Down the Cushings Road Again -- Abbie, 15 year old beagle is now at peace

[judymaggie]

Hi, all! I just got off the phone with Jill, Dechra technical staffperson. She was SO helpful and I heartily encourage everyone to contact them if you have any questions at all about treatment with Vetoryl. Jill confirmed all the good advice I have received here as well as on the articles in our resource section. She said:

1. a wash-out period is definitely recommended for any dog switching to Vetoryl from Lysodren. They recommend a full thirty days even if symptoms return before that time because the destruction of adrenal tissue by the Lysodren can continue to occur even after the drug is discontinued. If Abbie's symptoms have not returned by the thirty day mark, they recommend that Vetoryl not be started until symptoms do return. (An ACTH post should also be above 9.1; since Abbie's is already at 15.6, that marker has already been met.)

2. in light of Abbie having been on Lysodren and also taking Enalapril, they would definitely recommend a 20 mg. starting dose (if and when symptoms return) versus a 30 mg. start. Jill also emphasized the importance of frequent electrolyte checks because both Enalapril and Vetoryl can lower aldosterone.

I got a case number for Abbie and also gave them my vet's name and number. If he calls and he doesn't have the case number, they can connect him to Abbie's record.

My goal is to get a few minutes face time with my vet tomorrow when Abbie goes in for next round of kidney tests. He is very used to me bringing in articles and lists of questions so that won't be a surprise. I am hopeful that he will be open to calling Dechra -- it will help Abbie and any future dogs he treats with Vetoryl. Wish me luck!

[molly muffin]

Dechra is spot on. Let us know how the vet reacts to the information!

Hugs

[labblab]

Judy, I'm so glad you had a good conversation with Dechra. It's reassuring for me, too, to know that their advice corresponds with our own! :)

I sure hope your vet will give them a call if he has any questions.

[judymaggie]

Hi, folks! Back from the vet and great news about blood pressure -- down to average of 124 (from average of 168 at last reading)! :D Hopefully, when results are back from renal panel and UPC (probably next Monday), there will be more good news.

I did get to talk with the vet and relayed Dechra's recommendations. He seemed more comfortable with their dosage recommendations than with their guidance re waiting until symptoms come back to start Vetoryl. I gave him prices of Vetoryl at Target and California Pet Pharmacy. He did want to talk with folks at Dechra to find out if they ship directly to California Pet Pharmacy (he was dubious since their prices were so much less than Target) so he took technical staff number and Abbie's reference number. Maybe once he speaks with them himself he will have more confidence in their guidance. Anyhoo, at least he knows how I want Abbie's treatment to proceed with regard to Vetoryl and maybe think twice when treating other dogs.

[judymaggie]

Hi, all! Abbie’s UPC and renal panel results are back. In spite of having doubled the Enalapril, the UPC ratio has increased! It is now at 4.9 (last result two weeks ago before doubling med was 4.7). My vet consulted again with an IMS and Abbie will be starting on amlodipine besylate (brand name is Norvasc). Since both the Enalapril and amlodipine can lower blood pressure, we are starting at a very low dose of ½ of a 2.5 mg. tablet for one week followed by one week at 2.5 mg. Then vet will test UPC again. Since Abbie’s blood pressure had tested in the normal range, we were both optimistic that UPC had come down as well. True to form, Abbie doesn’t do anything predictable!

Renal panel results showed alkaline phosphatase, cholesterol and trigylcerides have increased. Potassium went down slightly but still high.

I was very pleased to learn that my vet had called Dechra and discussed wash-out period and best starting dose for Abbie. He had told me that he was going to call but only to ask them if they provided Vetoryl directly to California Pet Pharmacy. When I asked him what Dechra had said about the pharmacy, he said he had forgotten to ask them!!

We are on day 12 of the minimum 30 day wash-out from Lysodren. So far no obvious increase in drinking or peeing but I think I will measure water intake once a week to keep track.

[molly muffin]

I don't know that Dechra necessarily recommends compounding pharmacies (if you are thinking for trilostane) as they would prefer you buy the vetroyl. But you can also buy vetroyl from online pharmacies if that is what you chose to do.

Molly to is on amolodipine for BP and trying to get the UPC down. We are holding around 2.4 or so right now. We hope that if her cortisol stays controlled then maybe that will help with the UPC.

As you know and we talked about on my thread, there is the option of the ARB to add to the mix or in fact, some take them off the enalapril and just try the ARB.

hugs

[judymaggie]

Hi, all! I was really, really hoping that the addition of amlodipine (to enalapril) would bring down the UPC to a manageable level. Unfortunately, the news today was not good -- the UPC only went down to 4.8 (from 4.9 two weeks ago). :( I got the UPC result from a tech today -- I am sure my vet will call later to discuss. He has been consulting with an IMS and expect he will do that before calling me.

I really feel like I am between a rock and a hard place with Abbie's treatment. Today is the 30 day mark since stopping Lysodren and Abbie is not showing any Cushing's symptoms -- no increased thirst or increased peeing and she is going for walks even in the insufferable Florida heat and humidity. We have not done another ACTH because her cortisol was already high at the start of the 30 day period.

So ... do I start giving her trilostane because of the proteinuria? After reading all the literature I can find, I am just not convinced that the high UPC is a pre-cursor for renal failure. Also wondering if an ultrasound, with a concentration on her kidneys, would provide any worthwhile information (her next ultrasound was going to be in October -- a year from last one).

What do you think about me contacting Dr. Peterson to get his input? I couldn't see how to post a question on his blog -- I know someone here did post but can't remember who that was.

[Harley PoMMom]

If this were me, I would be more inclined into not starting the Trilostane unless her ACTH post number was high.

I also wanted to include a link to that thread regarding that new kidney test from IDEXX, I would ask your vet about this and see if the test is available yet.
New IDEXX Test Detects Kidney Disease in Cats and Dogs Months or Years Earlier than Standard Screening Technologies

Breakthrough in medical and preventive care; IDEXX to provide SDMA as part of routine reference laboratory chemistry profiles at no additional charge
SHARE

Orlando, FL, North American Veterinary Conference, January 19, 2015—IDEXX Laboratories, Inc. (NASDAQ: IDXX) announced today an upcoming kidney function test, called SDMA (or symmetric dimethylarginine), that promises to transform the way veterinarians diagnose and treat kidney disease in cats and dogs. The new renal biomarker identifies the onset of kidney disease months or even years earlier than traditional methods, greatly expanding treatment options.

IDEXX plans to include the SDMA kidney test in all routine reference laboratory chemistry profiles at no additional cost and with the same rapid turnaround time. This will enable veterinarians to diagnose kidney disease earlier, including during routine preventive care testing, while there is still enough kidney function for more effective intervention and disease management.

“We expect to begin trials with several hundred customers in North America by March, and to roll out the test as part of the routine chemistry panel in the North American market this summer. A roll-out in our global reference laboratory network will extend into 2016,” said Jonathan W. Ayers, president and chief executive officer of IDEXX Laboratories.

Chronic kidney disease (CKD) is a leading cause of suffering and death in cats and dogs. In time, one in three cats and one in 10 dogs will develop some form of the disease. Until today, kidney disease has been routinely diagnosed in part by measuring blood creatinine. However, creatinine alone cannot detect kidney disease until late in the disease process, limiting the opportunity to extend the life of the pet through treatment options. Typically, a diagnosis is made when 75% of kidney function has been irreversibly lost. At this point, the prognosis can be poor.

The new SDMA test changes that. In a recent clinical study, Oregon State University researchers showed SDMA identified disease much earlier in the disease progression, when the kidney had suffered far less damage that results in permanent loss of function—up to four years earlier in at least one animal. On average, SDMA detected kidney disease when only 40% of function had been lost, and in some cases, 25% of function. Earlier detection allows veterinarians to provide more effective intervention and disease management, which could add months or even years to pet lives.

“Until now, it hasn’t been possible to detect kidney disease until late in the course of the disease,” said Roberta L. Relford, DVM, MS, PhD, DACVIM, DACVP, vice president and chief medical officer of IDEXX Laboratories. “The ability to diagnose kidney disease earlier will enable veterinarians and pet owners to care for affected pets in a way that enhances their well-being and may even extend their lives.”

“For more than 30 years, IDEXX innovation has helped veterinarians elevate the standard of care for pets,” said Ayers. “SDMA is another result of our industry-leading investment in advancing veterinary medicine, and it represents a significant achievement in preventive care diagnostics. It will transform the way kidney disease is diagnosed and treated. We’re adding it to all routine chemistry profiles offered by IDEXX Reference Laboratories so that it becomes a standard part of good preventive care, helping pets live long, happy lives.”

IDEXX unveiled this breakthrough in medical and preventive care at the North American Veterinary Conference, taking place this week in Orlando. IDEXX will provide SDMA testing as part of all routine reference laboratory chemistry profiles. IDEXX customers can easily add an SDMA test to their in-house chemistry profiles by running a stand-alone SDMA test at IDEXX Reference Laboratories.

Veterinarians who wish to learn more about the technology and treatment protocols can visit https://www.idexx.com/small-animal-health/solutions/articles/sdma-diagnose-kidney-disease.html (This is a good article too)

https://www.idexx.com/corporate/news-and-events/press-release/2015/20150119pr.html

I also am including a link to a great article regarding proteinuria, it's a "roundtable discussion" http://www.idexx.de/pdf/de_de/smallanimal/education/proteinuria-round-table.pdf

Contacting Dr. Peterson is a great idea, I've never posted a question to him, but I know others here have.

Hugs, Lori

PS: it looks like that new kidney test (Symmetric dimethylarginine (SDMA)) is available, here's a link to a case study: https://www.idexx.com/small-animal-health/solutions/articles/case-study-discovering-disease-with-sdma.html

[labblab]

Hey Judy, I know the UPC result is disappointing, but I honestly don't know whether two weeks is a long enough time to expect to see significant change. Maybe Sharlene will know and be able to comment a little later on.

Also, if you are interested, here is Dr. Bruyette's email in the event you might want to bounce things off him, too.

David.Bruyette@vca.com

[judymaggie]

Lori & Marianne -- thanks for info! Abbie has been on treatment for proteinuria for two and a half months, with increasing doses and added meds as her UPC stayed high. Her high blood pressure has come down into normal range with meds.

I spoke at length with our vet earlier this evening. We are in agreement that it is best to hold off on Vetoryl treatment until Abbie's Cushing's symptoms return. The rest of Abbie's kidney markers on the renal profiles are all in normal range except for slightly elevated potassium. I asked whether he thought the SDMA would offer any useful information and he said that it might down the road but no need to have it run now. He attended the conference where IDEXX announced that they would be including this in their renal profiles -- it is not part of their profiles yet. He also didn't think that an ultrasound would offer any helpful info now and I don't want to put Abbie through a biopsy.

We are going to continue the enalapril and amlodipine at the current levels. Abbie will have another blood pressure curve along with a renal panel in three weeks. If she shows any Cushing's symptoms before then, we'll start Vetoryl.

I did a search and found that "dew nay" was the member who had posted on Dr. Peterson's blog. I sent her a PM asking how she did that.

[Harley PoMMom]

Hey Judy,

I came across this study published in 2014, this dog's proteinuria did not respond well to the benazepril/amlodipine treatment, then a drug known as Telmisartan was started along with lowering the doses of the benazepril/amlodipine. After 5 weeks of using the Telmisartan (and adjusting up the dose) the dog's UPC of 4.0ish went down to .33, they then upped the dose of Telmisartan and reduced the benazepril dose, one month later this dog's UPC was .14!
At most recent recheck, 31 weeks after the discontinuation of benazepril and on 10 mg (0.9 mg/kg) of telmisartan once daily, UPC remains reduced (0.33).

Article can be found here: http://onlinelibrary.wiley.com/doi/10.1111/jvim.12471/pdf

[judymaggie]

Lori--really interesting article and dog was even a beagle! :D I will definitely print out a copy to give to my vet. Sad commentary that I have read so much about proteinuria that I no longer have to look up the meanings of all of the technical terms.

[molly muffin]

Telmisartan is one of the ARB's that we talked about on my thread. It doesn't seem to be as prone to raising potassium as the one my vet had mentioned. (from what I read anyhow, you always have to watch potassium levels with any of these drugs) Abbie's protein is higher than molly's, so might be worth a shot to try and get that down.

We're heading in today for another ACTH and UPC. Cross fingers!

hugs

[judymaggie]

Hi, all! I have spent the last few days posting back and forth on Dr. Peterson's blog and e-mailing Dr. Bruyette. It is so wonderful that these two specialists will take the time to communicate with dog owners. I think I got a reply e-mail from Dr. Bruyette in just a few hours. Here is the link to Dr. Peterson's blog -- scroll all the way down and you will see my first post on the 14th:

http://www.animalendocrine.info/2013/09/working-up-asymptomatic-dog-for.html

I provided the same initial information to Dr. Bruyette and he responded (even signing his e-mail "Dave" :D):


Yes indeed. I would treat with trilostane to see if we can get better control of the proteinuria. I would also use omega 3 fatty acids and low dose aspirin and see if that helps as well.

Most of the articles about proteinuria do mention adding the omega 3 fatty acids but I am very hesitant due to Abbie's tendency to soft stools/diarrhea.

Abbie's requests to go outside and pee have started to increase -- she wants to pee approximately every two hours so, in addition to trying to control the proteinuria, it is definitely time to start Vetoryl. It has been 40 days since her last Lysodren dose. I am going to call my vet tomorrow to discuss starting trilostane -- when we discussed it previously, he had spoken about twice daily dosing and I feel better about that after having received guidance from Dr. Peterson. I did read one of his veterinary blog articles where he suggested doing the ACTH 4-5 hours after the morning dose with the goal of a post of 2-7 ug/dl; I am assuming the higher upper number is due to the dog not receiving a full day's dose before the test.

I am going to order Vetoryl from the California Pet Pharmacy so receipt will take a bit of time. Abbie is scheduled for a BP curve and renal panel on the 30th along with gland expression. Since Abbie is getting increasingly anxious when going to the vet, I will talk with the vet about timing all this with the first ACTH -- she will need a full chem panel then.

Question: since Dr. Peterson said evening dose can be given with a treat as long as it contains fat, I am thinking I will give her a little bit of kibble and canned food followed by the Vetoryl capsule wrapped in either peanut butter or cheese. Does that sound like a good plan?

I would subtract the food from her 3:45 meal. When Abbie was on Lysodren, she had started to spit out the peanut butter but I think the split Lysodren pill probably made it taste bitter.

[molly muffin]

Don't you love the access to specialist that actually will send a reply.
I too posted to Dr. Peterson and emailed Dr. Bruyette about Molly.

I would think your suggestion for administering the evening dose would be good one to go with. If Abbie is tired of the peanut butter try the cream cheese. The whipped cream cheese is easy to manage around pills I find.

As for the higher number that is just his controlled range. You won't or shouldn't be having any spikes with twice a day dosing but a very evenly managed cortisol level.

Huggers

[labblab]

Hi Judy, good for you for pursuing your questions so thoroughly with both these guys!!! :) :)

I am a little surprised to see Dr. Peterson say that just a treat (even if it does contain fat) is sufficient for the evening dosing. A couple of us have contacted Dechra in this regard, and they have told us that a full meal is really preferable -- that a treat is not enough for maximal absorption. Plus, this is somewhat contrary to what he has formally written in his blog. But maybe he is just taking the specifics of Abbie's situation into account, and believes that a treat will be fine given the fact that she does get a full meal during the late afternoon. Anyway, I agree with your plan to give her at least a bit of kibble/canned food in addition to the fat-wrapped capsule.

And yes, just as Sharlene says, I think the ACTH monitoring range he's given you is his ideal regardless of whether dosing is once or twice daily. He differs a bit in this regard from Dechra, as well.

Marianne

[judymaggie]

Hi! I just placed an order with California Pet Pharmacy -- my vet is out until Tuesday but one of his associates said she would be happy to help! It will take a few days for meds to arrive so will talk with my vet when he gets back. I did print out Telmisartan study to give to him.

Question: I am aware that first ACTH is to be done 10-14 days after starting. Is the 30 day ACTH done 30 days after starting Vetoryl or 30 days after the first ACTH?

