitary tumor as is currently suspected, it is also possible that the tumor may be enlarging to the extent that it is placing pressure elsewhere in her brain and causing additional neurological problems (such as loss of appetite, mobility, confusion, etc.). If that is the source of her current problems, then it is true that radiation therapy aimed at shrinking the tumor may be her best hope for improvement. We have had members who have proceeded with such therapy, and we can talk about that some more in another reply.
But for right now, I think the critical issue is determining whether or not she has dropped into an Addisonian condition as a result of a trilostane overdose. And as I say, that will necessitate evaluation by a vet.
Please continue to update us, as we shall be very anxious to hear how she is doing.
Marianne
Squirt's Mom
12-29-2013, 12:12 PM
Hi and welcome to you and Pheobe! :)
We are a Lysodren house so I will let those who use Trilostane (Vetoryl) talk with you about dosing etc.
I will tell you to STOP the Trilo for now. It does sound as if she is on a dose that is too high for her and causing the cortisol to drop too low - which can be life threatening. Get her to an ER vet if she does not improve soon.
Trilo has a very specific protocol and the timing of the monitoring tests is critical for this drug. Giving the med at night will require your vet to be available during the night time hours to do the ACTHs for monitoring. The ACTH MUST be done 4-6 hours after the last dose. So it is usually more logical to give the med in the mornings since most vets will not come it at 3am to perform an ACTH. ;)
It will help us a great deal if you could get copies of the tests done to diagnose the Cushing's and post the actual results here. Also any tests that show things like ALT, ALP (ALKP), BUN, CHOL, etc. would be beneficial.
This is a scary disease but you are not alone any longer. We will be with you all the way. Never hesitate to ask question, vent, anything - we are here to help in any way we can. I'm glad you found us and look forward to learning more.
Hugs,
Leslie and the gang
molly muffin
12-29-2013, 12:36 PM
Hello and welcome to the forum.
In addition to needing to know how much trilostane is currently been given (do not give any more at this time), do you have copies of the tests used to diagnose cushing as positive and the ultrasound results. You should be able to get a copy from your vet. This would be of great help to us in helping you.
It sounds like Phoebe's condition is very worrying, in that she has no ability to stand currently or walk. So we need to get to the bottom of why that is happening. Muscle wasting can occur from too much cortisol (uncontrolled cushings) but lethargy and weakness can occur from not enough cortisol, which is what the medication is used to control. So, important that this is sorted out.
As was stated earlier, you need an electrolytes test and and ACTH test to determine current levels. This can be treated, but is an urgent issue to address.
This should get you started on trying to sort Phoebe out and hopefully help her to get back to a normal life with you and your wife.
Sharlene and Molly muffin
camaeljax
12-29-2013, 02:43 PM
Our vet has advised us to stop the trilostane for a couple of days until the diarrhea stops and she starts to eat again. She was being given 30 mg of Trilostane twice a day, in the morning and evening with food. (30 kg dog, 2 mg/kg of weight). After her appetite returns we are to continue with half of the original dosage.
Our vet says that as Pheobe is still responsive and thrashing about occasionally trying to move - that this is a good sign. If she stops being responsive and moving about, we are to bring her in immediately.
Spacebo bolshoe (thank you very much) to everyone for the kind words, sympathy, and advice. Almost everything said confirms with our conversation with our vet. I will keep updating the situation and listening to your feedback.
Best regards and Happy Holidays,
Mark, Elena, and our Pheobe
goldengirl88
12-29-2013, 03:48 PM
Mark:
I am so glad you talked with your vet. I wanted to tell you that if you keep a daily diary on your Phoebe it will be easier to reference things that have happened. I would just keep a close watch on her even though she is off the trilostane for now. I am curious, is the trilostane expensive over there? I hope this gets your Phoebe feeling better. This disease is manageable once your dog gets on the correct dose. I will pray for your sweet Phoebe. Blessings
Patti
Renee
12-29-2013, 03:57 PM
Welcome to the forum. I am glad all the very knowledgeable people have stopped in already! The people on here are invaluable.
I agree with everyone else on stopping trilo, and I am glad your vet confirmed as well. Your pup may be especially sensitive to the medication. If she's 30kg, then that is actually 66 pounds, in which case 60mg per day of vetoryl does follow the dechra protocol.
That said, my pug just started vetoryl a week ago, following the dechra protocol, and her cortisol has dropped significantly. Each dog is different.
goldengirl88
01-04-2014, 08:55 AM
Just wanted to check in with you and see how things are going with your Phoebe?? Hope all is well and that she is feeling better now. Take care and Happy New Year to you and your family. Blessings
Patti
doxiesrock912
01-04-2014, 09:14 AM
Mark,
I'm so glad that your vet has the proper knowledge of Cushings. So many of us have had issues with vets not knowing enough.
2mg is likely to be too high on the Trilostane. As others have said, the best place to start is low and work up from there. Sometimes it takes a bit for the dog's body to acclimate to the medication too.
Please keep us posted on Pheobe's progress. You might also want to read some of the posts under the helpful hints section of this forum. There is so much information there.
Once the correct dosage is determined, you'll be amazed St the results. Don't give up but DO remain vigilant and educate yourself.
You are Phoebe's best weapon against this disease.
camaeljax
01-07-2014, 08:26 AM
I want to thank everyone for their advice and kind words.
