Another newbie, my Hallie, SARDS (Hallie has passed)

[HalliesMom]

I am so glad to have found this forum. I have read quite a bit and not only is there a ton of great information, everyone here seems SO nice and knowledgeable (although wish circumstances hadn't been for all of you to have to be). :(

My daughter is an almost 14 yr old rescue longhaired doxie named Hallie. 3 years ago she went blind overnight to SARDS. She has now also been deaf for several months. SARDS dogs as many of you probably know are also sky high risk for cushings (and kidney failure etc). So I've been worried all this time and seeing what I saw were some signs but of course vets etc said I was over-reacting since nothing was showing up on the her levels (until now).

I am afraid I don't have any copies of her tests handy I will be getting them but don't have them yet.

This all started with elevated liver levels, and now hypercalcemia, worsening liver levels, etc. She was getting UTI's also. She has had 2 ultrasounds and liver biopsy (which was normal) they did see a small nodule on one of her adrenal glands but at the time were not too worried about it.

Her symptoms right now are:

* Increased drinking and urinating (but not by a ton)
* Balding down her back and a bit on her sides
* Panting (I hate that one, anyone know just what causes this?)
* Gets hot easily
* Appetite "may" be increased....she is a dachshund so always hungry anyway.
* The worst one is she gets restless/anxious and will wander and bark for me...I am hoping this might be at least partly caused by cushings (which hasn't been confirmed yet) as it's exhausting for us both she can't settle and get a good rest until night time and does have a morning nap but breaks my heart to see her anxious. I know this may be doggie dementia and with her being blind and deaf also, makes it so much worse for her but am hoping some of it is cushings related so if we treat her, hopefully can help that some. Have any of your dogs experienced this?
* Snores/breathes louder then usual which I have read on the forum here has happened to some of your dogs also?
* Lethargic/weak. Notice muscle wasting. Doesn't want to go on walks etc.

We have done blood and urine tests and a month ago she had the 8 hr dex suppression test which did not point to cushings. But then she had a urine test since (sorry can't remember what they called it) that shows her cortisol levels are elevated, so cushings is not off the table (and I can't imagine it's not). So with the conflicting reports we are repeating the dex suppression test on Wednesday (thankfully my vet lets me take her home in between blood draws so she is only there a few minutes 3 times).

We have been to an internist already whose first suspicion was hyperparathyroidism due to what he thought were her lack of cushings symptoms (to me the symptoms were big and glaring but I guess he sees dogs a lot worse). But he now is thinking more towards the cushings.

We have worked with a holistic vet for 2 plus years also and with specialized organic diet, herbs and supplements, have gotten her off all of her tummy and allergy meds (she has always had a sensitive tummy and seasonal allergies she was getting immunotherapy shots every 3 weeks for all of her life) and she is doing tons better off the meds now than she was on. She is currently on adrenal strengthening herbs which I know won't cure or fix her but am hoping maybe they have at least kept the cushings symptoms in check so far.

Like I'm sure most or all of you, am terrified at this point and really afraid of the addisons crises if we do find it's cushings and treat her (it would be trilostane). But I am also hopeful if it is cushings (which again I am already convinced it is...diabetes and thyroid have been taken off the table and cancer is not likely as her appetite is so good etc) I may get some of my happy girl back. The blindness and deafness is enough to expect her to go through. :(

I guess what I'd love to hear from you at this point is how much of an improvement could I hope to expect to see in her if treated? This has come on fairly gradually and I have just been resigned that we won't be going on walks (even though I try every day) with her anymore, and I'll have to watch her struggle with these awful symptoms.

Also how often do you hear or experience the addisons crises? Is it easy enough to see the symptoms (for those of us, which I know everyone here is also or you wouldn't be here, that are super vigilant and neurotic about our kids so you watch like a hawk)?

And I imagine who you choose to have treat your dog is very important....our local vet said she would not suggest treating Hallie with her level of symptoms (although they have gotten worse since she said that) because she has treated only 3-4 cushings dogs and one did go into addisons crises. Another vet I talked to said something similar. But the internist we saw says he treats "many many" cushings dogs and has not lost one to the treatment since using trilostane and he attributes that to "scaring the owner enough to really watch the symptoms and educating them on it" (which is fine with me! I'm already terrified). So am guessing it would be best to have him oversee but also use my local vet for lab work, etc since she's right here and he's over an hour away?

I hope the fact that Hallie has SARDS and thus compromised immune symptom won't work against her too much with this darn cushings thing.

If not treated I understand all kinds of bad things will happen so I feel I would need to do it....?

Thanks so much I apologize for the long post I have gone through 3 time and cut as much as I can. :o

[addy]

Hi and Welcome,

I am sorry to hear about Hallie's problems but I am very glad you have found your way here.

From what I know about Sards, some dogs will exhibit Cushing symptoms but not have the syndrome and some dogs will go on to be diagnosed with Cushings.

I think the urine test your are referring to is the UC:CR- it can either rule out Cushings or indicate further testing is needed. It cannot diagnose it. The thing is, the tests for Cushings can be thrown off by non adrenal illnesses.

With the issues Hallie already has as well as a possible Cushings diagnosis, if you can manage having the specialist handle the diagnostics and treatment it would be the better route to go.

I will post some info given to another member regarding Sards:


SARDS (Sudden Acquired Retinal Degeneration). Here is a link that will explain a lot more about this syndrome:

http://www.eyevet.ca/sards.html

As you will see, dogs suffering from SARDS may exhibit a number of symptoms that overlap with Cushing's. Some dogs with SARDS will ultimately be diagnosed with Cushing's, as well. However, this is not always the case, and indeed seems unlikely for Dandy since his UC:CR urine test was "negative" for Cushing's. Unfortunately, the blindness is permanent in all cases. However, for dogs who suffer from SARDS alone, the symptoms other than blindness may actually resolve given some time. For dogs who also suffer from Cushing's, the other symptoms do not resolve without treatment.

We do have other members here with dogs who have been diagnosed with SARDS alone, and also with the SARDS/Cushing's combination. If you utilize the "Search" function for our forum and type in "SARDS" as the keyword, you should be able to locate many of these other members. Here's a search hint, though: request the search via "Posts" rather than "Threads," and it will be much easier for you find the specific replies that contain discussions of SARDS.



I am sure others will be along soon. Sorry this is short, I'm about to run out. I'll be back in a bit. Perhaps we should add Sards to your thread title.

[HalliesMom]

Thank you so much!

I tried to add SARDS to my thread title but didn't see how :o or does the moderator have to do that?

There is a SARDS researcher at Iowa State University who has had success in restoring sight to SARDS dogs (Dr Sinsini Grozdanic) but it has to be done right away. When Hallie was first diagnosed, we flew out to see him (we live in Washington State). But he was out of town for 3 weeks campaigning for grant money for his research, so it was 3.5 weeks between her diagnosis and when he could see her. Her retinas were still normal when she was diagnosed, so she could have been helped then but by the time we saw him, her retinas were the worst he'd seen he said, full of holes and detached in several places. So it was too late. The treatment is very risky at first (human immunoglobulin therapy, they are in ICU closely monitored for a few days) and then the dogs have to be on a very low dose of pred for the rest of their lives, so it may have been for the best although I have heard of dogs living just fine with it and keeping their eyesight (some do lose it again).

Hallie was lucky in that she had no cushings syndrome symptoms prior to going blind like most do. And seemed to be dodging that bullet until now. He also said that the most likely dogs to get SARDS are dachshunds, spayed females with allergies all of which she is. (In fact there were 3 dachshunds in the waiting room in Iowa when we were there with Hallie waiting to see him with SARDS.)There is also a hormone therapy being done with some success with SARDS dogs but I think all of it is a bit risky and very controversial.