Question (I keep forgetting to ask): Abbie is prone to ear infections, primarily yeast. To try and keep them under control, I flush her ears once a month with ear cleanser followed by Mometamax. I am not sure why it never occurred to me that Mometamax is a steroid drop! What ear drops do you use? I found one on-line -- Zymox Otic Pet Ear Treatment without Hydrocortisone but would prefer to get info re personal use.

[Harley PoMMom]

Question: I am aware that first ACTH is to be done 10-14 days after starting. Is the 30 day ACTH done 30 days after starting Vetoryl or 30 days after the first ACTH?[/quote]

It is performed at the 30 day mark from when the Vetoryl was started.

Question (I keep forgetting to ask): Abbie is prone to ear infections, primarily yeast. To try and keep them under control, I flush her ears once a month with ear cleanser followed by Mometamax. I am not sure why it never occurred to me that Mometamax is a steroid drop! What ear drops do you use? I found one on-line -- Zymox Otic Pet Ear Treatment without Hydrocortisone but would prefer to get info re personal use.[/QUOTE]

I found this post from Glynda with regards to an ear cleaning medication:
I'm a special needs small dog rescuer and many of the dogs I've pulled from shelters have really bad ear infections, among other things. A groomer turned me onto a product that is amazing for dogs with chronic ear infections. It's pretty inexpensive if you purchase it online through Amazon. You can also read over 100 product reviews, most of which reflects the same results I've achieved with it. You may want to put it in the ears outdoors or in the garage. It's pretty purple and if the dog shakes his head, it can stain whatever it lands on. I never really had that problem but my little white pups had a bit of a purple tinge on the hair around their ears for a bit but it's a small price to pay to keep the ears infection free.

http://www.amazon.com/For-Animals-K9-Ear-Solutions/dp/B000OUY5L6/ref=sr_1_5?ie=UTF8&qid=1389063921&sr=8-5&keywords=colloidal+silver+for+dogs

Also on the dogaware web site they have a list of medications, here's a link to that: http://www.dogaware.com/health/ears.html#yeast

Hugs, Lori

[labblab]

Zymox also makes a couple different versions of ear treatment solutions: one with hydrocortisone and one without. It is an enzymatic treatment, and my vet recommended it to me. I have used the one with hydrocortisone with success with both my girls when they've had inflamed ears (steroids are not an issue for them). But I think other folks here with Cushpups have used the version without the steroid and have also been happy with the results.

http://www.amazon.com/s/ref=nb_sb_noss_2?url=search-alias%3Daps&field-keywords=Zymox+otic

[molly muffin]

Yes the version without the steroid of symbol is what Barbara uses with trixie.

Okay my IMS said that she has two dogs on the ARB now. One in addition to a lower dose of benazepril and one she put on after taking completely off benazepril. In canada we use benazepril rather than enalopril. Same dosage though. The European group who has done the most studies in this day that on humans they see good results with stopping the ace inhibitor and going solo with the ARB. Another IMS in the same group also is using the ARB solo with a dog.

We will probably be moving Molly to this in about 6 weeks

[judymaggie]

Hi, folks! I posed a question to Dr. Peterson about the use of Mometamax:


Question: Abbie is prone to yeast flare-ups in both ears. To keep this under control, I flush her ears with Vet Solutions Ear Cleansing Solution followed by Mometamax every couple of weeks. If the yeast is widespread, there have been periods when Mometamax is applied daily for a week to ten days with flushing every few days. Is the amount of mometasone in the Mometamax significant enough to affect cortisol levels?

Dr. Peterson: Possible, but unlikely to make a difference for a dog on Vetoryl.

I received the Vetoryl yesterday and Abbie will start it on 7/29 (10 mg. twice a day) with an ACTH (along with superchem panel and UPC) scheduled for 8/11 assuming all goes well until then. We already had an appointment on 7/30 for a BP curve along with glands and nails -- I wanted to give Abbie at least a two week break before heading back to the vet, thus the reason for waiting to start until the 29th. My vet made some comments about adjusting the dose if necessary after the 14 day ACTH -- I pretty much ignored him and went on to talk about something else. Unfortunately, he still doesn't have a clue about the use of Vetoryl but he is willing to go along with what I want to do.

[judymaggie]

Hi, all! Abbie had her blood pressure tested yesterday and, unfortunately, the average has increased from 124 to 160 (back to where it was two months ago). :( Abbie has a UPC scheduled for 8/11 (along with ACTH and chem panel) so we are holding off adjusting any meds until we see the UPC results. Since her BP meds had been increased after the last UPC, I am discouraged that her BP has risen.

I did start Vetoryl on Wednesday. Abbie absolutely dislikes peanut butter!! She touched it with her tongue and walked away so I ended up putting the capsule in her canned food just to get it down her. I then gave her some whole milk ricotta and she loved it -- well, until I wrapped her evening dose in it! She put the whole thing in her mouth, ate the ricotta and spit out the capsule. So ... I bought sliced cheese yesterday and she gobbled up yesterday's doses as well as this morning. So far, so good with the Vetoryl -- no apparent side effects. Sure hope that it works to get down the cortisol and, in turn, the BP and UPC.

I have been giving Abbie a small amount of pumpkin in her morning meals and, after just four days, her poop has firmed up. Simultaneously, I have cut her metronidazole dose in half. Has anyone tried this product:

Diggin' Your Dog Firm Up Pumpkin Super Supplement

http://www.amazon.com/gp/product/B006CBD7UQ?psc=1&redirect=true&ref_=ox_sc_act_title_1&smid=ATVPDKIKX0DER

I am giving Abbie so little pumpkin that I doubt I will get very far down in the can before it spoils. The Amazon product is dehydrated pumpkin. My vet had not heard of it but said it would be worth a try.

[labblab]

Hmmmm...I've never seen that supplement before, but it really looks interesting, Judy! Thanks for pointing it out. If you end up buying some, we'll definitely want to know how it works. Gosh, it would be so much easier than messing with canned pumpkin!

I'm sure sorry about the darn blood pressure reading, but at least I'm glad the cheese slices are working for the meds. That's what I always use for my girls, too, and they will actually go and stand at the fridge when it's time for them to be dosed -- they must have an internal clock, they are sometimes so precise about the the timing!!! They love that soft cheese, and I love that I can mold it so easily. :)

Marianne

[molly muffin]

Molly too has decided she doesn't want to take her meds in canned food from my hand. If I just put it in her bowl, she will eat it, but I noticed this morning she left the omega 3 on the floor next to her bowl. I think it is just too big. So far she is getting the trilostane though. Whew. It can be a real trick finding something to disguise those pills in that they will like.

That is an interesting idea with the pumpkin. I too wouldn't mind knowing how that works for you.

Molly's BP was back up to 180 last time, although they put that down to her being excitable, still I don't like it, so know what you mean about Abbie's BP.

[judymaggie]

Hi, all! (Apologize in advance for long post …) Abbie’s latest round of tests were this past Tuesday. Tests included ACTH (at day 14 of Vetoryl, 10 mg. 2x/day), super chem panel and UPC. Results are below:

ACTH: Pre of 5.6 and post of 11.5 (range of optimal control between 1.5-9.1)

Post down from 15.6 on 6/10 when Lysodren was stopped – I expect her cortisol continued to climb up during the 30 day wash-out so probably was even higher by the time Vetoryl was started. I am very pleased that the Vetoryl seems to be working.

SUPER CHEM:

ALK: 141 (H)(range 5-131)

Although still technically high I am thrilled that it dropped from 401 on last test on 6/17! I have been giving Abbie S-Adenosyl pills for a while now and expect that has helped.

BUN/Creatinine Ratio: 28 (H)(range 4-27) (up from 22 on last test)

Potassium: 6.0 (H)(range 3.6-5.5)(up from 5.6 on last test)

Cholesterol: 691 (H)(range 92-324)(up from 661 on last test)(most likely related to protein loss in urine)

Triglycerides: 1065 (H)(range 29-291)(considerably higher than 595 on last test--non-fasting test probably contributed somewhat to increase but it is still really high)

UPC: 5.6 (range <=0.5)(up from 4.8 on last test on 7/6)

Major concern is Abbie’s kidneys – she is definitely what is considered a “non-responder” to typical treatment of amlodipine and enalapril. In spite of the cortisol coming down, her kidneys are not filtering proteins. The increased BUN/Creatinine ratio is very concerning as this usually only increases when there is significant kidney dysfunction.

I shared the telmisartan study with my vet – he had not seen it before and said he definitely wants to switch Abbie from enalapril to telmisartan. He wants to follow the same dosing and evaluation methods outlined in the study. He even helped me call pharmacies to find out the cost. It is very expensive at most pharmacies but our local compounding pharmacy had the best price and Target is willing to match their price. They had to order it so won’t be able to start Abbie on it until Wednesday morning. Over the next two weeks the enalapril will be lowered while the telmisartan is increased. After 7 days of telmisartan twice a day, the vet will run another super chem and her BP will be checked at the hospital (vet’s machine still not working). A week later another UPC will be run. The vet wants to continue the amlodipine which is aimed towards helping to lower the BP.

I am glad to report that my vet has definitely been reading up on the use of Vetoryl. Abbie has the next ACTH scheduled for day 30 and my vet agreed that, if we have to raise the dose, a 5 mg. increase from a compounding pharmacy would be the best route. Because Abbie’s arthritis has become troublesome with the drop in cortisol, we agreed that a post at the upper end of the range would be preferable.

Added into the mix are yeast infections in both ears! I am glad that Dr. Peterson said that mometamax should not affect cortisol levels while on Vetoryl as she is on it for two weeks with Triz-Ultra+Keto rinse once a day (and every third day also a cleansing solution rinse). Sure am glad that I am retired – her medication/eating schedule is definitely a full-time job!

[molly muffin]

Well I'm glad the vetroyl is hopefully working and maybe it will help to get the other things under control too. One can hope anyway right.

Oh I hate ear infections. Molly runs if she sees the bottle of ear drops. She doesn't fool around either, she is like, I'm outta here. LOL

I hope that the telmisartan works and gets that UPC down some. That might help with the Bun/Crea too? It is the Creatanine that is worrying in the ratio usually, so I would get that retested.

You know and I was thinking of this the other day, if there is any kind of upset tummy, gastro, that makes the UPC usually higher too. I was wondering about that with Abbie and I wondered about it with molly too, because molly's was higher last test and within a day she was having that bad diarrhea and not eating. I remember Trish and Tina both saying that it takes weeks for the UPC to be right after any kind of gastric issues.

Yea their schedules can be real doozies eh. :)

[judymaggie]

Folks: I think Abbie's last super chem results were distorted because she was not fasting. I asked Dr. Peterson via his blog:


With Vetoryl being given at 7:30 am after morning meal, how do we schedule a fasting blood test? Should a morning dose be skipped the day after the ACTH so that she is fasting? Or is the lack of fasting not a significant factor in test results?

Due to adding telmisartan, my vet wants to do a super chem 7 days after she has been on a twice daily dosing without the enalapril. This will be a week after her 30 day ACTH but would still have same issue of fasting.

He answered back:


The fasting sample should be collected on a separate day from when you are doing an ACTH stimulation test.

Unfortunately, this does not answer my question about skipping a dose of trilostane in order to do fasting blood draw. What do you all do when a fasting blood draw is needed?

[Harley PoMMom]

I think you could either skip her morning dose or opt in giving her a very lite meal with her morning Vetoryl. Wish Dr. Peterson would have been more specific with his answer to you. :(

Hugs, Lori

[labblab]

Perhaps I am not understanding your question, Judy, but on the day that you schedule the chem panel (as opposed to the day you are doing the ACTH), I would think you would just go ahead and give the trilostane but just without the breakfast. The trilo won't be metabolized as efficiently that way, but it's just one dose that would be compromised and some drug benefit is better than none at all.

In other words, it won't hurt her to get the trilo on an empty stomach that morning. That particular dose just won't be as effective in terms of lowering her cortisol. But you are not measuring cortisol on the chem panel, anyway.

Marianne

[judymaggie]

Marianne -- never even thought of that option! Since Abbie is on twice daily dosing, one less effective dose would be even less significant.You guys are so smart. :D

Maybe Dr. Peterson was confused by my inquiry although his response is good to know with regard to future ACTH tests. I try to do as few vet trips as possible as Abbie does get stressed but I definitely want accurate test results.

Since my vet is a newbie with regard to trilostane, I so appreciate your input.

[Harley PoMMom]

If this were me, I would opt out of giving her dose of Trilostane that morning, Trilostane is known to cause gastric upset, and if given on an empty stomach it could make her nauseated...JMO :)

[judymaggie]

Okay, guys, two for skipping dose, one for giving without food ... :rolleyes:

Since Abbie's stools are finally firm, I am leaning towards thinking that the risk of a stomach issue outweighs the benefit of one dose (and Abbie would still get her evening dose).

That said, the voting is still open! :D

[Budsters Mom]

I would personally never give Trilostane without food. It can be really hard on sensitive stomachs. I would sooner skip a dose than do that. ;)

[Squirt's Mom]

If it were me, I would tell the vet to run the other tests that require fasting at a different time. Vetoryl needs to be given with food before the ACTH just as usual. To my mind, leaving off the morning dose will not reflect an accurate picture of what it is doing for the cortisol since half her daily dose will be missing. That's my vote! ;)

[labblab]

Judy, if you feel uncomfortable giving the trilo without food, then certainly go ahead and withhold it. Even though my own boy usually took his trilo with a meal, he never had any GI issues on the occasions that food wasn't involved so I wasn't particularly thinking about that as a problem with Abby. Plus, my family members are told to please take all their medications as usual on the mornings of fasted tests. So that's more what I was thinking about and where my advice was coming from. But whereas, for instance, you really don't want a patient to skip even one dose of blood pressure medication especially on the day of an exam, it's hard to think the lack of trilo would have any immediate negative impact on the chem testing. So if you prefer to hold the trilo that morning, then I don't think it would present any problem.

Marianne

[labblab]

If it were me, I would tell the vet to run the other tests that require fasting at a different time. Vetoryl needs to be given with food before the ACTH just as usual. To my mind, leaving off the morning dose will not reflect an accurate picture of what it is doing for the cortisol since half her daily dose will be missing. That's my vote! ;)
Hey Les, the other tests are indeed going to be run on a different day than the ACTH. So what we're debating is just whether on the day that Abby is fasted for the chem panel, should Judy give the trilo or withhold it. ;)

[Squirt's Mom]

Ohhhhhhhhh...never mind then. :D

[Budsters Mom]

Judy, Have you called and asked the vet about Abbie's morning Trilo dose the day of the Chem panel? I wouldn't think it would affect any of the findings, but you could ask to be sure.;)

Trilo really tore up my little guy's stomach even when dosed with food. Abbie's is much bigger than Buddy was and it doesn't affect all dogs the same way.

If all checks out with the vet. I still vote for erring on the side of caution and skipping the morning dose of Trilo. ;)

Kathy

[judymaggie]

Kathy -- I am more concerned with the food that is given before the Vetoryl (and the cheese ball containing it) affecting the super chem results than I am about the Vetoryl itself. I do give Abbie pepcid before the two meals after which she gets Vetoryl and, thankfully, she has not had any negative effects.

Abbie goes for her 30 day ACTH on Tuesday and will discuss this issue with him when he calls with results. Abbie is only his third dog being treated with Vetoryl (and he is not following any prescribed protocol with at least one of them) so I am the primary decider with regard to this aspect of Abbie's medical care.

[molly muffin]

I'd skip the trilostane on the day of the fasting test. :)

The trilostane is for the cortisol, the fasting is testing for other things that shouldn't be affected by the lack of trilostane dosage. That's my thought anyhow.

[judymaggie]

Hi, all! Just got 30 day ACTH test results for Abbie and am pleased that her numbers are continuing to come down:

Pre: 2.4
Post: 9.7

(compared to 5.6 and 11.5 at 14 day mark).

Although below 9.0 would be ideal, we are going to keep Abbie's dosage the same because of her arthritis (... and my pocketbook!)

[judymaggie]

Hi, all! An update on BP and UPC -- unfortunately, Abbie's blood pressure average on 9/1/15 was 190 (up from 160 on 7/30). She was very relaxed at the hospital so stress not a contributing factor. This is very concerning to both me and my vet. We increased the telmisartan dose to 10 mg. in the morning and 5 mg. in the evening. Her UPC has gone down slightly to 4.6 (from 4.8 on 7/6/15).