Unfortunately Pheobe passed away on Friday January 3rd. At least she died at home, laying in the foot of our bed where she usually slept, quietly, with my wife cradling her (I had fled sobbing to the next room), as the last breath left her body and her eyes closed for the last time.
Regards the medical end: After stopping the trilostane treatment, her bloodwork just 24 hours later came back with normal cortisol levels, and no sign of serious adverse reactions to the trilostane. She maintained responsiveness, drinking water, and wagging her tail to the end. However - she never regained any control over her legs, she had labored breathing, she stopped eating for the last four days (we were force feeding her a liquid diet by bottle), and in the last two days even started losing control of her urine inside occasionally for the first time. Our vet shifted priority focus from the cortisol levels to the supposed pituitary tumor and we were awaiting an MRI to confirm this and begin radiation therapy to reduce the tumor - however we were delayed because most of the vet clinics in Moscow had reduced facilities due to the long Russian state holidays from New Years through Orthodox Christmas. We were about to begin antibiotic injections on the vet's orders to try to reduce the tumor swelling in the meantime, but she died that day before we could begin them. Although there was no autopsy and thus no conclusive diagnosis, the presumed cause of death was pressure and complications from swelling of the pituitary tumor from the Cushings. Our vet had followed the standard Cushing's playbook nearly to the letter and we place no fault on her. Our little girl's life just gave out.
Pheobe was cremated the same day. We of course were utterly devastated. She was the living soul closest and dearest in the world to me and my wife other than each other.
But as an epitaph we believe in mourning and then moving on and starting a new chapter (from my facebook post):
https://www.facebook.com/gramsci/posts/10151981254204425
Bo's Mom
01-07-2014, 08:44 AM
I am so terribly sorry to read about your dear little Pheobe. May she rest in peace and you and your family find the peace and comfort in the days/months/years ahead.
She is now among all the others who joined her at the Rainbow Bridge. Run Free Pheobe.....
labblab
01-07-2014, 08:50 AM
Dear Mark,
I send my deep sympathy to you and your wife upon your loss. But thank you so much for returning to tell us what has happened, so that we can join you both in honoring Phoebe and all that she has meant to you. Pheobe has now been added to our special memorial thread:
http://www.k9cushings.com/forum/showthread.php?t=5973
You will see that another one of our dear ones made her passage on the very same day. So now Phoebe and Cheza are companions of the spirit, just as are all our pups who preceded them (and also those who will follow). It is indeed a cycle and a circle of love and devotion. For that reason, I am touched to know that two other girls will now be joining your lives. I have an inkling as to how that feels...I thought it would be months before my heart would be able to make room for another after my own Cushpup passed, but it turned out that my husband and I could only last for 8 weeks before our empty house was filled once again with life.
Best wishes to you all, and please feel free to continue to stop by at any time to check in with us and to tell us how you all are doing.
Sending many hugs,
Marianne
camaeljax
01-07-2014, 09:10 AM
Thank you.
After a sudden two week descent and fight with Cushings Syndrome, our beloved shar pei and companion, Pheobe, the living soul that was closest and dearest to us in the world has passed away at home, where she loved to sleep at the foot of our bed, still wagging her tail, with my wife cradling her body as she breathed her last quiet breath (I was sobbing in the next room). She was almost 12 years old.
Pheobe had a good life. She was the 'cat-conqueror' (Koshkadav) of her home neighborhood of Tsaritsino in Moscow, she played with foxes in her backyard London for a few years, and hiked with us through the wilds of Russia, Scotland, and Norway. She was so good, kind, and obedient - the best dog in the world. She walked always without a leash and scouted the terrain and path just ahead of us.
Where ever she is now, that's what I like to think she's doing, looking back, head cocked, over her shoulder just waiting for us slow humans to catch up with her over the next hill.
We'll be along presently...
Until then, when we see you again, rest in peace, Pheobichka (although you were never one for resting), you will be lovingly remembered and so sorely missed. We love you always and forever...
- Mark, my wife Lena, and Pheobe's surviving chow chow "sister" Phedre...
goldengirl88
01-07-2014, 09:14 AM
Mark:
I am so sorry for you and Lena. You have endured a terrible loss, but I hope sweet Phoebe is running free and not in pain anymore. God Bless You Both and your sweet Phoebe in heaven.
Patti
labblab
01-07-2014, 09:46 AM
One of our dear members here, Saskia, introduced me to this wonderful descriptor: a "dog-worthy" life. I think it goes without saying that Phoebe's life was one that was abundantly rich and exceedingly dog-worthy. :o
What you have written conjures up such striking images of your beautiful, brave, faithful girl. I know you already miss her profoundly. If only our human relationships could be so perfect and so true as are those of our dog companions.
Fare thee well, Phoebe, on your new journey. I'll bet my own boy is right beside you now, sniffing the air and eager to head on down the path together.
Marianne
molly muffin
01-07-2014, 12:39 PM
I was sorry to hear of the loss of your dear Phoebe. It just all seemed much too soon. I know you will miss her dreadfully.
It is nice to know that you are opening your home and hearts to some new family members though. It is obvious that they, Freyja and Gerdr, will be joining a wonderful home with much love and adventures awaiting them.
Sharlene and Molly Muffin
Renee
01-07-2014, 01:14 PM
Sending my condolences on Pheobe's passing. I am so sorry.
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