I am sure that urine test you mentioned has to be the one just done on her. I get all the info so far over the phone so am not retaining what these tests are all called or the results but will get copies hopefully on Wednesday when they redo the dex suppression test.

Thank you again for taking time to respond!!

edit: I searched the forum for SARDS and saw Dr Grozdanic mentioned, I agree with what was said that his protocol must not have panned out as well as hoped as I also have not heard a lot about it since we were there. A real shame as it would have been great to have some hope for the dogs stricken with this.

[addy]

Ahhh- title already changed!!:D:D:D:D:D:D

My pup started to lose her hearing just as we started treating her Cushings. The following year she developed multiple eye issues. I remember how hard that was for me to accept. Sometimes we are bothered more than the pups are.

We see quite a few doxies with Cushings so I am not sure why they are prone to both Sards and Cushings. I know our state university was doing research on SARDs as well. I'm so glad you were able to utilize Iowa. So much more research needs to be done to help pups with SARDS.

I think you need to confirm you are dealing with Cushings now with the specialist. If it turns out that is indeed the case, treatment is nothing to fear. My girl was on Vetoryl (Trilostane) for almost three years, diagnosed with Cushings for four years. She passed away in February. She threw multiple blood clots. Zoe had many, many issues.

Knowledge is power and you are doing great in that area!!!!

[HalliesMom]

I am so sorry to hear about Zoe. :( Not fair they have such short lives and often, have so many illnesses while they are here. Not many are as lucky as Zoe and the other pups here with great parents though. February wasn't very long ago I'm sure you are still hurting a lot. I am glad to hear she did well for 3 years on the meds!

I hear you, the blindness and deafness was hard to deal with at first, and I'm really sorry you had to experience it too with your baby. But they always show us it's not as bad as we think it will be. Wish we could be more like them. As upset as we get when they come down with something, when they get the next one we wish they "only" had SARDS....or allergies....or whatever they started with.

Thank you for who adjusted our title!!!

[Mackenzie]

Hi Hallie's mom,
I don't have anything to contribute re the Cushing's issues since I am new here too and am just starting to learn about it all, but I just wanted to say that I visited your web site and I love both your art and Hallie's! What a fantastic dog you have :) Very inspirational.

[molly muffin]

Hello and welcome to the forum.

First I agree, love your website, beautiful work.

I also agree with Addy. I'd go with the speacilist and get a confirmed diagnosis of cushings and then go from there. Remember to start at the 1mg/1lb dosage, whether that is once a day or twice a day and twice might be better in the long run as you can tweak it a bit if needed. (that is a divided dosage so the total is 1mg/1lb).

Knowledge is the most important thing when dealing with cushings and I'd go with the specialist who has experience and hasn't lost a one. That is a good record and hopefully means he follows protocols and is familiar with the medicine.

SARDS, is hard, but I do think sometimes the dogs adapt better than the humans. We have a member who has rescued a couple blind furbabies and they are all doing very well with their loss of site. Luckily their new momma is pretty good at dealing with it too. :)

Looking forward to seeing what the test show.

Sharlene and molly muffin

[HalliesMom]

Thanks McKenzie, she has taught me a lot about acceptance and not letting anything stop you. :) Good luck to you with your journey also it's no fun but good to have someone going down a similar path with you.

Thank you Sharlene. I will go with the internist then. I will also get Hallie's previous results tomorrow when we go in for the repeat LDDS and results of those as well. Very thankful for you guys here.

[molly muffin]

We'll be here waiting and can go over any previous testing abnormal values if you post them with the ranges.

Sharlene and molly muffin

[HalliesMom]

Thank you so much!

[HalliesMom]

Hallie is having her 2nd LDDS today. She's had 2 draws so far we have one to go in a couple of hours. (they let me take her home in between so she is snoozing in her bed here).

I got copies of her previous reports and wanted to post them to see what you think. Also if I didn't mention it already, Hallie is a longhaired dachshund, almost 14 yrs old and weight hovers between 11.5 and 12 lbs.
Thank you so much!

May 20 - Hypercalcemia of Malignancy Profile
Parathyroid Hormone - 2.50 (Reference Range: 0.50 - 5.80 pmo1/L)
Ionized Calcium - 1.59 (Reference Range: 1.25 - 1.45 mmo1/L)
Parathormone Related Protein - 0.0 (Reference Range: 0.0 - 1.0 pmo1/L)

June 6 - LDDS
Cort 0 hr - 5.4 (Reference Range: 1.0 - 10.0)
Cort 4 hrs - 1.2 (Reference Range: left blank but below says this is inconclusive)
Cort 8 hrs - 1.1 (Reference Range: 0.0 - 1.4)

June 29 - Urine Cortisol Test
Urine Cortisol - 14.6 (Reference Range: -ug/dL)
Urine Creatinine - 64.8 (Reference Range: -mg/dL)
Urine Cortisol/Creatinine Ratio - 70 (Reference Range: - left blank)

[Harley PoMMom]

Could you edit your post and add the reference ranges for those values, thanks!!!

[HalliesMom]

Sure, I just added them (although not all were listed).
Thank you!

[HalliesMom]

Hallie was finally diagnosed with cushings. :( I was sure she had it just waiting for the vets to figure it out. She is being started on 10 mg trilostane for 3 weeks, we are waiting for ACTH test and blood calcium results (she may also have hyperparathyroidism).

I am a wreck of course watching her like a hawk. My questions are, would she be more likely to go into an Addisonian crises during this lower dose phase or once levels are raised?

Also how long at this dose before I might see some improvement in her?

She also has been having a lot of GI issues, (mucous stools, lots of gas etc. She has had this before but changing her to homemade diet via holistic vet 2 years ago cleared her up completely. now it's back and I don't know why as it started before we started the trilostane). Can anyone give me advice on what kind of tummy meds are safe for an older girl on Trilostane? I can and will of course call the internist about this but thought I'd ask here as I'm sure some of you have been through it with your babies too.

Thanks!

[labblab]

Hi Dee Dee,

You'll see that I've merged your newest post into your original thread about Hallie. This way, it will be easier for us to review her entire diagnostic and treatment history. And if you have a chance, it would be great if you'll post her LDDS test numbers, as well as any other information that helped finalize the Cushing's diagnosis.

As far as the timing of an overdose, should it happen: honestly, there is no specific time that is way riskier than another. But I see that you are starting off at a very reasonable dosing level, given her weight. So we have every reason to expect that she'll do just fine :). As to how long it will take to see symptom relief, that will depend upon her response to this initial dosing level. If 10 mg. is high enough to significantly lower cortisol levels, then you may see improvement in some symptoms such as thirst/urination/hunger even within the first week or two. If it turns out that a higher dose is needed, then accordingly it will take longer to see results. Your observations as to whether or not she is improving will be equally as important as the monitoring blood tests as far as determining her optimal drug dose.

I have edited your thread title so as to show that she's now being treated with trilostane. Definitely keep us updated, OK?

Marianne

[addy]

I would hesitate to introduce something new for Hallie's gastro upset as starting two new meds at the same time can sometimes skew the picture. The gas and mucus stools are sometimes diet and it could be the "new" 2 year old diet needs tweaking. It could be a short course of metronidazole would help her. Pepcid can help with tummy upset but it sounds like Hallie is not vomiting.

Sometimes if a dog has high cortsiol it makes them prone to bacterial infections. It could be that once her cortsiol is lowered, that colitis stops as those repeated infections become less frequent. One never knows.

Normally, I would be concerned that Hallie went through testing for Cushings while having a "colitis" flare up but I went down that same road with my Zoe minus the Sards issue.

What does your vet suggest?