We agreed that it would be good to schedule a follow-up appointment and ultrasound with Abbie's internist rather than wait until mid-October. That appointment is on 9/28/15.

Abbie's affect has been very dull the last few days. The arthritis in her right back leg has definitely been bothering her -- she is dragging that leg more often. I'm sure our high humidity and hot temps are contributing to this -- hopefully, only a few more weeks of it! Today, for the first time ever, Abbie didn't get off the bed when I was leaving the house. As many of us have noted before, it is so hard to determine causes, i.e., lowered cortisol, medications, cognitive changes, etc.

[molly muffin]

Good grief, I thought I'd completed and sent my reply 2 days ago and just found it, still sitting here where I'd started writing it.
I swear Judy I am losing my mind work and stuff is so busy right now. My apologies.

So, here is what I was writing..
Hi Judy,
Darn, don't like to see that BP go up. I know you don't either. We too struggle with Molly's jumping up sometimes.
Maybe the internist will have another idea on how to get her UPC down? How long is it suppose to take to see results on telmisartan?

I did like to see her cortisol levels where much better last time so that is a plus, not just the UPC and BP, same things that we are working on with molly, although Abbie's UPC is higher, so seems like there is plenty of room for that to come down.

I notice that when Molly's cortisol came down we have a lot more problems with the back legs than we do when it is higher, but if it is higher then more problems with the other stuff :( It's such a fine wire balancing act we are doing with these cushpups sometimes.

Hugs

[judymaggie]

Hi, folks! Update on Miss Abbie – we saw the internist on 9/28. Ultrasound didn’t show significant changes from a year ago which was good news. Her BP average was 180. We discussed Abbie’s cognitive changes. The internist believes that it is more likely that changes are due to an increase in tumor size rather than canine cognitive dysfunction. To try and control both blood pressure and proteinuria, he recommended that a 10 mg. Vetoryl increase be started to try and lower the ACTH post to the 6-7 range.

An ACTH was conducted at my vet’s office on 10/1/15 and, to our surprise, the post had dropped to 8.5 from 9.6 a month ago (pre of 4.0). Because of the drop, my vet and I agreed that a once a day 5 mg. increase was the best choice. My vet faxed a prescription to Diamondback and the 5 mg. capsules arrived today.

I have read that, with twice daily dosing, the larger dose would typically be given in the morning if day time symptoms are more pronounced and the evening if symptoms are greater in that time frame. Since we are targeting blood pressure and proteinuria, I am trying to decide whether to give extra 5 mg. in the a.m. or p.m. My vet thinks the p.m. in order to avoid any negative effects while Abbie is awake. I am leaning towards a.m. so that future ACTH tests would be based on the increased dose and, hopefully, increase might perk her up a bit during the day. Abbie is increasingly uninterested in going for walks in spite of cooler weather or getting off of bed to greet visitors or when I leave the house. I have submitted a question on Dr. Peterson’s blog to see what his thoughts are but I haven’t received a response yet. Your input would be greatly appreciated.

[labblab]

Hi Judy, I don't know what Dr. Peterson will say, but Dechra recommends that the larger of two unequal doses be given in the morning. I suspect this is for the reason you've already noted: for safety's sake, in order to make sure the monitoring ACTH is always catching the cortisol at its lowest point. This is from the U.S. Product Insert for Vetoryl:


Once daily administration is recommended. However, if clinical signs are not controlled for the full day, twice daily dosing may be needed.

To switch from a once daily dose to a twice daily dose, the total daily dose should be divided into 2 portions given 12 hours apart. It is not necessary for the portions to be equal. If applicable, the larger dose should be administered in the morning and the smaller dose in the evening. For example, a dog receiving 90 mg would receive 60 mg in the morning, and 30 mg in evening.

[judymaggie]

Marianne -- thanks so much for your quick reply! :D I never even thought to go back to the Dechra insert for guidance.

[Beaglelover]

Marianne,

Disregard my private message asking about Abbie, I'm caught up now after finding your recent post. Abbie's success with treatment is encouraging news to me. I wish I knew more about dosage and giving advise, the best I can do until I get more educated is provide moral support and prayers. What did you decide about dosage?

I will be starting Jenna's compounded treatment tomorrow or Thursday. I did another blood test yesterday to see if her Liver enzymes came down and they did not. Besides the very elevated enzymes Jenna seems pretty normal. Vet is concerned about getting her going on treatment to bring the Liver enzymes down to avoid kidney problems.

I'll post her update on her thread

[judymaggie]

Tammy -- thanks for checking on Abbie! I decided to give her the larger dose in the morning so she is getting 15 mg. in the a.m. and 10 mg. in the p.m. She has had two days of the increased dose and has had more energy. I am keeping fingers crossed that this is due to the increased dose rather than slightly cooler weather (which ended today ...) but I'll take it either way! :D

[Beaglelover]

Hi Judy

Glad to hear that Abbie is getting more energy. Did you say you are giving her the liquid form or capsule?
Jenna's medicine will arrive tomorrow, vet want to start her on 10mg AM & PM, Jenna weighs about 25 lbs. it on the lower side which I am more comfortable with, what do you think?

BTW we live in Michigan but have a townhouse in West Palm Beach, Fl. My dogs don't like the heat, and they get frisky with the cooler weather.

Kisses to Abbie
Tammy (Jenna, Charlie, Sandie)

[judymaggie]

Tammy--I am giving Abbie the capsules. "Low and slow" is what I learned from folks here with regard to trilostane dosing. You may end up having more ACTHs if dose adjustments are necessary but you lessen the risk of a negative reaction. Abbie weighs 24 lbs. and I started her on 10 mg. twice a day. The only reason I started her on twice a day dosing was to try and regulate her high blood pressure and proteinuria. Being her beagley self, she certainly doesn't mind having an evening meal!

[Beaglelover]

Judy

Sounds like Abbie and Jenna are about the same size/weight. Because I learned so much on this forum about the recommended dosage I asked my vet to start "low and slow" for Jenna's treatment. He respected that we are also starting 10mg x 2 day. Jenna is pretty much symptom free and is very happy. Our struggle is her blood work is off the charts; Liver, Kidney and Bilirubin's especially. The vet is very concerned about Jenna having Kidney problems if we don't start the medication. Her organs are working over time because the cortisol in her body? The medicine will arrive today, but I hesitant to start her until I can be there to see how she does. I was thinking rather than starting her tonight to start Saturday AM so I can be with her? What are your thoughts?
Maybe because the does is low she will handle it well. Jenna's got the typical Beagle appetite so getting her to take is no problem, lol.

Tammy

[molly muffin]

Hi Judy, hope this increase will help with Abbie's BP. I sympathize completely as we're trying to get molly's down too and increased trilostane and amoldipine both. (her ACTH had gone up so the increase was needed for more than just the BP) But her BP was back in the 200's. sigh These girls sure do keep us hopping don't they!!!

Molly does love the cooler weather we are having now with fall. A bit more energy on the walks and more bounce in the step. Hope Abbie is the feeling good too.

hugs

[Beaglelover]

Sharlene and Judy

I received Jenna liquid medicine, we start tomorrow 10mg x 2 day.
My concern is Jenna is almost symptom free, except her beagle appetite I'm worried how to know she's loaded. I am nervous, I will post on my thread please follow me as I will need your support. I hope your fur babies are doing well

Hugs
Tammy (Jenna, Charlie and Sandie):)

[judymaggie]

Hi, folks! Abbie has been so quiet the last few days that I was really starting to worry about her--even more than usual. Then this evening she went for her first 30 minute walk in months! :D Weather is beautiful right now with low humidity and cool temps in morning and evening --supposed to continue for at least a few days so, hopefully, Abbie will feel up to more good walks.

Have run into an issue in the mornings--I give Abbie pepcid and zrytec wrapped in canned food when she gets up. Several mornings she hasn't wanted to take it. I have been able to open her mouth and put it in and close her mouth until she swallows but this is not an easy task. She also has been spitting out the cheeseball with her Vetoryl inside. I now roll the front edge in canned food and she takes it. I have no problems the rest of the day, including her evening Vetoryl inside cheese. Only conclusion I can make is that she is nauseous in the mornings. Not sure how to handle this--

[molly muffin]

I'm having the same issue with Molly in the mornings. Canned food works the best so far but it has to be a tasty food that she wants

[Harley PoMMom]

My Harley took Pepcid AC for a while and then I did notice he was becoming nauseated with it so I switched him to slippery elm bark (SEB). The SEB really did help, the one cautionary note with the SEB is it has to be given a couple of hours away from other medications as it may interfere with absorption.

Hugs, Lori

[SasAndYunah]

Wishing for more good walks for Abbie (and her mom ;) ) and for long lasting good weatherconditons :)

Liverwurst...might be worth a try? :D Or can't she have that?

Sas and Quincy :)

[judymaggie]

Lori -- I have kept the SEB in the back of my mind but the timing would present problems since Abbie is on a twice-daily trilostane schedule. Also, I don't think Abbie would tolerate waiting two hours for her breakfast!

Saskia -- not sure about liverwurst but, along the same lines, I am wondering if I should get a different canned food to give with her morning pills. Royal Canin makes another low fat canned food that has a fishy smell -- not something I would want to eat first thing but beagles do like smelly things! I'll be speaking with the vet after next week's ACTH and will add that to my list.

Thanks for the suggestions!

[molly muffin]

Do you get Halo canned food in your area Judy?
I just found one that molly is (at the moment) loving, lower in fat and protein than the Medi-cal Moderate Protein canned that I get from the vet.
The Spot Stew Wholesome chicken version one, has veggies in it too. Still good enough consistency to wrap a pill up in too. You are giving Omega 3 right? Is good for kidney's but the pills are big enough they have to really be gobbled down.

[judymaggie]

Sharlene--I am able to get Halo here. Just looked at the canned chicken stew. Not surprised Molly likes it--really good ingredients.

I haven't been giving Abbie Omega-3. I have read that it is a good supplement for kidney issues and high bp but have been reluctant to start Abbie due to her propensity for diarrhea. Next UPC and BP check will be during the first week in November. If no significant improvement, will definitely need to make some treatment changes.

[molly muffin]

I ended up,having to give the omega 3 in the morning and her ocu glo supplement in the evening and that helped with the diarrhea issue. I just can't give them together and now she is adjusted to it so,doesn't get the runs. I give it for the kidney issues.

Yes Molly is pretty happy with it for the moment. She doesn't like anything forever so have to,switch it up. But most important was the low,protein and low fat. So hopefully alternating that with the moderate protein can will keep,her happy. Worth a shot anyhow. Now if only I could find a low protein low,fat dry to work with too. Lol

[judymaggie]

Hi, folks! This past Tuesday Abbie had the 14 day ACTH after her trilostane increase (up 5 mg. a day). Great results -- pre of 4.1, post of 7.2! :D I am so glad that we didn't go with a 10 mg. increase. Abbie's cortisol usually decreases even more as the first month goes on. I am so hoping that this drop in cortisol will correlate to a drop in BP and UPC (scheduled to be tested on 11/3).

Vet also did a CBC and chem panel on Tuesday. Amazingly, Abbie's ALP is now normal! The BUN/creatinine ratio is high but creatinine by itself is normal so not worrying about ratio. Everything else is pretty darn good.

When discussing pill-taking/breakfast issues with the vet's office manager, she said she had the perfect thing -- canned kitten liver & chicken pate. I put a tiny bit on top of the cheese ball and Abbie just gobbles it up! Only problem is that she knows it is coming and needs a great deal of coaxing to eat her breakfast. She will take a mouthful and sit down waiting for the "treat". When I tell her she has to eat more, she takes another mouthful and sits down. Eventually, she eats what is in the bowl but she is really too smart for her own good! ;)

[Harley PoMMom]

So glad to hear that her ACTH results are so good!!! Keeping all fingers and toes crossed for great results from the UPC and BP ;)

What a really neat idea about the canned kitten liver & chicken pate, so glad it worked for Abbie! I will have to keep that idea in mind!

Hugs, Lori

[molly muffin]

Yay for a good ACTH! Hopefully this will help with the BP and UPC too. It might take a bit to see the change, especially in the UPC but I'm keeping my fingers crossed!

Right now I'm using that Halo dog food, chicken pate. She seems to like that one better than the beef or salmon pate. In fact, she has turned her nose up at the salmon a couple times. Tricky little things aren't they!

Hugs

[judymaggie]

Hi, folks! I had second consult with Abbie's vet last night after her tests done on 11/3. Here are the results:

ACTH: pre 2.7, post 7.1 (compared to 4.0/7.2 on 10/20)

BP: average systolic -- 147 (lower than last measurement)
average diastolic -- 108 (higher than last measurement)
MAP -- 128

UPC: 5.2 (compared to 4.5 on 9/10).

The vet and I agreed that it was time to add omega 3 fish oil to try and get proteinuria under control and help keep BP steady. He then consulted with Abbie's internist to see if he had any other thoughts. Before my vet could tell him that we were going to start omega 3, the internist suggested the same thing! I am going to order the same omega 3 that Sharlene is using with Molly as it comes with a pump so I can try and avoid any diarrhea issues by starting with a very small amount and increasing by small increments.

Internist, vet and I are all on the same page that goal is to keep Abbie's quality of life as good as possible, especially her energy level, so no changing of meds at this time. Abbie gets her glands expressed every 6 weeks at the vet's office so that will be the schedule to check her BP. Unless I see a change in symptoms, next ACTH/super chem panel/UPC will be at three month mark from last Vetoryl increase.

[molly muffin]

That is excellent that she is making such good progress. Getting that BP in range will help a lot I think along with the cortisol being lower.

I find that the two combined, also help the UPC, as long as there is no stomach upset. If she is having any gastro upset the UPC tends to go up.

Steady days ahead!

hugs

[judymaggie]

Hi, all! Another good news story for Sharlene ... :D I haven't given Abbie a bath in a very long time for a couple of reasons--one, it is hard for me physically and, two, I didn't want to stress Abbie out. Lately, she has just started to smell like a dog so decided today was the day. It wasn't too bad for me and Abbie loved it -- from the massage with the shampoo, the treats so she would sit in the tub through 5 minutees of shampoo and 5 minutes of conditioner and then the best part ... the rub down! Not sure if other breeds go nuts after a bath but beagles are known for their post-bath "zoomies". Abbie ran around the house, complete with play bows for several minutes. It was a great sight and the bonus is how pretty she looks!

[molly muffin]

I love those good news days.

Molly needs a bath - Badly! LOL

She does the same thing after a bath, run and run and back and forth and down and up. I just crack up laughing at her.

What a fun day you had! and now a pretty, nice smelling Abbie!

huggers

[judymaggie]

Hi, all! Never a dull day ... I was fixing Abbie's afternoon meal with her sitting at my feet. When I looked over at her, there was thick, very red blood coming from her left eye!! Since blood in her eyes is the main indication that something has gone wrong with the cysts she has in both eyes, I quickly called the vet's office and told them that I was on my way in with her. When I cleaned off the blood, her eye didn't look blood shot but I couldn't tell where the blood had come from. Of course, it was rush hour on a Friday afternoon ...

The vet's office was very busy with surgery pick-ups and appointments. They took her in the back as there wasn't a room available. The vet came out with her a few minutes later with good news -- her eye is fine! Blood came from a small tumor in the inner corner of her eyelid -- neither the vet nor I had seen anything there before so it had grown quite quickly and the vet said it will continue to grow. He said it is the kind of tumor that will ooze even without Abbie rubbing it. Plan is to take it off under a very light sedative at some point. Vet said he can give her the sedative, take it off in a couple of minutes and then give her something to wake up. If it continues to bleed before her 12/3 appointment, will do it then. More good news -- the vet wished me a happy thanksgiving and ushered us to the door -- no charge!

[Squirt's Mom]

Oh I am so glad things worked out as they did! And no charge!! WOOHOO!