[HalliesMom]

Thanks Lablab and Addy
(thanks for moving my post) :)

I actually had just written a long post back to you guys but the internist just called back and wants to see her now so we're on our way. Of course it's not the day he's working at his clinic closer to us so we have a 2 hour drive ahead. I'll feel better if he sees her though, thanks so much for the advice and support!

[addy]

let us know what happens, ok?

[molly muffin]

Checking in of you and Hallie. I too want to know what the internist had to say. It sounds like they are being very cautious and I always like that as a conservative approach usually has the best results.

Sharlene and molly muffin

[HalliesMom]

We just got home...it wasn't an Addisonian crises, she was actually a bit dehydrated?? She has been drinking about half her usual amount, maybe a little more, the last few days but it actually started just before her first trilostane 4 days ago so not sure what is up with that as that has not happened before. So they gave her fluids.

He also sent us home with Metronidazole for her GI issues so hoping that helps her feel better also.

He got her ACTH test back, and unfortunately her cushings is originating from her adrenals and not her pituitary (we knew she had a nodule on her adrenal gland and he thinks that is the culprit).

Also unfortunately, it appears she also has hyperparathyroidism. Her blood calcium level had gone up yet again. :( Both tumor on adrenal and parathyroid could be malignant.

She also has a stye or cyst or bite or something on her eyelid and has now been rubbing and scratching it like crazy (she had not bothered it the last 2 days) so are waiting for a call back from our local vet as well.

The internist said we have to take baby steps so will continue the trilostane to see if it works and can help her to feel better, as well as the Metronidazole.

If that helps, he would change his treatment to Mitotane and kill off her adrenal glands on purpose to put her into Addisonians as he said that will be easier to treat in her case than cushings.

The treatment for the hyperparathyroidism is putting her under :( doing an ultrasound and inject alcohol into the gland. This would cure it but if any leaked out of the gland it would be very bad as it would also damage her nerves in her neck/throat.

I am beside myself....how do you know when enough is enough for them? Although I have very little money, money is also not an issue in the least as I would literally sell a kidney if I had to to help her and keep her with me. I can't imagine surviving losing her she is all I have. I just don't want to put her through a bunch of awful stuff and lose her anyway. Although it sounds like, if each of these things do work, she could feel a lot better.... :confused:

[addy]

I admit I can get confused easily - I am confused as I am not aware that an ACTH test can tell if a dog has pituitary or adrenal Cushings. Also a nodule does not always equal tumor. The worst of my confusion is that here in the states, our vets do not purposely cause an Addison's crisis because it is easier to treat.

Do you have the test results other than the LDDS test you posted?

The only thing I am not confused about is that perhaps the metronidazole may help her tummy and stools.

What caused the dehydration? The loose stools?

I don't mean to give you a bad time. I feel awful for you and Hallie and just want things better for you both.

[molly muffin]

I think she had a second LDDS not an ACTH and that is what pointed to the nodule on the adrenal gland being the culprit.

I am concerned about using miotane to put her into Addison as that can be a dangerous manouver, in that there is no going back from it and if you give to much at any point, then the results are dire. So for me at least that is scary but I guess the specialist is thinking this will take care of the adrenal tumor without having to do surgery?

We currently have one dog Jasper, who is Addisons from lysodren (miotane) on the forum (that wasn't intentional). You can read their thread and journey here and get a bit of information about Addisons:

http://www.k9cushings.com/forum/showthread.php?t=4372

Now, how likely did the specialist thing it is that there would be any leakage if they went with the dye? Is this something that can be managed with medication instead?

There are a lot of things to consider here, and of course which will give her the best quality of life and life expectancy too.

Sending you big hugs as this is not an easy position to be in, when you just want to do what you can to help her out.

Sharlene and molly muffin

[labblab]

I am wondering whether perhaps the recent test that was run was an endogenous ACTH rather than an ACTH stimulation test? The endogenous ACTH can help differentiate between pituitary and adrenal Cushing's, so that would make sense as a follow-up in a situation where the LDDS result could be consistent with either form.

Marianne

[HalliesMom]

I'm sure I'm the one who is confused. :) I don't always have complete info to give you so makes it hard for you....I looked at our itemized statement but it doesn't say what kind of test. I'm sure he said ACTH so am guessing it's the one labblab suggested.

You aren't giving me a bad time Addy! I VERY much appreciate all your help! It's good when you guys question things because then I can base my decisions on more info.

He wasn't sure either why she is dehydrated. It wasn't extreme but her gums were definitely dry and a bit sticky. I have no clue why she only drank a cup over 2 days when normally I am worried about her drinking too much. I'm sure the loose stools played into it also.

I don't have further test results yet....I have not been back to the clinic that has them since yet, but will get them.

I do know her blood calcium went up again to 13.4, from 12.4 the last time. :(

I am not sure why he is thinking to go to Miotane to push her into Addison's but was also guessing maybe to avoid surgery. He also mentioned that the adrenal tumor and the parathyroid one could be malignant and that the miotane would also get rid of the one on her adrenal gland if they killed it all. I talked to our local vet here tonight and she was taken aback at that suggestion also. She asked why not just take the adrenal gland out laparoscopically, there is a board certified specialist who can do that not far from here. So I'll certainly look at that option when and if the time comes. I agree, I can't see putting her into an Addison's situation either. You guys just helped confirm that for me.

He didn't say what the risk was of the alcohol leaking out of the parathyroid gland, I wanted to ask but they squeezed us in between clients and as he was telling me that, he added that we can talk more about it if and when we get to that point. He said for now we need to treat one thing at a time and see what works and helps her. I'm the kind that wants to know it all now.

Yes like all of us I just want to be sure to not put her through too much but do enough to help her. Hard for us to know sometimes.

Thank you for the link on Jasper! I will go check that out now.

[addy]

http://endocrinevet.blogspot.com/2012/04/medical-treatment-for-adrenal-tumors-in.html

discussion of treatment of a possible adrenal tumor by Dr. Peterson, renowned endocrinologist.

[lulusmom]

Hi Dee Dee and a belated welcome to you and Hallie.

I am just getting a chance to read your thread and have a few questions for you. Did your vet confirm primary hyperparathyroidism by doing an ultrasound and visualizing nodule(s) that are present in primary disease, or does he suspect primary disease because ionized calcium and PTH levels were elevated? If imaging was not done, it's possible that the increase in PTH and ionized calcium is being caused by cushing's, which definitely messes with calcium metabolism. I am providing a link to an abstract of a study that showed a direct correlation between these values and basal and post acth stimulated cortisol. Clinical Significance in abstract reads, Adrenal secondary hyperparathyroidism is a cause of increased PTH concentrations and may be associated with abnormalities in calcium and phosphate metabolism in dogs with HAC. The findings of this study could explain why canine HAC may cause clinical signs such as calcinosis cutis that are associated with altered calcium metabolism. If nodule on the parathyroid gland was found by imaging, this is a moot point but wanted to cover all the bases.

http://www.ncbi.nlm.nih.gov/pubmed/16300114

With respect to the specialist suggesting total ablation of the adrenal glands to eliminate the adrenal tumor, I have never seen any studies showing that mitotane shrinks and kills tumor cells. Even in Europe where this was a treatment of choice, a fair number of dogs are expected to become symptomatic again within a year or two. Adrenal tissue is extremely resilient and unless every single cell is killed off, it will regenerate. Total ablation is a very risky proposition so if it were my dog, I'd opt out of that option, especially with no guarantee that it would completely eradicate the tumor.

Can you please round up copies of all testing that has been done and post the results here. I too am confused as to which acth test your vet did to confirm an adrenal tumor. Marianne suggested it might be an endogenous acth test but that test is done to differentiate between adrenal and pituitary disease after an acth stimulation test or LDDS test yields a result consistent with cushing's. It will be a lot easier for us to provide meaningful feedback if you can bring use completely current on Hallie's test results.

I look forward to hearing much more about Hallie.

Glynda

[labblab]

Hi again from me,

Glynda is absolutely correct that an endogenous ACTH would follow an initial diagnostic LDDS or ACTH stimulation test that was consistent with a general diagnosis of Cushing's. Since you told us that Hallie was having a repeat LDDS performed at the beginning of July, I was assuming that the LDDS was positive for Cushing's but did not clarify the type of tumor. But it will definitely be helpful for us if you can give us the results of that preliminary LDDS testing (if that is, in fact, what happened).

I also agree with her that I have never seen any actual research studies detailing complete adrenal tumor destruction through the use of mitotane. However, I did long ago bookmark this 2006 article by Dr. Claudia Reusch in which she makes this statement:


For inoperable AT we currently use mitotane
according to a protocol aiming for complete
adrenal destruction. In some dogs, this treatment
regime results in complete tumour remission and
even disappearance of metastases.

http://www.ivis.org/proceedings/wsava/2006/lecture9/Reusch2.pdf?LA=1

At that time, Dr. Reusch was affiliated with the University of Zurich (and may still be there). As has been said, total adrenal destruction has been more widely accepted as a treatment protocol in Europe than it is has here in the U.S. In the intervening years since this article, we've had many members here with dogs suffering from adrenal tumors but none who have had this option suggested/offered. However, I still thought I'd mention this quote because Dr. Reusch is a very credible Cushing's researcher and her statement has always stuck in the back of my mind although I have not seen it discussed elsewhere.

But first things first, and I think Glynda has raised a very important question re: the diagnosis of hyperparathyroidism.

Marianne

[addy]

Hi Dee Dee,

Just stopping by to see how you and Hallie are doing.

Hugs

[HalliesMom]

I thought I educate myself about my puppers health issues quite well but you guys are amazing you blow me out of the water with all you know about this. :)

Your links were great. I agree with you guys (and so does our local vet) that the idea of blowing out her adrenals with Mitotane is very scary. My vet asked if he thinks it's the nodule on her adrenal gland causing it then why not just take it out laparoscopically instead. I had no answer to that...I'm sure when and if that time comes they will talk it over. Although the link you posted Marianne, sure does support the other side of it! I wonder why it's not common practice over here.

I wish she didn't have to deal with the hyperparathyroidism on top of everything. :( Although she is not definitely diagnosed with that yet, I'd love it if you are right Glynda and it's just the cushings messing with her levels. He wants to treat her for 3 weeks with the Trilostane and see if we can get her feeling better and stable before doing the ultrasound of her parathyroids. I worry a lot about the anesthesia so will have to stew on it a lot.

I have posted all of the test results to this point (not counting the ones 2 days ago) earlier in this post and just got the ones from Wednesday in email. Hopefully this will clear things up for you some rather than me trying to relay info I am not understanding as well. :o

Procedure Ref Range Units
Endogenous ACTH 2.0 L [6.7-25.0] pmol/L
Endocrinology Interpretation See Below
07/17/2014 12:30:00 Endocrinology Interpretation
Previous cortisol test results described in the history were in support of a diagnosis of hyperadrenocorticism. This low
concentration of ACTH provides additional evidence for the presence of a functional adrenocortical tumor.




He also checked her cortisol levels to be extra sure it wasn't an addisonial crises. Here are those results.

Cortisol, 0 hr Final - Approved 07/24/2014 6:24AM
In Range Out of Range Reference Range Units
Cort 0 hr 4.2 1.0-10.0 ug/dL
A patient with a resting cortisol >2.0 ug/dl has a 99% chance of NOT having Addison's Disease. With a resting cortisol <2.0 ug/dl,
an ACTH response test is needed to rule-in Addison's Disease. This interpretation is valid if no oral or topical steroids have been
given in the last 6 weeks.
A resting cortisol cannot be used to rule-in or rule-out Hyperadrenocorticism. A LDDS and/or ACTH Response Test needs to be performed.



Her calcium level :(

Calcium Final - Approved 07/18/2014 2:44AM
In Range Out of Range Reference Range Units
Calcium 13.4 H 8.0-12.0 mg/dL



Large intestinal diarrhea
Adrenal-dependent hyperadrenocorticism, right-sided adrenal nodule
Hypercalcemia, probable hyperparathyroidism
Slightly increased liver values and mildly hyperechoic liver – likely due to hyperadrenocorticism
Previously diagnosed SARDS and cataracts
Diagnostic testing:
Physical examination (7/23)
BAR; probable mild dehydration; BCS = 4/9; BW = 5.24 kg
EENT: clean teeth; mature cataracts; meibomian cyst on lower left lid
Derm: tiny ulceration and swelling of lower left lid
Abd: poor tone but not pot-bellied, relaxed, nonpainful
H/L: NSF
LN: WNL
Derm: thin haircoat particularly over dorsum
Cortisol level (7/23)
Serum electrolytes (7/23)
ACTH level (7/17)
Serum total calcium (7/17)
4.2 μg/dl
Na = 136; K = 5.4
2.0 pmol/L
13.4 mg/dl
Other recent testing:
Low-dose dex-suppression tests (7/10 & 6/5)
Urine cortisol-to-creatinine ratio (6/29/14)
6.7  2.4  3.5 μg/dl (5.4  1.2  1.1 μg/dl)
70
PTH (5/16/14)
PTHrp (5/16/14)
Ionized calcium (5/16/14)
2.5 pmol/L
0.0 pmol/L
1.59 mmol/L
Chemistry panel (5/9/14)
Total & ionized calcium (5/13/14)
T4 (5/9/14)
Complete blood count (5/9/14)
Urinalysis (5/9/14)
Urinalysis (5/11/14)
Liver cytology (3/6/14)
Abdominal ultrasounds
(1/16/14 & 3/5/14)
Slightly increased liver values (ALT>alk.phos.); mild hypercholesterolemia; mild hypercalcemia (12.4 mg/dl)
12.4 mg/dl & 1.56 mmol/L
1.1 μg/dl
Mild thrombocytosis; otherwise no significant findings
SG = 1.019; otherwise no significant findings
SG = 1.010; hematuria; mild pyuria; questionable bacteruria; trace proteinuria
Mild inflammation; benign nodular hyperplasia
Right adrenal nodule with normal left adrenal gland; hyperechoic liver; left-sided renal cortical cyst; mild intestinal thickening
Discussion:
The result of the ACTH level demonstrates that Hallie’s hyperadrenocorticism (HAC) is due to a functional adrenocortical tumor. Options for treatment include adrenalectomy, mitotane, and trilostane. Trilostane has already been started. Control of HAC tends to be easier with this medication than with mitotane. Both medications are less invasive than adrenalectomy. However, trilostane is only treating the HAC and is not treating the tumor itself whereas both mitotane and adrenalectomy would do so. For now, it is recommended that trilostane be continued but in the near future it may be recommended that mitotane be used instead.
The calcium is now higher than it was previously. It is increasingly likely that Hallie has hyperparathyroidism (hyperPTH). HyperPTH is most commonly due to a parathyroid adenoma but in a patient with a concurrent endocrine neoplasm, there is an increased likelihood that hyperPTH is due to a parathyroid carcinoma (multiple endocrine neoplasia). An ultrasound of Hallie’s parathyroid glands is recommended. If a nodule is identified, the ideal subsequent steps are to perform needle aspiration and cytology. Alternatively, this step can be skipped and the mass can be ablated with ultrasound-guided ethanol injection.
Hallie has had mucusy, soft stool. The mucus is a sign of large intestinal inflammation. Based on the results of the cortisol level and serum electrolytes, this symptom is not due to an Addisonian crisis. This symptom could be a direct side-effect of trilostane. Metronidazole was started and subcutaneous fluids were administered on 7/23/14.