[Harley PoMMom]

Oh Judy, I would of freaked out :eek: what a scare that was :eek: so glad it was something that the vet will be able to take care of. WOW no charge...WOW

Hugs, Lori

[molly muffin]

Abbie and Molly should compare notes! I came home to blood all down mollys face one day. Horror!!!!! It turned out to be a mole type cyst in the corner of her eye had broken open. Hers isn't on the inside but more on the outside of the eye and just rubbing and messing with it enough and it broke open. Gawd, I had never seen so much blood on a white dog before. So if it was anything like what molly had happen, then I'm sure you where freaking like I was.

Molly too is fine now, and it just had to close back up. Cold water compresses against it helped us.

How cool that the vet didn't charge you!

[judymaggie]

Abbie and Molly are definitely sisters from a different mother!! :D Sounds like exactly the same situation -- vet called it a tumor but, to me, it does look like a mole, i.e., like a little cauliflower. Abbie's growth did start on the inside -- that's why we never noticed it but it has now grown onto the outside. Abbie has been pawing at it so the vet and I talked tonight and decided it would be best to remove it at her already scheduled 12/3 appointment. We also decided that, since it has been over two years since Abbie has had her teeth cleaned, a cleaning will be done at the same time since she will already be sedated. The original appointment was made to do her BP and express her glands. Now she will get her glands cleaned out really good since she will be "under the influence"! The vet will monitor her BP carefully during sedation. Since Abbie is relatively stable, health-wise, I think it best to get these things done now. Of course, I will be anxious!

[Budsters Mom]

It sounds like a good plan!:)

Hey Judy, Does Abbie's tumor fill with fluid and cause pressure on her eye? My friend's dog had a cyst in about the same place. It eventually had to be removed. Warm/damp/sterile compresses (every few hours) helped it drain and relieve the pressure on the eye. It helped with his comfort level. I don't know if Abbie has the same thing. Just a thought..:confused:

[judymaggie]

Kathy--not sure if Abbie's is the type you are describing or not since all I have seen come out of it is blood. I have been using warm compresses to keep the area clean. The vet said it would grow quickly so I want it removed before it might cause any issues with her eye. Abbie already has to deal with very large iriciliary cysts in both eyes so don't want to complicate things.

[judymaggie]

Hi, folks! Abbie is home, safe and sound from her surgery. The vet was able to use a laser to remove the tumor on her eyelid so no stitches necessary -- he said it will form a scab which might get itchy. The tumor had a fairly large base so it was good that we had it removed. Her teeth are gleaming white! :D Just tartar removal -- gums looked good and no need to remove any teeth (she doesn't have many left so that is a good thing ...).

Her BP was quite high today, especially the diastolic. Although they measured her BP before anything else, it is probable that Abbie knew something was up and was more stressed than usual. The vet wants me to bring her back in 10 days for another BP check. If still high, we will discuss medication adjustments at that time.

The pain meds Abbie got are definitely working -- she is snoozing away, snoring loudly!

[Budsters Mom]

Great news over all!!! ;) So glad Abbie's home safe and sound and all went well. :p

Hugs,
Kathy

[Harley PoMMom]

Glad to hear that this is behind her and that she is doing well. Keeping all fingers crossed that the high BP was just that one time and her next BP check will be normal.

Hugs, Lori

[molly muffin]

awesome news! Sounds like a successful visit. Hopefully the BP will be okay on the next visit.

[judymaggie]

Hi, folks! Good news today--Abbie's BP in normal range today! :D:D Plan is to stay on course with next BP check in 5 weeks followed by ACTH/UPC/ super chem panel in February. I have been gradually increasing the omega-3 oil with no negative effects and we are really hoping that will bring down the UPC. We are having terribly hot and humid weather--Abbie's back legs are definitely weaker so I just let her dictate how much she wants to walk outside. Cold air is supposed to come this way by the weekend and last a whole two days. :rolleyes:

[Budsters Mom]

YAY!! For normal BP!!!! Great news indeed! :D

[molly muffin]

That is totally fabulous news!!!! whooo hoooo!!!

Thrilled you got that sucker down!

[Harley PoMMom]

Normal BP!!!!!! YAAA!!! Good job Judy!

[molly muffin]

Judy, hope you and Abbie had a wonderful Christmas :)

[judymaggie]

Sharlene, thanks for your well wishes! We have had a good holiday season. Abbie has accompanied me to celebrate with friends on the 20th who were going away after that and also for another celebration on the 25th. The latter was at my best friend's home about an hour from my house. Abbie does great in the car--if the sun is out she sits up with the sun in her face! My girlfriend has a new cat, Agatha, who is about a year old. We had no idea how Abbie and Agatha would do together but my girlfriend was willing to keep Agatha in the bedroom if it didn't go well. It went better than expected--they both pretty much stayed in their own space. We, including Abbie, took a long walk --Abbie did pretty good in spite of the heat and humidity. She did sleep soundly all the way home and has slept most of today but really has handled all the holiday events quite well. :D

[molly muffin]

Sounds like you had a lovely Christmas. Now on to a wonderful New Years!!

:) Molly aggravates cats, just can't leave them alone and gets herself in trouble every time. It didn't help that a neighbors cat would come to the sliding glass door on the deck and just tease molly with it's presence either. LOL Poor molly. I think Abbie did much better!

[judymaggie]

Hi, folks! Not a good day here today -- Abbie has hurt her neck (again). She was fine when she woke up -- ate breakfast and took meds without any problems. While I was washing my breakfast dishes, Abbie came into the kitchen from the bedroom. Her head was down and she seemed a bit disoriented. I took out her cooked chicken which she eagerly awaits every morning. There was no reaction from her. Normally I cut up the chicken and throw her little pieces. She just let them hit her mouth. When I put a piece near her mouth, it was almost like she couldn't see it. She has been shaking off and on. I fixed her dinner but she had no interest in that either. I tried to give her a tramadol wrapped in food but she wouldn't even let me open her mouth and screamed when I tried to force it a bit. She is walking much slower than usual. I was hoping the vet would call with some test results from Thursday so I could tell him what is going on but he hasn't called. She has now fallen asleep on her bed that is on the floor near me.

I doubt I will be able to get her to eat later so will have to skip her evening Vetoryl dose and other meds tonight. I wish I had some liquid pain meds that I could syringe into her mouth. Does anyone know if I can crush the tramadol up and mix it with water?

[mytil]

Oh no Judy,

I am so very sorry to read this --- poor little girl. I have never mixed tablets with water before to administer, but if it is easily dissolved tablet, it would be worth a shot. Keep us posted on what the vet says.
T.

PS --- there is a dissolvable form of Tramadol --- meant specifically to place under the tongue to dissolve. It is not the time release version.

[labblab]

Oh Judy, I don't know how I overlooked seeing this yesterday! I am so sorry Abbie was feeling so poorly, and I'm surely hoping she is better today. These ortho/neuro problems are just so upsetting and frustrating! My girls will do fine for weeks and then, suddenly, out of the blue one of them will start limping or hobbling and we have no idea what has set it off or how long it will last.

You've undoubtedly already been researching yourself, but most websites I checked specifically said you should not crush Tramadol. I understand why not if you are using time-release tablets, because you'd risk severely overdosing by releasing all the med at once. And I guess that even with regular tablets, you'd still be hastening the absorption and that may not be safe. I'm really hoping Abbie was finally willing to swallow a pill on her own...

Please let us know how you guys are doing this morning.
Marianne

[judymaggie]

Hi--Abbie still not doing well. Last evening I was able to hand feed her a little bit of chicken and tricked her into swallowing a piece with the tramadol in it. She tried to spit it out (I have read that a split tramadol is very bitter) but I had another piece of chicken in hand which she took. I was also able to give her one of her BP meds but no Vetoryl. The shivering was so bad that I put a sweater on her. That and the tramadol helped her sleep (probably better than I did).

This morning Abbie went outside and peed and pooped but refused all food (even the smelly cat food). After a while of sitting and shivering, she climbed onto the bed. She just ate a little more chicken along with another hidden tramadol. She is now sleeping.

I thought about giving her some prednisone but really didn't want to as I suspect the vet will give her a dexamethasone shot tomorrow. I am really hoping that will help her eat more so we can get back to the Vetoryl (and all her other meds). This is the first time I've had to suspend treatment--she has been doing so well that I would hate to go backwards.

[molly muffin]

Oh you must be worried sick.

You think it is her neck? What about her back? If you touch down the back does her skin do that ripple effect? That can be a sign of a sore spot.

So not eating because the pain makes her nauseous you think?

Today will probably be a long day. Hopefully the vet can give her something to make her feel better.

[judymaggie]

Hi! The tramadol seems to be making a difference. Abbie ate some canned food mixed with pumpkin at about 1:00 and I was able to give her some of her meds rolled into the canned food. She is still not eating enough to get the Vetoryl but will see how it goes this evening. I took her outside and, after peeing, she just wanted to stand in the sun, with her nose catching all the smells (it is very windy today). Just gave her another dose of tramadol and she is sleeping now. A lot less shivering this afternoon.

Sharlene -- I did try to see if her back/neck rippled with touch. I didn't see anything but really didn't want to press too hard. The only reason I think it is her neck rather than her back bothering her is that yesterday she wouldn't even open her mouth and, when I tried to open it a little bit, she screamed. I'm sure the vet will do a more thorough check.

[Harley PoMMom]

Oh, sorry that our dear Abbie was feeling poorly :( And so glad to read she is feeling better!!! Give her some hugs and kisses from me :)

[judymaggie]

Hi, folks! Abbie woke up today back to where she was on Saturday -- in a lot of pain, barely able to move and not eating anything. I called the vet and he told me to bring her right in (interestingly, the receptionist, who is new, said he only had 4:15 available but I asked her to check with the vet as he will always give priority to Abbie). My Abbie is now very drugged up!! Vet thinks partially collapsed disc (seen on previous x-rays) caused inflammation of the nerves in her neck. He said her neck was just one big, tight area with lots of muscle spasms. He gave her a shot of buprenorphine (a morphine derivative) and a dexamethasone shot. I have prednisone, valium and tramadol to give to her at home. The vet knows I am not happy giving her prednisone but he strongly believes that her current issues override those concerns.

A little while ago I was able to get her to eat a few pieces of chicken while she was laying down and tucked pills inside. The hope is that the meds will perk up her appetite so we can get back to giving her Vetoryl.

Unless she gets worse, we go back to the vet in a week. After that, if pain and spasms have calmed down, I will make an appointment for her to see the veterinary chiropractor. The last time she had this problem the chiropractor was like a miracle worker.

Think healing thoughts for Miss Abbie!

P.S. I did get all of her test results from last Thursday. All in all, pretty good. Her ACTH pre was 3.8 (up from 2.7) and post was 8.5 (up from 7.1). Not enough change to increase her dose, especially since she has arthritis/inflammation issues. UPC dropped a whole point to 4.2 (from 5.2). Urinalysis/culture normal. Potassium was high: 6.0 (range 3.6-5.5)(was 5.5 last time). I vaguely recall that her BP meds might make this go up but too tired to look this up ...

[Harley PoMMom]

Oh poor Abbie :( hopefully the pain meds work for her, I'll be praying that they do.

Yep, BP meds can cause the potassium to elevate, was her creatinine within the normal limits?

Always love to see that UPC number come down..good job!!

[molly muffin]

Great that the UPC came down.

She has had the collapsed disk or partial collapsed disc before? That sounds painful alright. I certainly wouldn't worry too much about the cortisol levels while working on the disc issue, definitely more important.

Talk about seeming so unfair when she was doing so good. :(

[judymaggie]

Lori -- creatinine was within normal limits. BUN/creatinine ratio has been consistently high. As much as I read about the ratio, not sure what it really means. :confused:

Sharlene -- yes, Abbie has had disc issues before. I think it has been a year since the last episode -- we tried acupuncture which Abbie couldn't tolerate and then chiropractic adjustments which helped immensely.

I agree -- not fair!! :mad: We have even been going on good walks now that our weather is nice and cool. Abbie is definitely more comfortable tonight and not stumbling with crossed legs like she was after the morphine injection. She just ate her usual evening meal so I was able to give her Vetoryl. Prednisone and valium in a couple of hours so I think she will sleep quite well tonight. Thankfully, so far she is signaling the need to go out and pee. In the past she has had significant side effects, i.e., drinking/peeing, from both dexamethasone and prednisone

[Harley PoMMom]

Lori -- creatinine was within normal limits. BUN/creatinine ratio has been consistently high. As much as I read about the ratio, not sure what it really means. :confused:




The ratio of BUN to creatinine is usually between 10:1 and 20:1. An increased ratio may be due to a condition that causes a decrease in the flow of blood to the kidneys https://labtestsonline.org/understanding/analytes/bun/tab/faq/

I really didn't know what was learned by the BUN/creatinine ratio but thought this was a good definition. So many things can elevate that BUN, dehydration is one, so I never put a lot of stock when the BUN is a bit on the high side.

[judymaggie]

Hi, folks! Abbie did not sleep well last night and, this morning, is back to hanging her head and creeping around. Even going down the last step of her steps from the bed caused her to yell out. She would only eat a liitle bit of chicken--I was able to get her meds into her tucked into the pieces.

Question: since I am giving Abbie prednisone, is there any reason to give her Vetoryl if she does eat a full meal? I am thinking that the Vetoryl would be diminishing the effect of the pred and vice versa.

I wish I could make my Abbie feel better ... :(

[labblab]

Aww Judy, I hate it that Abbie is hurting!!

As paradoxical as it sounds, we have had occasions here when dogs have been dosed simultaneously with pred and trilostane. Examples include cushpups with lymphoma or pituitary macrotumors. I've always supposed the rationale is to keep the natural cortisol production stabilized so as to allow the pred to be dosed, and the total overall steroid profile to be maintained, on a controlled and consistent basis. So on a longer term basis, it may make sense to dose them together. On the short run, though, when she is struggling so much with both appetite and mobility, I don't know that I would be worrying about getting the trilo in her. Just my two cents worth...

[molly muffin]

Oh I too hate to hear of Abbie being in pain, just breaks my heart as I'm sure it does yours. I know I get really freaky and upset when molly is in any kind of pain/distress.

Maybe she is going to have to not do any steps for awhile, as that seems to bother her. :(

[judymaggie]

Hi -- just a quick update. I spoke with the vet last night and we decided to add another dose of tramadol to 3x/day. Abbie is still not sleeping well (and neither is her mother ...) and was obviously in a lot of pain this morning. She was willing to eat some hand fed chicken so I just kept tucking in pills until she had gotten them all. About an hour after she gets the valium/tramadol/prednisone she was much more comfortable. She then ate some canned food mixed in with pumpkin. I am taking her out to pee fairly often and, so far, no accidents in the house. Poops are very normal but, interestingly, she poops on the driveway instead of on the grass. I am thinking the valium is making her a little loopy.

The vet wants me to call him tomorrow with an update. He will be out Friday - Monday so I want to ask him to give a heads up to one of his associates just in case I need to talk with someone. If Abbie is still having significant issues when we see the vet on Tuesday, he said he will probably switch her from tramadol to methocarbamol (Robaxin) which is a muscle relaxer often used for spinal pain.

[molly muffin]

I just get butterflies in my stomach when I see a post for Abbie. The little darlin, I just worry about her. Her and molly have followed some similiar paths and others not so similiar but still its that connection of what is your result, here is mine, that makes my stomach flutter with worry for you both.

You both need rest I'm sure.

Well I certainly do hope that she starts showing some improvement but you know how these back injuries are, they take a long time to heal and the worse they are the longer they seem to take.
Having someone aware of what is going on though just seems like the smart thing to do.

Crossing fingers. I think valium would make most of us loopy. LOL

[Trish]

Hi Judy

I am not sure if it is available where you are but I had Tramadol drops for Flynn at one stage. It was great as I could just squirt it in his mouth. When it was a new bottle he had no problem with it, but after a while it did get bitter and he hated it. I squirted a bit on my tongue once to see what all the fuss was about and dear god in heaven it was awful so I could see why he didn't like it and threw it out. I have also split his tramadol capsules and I would take the powder out. They were not slow release which as you know should not be cut or divided as they might get too much at once. But our vet said it was ok with these capsules. Again very bitter and I had a devil of a job hiding it. He was prescribed codeine phos once it worked really well but had to watch for constipation.

He remains on previcox, despite his liver and kidney issues they have not deteriorated for the two years he has been on it daily. He has had PLN for 4 years. Our vet went into a lot of detail on how this Cox II inhibitor if given at the right dose per weight of your dog should not impact on kidneys and despite my initial reservations he has proven to be right. Luckily for us it has been a godsend.