I am happy to say that Hallie is feeling better today! She has interacted with me more and her stools last night and today have been pretty much normal which is a first in weeks. I'm sure that is why she's feeling better. She's still more tired than I think she should be but it's a start.

Thank you so much for taking the time to read this!

[HalliesMom]

Also I don't think I mentioned that 3 days ago she suddenly got her first stye under her eye. It has now moved to the other eye also (although not quite as bad). Do you think it is a coincidence or could something going on, meds or just having cushings etc, have triggered this? The internist didn't seem to think so but the timing was fishy. Been warm packing it and using Neomycin Polymyxin ointment.

[labblab]

Hi again, Dee Dee, and thanks so much for all this additional info. This definitely helps clarify the treatment recommendations that have been made. Based on Glynda's earlier post, though, I do still think it will be interesting to see whether Hallie's calcium level may possibly respond favorably once the control of her cortisol level becomes optimal.

I'm afraid I don't know anything about styes :o. They have not been reported here in conjunction with treatment, though.

As far as your vet's comments re: Cushing's treatment options, for the most part this all makes sense to me.


The result of the ACTH level demonstrates that Hallie’s hyperadrenocorticism (HAC) is due to a functional adrenocortical tumor. Options for treatment include adrenalectomy, mitotane, and trilostane. Trilostane has already been started. Control of HAC tends to be easier with this medication than with mitotane. Both medications are less invasive than adrenalectomy. However, trilostane is only treating the HAC and is not treating the tumor itself whereas both mitotane and adrenalectomy would do so. For now, it is recommended that trilostane be continued but in the near future it may be recommended that mitotane be used instead.

If surgical removal is not an option, originally our experience here was that mitotane was most often the drug prescribed for treatment of adrenal tumors. I can speculate that was partly because there is, indeed, some chance that the mitotane might shrink or at least retard further growth of the tumor cells themselves. That is the purpose for which Lysodren is prescribed in humans. However, in humans the intent is not to cause complete adrenal destruction, and the effects on tumor cells are variable.


Chemo does not work very well in adrenal cancer, so it is most often used for adrenal gland cancer that has become too widespread to be removed with surgery. Chemo does not cure adrenal cancer...

...The drug most often used for people with adrenal cancer is called mitotane. Mitotane blocks hormone production by the adrenal gland and also destroys both adrenal cancer cells and healthy adrenal tissue...

...Sometimes mitotane is given for a period of time after surgery has removed all the (visible) cancer. This is called adjuvant therapy and is meant to kill any cells that were left behind, but were too small to see. Giving the drug this way may prevent or delay the return of the cancer...

...If the cancer has not been completely removed by surgery or has come back, mitotane will shrink the cancer in some patients. On average, the response lasts about one year, but can be longer for some patients.

Mitotane is particularly helpful for people with adrenal cancers who have problems caused by excessive hormone production. Even when it doesn't shrink the tumor, mitotane can reduce abnormal hormone production and relieve symptoms...


http://www.cancer.org/cancer/adrenalcorticalcancer/detailedguide/adrenal-cortical-cancer-treating-chemotherapy

In dogs, I would guess that the same thing is true: because there are many different types of adrenal tumors, cells in some dogs may respond to mitotane, but for many dogs they may not. But if there is any chance at all that the mitotane may help control tumor growth at least for a while, why not always start with it? I think for the very reason your IMS stated: more recent experience has shown that for many dogs with adrenal tumors, management of dosing and treatment side effects has been significantly easier with trilostane. So probably the majority of ADH dogs we see here now are treated with trilostane.

I see I've written a book here :o. but I mainly just wanted to provide a bit of a frame of reference for the choice of mitotane vs. trilostane for treatment of adrenal Cushing's. I hope I haven't just made things more confusing!

Marianne

[Trish]

Hi!

Just going to chime in about the adrenalectomy side of things. I can see why you would hesitate with the surgery in a 14 year old dog, but if your vet is mentioning it I presume it is not totally off the table? I am interested in the laparoscopic approach. My dog had an abdominal adrenalectomy at age 11, he did well and is now nearly 2 years post op. I have read a few articles about laparoscopic adrenalectomy, but in my time here on the forum which is a bit over 2 years I do not remember a dog having it done this way, but no doubt as in humans, it will be the way in the future and there are quite a few studies on it online if you google it. Also in humans laparoscopic surgery has quite a steep learning curve, so while you have the benefits of faster recovery with this type of surgery I would want to have a surgeon very, very experienced in using a laparoscope before proceeding. This is an article from conference proceedings in 2012 specifically discussing laparoscopic adrenalectomy in dogs. It is on page 18, so you need to scroll down a bit! :)

http://www.avsts.org.uk/sites/avsts.org.uk/files/event-proceedings/avsts_proceedings_spring_2012.pdf

If you do decide to investigate that aspect further, I have put together a list of questions regarding adrenalectomy which might be helpful to discuss with the specialsits. Good luck with getting Hallie sorted out!

[HalliesMom]

Thank you both! For the info and the links this is helping a lot.

I just now got off the phone with the internist and I have some big decisions to make. :confused:

First of all, the Metronidazole has cleared up her GI issues great and she is feeling much better! She also seems a lot more comfortable overall and has a spark back, I haven't seen her pace and pant and her eating and drinking seem fine. So I'm happy there.

It is so unfortunate that she also has the high calcium issue. I asked him if the cushings could be causing that and he said no, that if anything the cushings should decrease any calcium issues. And hers has elevated a full point in the last 3 weeks or so.

So he highly suspects she has hyperparathyroidism also. He said that malignancy in hyperparathyroidism is rare but he is very concerned hers might be as he's only seen it in one other dog and that dog also had the adrenal tumor and the parathyroid tumor and was malignant.

He of course can't say if it is malignant, whether it has spread or not.

So the options are to first have him do an ultrasound to see if there is a nodule on her parathyroid gland. If there isn't, then I think hyperparathyroidism is off the table. But he really feels that is what it is. She would have to be put under for the ultrasound which scares me to death with her age and her autoimmune issues.

But if they do the ultrasound, and see a nodule, he would at the same time like to inject it with alcohol. That terrifies me also as if any of the fluid leaks out of the capsule the parathyroid gland is in, it can damage any tissue and/or nerves around it (the alcohol is to kill the parathyroid gland). I asked him how many dogs he's done this to and if there was a problem with any and he said between himself and the other vet there they have done maybe half a dozen. :( He said of those only one had a problem and it wasn't permanent.

The other option would be to do surgery and remove the gland which is more invasive and has similar risks. But we'd at least know if it is malignant or not.

In either case, she would have to be hospitalized for up 2-4 days. When the bad parathyroid gland is producing too much calcium, the other 3 will shut down. So when you destroy the bad gland, the calcium levels can drop dangerously low until the other ones kick back in. So she would have to be closely monitored and have blood checked often for those few days before she could go home.

That is a HUGE problem also because I am never apart from her and I would hate to put her through a few days in a scary place (being deaf and blind especially) without me. He said I could visit frequently but would not be able to be with her the whole time. I would be camped out in their waiting room the entire time when they don't let me back with her. I just don't trust ANYone with her I've had some bad experiences leaving my dogs at the vets before.

He said if we don't do anything, her calcium could level off in the teens (but not likely for her as her calcium is elevating fast) which would cause kidney disease, etc over time. It isn't possible to say how long, etc. We don't know if her adrenal tumor is malignant or not either although he feels it could be. So have no idea if it has spread if so. If it keeps elevating which it probably will, it can cause kidney or bladder stones, calcification in kidneys and will kill her.