I hope she is feeling better soon
Trish

[molly muffin]

Hi Judy, how was Abbie today on the 3rd of tramadol a day? Just checking in on you both. Did you get any sleep last night

[judymaggie]

Hi! Thanks for checking on us, Sharlene -- both of us slept better last night. Abbie started the day out the same as others -- head down, almost touching the floor and shuffling her feet. It's odd because, when she wakes up, she comes and sits near me and wants to be rubbed and seems okay. She was hungry for some chicken -- I could barely get it to her mouth as her head is so low to the ground! I was able to get her meds into her. She perked up about 45 minutes later. She ate a pretty good meal mid-morning. Had a "duh" moment when it was time to give her the nasty tramadol at noon time -- took out the cheese and cat food. She eagerly swallowed it. At 3:30 she ate a regular meal out of her food bowl for the first time all week. It was a busy day at my house as a new air conditioner was installed -- Abbie did pretty good with all the traffic. She slept most of the afternoon. I am going to give her evening meds in cheese. All in all, a better day!

Trish -- I give you a lot of credit for doing the taste tests with the tramadol! I take it myself and, thankfully, don't have to break it up. I'll have to ask the vet about the previcox -- not sure if that would help Abbie's disc issues or not.

[judymaggie]

Hi, folks! A Valentine's Day hug to everyone's pups! :D Unfortunately, Abbie has not been improving at all and slid back a bit as we started to wean her off the prednisone. Friday night she was awake off and on and, from about 6:00 am, started shaking very badly. She finally stopped a few hours later. On Saturday the associate vet consulted by phone with my vet. We went back to twice a day prednisone and, instead of valium, started her on Robaxin. Abbie slept better last night but had a rough start this morning. The drugs kicked in about 9:30 and she is now resting. The associate vet will call tomorrow to check on her and we go in on Tuesday to see our vet. I so hate to see Miss Abbie in pain and really hope the Robaxin will work on the muscle spasms.

[Harley PoMMom]

Oh Judy,

It is so hard to see our pups not feeling well :( Hopefully the Robaxin will make her feel much better. Sending healing and comforting hugs, Lori

[molly muffin]

I really hoped that she'd be making some improvements. :( Very sorry to hear that she isn't. I too hop ethat the Robaxin helps her to feel better.

Sending you big hugs!! Happy Valentines day

[Joan2517]

Poor Abby....feel better.

[judymaggie]

Hi, folks! Abbie is really not responding to treatment with meds. We went to see vet this afternoon and he is concerned about me taking Abbie to the chiropractor without knowing exactly what is going on in her neck. So ... we are off to the neurologist tomorrow. I am taking Abbie to see the same neurologist who saw my Maggie -- I really liked her and her clinic is very well respected in the area. It is an hour away but I feel more comfortable going to someone I already know. Think good thoughts for us!

[mytil]

Hey Judy,
You bet, tons of good thoughts heading your way!!! Let us know what happens after the appointment.
Terry

[molly muffin]

Definitely sending good vibes your way. I do hope the neurologist can tell you what is happening, why she isn't responding to the meds and set up a plan for a course of action to get her back on track.
Let us know! We'll be watching for an update!

[Harley PoMMom]

Most definitely sending positive thoughts and energy your way.

Hugs, Lori

[judymaggie]

Hi, folks! We went to the neurologist this morning -- after listening to history and examining Abbie, the vet was 99.9% positive that she had a herniated disk. The other options were not good so I was hoping for the disk diagnosis. The vet did say that, because I brought her in so quickly, there was minimal neurological damage -- just slightly weaker back legs. I left Abbie to have an MRI and, if she did have a herniated disk, she was going to go straight into surgery. I just got a call from the neurologist -- Abbie did have a herniated disk in her neck, it was removed with "minimal bleeding" during surgery and she was already able to move her head from side to side although the vet said she was a bit "drunk". Hooray!!! :D:D If she has a good night, I will be able to pick her up tomorrow and bring her home. The vet said recovery is typically two weeks of rest. Because, unlike in humans where disks are usually fused, removing the disk completely makes for a shorter recovery. I don't know if a spacer is put in -- will have to ask that tomorrow. For now, I just wanted to know that she was doing good!

P.S. Forgot to include that I had the opportunity to put my Cushing's knowledge (that I have gained here!) into good use today -- the neurologist was looking at Abbie's last set of labs. She commented on the increased potassium and, when she got to the ACTH, said that she was concerned Abbie might have Addison's and proceeded to explain to me what that was. I told her I was quite familiar with Addison's and asked her what on the ACTH gave her that thought. She pointed to Abbie's post of 8.5 and the reference range of 8-17. I told her (politely) that the reference range was for non-treated dogs and asked her to scroll down the page to the info about "post-trilostane" levels. She then said "Ah ..."!

[molly muffin]

That is excellent news!!! They fixed your Abbie!!! yay! I'm really pleased to hear that she was already able to move her neck. That is a huge improvement right there. I am pretty sure you are a happy girl too, as this was the best possible option of what might be the problem.

Interesting how if they remove it, it's a quicker recovery time and only 2 weeks. That is good!

[Harley PoMMom]

Oh Judy!!!!! What GREAT news!!!!!!!!!!! I am so happy that they found out what was going on with our Abbie and have now fixed it...you are such an amazing advocate for your sweet girl.

[labblab]

Oh Judy! I've been following along, too, and I'm so relieved to hear this!!! Sending huge healing wishes to Miss Abbie (and to you too cuz I know how worried you've been! ;)).

:) :) :)

[Joan2517]

So glad you found an answer...the uncertainty is the worst~

Joan

[mytil]

Oh that is fantastic news!!!!!!!!!! Gentle smoochies from me when she gets home.
Terry

[My sweet Ginger]

Oh, your post today makes me very happy. Good job Abby and mom!

[judymaggie]

Hi, all! Spoke with the surgeon this morning and she said, when she came in this morning and checked on Abbie, she was quite loopy and was drooling. She has backed off on the pain meds as she thinks she was reacting to them. She will be giving Abbie a hyperbaric oxygen treatment to help with healing and will call me back this afternoon to let me know how she is doing. She mentioned possibly bringing her home later today but, as much as I want her with me, I am not adverse to a second night in the hospital if that is in Abbie's best interests.

[onlyg]

Congratulations!! So happy for you both!!:)

[judymaggie]

Hi, all! Just a quick update -- the neurologist wanted to give Abbie a second hyperbaric treatment this afternoon so Abbie is spending tonight at the hospital and I will pick her up tomorrow morning. The neurologist called my vet and also faxed him a treatment summary. I will meet with the neurologist when I get Abbie so will bring my list of questions. I definitely want to find out what the rest of her disks looked like -- I am assuming the MRI would have shown all of them. I also want to know when I can restart all of Abbie's regular meds, including the Vetoryl.

Question: the neurologist is going to have Abbie continue on prednisone for a short while. Assuming Abbie is eating regular meals, do you think I should hold off re-starting the Vetoryl until the prednisone is stopped? She has been off Vetoryl since 2/9/16 and has been on prednisone since then.

[labblab]

Judy, that's a great question, and I would definitely ask the neurologist about that specifically. As we talked about earlier, it may be the case that they'd like to keep her natural cortisol production under control at the same time that she receives the supplemental pred. But since the anti-inflammatory considerations may trump everything else right now, the neurologist may want her to remain off the trilo until she has completed the course of pred, especially since it's only going to be for a short time. That's a really important question to ask tomorrow.

Surely hoping she'll feel much better by the time she comes home tomorow!

[molly muffin]

Oh yes. Hope she is home soon. Definitely worth a chat with the Neurologist. What did he say.nthe other discs look like? Hoping they look really good.

[judymaggie]

Marianne/Sharlene -- my concern is that I don't think the neurologist knows much about Cushing's (take a look at the P.S. I added to my first post about the surgery -- I had to show her how to read the ACTH results). My vet is learning from me so don't think he would know either. I am thinking the hospital may have an internist on duty whom the neurologist could ask but I would have to be very diplomatic ...

I will definitely ask about the condition of the other disks. Since the issue last year was lower down on her back, I am concerned about the rest.

[Harley PoMMom]

I remember reading in a Dr. Feldman article that with Lysodren it should be stopped for surgery, stressed situations..etc so the cortisol can run higher. My thinking is that this protocol would be followed with Trilostane too.

Give our sweet girl some gentle hugs from me.

Hugs, Lori

[molly muffin]

If there isn't any reliable I out from the vets then myself I would not give the vetroyl for exactly the reason Lori mentions. To allow her body to do what it can to help her over this hump

Yes you mentioned this had happened before so I can see the worry there. I'd want to know too how the other discs are.

[labblab]

I would definitely agree about stopping the Vetoryl if the prednisone wasn't involved. It's the fact that the pred is being given, in addition, that makes me wonder. If nobody knows a definitive answer, then I agree that I'd hold off on the Vetoryl rather than give it. But even if the neurologist is not that familiar with Cushing's, hopefully he'll understand the dynamic that is involved once you explain it. Does he want a lid on the natural cortisol or not, in conjunction with the pred? It may depend somewhat on the size of the pred dose and duration.

[Harley PoMMom]

I've should of added that Dr. Feldman stated that in those certain situations that prednisone is needed.

[judymaggie]

Thanks, guys! I have all my notes ready ... ;)

[molly muffin]

And how is our precious Abbie doing today? I hope she is feeling better.

We're ready and waiting to hear all the news!!! :) :)

[Harley PoMMom]

I wanna know too! :)

[judymaggie]

Hi, all! It's been a long-g-g afternoon/evening. Abbie has finally closed her eyes and I am getting to sit down with a heating pad on my back. Fibromyalgia and lifting a dog up and down don't go too well together ...

I met with both the neurologist and then her surgical tech. The neurologist said that she removed the portion of the bone and dispaced disk material in one disk in Abbie's neck that was completely herniated and then did what is called "fenestration" in all of the remaining disks, including one disk that was calcified. From what I understand, this involves removing the center of each disk. She said that she wanted to do what she could to avoid another herniation and, thank goodness, for no additional charge. Abbie was eating, walking short distances and peeing in the hospital.

I asked her what her thoughts were about starting the Vetoryl re suppressing cortisol. She said "What an excellent question!" :D She said to start it when the pred was reduced to every other day (in four days). The tech went over all her meds with me (tramadol, prednisone, robaxin and keflex). I am supposed to put neosporin on her incision three times a day and also put ice packs on it three times a day.

We got home about noon. I put Abbie on the bed--she was panting very heavily and shaking along with intermittent muscle spasms. She did drink some water. She was obviously uncomfortable so tried to get her to eat at around 4:00 so I could get some meds into her. I tried five different things but she wouldn't eat anything. I called my vet and he suggested I come by to pick up some recovery food which can be mixed with water and fed by syringe as well as a liquid food. I got one syringe of food into Abbie before she balked. Then I tried to get some meds into her via a cheese ball--what a fiasco. Ended up with cheese and pills all over both of us. A couple of hours later I gave her some of the liquid food. I was fixing my dinner and went into the bedroom to check on her. She had thrown up all over the bed. She seemed much calmer ...

After changing the bedding I called the neurologist. She gives all clients her cell number and encourages calls but I was still hesitant to bother her. She said to not push any food or meds tonight and tomorrow see if she would eat some white rice cooked in chicken broth. She said to text her with any concerns tonight and to not hesitate to bring her back to the hospital. So that's the plan!

My vet had an interesting observation after reading the neurologist's reports. He noted that the herniated disk had compressed to the side rather than straight down. This was why Abbie wasn't showing more severe neurological symptoms. We really dodged a bullet! I did ask him why the incision was on Abbie's throat rather than the back of her neck. He said that there are too many arteries as well as too much muscle in the neck to access the spine that way.

Abbie is still resting comfortably--I am hoping she will walk a bit more tomorrow so I don't have to carry her out to pee and sure hope the rice is a hit!

[mytil]

Wow, what a long day for sure. I am so glad she is doing better - I know it makes you feel better as well (stress is not good at all for fibro).

Keep us posted
T.

[labblab]

Fingers crossed that today is an easier day for both you girls!

Judy, I don't know whether a supportive harness like this would be OK to use after spinal surgery, but we bought one to help us with Peg when her hip really flares and she has trouble walking on her own. There are lots of varieties on the market, but this is the one we got from Amazon. They have several other brands for sale, as well.

http://www.amazon.com/Blue-Lift-Support-Harness-canine/dp/B016AUJY50/ref=sr_1_1?ie=UTF8&qid=1455968734&sr=8-1&keywords=dog+support+harness

If Abbie can't yet walk at all, then this probably won't help. But once she regains some mobility, this may assist her and also save your back. :o

[judymaggie]

Marianne -- Abbie will walk, albeit very, very slowly, outside to pee. Today she did not want me to pick her up. This afternoon she did sleep for a while without any muscle spasms. Biggest problem now is to figure out something she wants to eat. This morning she did eat a small bowlful of chicken and rice which was encouraging. She ate nothing the rest of the day and tonight she wanted nothing to do with the chicken & rice and would only eat chicken by itself. I really didn't think she ate enough to even coat her stomach but I gave her the tramadol, prednisone, robaxin and keflex anyway. I am not that concerned about weight loss (although she has already lost two lbs. since she got sick) but she needs nutrients to get better. If she will only eat chicken in the morning, I think I'll text the neurologist and see what her thoughts are. I hate to go down the Nutrical road ...

[Joan2517]

I hope she feels better tomorrow, Judy...the poor girl. I had back surgery and it is no easy thing!

[molly muffin]

Hopefully you won't have to go down the nutrical road, but even if you do, it would only be temporary to get her through this period of time.
Hopefully each day will see a bit of progress and at the end of 2 weeks she will be so much better and recovered and you can put this all behind you.

Hugs!

[judymaggie]

Thanks Sharlene and Joan (Joan, you are a special person to be worrying about other's pups when you are going through a traumatic time)! Unfortunately, about an hour and a half after eating chicken and getting meds, Abbie threw up--mostly white foam but some undigested chicken also. I was pretty sure she hadn't eaten enough to handle the meds and I think that's why she threw up. She is sleeping now--no muscle spasms but, to my untrained eye, her respiration rate seems faster than normal.

[Harley PoMMom]

Oh Judy,

Glad to read that Abbie is home. I know how worrisome it can be when your baby doesn't want to eat. I wonder if her food was more of a soupy/slurry mixture if that would entice her. I was thinking that you could put her food in a food processor and maybe she would lap it up??

Keeping you both in my thoughts and prayers.

Hugs, Lori

[molly muffin]

I wonder if the respiration is up due to the throwing up and not having anything in her tummy. do you give the meds and food all at the same time or the meds after the food? So there is something in her tummy? Or before..I wonder which would work best for her. If the meds make her nauseous, what if you gave them after the food?

It is so darn hard sometimes trying to figure these things out. :(

[judymaggie]

Hi, folks! It has been a long 24 hours. Last evening Abbie would only eat a few pieces of chicken. I didn't think that it was enough to coat her stomach but went ahead and gave her the meds. Sure enough, an hour later she threw up, including undigested chicken. (Sharlene -- I had been trying to get her to eat something, then give her meds.) She slept well. This morning she was very alert and moving quite well -- I even got a little bit of a tail wag. I decided to give her a pepcid, wait a while and see if she would eat anything. No go -- not even a piece of chicken.

I texted the neurologist and asked her what to do. She said forget the meds and she would call in a prescription for zofran (for nausea). From what I have read it is often prescribed after surgery. Vet had given instructions to give 1/2 pill up to three times a day. I asked the pharmacist if they were bitter -- she said she didn't know but, as a precaution, to wrap it in something before sticking down the throat. She said to wait about 30 minutes after dosing to try food. I did so and "drum roll please" ... Abbie ate a small bowl of chicken and rice! :D I thought she might pick out the chicken but she cleaned the bowl and all that was on the bottom was rice.

Right after Abbie finished eating I saw poop on the floor. :( She didn't even realize she had pooped. More poop came out in a few more places. It took a while to clean Abbie up and then the house. I don't think she had had a bowel movement since last Tuesday -- I sure hope this is just a post-surgery event and not something that will continue. Since Abbie didn't have any neurological symptoms like loss of bowel control before the surgery, I am thinking it wouldn't start now.