My big thing with her is as little pain and hardship at the end of her life as possible (as I'm sure, is with us all). She is 14 and deaf and blind...but at the moment she's doing pretty well, she's not suffering and is my happy loving little girl. I don't want her to have pain or fear with these awful procedures but it sounds as if it will really help her quality of life if it works. I asked him if it would buy her much time at her age and he said he didn't know if it would buy her any time but would make her quality of life better. But then he said well yes it could buy her more time too.

So in lieu of a crystal ball, how in the world can we make decisions on this? When we just don't know what will happen.....I would love your thoughts on this I told him I'd think it over for a couple of days and let him know. I will also talk with our local vet.
Thank you!

[addy]

Dee Dee, I don't know what to say. Personally, I am concerned the IMS and his partner have only done this procedure six times - but I am not there listening to him explain things to get a good or bad gut feeling about it.

Is there any way to get a second opinion from another IMS? With my Zoe, I tried to always listen to my gut. Sometimes it screamed no, sometimes it said yes.

I dont know enough about the calcium issue to have a good opinion, I am just reading your thread and not liking the number six.:o:confused::(

[molly muffin]

I know what Addy means, I'd rather it was 600 times with good results.

Is there any larger hospital, maybe teaching hospital? or something that might have more experience?

I hate that you are in this kind of position.

There is a list of questions that Trish made up for if you are going in to talk to a surgeon about having something done, adrenelctomy, etc. It might help you to evaluate things.


Part I - Questions to ask when considering if surgery is an option for your dog’s adrenal tumour:
1. What type of tumour do you suspect, ?functional, ?non-functional, pheochromocytoma, benign, metastatic
2. Expected life span for my dog in a normal situation. If your dog is close to, at or past his expected lifespan for his breed is surgery going to be of any benefit?
3. Prognosis for my dog if we treated medically i.e. with Cushings medications. AND if we do not proceed with surgery how long do you think it would be before the tumour started adversely affecting his quality of life?
4. If he is miserable now, does the benefit of potentially risky surgery outweigh his current quality of life?
5. Are there any other health problems that could impact on a positive surgical outcome, for example: if your dog is overweight or has heart, BP, liver, kidney or lung conditions
6. Is there any sign of tumour spread – imaging should be done, including ultrasound and on advice of specialists either CT or MRI to check whether there is local invasion around the tumour, into blood vessels including vena cava or spread further away in the body to lungs etc
7. Surgeon recommendations – would he/she do it for their own dog?
8. Psychological impact for the owner: It is important to understand this is risky surgery, sadly current guidelines indicate 1:5 dogs do not make it, and some recommendations are not even that high. Can you accept it if your dogs dies during or in the postoperative recovery period surgery? This is where it is important to weigh up whether the benefit of your dog being fully cured is worth the risk of possibly losing him.
9. Financially – can you afford it? Find out estimate of costs.
10. Hopefully this will not happen, but if your dog collapses, e.g his heart stops either during his surgery or afterwards what emergency measures should be undertaken, do you want your dog to have CPR, how far are you (the owner) willing to go for your dog to be saved in such circumstances

Part II - Surgery has been recommended as treatment for your dogs adrenal tumour, here are a few suggestions on what questions you should ask your surgeon:
1. Are you board certified? How many operations of this type have you done? What complications have you experienced? What were the outcomes?
2. Please explain to me how you will do the surgery, which part would likely give you the most trouble? Will you be doing the actual surgery or a resident in a teaching situation? If so, is their close supervision?
3. Will there be a specialist anaesthetist available for the surgery?
4. If it hasn’t been done, do we need a CT/MRI scan to look at the tumour more closely to check for vena cava involvement or any other tumour spread?
5. What are the risks associated with this surgery, including
• Bleeding (including trauma to blood vessels or other organs during surgery)
• clots
• Blood pressure or heart problems such as arrhythmias
• pancreatitis
• pneumonia
• kidney failure
• infection
• wound problems
• bowel problems
• anaesthetic risks
• adrenal insufficiency or electrolyte abnormalities
• death (sorry but you have to ask that risk too)
6. If we proceed with surgery does my dog need preoperative treatment with Cushing’s meds, antihypertensive if high blood pressure is a problem – phenoxybenzamine recommended preoperatively for dogs with pheochromocytoma, anticoagulants or anything else?
7. How will you treat to prevent clots postoperatively?
8. What would you do if you found anything else during the surgery i.e. nodules in other organs e.g. spleen, opposite adrenal, liver, kidney. Would you remove them and what are the risks associated when doing additional abdominal surgery together with adrenalectomy
9. How long will it take and when will you contact me so I know all is OK, when can I visit after surgery?
10. How will the postoperative period go, how long would you anticipate he would need to stay in hospital? How will we manage pain?
11. What monitoring would be needed, e.g. heart monitoring, oxygen levels in the postoperative period
12. If your dog has an adrenocortical tumour affecting cortisol production will he need to be on steroids following surgery and for how long?
13. If there are problems when I take him home, who do I contact? Hopefully the surgical team until all is stable.

Anyway, I think that those questions are good with any risky procedure, so maybe evaluating them, will help you in some way. I hope so.

hugs
Sharlene and molly muffin

[Harley PoMMom]

Hi Dee Dee,

I am so sorry that you are in this difficult position but I do know that any decision you make you always have her best interest at heart.

When I had to make a decision for surgery or not for one of my furbabies the one question I would ask the IMS is, if my furbaby were their dog what would they do, it did help me in deciding what to do.

I, also, wanted to provide a link to an article that I found on the ACVS (American College of Veterinary Surgeons) site regarding parathyroid tumors, one section stuck out to me:
If a parathyroid tumor is suspected in your pet, whether because of hypercalcemia detected in a blood screen or because of clinical signs related to hypercalcemia, the definitive test done by your primary care veterinarian is the measure of PTH in the bloodstream. This is a very specific test that measures two types of parathyroid hormone, PTH and PTHrP (PTH related-peptide). Both PTH and PTHrP cause elevation of calcium in the bloodstream. However, PTH is uniquely produced by the parathyroid glands while PTHrP is released from certain cancers such as lymphoma, multiple myeloma, and anal sac adenocarcinoma. If PTHrP is elevated in the presence of hypercalcemia, then a diagnosis of a non-parathyroid tumor is supported. However, if PTHrP is non-detectable and PTH is in the normal or elevated range, then a parathyroid tumor is strongly suspected

Full article can be found here: Parathyroid Tumors (https://www.acvs.org/small-animal/parathyroid-tumors)

Did the IMS see if the PTHrP was elevated? Forgive me if I missed this in your posts.

You both are in my thoughts and prayers, hugs, Lori

[HalliesMom]

Thank you for that list of questions, those are excellent. I will print them out.

Thank you too for your responses. I totally agree with the number "6" with the internist. Glad you nudged me to think of getting a 2nd opinion. We had an appointment with our local vet today just to talk over the options and I asked her about that so we got an appointment with a different internist for this coming Tuesday for a 2nd opinion. This is at a larger hospital. Our vet here thought that was a good idea and she is going to call a specialist she knows also to get her take on things, as she is not quite sure which direction to point us either.

I also always ask the vets what they would do if it were their beloved pup. Dang though, they all have said different things so I'm still confused.

Great article Lori! I don't recall seeing a PTH or PTHrP level at any time. I will look into that. He did say he is concerned (this is the 1st internist) that Hallie's adrenal nodule and parathyroid nodule (well this hasn't been confirmed yet as we've not done the ultrasound yet but is highly suspected) are malignant because the one dog he's ever seen with both, was. I hope he is wrong!!!!

I will let you know what we find out I can't thank you enough for all this help.

[molly muffin]

I think I would want to know quite a bit about the surgery options, laphroscopy, like how long would she be under anesthesia, would they have to go in by regular means if any problems are encountered, etc. Get as much information as possible about all options.

hang in there!
hugs
Sharlene and molly muffin

[addy]

Just stopping by to offer hugs and let you know we are all thinking of you and Hallie.

I saw a photo yesterday of a dog holding a paint brush in his mouth, painting a photo.:):):):):)

So my thoughts turned to you and Hallie.:):):)

[molly muffin]

Hi Dee Dee, hope you and Hallie are having a good week. How is she doing?

hugs
Sharlene and molly muffin

[HalliesMom]

Thank you so much for asking about her. 2 weeks ago my back went out big time (never had back issues before) I was in the ER and had to have 24/7 care at home I couldn't even take care of Hallie myself. So we had to cancel our app't with a new internist for a 2nd opinion (SO frustrating to have back issues when I all care about was getting Hallie taken care of) :mad:

Much better now and we did go see the other internist the other day. The first one has only seen 6 dogs with the hyperparathyroidism, this one has only seen 10. So I guess it really is a rare thing and not just inexperience.

He did an X Ray and an ultrasound (didn't have to even sedate her the first guy was wanting to put her under) and did find the tumor on a parathyroid gland so hyperparathyroidism is confirmed. The nodule on her adrenal gland is slightly larger so they suspect both that and the parathyroid one may be connected and malignant but can't say for sure. Doesn't really matter anyway as if the adrenal tumor continues to grow it will push on organs etc and she can't have surgery to remove it.

He was very blunt, said she is like a 120 yr old human and she wouldn't be strong enough to withstand surgery or ablation (which would cure the hyperparathyroidism). She also was having some major colitis which was cleared up with Metrinidazole (sp?) but her intestinal walls are thickened which could be cancer, IBS, autoimmune, etc. Because of that and also because of her arthritis he wants to under manage her cushings since the extra cortisol in her system is helping with those 2 issues. So she still is having some cushings symptoms although probably not as bad as before. (I hate the panting and restlessness) :(

He said with all her issues (including the dang SARDS, etc) if she were here in a year he'd be amazed. It was a very hard day for us both, I was really thinking they could do at least the ablation to alleviate some of her risks and symptoms. I have decided no more procedures with her, she was panting after the X Ray (from stress...which is partly from cushings I'm sure as she has NEVER panted much in her life) except for occassional blood draws to monitor her cortisol levels. She is having ACTH next week. We'll probably just leave her at 10 mg of Trilostane.

I can't bear to think what the near future holds for us but will do all I can to keep her as comfortable for as long as possible. We also have her on Tramadol just to see if she is having some pain from anything. If I see a difference in her, we'll just keep her on it. Also will go back to our holistic vet just to see if anything extra can be added to support her. I think we will stop acupuncture and B12 shots though she doesn't like it and I really have not seen any significance difference in her.

So horrible for us all to have to see our kids go through this. My heart goes out to everyone. I read of so many passing while scrolling down to find my thread. Such an awful disease that hits so many. I live alone with Hallie, my family has all passed young, most since I've had her, she's my whole world it's hard to get your mind around losing them.

[molly muffin]

Oh Dee Dee. Not the kind of news that anyone really wants to get. :(

I hope that you have a very long time together still, but whatever happens, we'll be right here for you.
If you need to vent, then do so, if you are having a hard day, let us know, someone will be around.

I know this really sucks and right now you are feeling like you've been run over by a mac truck. Just do the things you love to do together and enjoy every minute. I know you know that already.

Many cushing dogs have IBD, colitis, and problems with gastro systems. So, that can be managed. The cushings can be "under managed" as he said, just keep the coritsol a tad bit higher but bring it down enough to not cause too many symptoms.

Hang in there!
hugs
Sharlene and molly muffin

[Mackenzie]

Hi Dee Dee, I don't have any helpful advice to offer, but I just wanted to say that I'm sorry to hear about the news from the second internist. I'm still following along with Hallie's thread and hope for the best for both of you with many more joyful moments together.

[addy]

Dee Dee I am sorry to read the news about Hallie's latest vet visit. I do want to say Zoe's IBD was well controlled as it was antibiotic responsive. If the metronidazole helps Haillee, it may be smaller doses once a day a few days per week will control it for awhile. We did it for 4 years, eventually needing once a day 1/4 of a tablet but there are other options, Tylan powder and Budisone ( not sure if I spelled that correctly). Zoe had scar tissues too.

I know it sound like bad news but I would keep the faith you can manage it all.

Big hugs

[HalliesMom]

Thank you so much. We went to the internist again today for an ACTH test. Hallie has been feeling pretty good the last 2-3 days :) she ran on our walk last night and rolled in the grass etc. which was so wonderful to see.

I am going to expect the same thing....that she will prove him wrong and be here a lot longer and a lot better than they predict.

Good to know about Zoe's IBS issues being controlled by Metronidazole. So far since her last dose of it (2 plus weeks) her stools have been great!

You guys are the best I hope you know what a godsend you are to so many people. Just wish you weren't so knowledgable because you had to go through it yourselves. :(

[HalliesMom]

I have a request also....can anyone point me to a web site that describes the signs to watch for for an addisonian crises while on Trilostane? Particularly the collapse and sudden death part and how quickly from the first signs it can happen. I have not left Hallie's side in over 3 years, since she went blind. I work from home so am with her constantly she really stresses if I'm not here. Which isn't good for her cushings of course not to mention just her mental stress. Now that she is on trilostane I REALLY am not leaving her, for anything. I have no one I could trust to see signs etc to sit with her. And I've been summoned for Jury Duty. :mad: Normally I wouldn't mind doing my civic duty. But in this case I can not leave Hallie for this. I would need oxygen. I have nightmares often about being forced to leave her alone and I am really freaking out they are forcing me to do this. I have already sent in an excuse (telling about Hallie and also I have my own business and I will lose customers if I am away for even half a day). They have just denied my request to get out of jury duty. I am beside myself...

So I am going to send them a copy of her medical records and also want to print off information from the web on the addisonian crises but can't find one that tells how fast this can happen and how it can cause instant death.

Thanks!

[addy]

Ok, I dont have that link right now but I can tell you that I just went through the same thing with jury duty and basically what they tell you is they dont care unless you have a doctor's excuse. They should allow you to postpone it though. I was able to postpone mine twice, first for 3 months, the second time for 1 month. So you may get only a postponement with the vet info.

However, do you have a family doctor or regular doctor? If so you could take the medical records to an appointment for yourself, explain how sick your dog is and that you are now suffering from panic attacks when you have to leave her and could they write a medical excuse for you? Just a thought.


I'll see if I can find the info or perhaps someone else has it handy

[Dixie'sMom]

Hey Dee Dee and Hallie. I am Suzie and am new to this board so I don't have any advice to give or wisdom to share but I do have a hand to hold and a shoulder to lean on and a hug to give. I also have a little female doxie so that makes us soul sisters. I was so sorry to read about Hallie's recent test results and will keep you both in my prayers and close to my heart. Hugs for you and your beautiful baby girl.

Suzie

P.S. Your website is amazing!

[HalliesMom]

I appreciate that so much. I rarely get mad...but this makes me FURIOUS. So sorry you went through that too Addy. It's horrible to be forced away from them! That is a good idea about my own Dr. I am on a couple things for the stress of Hallie's condition so I can try to work with that too. If they do end up making me go they will have the most uncooperative, blubbering mess to deal with they've ever seen. :mad: So any info you have would be very grateful for thank you. Postponement would suck too as she isn't going to get better only worse if anything and if I lose her they will have to come find me in the nuthouse anyway .:p

Hi Suzie and Dixie! I am so sorry you and Dixie are going through this also. It seems pretty common in doxies. Hallie has SARDS also, so I kind of figured cushings would rear it's ugly head sooner or later. Hug Dixie for us also I will follow your journey with her and be rooting for you both.