I'll try some more food in a few hours. The pharmacist said to try the food first. If she eats, then don't give her the zofran. If she doesn't eat, give her zofran and wait the 30 minutes before trying the food again.

P.S. Texted the neurologist about the loss of bowel control. She said she thought the zofran was the culprit and, if I needed to give it again, to only give 1/4 of a pill (which is the low end of the recommended dose). No accidents in the last hour so, hopefully, effects are wearing off. I'll try food in a while and see what happens. I am hoping I won't need to give her any more zofran.

[Joan2517]

If she hadn't been eating there wouldn't have been anything to poop out, so it could just be that the food made it's way through and because the bowel had been empty, it just worked overtime.

[Joan2517]

Thanks Sharlene and Joan (Joan, you are a special person to be worrying about other's pups when you are going through a traumatic time)! Unfortunately, about an hour and a half after eating chicken and getting meds, Abbie threw up--mostly white foam but some undigested chicken also. I was pretty sure she hadn't eaten enough to handle the meds and I think that's why she threw up. She is sleeping now--no muscle spasms but, to my untrained eye, her respiration rate seems faster than normal.
I think I need someone to worry about now...I have gotten so used to it.

[judymaggie]

Joan -- you can definitely be an honorary Mom to Abbie!

I think it was definitely the zofran (see my p.s. below) that prompted the loss of bowel control. About an hour ago Abbie ate a bowl of chicken and rice without my having to give her any zofran beforehand. Still going to forego any meds. She seems to be doing okay without them. I need to get back to giving her her blood pressure meds and will check with the neurologist tomorrow re starting them assuming everything stays calm tomorrow.

[Joan2517]

Well that is certainly encouraging news, Judy~

[molly muffin]

Yes that is excellent news.

Poor Abbie, probably a good thing she didn't realize what was happening, or she would be mortified. Dogs take these things very seriously you know. :)

Yikes though, bet that wasn't a fun clean up job. I have always had to clean up any accidents or messes, like when molly had bad diarrhea with the bacterial stomach thing. My husband makes these horrible gagging sounds and runs to the bathroom. Well, duh, I want to gag too but it has to be cleaned. How that man managed to survive diapers when the girls was little beats me. (and yes I know he changed diapers) LOL

Still, so good to hear that Abbie is doing better. Makes those 2 weeks feel like a really long time though. :)

[judymaggie]

Hi, all! After having one more bowel accident last night (yup, more sheets to wash), Abbie had a good day today and I can really see her improving. I only had to give her one 1/2 dose of tramadol. When checking in with the neurologist this morning, she told me it was okay to restart Abbie's regular meds, in particular the metronidazole and also wanted me to stop the prednisone. I was not comfortable with the abrupt stop so called my vet. He agreed that I definitely needed to wean Abbie off the prednisone and also thought the keflex was going to be hard on Abbie's stomach.

I brought her in to see him this afternoon to get an antibiotic injection that would last two weeks and would bypass her stomach. He said the incision looked great. Every other day this week I'll be giving Abbie prednisone for a total of three doses and also starting all of Abbie's regular meds. She ate three bowls of food today--chicken, rice, canned LF and pumpkin--enough to restart Vetoryl. Tomorrow I am going to start adding in Abbie's dry food even though I'm sure Abbie would love to continue eating chicken and rice.

It's great to see my baby getting better! :D

[Joan2517]

That's such good news, Judy! I'm so glad she's eating again.

[Harley PoMMom]

It is great news to hear that Abbie is eating and feeling better. I'm surprised that the neurologist didn't recommend a tapering down with the prednsione. Every now and then when I get those cluster migraines my neuro puts me on a cycle of pred and he always has me to slowly decrease the dose...thankfully you knew to do that, Good job, Judy!!!

[Budsters Mom]

So glad that Abbie is eating!!! Go Abbie!!!:p

[judymaggie]

Hi, all! Friends from Georgia came yesterday to visit Abbie (I just happened to be home ...). I posted some pictures to her photo gallery -- the only time I can get any is when I distract her and someone else takes pics. Abbie continues to recover -- she does have an occasional muscle spasm with some shaking but it is infrequent.

[molly muffin]

Aww great pics Judy. She is looking really good and definitely happy.

[tank&kat]

Hi Judy,

I have a soft spot for beagles. Abbie is beautiful! Love the pics.

~Katherine

[mytil]

Great photos!!!!! She looks very happy!! Her sweet, soft face looks so cuddly. Glad you posted these.
Terry

[Joan2517]

Loved the pictures!

[judymaggie]

Hi, all! Today was post-op check with the neurologist. She was very pleased with Abbie's recovery and remarked on how well she was walking. I was very surprised that Abbie has lost another pound since her surgery. She is down to 22.5. She removed the one external stitch and she showed me how she sutures with having them all internal. Really fascinating! She did say she needed to check whether Abbie had pain in her ribs which is very common after a dog has such severe muscle spasms and pain. Sure enough, when she pressed under Abbie's forearm, she yelped. Diagnosis: rib head subluxation. The recommendation was for Abbie to be seen by a chiropractic vet to adjust the rib head and spine. She also recommended for the acupuncturist to see her first to relax the area of the rib heads and spine musculature. I have a call in to the chiropractic vet -- Abbie did not respond well to acupuncture last year so want to get chiropractic vet's thoughts on seeing her alone as opposed to seeing both of them. We got the "all clear" to resume regular walking -- I told her Abbie was tiring out pretty quickly after our short walks and she said that she might do better after rib pain is gone. She also said "... and she is 12, you know!" I think she does pretty darn good for a 12 year old pup!

[molly muffin]

Yay, sounds like good progress and nice she can have some walks again.

Sure she will feel tons better once the rib issue is fixed too.

Really good job you have done with her Judy!

[Harley PoMMom]

So glad to hear the Abbie is doing so well after her surgery!!! Hope the chiropractic can fix her rib issue.

Sending soothing and loving hugs, Lori

[judymaggie]

Hi, all! I am worried about Abbie. We got the all clear from the chiropractor after just one visit so I think recovery from surgery is complete. We have been having some cooler, less humid weather and Abbie has wanted to go on walks. Not sure how to describe it but, the last week or so, she has been laying down in unusual places. For example, instead of walking over to the carpeted hallway near the kitchen to lay down as usual, she just plops down on the tile. Every night we go out at the same time to meet our neighbor and her dog and walk back to her house for a treat. Tonight Abbie wouldn't stand up to go out--I helped her up and she was able to walk outside where our friends were. Abbie peed and turned around to go inside--my neighbor was worried about her as well. Even on the bed she is laying down as soon as all four feet are on the bed instead of walking up to her pillow.

I know this all sounds insignificant but Abbie is definitely a creature of habit and she is just acting differently. I haven't seen her rear legs give out but they definitely were not working properly tonight.

We have a vet appointment scheduled for tomorrow--kind of a mini annual check to get her shots and heartworm check so will definitely be discussing all this with the vet. We aren't due for an ACTH, etc. until the middle of May.

[Harley PoMMom]

I definitely see why you are worried, it is very concerning when they do things out of the norm. Is she tender to the touch at any place on her body?

Please do keep us updated and hopefully the vet will be able to figure things out, do you think the neurologist would have any idea of what is going on, maybe the vet can confer with the neuro.

[molly muffin]

Oh no. You are really right. You know when something is off with her and I too see why you are worried. I'm thinking they might want to do X-rays to see if anything has changed with her discs.
Hoping for good news after the vet visit. Really glad you are going in right away.

[molly muffin]

How is Abbie today? Hat did the vet say?

[judymaggie]

Hi! Abbie is doing fine today. Vet visit went well -- he believes that her back leg issues are related to the trauma that her spine underwent so primarily neurologically based. Her back legs did splay out a couple of times when we were there so he could actually see what I was worried about. He said to try and encourage her as much as possible to go on walks and to gently massage her rear legs. He said muscle mass has not declined at all and commented on how great her coat looks -- I think that omega3 oil has really helped in that regard. All else checked out perfectly, even her ears! Rabies and bordatella done and we were on our way home. Thanks for checking on us!

[Harley PoMMom]

So glad to hear that Abbie is doing better!!!

[molly muffin]

That is good that Abbie was better when you went to the vet. How has she been since? If she doing her walks okay?

[judymaggie]

Sharlene--Abbie isn't very interested in her walks yesterday or today, even though the weather is very comfortable. I have seen her back legs splay out a couple of times, each time she was on the tile floor. I did some reading about this and it seems pretty common for senior dogs when walking on tile or hardwood floors. I did email the neurologist in case she had some thoughts about it but haven't heard back.

Other than not wanting to go on walks, Abbie seems to be in good spirits. I told the vet that she is going to start clucking with all the chicken she eats. I am now wrapping the cheese ball in a thin slice of chicken and have another piece ready as a chaser! What we go through to get all the meds down ...I am still putting some cut-up chicken mixed in with her food. I started after her surgery to get her to eat and now she won't eat without it.

[molly muffin]

That is so funny about the chicken. Molly never turns down chicken either. Or any other kind of meat and carrots, steamed carrots just really tickle her fancy for some reason.

Did you hear back from the neurologist at all?

[judymaggie]

Hi! No, never did hear from the neurologist--surprising as she has always been responsive. Abbie very quiet today--even passed up her favorite treat. I didn't sleep well last night and had a lot of muscle pain today--maybe she was just having an off day also.

[molly muffin]

Hopefully you both are having an off day and tomorrow you both will feel better. I sure do hope so.

Molly has some off days too. When they are off, she is quieter and doesn't want her treats either or to play. Recently that hasn't been the case, but about a month ago we where having Many off days and it was just hard to see. So I'm hoping that like Molly, Abbie will bounce back soon and feel better.

[judymaggie]

Here is a poem in honor of Abbie's 13th birthday (and adoption day)!


A companion, a pal,
A very best friend.
Someone to trust,
To love 'til the end.
Someone to trust,
When feeling blue.
Always a smile,
T'always greet you.
Always a smile,
To dry up your tears.
A person to be there,
To quiet your fears.
A person to be there,
When lonely or sad.
Loving regardless,
If hating or mad.
Loving regardless,
If caring or cruel.
No matter what,
Genius or fool.
No matter what,
They stand by you.
Who is this person,
Have you a clue?
Who is this person?
I'll tell you who.
This is your pet,
That loves through 'n through.
~~ Author Unknown

[Harley PoMMom]

Sorry I'm late in wishing dear Abbie a Happy, Happy 13th Birthday!!!!

What a great poem to pay tribute to such a sweet girl, Abbie. I took the liberty and changed her age in her thread to reflect her recent birthday, I hope that was ok.

Love and hugs, Lori

[molly muffin]

Whooo Hooooo 13

Happy Birthday Abbie!

What a truly lovely poem!

[judymaggie]

Hi, all! Abbie had her 3 month ACTH along with a super chem and UPC yesterday. She was also supposed to have her blood pressure tested but that didn't work out due to an unexpectedly long surgery for the vet.

All of her test results are excellent except for the UPC. Her ACTH pre was 3.4 and post was 6.9 (2/4/16 results were pre of 3.8 and post of 8.5). Her alkaline phosphatase was only slightly elevated at 147 (range of 5-131; 2/4/16 result at 168). Only other elevated lab was potassium at 5.8 (range 3.6-5.5; 2/4/16 result at 6.0).

Then there is the UPC ... 6.6!! :( This is the highest it has been since we started measuring and last level on 2/4/16 was at 4.2. Since the last test I had added omega-3 fish oil to her regimen and it doesn't appear that that is doing anything positive. Very discouraging -- now we really have to check the BP. If her numbers are okay, then I think we'll just continue the current meds but, if her numbers are at all elevated, I will ask the vet to consult with Abbie's internist. I may also post on Dr. Peterson's blog to pick his brain.

[molly muffin]

I think it might be worth checking with the internist for that high UPC. Drat that thing is stubborn!!
Great though that her cortisol is good. Her liver is good too.
Are is feeding her a low phosphors food? I can't remember. Dog aware has tips for lower phosphorus foods. it is hard as I know molly is picky and none of the kidney diet foods interest her at all

[Squirt's Mom]

A VERY belated wish for Abbie -


HAPPY 13TH BIRTHDAY, SWEET GIRL!

[judymaggie]

Thanks all for the birthday wishes! Abbie really surprised me today--when we went out after dinner, temp was about 87 with pretty high humidity. Abbie walked for a full half hour--first long walk in several weeks! I have no idea what was different tonight but was very pleased.

Sharlene--I haven't changed Abbie's food to a low phosphorus. Like Molly, she is very picky. After a while of not wanting to eat breakfast, she is eating all her meals. I hate to rock that boat. Also, all of the other kidney markers on her labs are normal. That said, obviously, with such a high UPC, her kidneys aren't filtering as they should. Hopefully, her BP is stil controlled.

[Harley PoMMom]

That's great that her lab values have come down and that her cortisol is staying controlled. All sorts of things can elevate that UPC so just maybe it was a fluke result....crossing fingers.

[judymaggie]

Hi, all! Abbie had her blood pressure evaluated this week and it is exactly where it should be. :D Therefore, will be keeping all meds the same.

Abbie is showing more signs of aging--she is missing the grass when peeing more times than not and, on a walk yesterday, she stopped walking and pooped right in the middle of the sidewalk. Thankfully, her poop was firm ... When discussing these behaviors with the vet, he said he is seeing the same thing with his elderly dachshund and thinks it is a combination of senility and loss of impulse control. I have thought about trying Novifit since I have seen other signs of general confusion but Abbie is on so many meds already that I hate to add one more. Part of me thinks that this is all the natural progression and, considering all her other issues, she is doing pretty darn good!

P.S. Upon reading Virbac's literature again about Novifit, I decided that it couldn't hurt to do a two month trial Virbac says that, if it is going to help, changes will be seen within a two month period. I went on-line to order some and every site said "out of stock". I called Virbac and their rep told me that they are in the process of updating their manufacturing equipment. They don't have a date as to when Novifit will be available but suggested that I call them back in a month to check if they have more info.

[Joan2517]

Oh, Judy...it's so hard when they start to show signs of getting old, isn't it? We still want them to be the puppies we always think of them as.

[judymaggie]

Hi, all! New, concerning symptom ...Abbie's back legs have collapsed on several occasions. There doesn't seem to be any common thread as to where or when it happens. She looks surprised when it happens and is able to get herself up. If I push down on her rear end, she seems strong which leads me more in the neurological route. I always worry about the IVDD rearing it's ugly head again.

We have a chiropractor appointment this Friday and will certainly discuss with her. She will be able to determine if Abbie is having any pain. I haven't been giving Abbie any tramadol as she has been going on walks most days and seems comfortable. No walk this morning but it is already very hot and humid here!

[Harley PoMMom]

Oh Judy,

I am so sorry to hear that Abbie is having trouble with her back legs. And I know how worried you must be with this new symptom. Is she having any knuckling under issues with her paws?

Sending comforting and loving hugs to you and our precious girl.

Lori

[molly muffin]

Dang. Poor baby. Just when she is doing good again.
So you are tHi king its maybe the spine again? Will they do more X-rays to see for sure? Hmm didn't they fuse a couple extra points to try and prevent future issue?
I know lots of questions right. :).

[labblab]

Oh Judy, I'm afraid I have no suggestions but I can surely understand your worry. That's how I'm feeling, too, when Peg goes down, although with her the cause is more obvious. It's darn hard to watch, though. Sending comforting pats to Miss Abbie, and I do hope a solution can be easily found.

[judymaggie]

Hi, folks! Thanks for your thoughts. During her surgery the discs in the thoracic area were all cleaned out so as to greatly reduce the possibility of future herniations in that area. Unfortunately, that still leaves the rest of her spine at risk. She has had episodes of pain in her lower back before which were resolved, at least for a while, with pain meds and chiropractic treatments.

She has no knuckling, only the collapsing. After our visit on Friday with the chiropractor I am going to contact the neurologist, primarily to find out if there is anything I can do to avoid things getting worse. If she wants to see her, that will be fine. If x-rays would show disc issues, I would prefer the neurologist take those herself rather than my vet. I honestly don't know if I would go the MRI, or god forbid surgery, route again.