I do have some good news to share. The internist just called and Hallie's cortisol level they tested today is normal!! So relieved we won't have to increase it. Shes on 10 mg and doesn't have to be seen again for 3 months which is also wonderful.

[Squirt's Mom]

One good way to get out of jury duty is to learn all you can about the case you are to hear then state that you believe with all your heart the person on trial is guilty - beyond all doubt in your mind, they *are* guilty. ;) Whether you actually believe that or not is irrelevant but convincing the attorneys that you feel that way should make you ineligible to be on the jury. ;) You may have to sit through a few hours of selection but not be tied up for days on end. Another is to state that you will not be ruled by this corrupt and evil government nor it's laws - ie, be a real radical. :p

I served on a Capitol Felony Murder trial many years ago with the death penalty in play. We found him guilty but sentenced him to life in prison, not execution - he pulled the trigger but his wife set the whole thing up, including putting the rifle in his hands. When the verdict was read, people in the audience stood up and threatened the jury - to kill each and every one of us. :eek: Because this was a capitol felony case with the possibility of the death sentence, the jury was given the option of opting out of further jury duty for life by the judge and I JUMPED on that offer! ;)

I hope you find a way out of this so you can stay with your sweet girl. I know just how you feel. For the last few years of my Squirt's life I refused to leave her for more than a few hours at a time. To leave her overnight or all day was out of the question, period. Whatever I had to do, whatever I had to give up, I would not leave her.

When I can, I want to come back and talk a bit about what the IMS said about Hallie. That, too, I understand in depth; I know your heart, because mine has been there also.

I hope you are feeling better and not in as much pain. Back problems can affect every aspect of your life! Take good care of you! ;)

Hugs,
Leslie and the gang

[addy]

Leslie has a point, get a postponement, request a date later in the week, not a Monday, when they interview you as a potential juror, answer the questions honestly but do speak up- I told them I was extremely angry about it as I had already done it 3 times. They will ask you if it is a financial burden, tell the judge you are self employed and have no one to do your job so you wont be paid, your sick dog, etc and they wont select you however you may end up being there all day.

I cant find the link about how fast adrenal rupture can happen, just the statements of "sudden death" by adrenal rupture can happen.

hugs

[Squirt's Mom]

I said I would come back and talk to you about your decision concerning no more procedures for your sweet girl and what the specialist said. My youngest grandson spent the weekend with me and I knew I couldn't get through this message without sobbing so I waited til today.

Vets are woefully lacking in understanding the depth of our love for our babies and how much power lies in that love. Squirt's last vet and IMS both told me when they first met us that there was no logical reason for her to still be here, much less for her health to be as good as it was in spite of her conditions. Her GP stated a couple of years later that the only reason she was still alive was because of me. I simply told him, "I love her". Because we love them so very much we go to great lengths on their behalf and as a result our babies often surprise their docs. So don't let that comment bother you - that doc doesn't know you nor Hallie, and doesn't understand the power of the love you share.

When I read your post, I was taken back to about a year ago when I made the same decision for my Squirt, the light of my world, who was released in May. We had gone to the vet because she was limping and I couldn't find a reason so I wanted her examined. She was extremely stressed during the exam to the point it took several people to hold her 13 lb self. Because she had been to vets so so much over the prior 6-7 years, vet visits had become stressful anyway as had rides, something she at one time loved almost as much as she did me. The day after the exam she couldn't walk and was so miserable. I decided then that was it, no more, and I promised Squirt no more vet visits unless she was in dire straits and required help. My Sweet Bebe had had enough.

Early in 2013 I realized we were engaged in our "final battle", one we would not win this time. Making the decision that she would be put through no more pokes, prods, pushes, pulls, or cuts from the vets was one of the gifts I could give that would makes her days easier, a little taste of the freedom that awaited her. After, my attention was solely on making each and every day as wonderful as possible for us both.

We spent our final year together walking and talking, sharing memories and thoughts about the future that lay ahead. If it brought a smile to her face and light to her eyes, I did my best to make sure she got lots of that, whatever it was. Squirt was always the Queen of her world but now she could have just about anything she wanted and do anything she was able. My focus was no longer on fighting progressions or preventing further damages, it was solely on making her happy and as comfortable as possible.

That decision led to a time that is priceless, a time Squirt and I bonded tighter than ever. We had our scary moments but most of that last year was enjoyable for us both, and very meaningful. I know how hard it was for you to come to this point and I know the pain and fear that weaves through your Soul today. But I pray you and Hallie find what Squirt and I did - a time of togetherness, of unity, of heightened awareness and communication, a time of hope and promise.

Hugs,
Leslie and the gang

[Trish]

Hi hope you managed to get out of jury duty. I can totally understand your desire to avoid that and spend time with Hallie. Hope she is holding her own and your having loads of special time together xx

[addy]

Thinking of you and Hallie and hoping you are not sitting on some jury!!!

[Dixie'sMom]

I just read on facebook that Dee Dee Murray lost Hallie to the Rainbow Bridge on Christmas Eve. :( For those of you that remember, Hallie was a SARDS doxie rescue and Dee Dee is an animal artist. Dee Dee taught Hallie to paint and all of her paintings and ornaments were sold with the proceeds going to animal rescue. Dee Dee posted on our site around the end of summer this year, but I believe it was determined that Hallie had a parathyroid tumor.

I Please keep Dee Dee and Hallie's fans in your prayers.

[labblab]

Suzie, thank you so much for letting us know. This news is so very sad, but this way we can join Dee Dee in honoring sweet Hallie, always. Hallie has now been entered on our special "Remembering" thread, and we will always remain here to support Dee Dee, as well.

Always in loving memory of dear little Hallie ~
Marianne

[Dixie'sMom]

Thank you Marianne.

[molly muffin]

Oh I am so very very sorry that little Hallie has passed. :(.

[Squirt's Mom]

I am so sorry to hear about sweet Hallie. Our thoughts and prayers are with you all.

Our deepest sympathies,
Leslie, Trinket, Brick, Sophie, Fox, Redd and all our Angels



A Special Gift

They're a very special gift, to be cherished and loved;
You're chosen for each other by God Himself above.
It's a match made in heaven so it can't be wrong;
You're tied together by a bond that's oh so strong.

All they'll ever ask from you is to be loved and fed,
And at night make sure they have fresh water and a bed.
In return, for so little, the rewards are so great!
You'll get a companion for life with some very special traits.

When you are lost and the end seems so far away
They'll walk by your side, they'll help you find your way.
When life gets you down they can put a smile on your face
As they run you in circles with their fast pace.

You'll share the good with the bad, you'll be happy and sad;
And through it all you have a friend, the best you ever had.
You're time together will be special and unique;
It will be as priceless to you as a rare antique.

Then, before you know it, the day will arrive
When suddenly your life takes a steep dive.
The furry friend who's been with you for all of these years
Has now passed on and left you in tears.

As you sit and wonder what did I do?
Why is this all happening to you?
Into each of our lives a little rain must fall,
And you must be strong to answer the call.

Your little one's spirit has flown home on the wings of a dove,
To a special place that awaits them in heaven above.
St. Francis will meet them; when they get home
He will take them to a meadow where they're free to roam.

There in the meadows, down by the pond,
Your furry friend will remember his loving bond.
He'll look into the water, then you appear;
He can see you're frightened, he can feel your fear.

Through the bond that still ties you from heaven above
He looks down upon you, he sends you his love.
Because you loved him and because you care
Whenever you need him, he'll always be there.

There, in the meadows, they patiently wait for the day
When you will celebrate your life together, each and every day.
Waiting for that day; when you come walking back home
When together for an eternity through the meadows you'll roam.

Author Unknown