[judymaggie]

Hi, folks! Abbie is obviously uncomfortable today -- was hanging her head a bit and shaking which was the pre-cursor the last time around. I gave her some tramadol at noon and she is resting now. I decided to call the neurologist and get her thoughts -- wanted to make certain that chiropractic appointment on Friday wouldn't hurt her. When I called the neurologist, her assistant told me that the vet would actually be in Tampa tomorrow at an imaging center (30 minute ride rather than an hour away in Sarasota) and could see Abbie in the morning. So glad I called! I did ask if I should give her any tramadol in the morning and she said to forego it so vet could see her without having had pain meds.

Think good thoughts for Miss Abbie (and me ...)!

[DoxieMama]

Hi Judy, how fortuitous you called today! I'll be thinking of you both til then. Hope the tramadol helps her in the meantime.
Shana

[Harley PoMMom]

Keeping you and Abbie in my thoughts and prayers and sending positive energy your way.

Hugs, Lori

[judymaggie]

Hi, folks! Well, today's visit didn't go the way I expected. Neurologist said that, neurologically, she thinks Abbie is doing fine and did not believe that collapsing legs were an indication of anything neurological. She was, however, very concerned that Abbie's tongue was gray ... I honestly never pay attention to the color of her tongue. She has had a low grade heart murmur for quite a while and blood pressure is now controlled but no other cardiac issue. It was her recommendation that I take Abbie to see a cardiologist for evaluation and x-rays. She did say she thought it would be fine to keep Abbie's appointment with the chiropractor on Friday.

My vet is off today but I think I'm going to call him tomorrow and ask him to see Abbie first. If he agrees that a cardiologist's evaluation is needed, I will have a better chance of getting an appointment if he calls to schedule.

Always something, huh ...

[Renee]

Very interesting - so, is the greyish tongue an indication that she's not getting enough oxygen?

[judymaggie]

Renee -- that's what she said and, of course, read some things on internet that confirmed that that is a possibility. Still would like to know why Abbie's back legs have collapsed a few times even though her muscle mass and reflexes are intact. Neurologist wanted me to try and get a video of this happening but that is impossible. When I happen to see it, she is back upright in seconds. Vet said to keep checking her tongue color -- am sure Abbie will be thrilled with that!

[molly muffin]

Oh my gosh. So that was unexpected. Would a cardiology issue cause the back legs to just go out though? Or did she have any thoughts on the legs going aspect?

Gosh sure hope that there isn't a heart issue to deal with too. (other than a low grade murmer of course)

[judymaggie]

Sharlene -- I don't think the neurologist thought the back leg issue was related to any possible cardiac issue. She did mention the possibility of seizures and that's why she wanted me to try and get a video. I have been down the seizure road with Maggie and nothing that Abbie has going on seems familiar to me but then I am definitely not the expert.

[judymaggie]

Hi, all! Just an update after speaking with my vet and Abbie's treatment today with the chiropractor -- my vet agreed that there is no urgency in checking Abbie's oxygen levels. I already had an appointment with him on 6/23 and he has the machine that can measure her oxygenation at that time. He will be away all next week but said to contact one of the other vets if anything comes up that is concerning.

The treatment this morning with the chiropractor shed some light on the weakness in Abbie's back legs. Abbie had significant pain in her lower back. She also had quite a bit of trembling/tremors in her back legs during the treatment. The chiropractor believes that she has a pinched nerve in her back. Abbie has had a similar diagnosis in the past -- all related to the IVDD. We made another appointment for 7/5.

I have been unable to get Abbie to swallow the tramadol. She was prescribed 25 mg. which meant I had to split the tablet. I have been told that the split pill is extremely bitter and, no matter how I wrapped the pill, Abbie would spit it out. I called the vet back today and left a message re chiropractor's comments and asked if I could give Abbie a full pill of 50 mg. He called back and said I could give her 50 mg. up to three times a day. I was able to give Abbie a 50 mg. a short while ago.

[DoxieMama]

Awww, poor Abbie. I hope the tramadol gives her some relief. Is she on restricted movement now, or is that not necessary?

[judymaggie]

Shana -- Abbie is real good about restricting her own movements. She has used steps to get up to our bed for a long time and she goes up and down them very carefully. I used the same steps for her to go in and out of the car. If we do go out for a walk (as opposed to just pee/poop trips outside), when Abbie is ready to go home, she stops walking and, if I say "ready to go home", she turns around and heads home. Our weather is unbearably humid right now so neither of us are too eager to go walking!

Tramadol knocked her out -- she has been sleeping soundly for a while now.

[Harley PoMMom]

Sorry to hear that our Abbie is having pain with her lower back :( If the 50 mg of tramadol seems too much I wonder if using those empty capsules to hide the split tramadol would work?

Sending hugs and love to you both, Lori

[Trish]

Hi Judy

Sorry to hear of Abbies troubles. I had trouble with tramadol too, i was giving up to 50mg for approx 30 pound Flynn. That would sedate him too much but also not give enough pain relief. Gabapentin was another option and i am wondering if that would help especially if it is nerve pain. Tramadol is incredibly bitter, i tried it. I could only get it in capsule format so when I was splitting them I got empty capsules from my pharmacist and I could get them down him. But if he got a whiff of it, no sirree, not swallowing that thank you very much. Another option is you can get them in drops, but they come fruit flavoured, so all very well if Abbie likes fruit. Flynn didn't!

Hope she is feeling better :)

[judymaggie]

Trish & Lori--thank you for your input. Trish, you are a very special person to be thinking of others as you cope with the loss of dear Flynn.

Abbie is doing much better--she has decided to stop fighting with me and swallow her chicken wrapped cheese balls with all her pills inside! I know better than to think it will last but appreciate it for now. I haven't seen any leg collapsing since her chiropractic treatment. The chiropractor called to change her next appointment and was pleased she responded so well. It is unbearably humid here so neither of us are eager to go out but we have gone on some short walks.

We have had some very strong thunderstorms due to extremely hot weather. Not sure why but Abbie no longer reacts. However, Sunday night there was a really violent clap of thunder and Abbie went flying off the bed! I was so afraid that she might have hurt herself but I have not seen any ill effects.

[molly muffin]

Well that is just excellent news Judy! So glad that Abbie is doing better and what! even taking her pills!!! Shocking!

Maybe either her hearing is going or she just doesn't care as much about the thunder. Seriously glad she didn't hurt herself with a jump down off the bed though. Gads, that would have given me a scare too.

Big hugs, stay cool

[judymaggie]

Hi, all! Just wanted to give an update on Abbie since I've seen changes over the past month.

Sharlene mentioned the possibility of Abbie's hearing going since she no longer reacted to thunderstorms -- definitely the case! Abbie is not responding to me talking to her, calling her name, sounds around her, etc. She was walking away from me one day and I called her -- no reaction. I then literally screamed at her and nothing ... This makes me sad as it is increasingly hard to interact with her. I have always taught my dogs some hand gestures -- the problem is that I have to get Abbie's attention first before I can use the hand gesture. Over the last month she has been barking more and more in the house -- the only time she used to bark before this was when she was trying to hurry up my food preparation. I am assuming the barking is related to the hearing loss.

Abbie had a chiropractic treatment on Tuesday. It had been a month since the last visit and I saw positive changes with regard to rear end weakness and leg collapsing almost immediately the last time and they lasted about two weeks. During the visit this week Abbie obviously had a lot of discomfort in her lumbar and sacrum spinal areas. The chiropractor worked on her for about 20 minutes. Unfortunately, I am not seeing significant positive changes this time around. Wednesday and Thursday Abbie didn't want to go on any walks and yesterday she had two episodes where her rear legs and rear end started shaking followed by a leg collapse. Today she seems a bit better and did go for a short walk this morning. I do have her next chiropractic appointment set for 8/1 -- I'll keep it and will discuss with the vet what happened this time around. If I don't see positive results, I won't keep taking her.

Otherwise, things are good -- excellent appetite, still taking pills, good poops and no urinary accidents. She doesn't always make it to the grass to pee and poop -- my vet has said he sees that in his senior dog and is probably due to lack of sphincter control. I am still giving Abbie 25 mg. of tramadol a day -- may up that to twice a day and see if it makes a difference. Trish had mentioned Gabapentin and I will ask the vet on our next visit.

Next ACTH is scheduled for 8/4 along with a super chem panel and, for the first time, a SDMA test. With such a high UPC and other kidney factors normal, I really want to see if she truly has any kidney disease. I have chosen to forego doing a UPC.

I really wanted to do a trial of Novifit with Abbie but, unfortunately, it is still not available and Virbac has no idea when it will be available.

[Harley PoMMom]

The active ingredient in Novifit is SAMe (S-Adenosylmethionine), and I bet that the product SAMe is a bunch cheaper.

I do hope that the next chiropractor visit will help Abbie even more.

I found this web site with many tips on how to teach a deaf dog hand signals, don't know if this will help or not. :o http://www.deafdogs.org/training/signs.php

Hugs, Lori

[Joan2517]

It's so sad when that happens...I cried for a week after I realized Lena was pretty much deaf. I thought she was just ignoring me and didn't want to come to me anymore. It broke my heart to see her looking around at the garden knowing she couldn't hear the birds or the outside sounds anymore. I can still see her in my mind just sitting and watching.

I started getting her attention by whistling loudly, which she was able to hear a little of, or stomping on the floor, clapping my hands loudly, and flickering the lights.

I would touch her gently to wake her up so she wouldn't get startled and start to shake. We started learning hand signals and she began to pay more attention and watch me for signs. My greatest fear was that she would get out and get lost.

In her last few years, it didn't seem to bother either one of us anymore and it was a blessing I think that she didn't hear the other 3 barking like lunatics every time they heard something.

You will both adjust and start a new language together. Lena and I were so close that even when she couldn't hear me anymore, if I was upset and yelling on the phone or something, she felt it and would come running from another room to try to make me feel better.

It will be alright....

[kanga]

Aw so sorry about your lose! And sorry that you facing this kind of problem again, hope your dog will be okay soon. It's so hard for us to see our dog suffer with those kind of disease hope Abbie will be treated soon. You are always in my thought I pray for you and for Abbie.

[molly muffin]

So it is the hearing. That makes it tougher to get her to learn the hand signals but I bet you will get her up to speed eventually.
You know how they Always know when it is dinner time? Well, maybe doing more schedule type things would help her to adjust to what is going on when. Like walks at specific times, food, lazy watch tv time, etc I don't know how much of that is actually realistic but throwing some ideas into the wind.

[Squirt's Mom]

A comment on regular SAMe VS Novifit. Squirt was on regular SAMe and had been for some time when she started showing signs of dementia. The Novifit helped her immensely where the regular SAMe had no effect at all. I asked the company what the difference was and they gave me a long "greek" explanation that boils down to how the molecules are arranged making the Novifit stable. Also, regular SAMe must be given on an empty tummy while the Novifit can be give with food. ;)

[judymaggie]

Leslie -- I had received the same explanation from Virbac about regular SAMe versus Novifit. Thought it might just be their sales pitch but your testimony is confirmation that there are differences. Just wonder why they aren't making it anymore --

Sharlene -- fortunately, Abbie and I are both on a very regulated schedule. Being retired helps out a lot in that regard and her liking a schedule fits right into my tendency towards OCD. That said, some situations are difficult. I was going out earlier -- typically, Abbie would be watching me the whole time and move right into the kitchen and wait for a treat as I leave the house. Today she slept right through everything -- I didn't want her to wake up and find me gone so I touched her gently to wake her up. She startled awake and then came to get her treat.

She already knows some hand signals -- problem now is getting her attention so she can see the signal.

[labblab]

Judy, Virbac has been in hot water with the FDA for quite some time now, and I am speculating this may have something to do with production lapses for some of their products. I had been giving Luna a topical skin product made by Virbac, but it is now mysteriously "out of stock" for most U.S. suppliers. When I called Virbac and asked them about this, they told me that the FDA has an issue with one of the ingredients. But after researching more myself, I'm thinking the problem is bigger than that :rolleyes:. From the sounds of the warning letters sent to Virbac by the FDA, it may be quite some time before production is normalized at their U.S. facility. :o

http://www.law360.com/articles/759473/fda-warning-wire-quality-of-popular-pet-products-in-doubt

[Squirt's Mom]

Oh that is too bad about Virbac. :( I never had any issue with their products and it is a real shame that Novifit will no longer be available to help dogs.

[molly muffin]

That is very, sad. It did help some dogs and for it to no longer be available is going to be a hard it for many.

[judymaggie]

Hi! Looking for some guidance ...

Abbie goes in to the vet tomorrow for her 3 month ACTH and super chem. Since she is now peeing every two hours and has had three accidents in the house, I asked for a urinalysis & culture. Vet wanted to do just the urinalysis but I have requested both.

Because Abbie's UPC is so high but other kidney markers are normal (and now she is having urinary issues), I also asked for an SDMA. Since my vet uses Antech labs and the SDMA is not part of its chem panel, I asked them to check on the cost. When I got a call back, the tech said that vet did not think the SDMA is necessary.

Abbie has been taking amlodipine and telmisartan to control her BP and try to lower the UPC. We have had no success lowering the UPC -- instead it has gone up (now 6.6!). All of the other kidney markers are normal. The pharmacy where I purchased the telmisartan has been sold and the new owners are not honoring the previous company's prices. Their price is three times as much and I cannot afford it. The telmisartan is the third drug we have tried in order to lower the UPC.

Now we will need to decide if we are just going to treat the high BP and not worry about the UPC. My thinking was that, if SDMA shows no kidney issues, we can look at the UPC as an aberration. From what I have read in past articles and the new article from Dr. Wooten that Lori posted, it is possible to have a normal creatinine level and still have kidney disease. I am unsure as to whether I should push getting the SDMA.

Your thoughts?

[labblab]

Hi Judy,

For me, I guess the question would be, what would you do differently even if the SDMA was elevated? You are already medicating to control Abbie's blood pressure, I think you are giving Omega-3s, and you've instituted a degree of protein restriction to her diet. This should also be helping with phosphorous control which is a main dietary concern for animals with kidney disease, although perhaps that's an area that could bear more attention with an elevated SDMA.

However, at this stage, as long as her creatinine and BUN are still normal, I'm not sure how much else you'd be doing to actively intervene with the proteinuria and early kidney disease even if the SDMA is indeed elevated. Here's a great set of FAQs, though, that IDEXX offers to help with deciding about the usefulness of the SDMA, and also what steps to take based on test results. If you look through it thoroughly, you may find some suggestions or info specific to Abbie's situation that I am missing or confusing.

https://www.idexx.com/files/small-animal-health/solutions/articles/sdma-faqs.pdf

[judymaggie]

Marianne -- thanks so much for the link to the IDEXX FAQs. It really was a thorough discussion. It is apparent that, since Abbie has already been diagnosed with proteinuria and high blood pressure, the SDMA would not offer any new information. I usually do give my vet the benefit of doubt -- guess I will this time as well!

The only aspect of kidney disease control that I have not instituted is changing Abbie's diet. She is very picky these days and, from hearing from others about how unpalatable the renal prescription food is, I have been hesitant to try it. This afternoon I spent 10 minutes getting her to her bowl to even try to eat -- this was the first time this has happened so not sure what is going on. I do think that canine dementia comes in to play as she appears more confused more frequently.

Anyhoo, her current prescription dry food has 21% protein; her prescription canned food has 6% protein. I would have to look at the renal prescription food to compare.

[labblab]

I totally understand your reservations about the commercial Rx diets. When my Peg was troubled by acute pancreatitis attacks, I realized we needed to try to make some low fat dietary changes but I was so put off by the ingredients in the Rx foods that I balked at using them. I ended up trying to find other commercial foods that shared a similar nutrient profile but contained ingredients that seemed of higher quality to me. It wasn't easy, but I did find some. However, palatability was never an issue for us -- Peg would eat anything. :o

The other thing I've been told, though, is that as distasteful as the ingredient lists for the Rx diets may be, sometimes dogs really do like them. I'm not sure that is true of the renal diets, but do bear in mind that Abbie probably may not benefit from the very low protein Rx diets at this point. Probably only moderate restriction would be recommended right now, and so those foods might be more palatable. For instance, I think Royal Canin has two renal versions: a moderately restricted food as well as a lower protein food.

Marianne

[judymaggie]

Hi, all! Abbie had her 3 month ACTH along with a super chem and urinalysis/culture last Thursday.

Her ACTH pre was 3.1 and post was 8.3 (5/13/16 results were pre of 3.4 and post of 6.9). Since I have not seen her back legs collapse the last few weeks, I am going to keep her Vetoryl dose as is even though cortisol has gone up a bit. Her alkaline phosphatase was only slightly elevated at 157 (range of 5-131; 5/13/16 result at 147). Potassium is still elevated at 6.0 (range 3.6-5.5; 5/13/16 result at 5.8).

Of concern is the urea nitrogen (also known as BUN) which is now elevated at 39 (range 6-31; was normal on 5/13/16 at 30). From what I have read the kidneys must be damaged to the point that 75% of the kidneys are nonfunctional before this will increase. The BUN/creatinine ratio is higher at 39 (range 4-27; 5/13/16 at 33). However, creatinine remains normal.

No signs whatsoever of a UTI. Specific gravity is low normal. Protein remains at 3+.

Due to the cost of telmisartan sky-rocketing, we are switching Abbie to benazepril along with continuing the amlodipine. Four weeks after starting the benazepril we will run a UPC, check blood pressure and run another chem panel. Benazepril is processed primarily through the liver rather than the kidneys so this is a plus.

The vet and I agree that the frequent peeing and accidents in the house are most likely due to the issues with Abbie’s kidneys along with increasing dementia. During the last week Abbie has not been as interested in going to her food bowl at meal times. Once she decides (after much encouragement) to go to the bowl she does eat everything. She has not gone on a walk (other than a very brief one mid-day) in at least two weeks. I have had to carry her from the bed to the kitchen a few times just to get her to go out to pee. She really just wants to sleep. In spite of the lack of exercise, she has lost ½ pound.

Seeing Abbie age is tough to watch – fortunately, none of her issues seem to make her uncomfortable. I am continuing to give her 25 mg. of tramadol every day.

[Harley PoMMom]

Hi, all! Abbie had her 3 month ACTH along with a super chem and urinalysis/culture last Thursday.

Her ACTH pre was 3.1 and post was 8.3 (5/13/16 results were pre of 3.4 and post of 6.9). Since I have not seen her back legs collapse the last few weeks, I am going to keep her Vetoryl dose as is even though cortisol has gone up a bit. Her alkaline phosphatase was only slightly elevated at 157 (range of 5-131; 5/13/16 result at 147). Potassium is still elevated at 6.0 (range 3.6-5.5; 5/13/16 result at 5.8).

Yep, I agree, I wouldn't raise her dose either. I'm a firm believer that you treat the dog and not those numbers.


Of concern is the urea nitrogen (also known as BUN) which is now elevated at 39 (range 6-31; was normal on 5/13/16 at 30). From what I have read the kidneys must be damaged to the point that 75% of the kidneys are nonfunctional before this will increase. The BUN/creatinine ratio is higher at 39 (range 4-27; 5/13/16 at 33). However, creatinine remains normal.



There are other things that can elevate that BUN, dehydration is very high in that list that contributes to a high BUN. From my understanding, when high levels in the creatinine are seen there is already 75% of kidney function lost. So it is great news that the creatinine is normal!!! Abbie had a SDMA test right, and if she did, what was her score?

Hugs, Lori

[judymaggie]

Hi, Lori! With regard to the SDMA, my vet didn't recommend it as we already know Abbie has kidney disease. After making my way through the 11 page IDEXX paper, I agreed with him.

I looked in our Resource forum at the section on lab explanations. The first article from Washington State Univ. refers to the 75% in relation to the BUN. That is why I was concerned that Abbie's BUN was elevated for the first time. (I had to move to my Nook as we are in the middle of a really bad thunderstorm so I can't insert the link here.).

[Harley PoMMom]

Hope the thunderstorm didn't cause any damage, I love those Tstorms except for when it causes a loss in electricity. :eek:

I did find that article and I understand your concern. From researching kidney disease so many things can elevate the BUN, this excerpt lists some of the reasons why BUN may increase:
Urea production and excretion do not occur at a constant rate. While renal dysfunction can cause increased BUN concentration, nonrenal causes also often result in increased BUN concentration. In the liver, BUN is a byproduct of the urea cycle and protein catabolism. Urea production and excretion increase after a high-protein meal, so an eight- to 12-hour fast is recommended before measuring BUN concentration to avoid the effect of feeding on urea production. Clinical conditions characterized by increased catabolism (e.g. starvation, infection, fever) also can increase BUN concentrations.

Gastrointestinal (GI) hemorrhage may also increase BUN concentrations because blood is an endogenous protein source. In 52 dogs with hematemesis, melena, or both, BUN concentrations and BUN:creatinine ratios were significantly higher than in age-matched control dogs, suggesting that GI hemorrhage contributes to increased BUN concentrations in dogs as a consequence of increased GI absorption of nitrogenous compounds.9 BUN concentrations may be increased by prerenal factors such as dehydration, which increases urine volume, and some drugs that increase tissue catabolism (e.g. glucocorticoids, azathioprine) or decrease protein synthesis (e.g. tetracyclines), but these effects are usually minimal.9

http://veterinarymedicine.dvm360.com/laboratory-evaluation-kidney-disease?id=&sk=&date=&%0A%09%09%09&pageID=3

Although a high BUN can be worrisome it is when it is paired with an elevated creatinine that a major concern takes place. Since Abbie's creatinine and other kidney markers (phosphorus, sodium, calcium, chloride) are normal than that would make me believe that her kidneys are still functioning pretty good, so the high normal BUN is something I would monitor.

Hugs, Lori

[molly muffin]

I agree that my specialist doesn't worry as much about BUN unless creatinine is raised also.

I hope the amoldipine and benazepril do the trick. We've had to increase molly amoldipine again and I'm hoping this will help her BP stay where it needs to be.

I've been using both of these sites for kidney information as far as test and their what to look out for within the results, etc.

http://dogaware.com/health/kidneytests.html
http://www.2ndchance.info/kidneydog.htm

You probably already have those bookmarked but if not..

[judymaggie]

Thanks to both of you for the reassurance about the elevated BUN -- my vet had not mentioned it at all but you know what a little reading can do to the imagination!

Okay, now I need some help ... Abbie sleeps next to me on the bed. Our previous typical morning routine would be that I would get up, do the bathroom routines and then Abbie would get up and follow me into the kitchen. I would give her her pepcid, she would get water and we would head outside for a couple of pees and a poop. Fast forward to present: I get up, do my thing, head to the kitchen, get Abbie's pill ready, get her breakfast things ready and, when there isn't anything else I can do, go back in the bedroom to try and get Abbie out of the bed. Here is where I run into a "brick wall" -- she has no desire to move, let alone get off the bed. I have tried rubbing her belly and using encouraging words to no avail. I have tried the hand clapping with an excited voice. She is usually on her pillow so I have tried to lift the pillow up and roll her off. This gets a few snarls but no effort to get up. I have managed a couple of times to lift her up and put her down on the floor where she tries to go back up her steps but I can block her. Now, as I approach her, the snarls turn into snaps. Yesterday she came close to biting my hand. She really just wants to be left alone! This wouldn't be a problem if I didn't need her to eat so I can give her Vetoryl and other meds. Tomorrow I thought I would try to entice her with a piece of chicken ...

Any suggestions?

[flynnandian]

i do recognize everything. the siblings mom did all of this in the end too. i had to use a thick blanket to grab her because in the end she would really bite me. i used a broom to force her to go outside to pee and poop. she was mega grumpy. she used to be a very sweet dog.
but i had to go to work in time, so i couldn't let her sleep in. she couldn't hold it till lunch time. she was 14 years old and when it got worse, i decided to let her go. she had kidney failure, but not too bad. the vet and i agreed that this was making her feel miserable and that this was the reason she bit me. her numbers were not very bad, but bad enough in her case to make her grumpy and ending really attacking me. [or maybe a brain tumor? i will never know for sure]
i think abby is not feeling well too. we tried strong painkillers and other meds , but that didn't help enough. it is no fun seeing your dogs personality change from sweet to a very grumpy and even biting dog. i didn't recognize her anymore in the end. i hope abby won't really hurt/bite you when you have to force her out of bed.

[Harley PoMMom]

Food enticement is what I would try first, something stinky maybe :eek: like tuna or tripe. Do you think that her mood change is due to dementia? If she doesn't respond favorably to the food another option could be to leave a harness on her so that you can just attach a leash and coax her down that way...We can ask Saskia, since she is a certified dog behavioral trainer, as she may have some better ideas.

When my cat is doing something he's not supposed to be doing I squirt him with water (just a little spritz) which he doesn't particularly like and it stops the unwanted behavior.

Hugs, Lori

[judymaggie]

Hi! Fifteen minutes and two pieces of chicken and Abbie made her way down from the bed this morning. She was pretty reluctant so not sure this is going to be the best enticement. I'll have to find something that will work better with her but won't make me gag (tuna and tripe fall into the latter ...). She needed a lot of coaxing to eat this morning but finished almost everything in the bowl.

The suggestion about the harness is a clever one -- will definitely keep that in mind although I think I might end up having to drag her across the bed and onto the ottoman/steps.

I don't think she is in pain (although certainly hard to tell sometimes) so am thinking probably a combination of dementia and old age except for the fact that this change seemed to have started suddenly. I do give Abbie 1/2 tramadol in the evening to help with any back pain -- guess I could add a 1/2 in the morning to see if that helps. This morning she was sleeping so heavily when I left that she didn't even wake up -- she seemed fine when I came home and went for a short walk a bit ago.

Another example of "sure wish they could talk"!

[Joan2517]

Yes, that would make it so much easier, wouldn't it? Just tell me what you need, what hurts, and why you don't want to eat?

[molly muffin]

hmm, could the tramadol at night along with the hearing loss be making her sleep much heavier than before?

I turn the light on in the bedroom and leave it on and hope molly wakes up and comes out. She usually does if she smells something or hears something in the kitchen. Hearing won't help you but smell, is there something you could that she likes particularly? Molly always comes out for bacon cooking, ham and chicken cooking smells are winners too. She might not want to eat something but the smells are pretty enticing.

[judymaggie]

Hi! I didn't give Abbie tramadol last night just to see if it made any difference and it did not. After doing some more reading about how to detect if a dog is in pain, I am beginning to think she may be in pain. My vet isn't in today but am going to talk with him tomorrow. I want to see what he thinks about having the chiropractor check her (as she seems more able to locate painful areas) and then get back with the vet to discuss pain meds if applicable. If she is in pain, the tricky part is to find pain meds that help with the pain but don't make her even more lethargic and/or confused.

Addendum from 8/18: Abbie was moving very, very slowly this morning so took her to see vet this afternoon. He checked her thoroughly--every time he pressed on the middle area of her back, her back legs collapsed. She was so stoic, never letting out a peep. She got a dexamethasone shot and I am to give her 1/2 tramadol three times a day. Vet wants me to call him tomorrow afternoon and give him status. Am very glad I took her in--she just wasn't acting right. Tonight Abbie went out to pee and poop but no walks. I am going to be gone for a while tomorrow but my neighbor is going to take her out every couple of hours.

[judymaggie]

Hi! Update (from addendum below) -- Abbie guzzled water all night. We went out twice during the night for pees. She got off the bed a little quicker this morning but still moving slowly. My neighbor said she wouldn't walk this morning but did take a short walk at 1:30. I just spoke with vet. He said that, if Abbie isn't consistently better by Monday, he might want to give her a prednisone shot so will see how the weekend goes. Hard to see her so uncomfortable -- :(

Would appreciate your thoughts on whether a better option (than pred shot) would be to stop the Vetoryl and let her natural cortisol increase to assist in lowering inflammation in her back -- or maybe do pred shot and stop the Vetoryl?

[Harley PoMMom]

Oh poor Abbie :( sorry to hear that she hasn't gotten better. Dang, if the dexamethasone didn't help I'm not sure if prednisone will, so I believe I would be more inclined to use a NSAID instead, such as Rimadyl. I always worry a bit when I hear that a dog is on it and it does carry a cautionary note about liver toxicity but all NSAIDs have that potential. The people I have talked to that have their dog on Rimadyl say that it really helps with the arthritis.

If a NSAID is a choice you decide to take than I'd keep giving Abbie the Vetoryl. Hope she is feeling much better soon.

Hugs, Lori

[judymaggie]

Hi, all! Abbie is not showing improvement so I will call the vet tomorrow and discuss additional options.

Lori -- I also do not see the purpose in a prednisone injection since the Dexamethasone didn't help. The only changes after the injection were two frenetic bursts of energy on Friday. Her issues are from inflammation due to IVDD rather than arthritis. Due to many issues with Rimadyl, I always choose other NSAIDs and usually use Deramaxx.

I am also considering taking her back to the chiropractor to see if her treatment will give Abbie any relief. Last night I was able to walk behind her and noticed that her gait is very, very awkward -- stiff with her back legs wider than usual. I wish that she had had a better tolerance with acupuncture. My biggest fear is that she will end up with another ruptured disk -- I wouldn't put her through another major surgery, especially so soon after her neck surgery.

[Squirt's Mom]

Have you considered Adequan injections? Might be worth discussing with her vet. I so hope you find something that will help her. I know how hard it is to watch our precious babies hurt. :(

[judymaggie]

Leslie -- unfortunately, it is nerve pain that results from the inflamed discs in IVDD. We tried a round of Adequan shots when Abbie's back was bothering her a while ago and there was no relief whatsoever. My vet didn't think they would help but I decided it was worth a try. I did find that Adequan helped immensely with Maggie's arthritic pain so I would still recommend that for dogs having those issues.

[Harley PoMMom]

I found this article titled: Managing Neuropathic Pain in Dogs

It is a very comprehensive and I didn't read it in its entirety.

It was published Feb 22 2016, here are a couple quotes taken from it:


Treatments aimed at reducing neuropathic pain are targeted at one or more of these mechanisms. Several drugs are commonly used in the veterinary clinical setting to treat neuropathic pain. These include gabapentin, pregabalin, amantadine, and amitriptyline...

A recent meta-analysis of the human neuropathic pain literature makes strong recommendations for the use of drugs such as gabapentin, pregabalin, and tricyclic antidepressants (TCA), while weaker recommendations are made for tramadol and strong opioids such as morphine (related to both efficacy and side effects) and topical lidocaine or capsaicin (45). The most common drugs used specifically for neuropathic pain the veterinary setting are gabapentin and pregabalin, with TCA occasionally referenced (46, 47).


Hugs, Lori

[judymaggie]

Lori -- thank you so much for the article. I was able to find it and have printed it off. Someone had mentioned gabapentin previously (sorry, can't remember who ...) and will definitely ask the vet about that when I call him this afternoon.

Thankfully, Abbie perked up a bit last night -- went for a short walk after dinner and went out again at 8:30 and walked down to our neighbor's house for a treat. She was also more interested in dinner. Improvement continued this morning as she got off the bed without my having to encourage her and finished her breakfast quite readily. When I came home from tai chi she was actually in the kitchen and barked at me as I came into the house. :D

Not sure why it took a few days to show signs of improvement but I'll take it!

[Harley PoMMom]

So glad to hear that Abbie is doing better!!! And I am sorry I forgot to provide you with that link :o my feeble mind

Hugs, Lori

[molly muffin]

We are using the gabapentin for nerve pain. My vet said for pain in the spinal area or anything involving nerves, it is a good one to use, and can be used with tramadol if needed. (we aren't using tramadol at this point) It takes a bit to see the results I think as molly has had a couple days doses (she gets twice a day) and last night and this morning was the first time I saw her trying to run a bit on her walks. No jumping for any reason for 6 weeks, same as any other back injury.

Not sure if that will be relevant to Abbie but thought I'd share it. We're all in this together. :)

[judymaggie]

Sharlene -- I appreciate your feedback about gabapentin. Interestingly, the article that Lori directed me to has quite a bit of information about the benefits of using gabapentin combined with tramadol. When the vet and I spoke yesterday, I did ask him about adding it to Abbie's regimen. He is certainly open to it at some point as he is using it for several dogs but would prefer to continue just the tramadol since there have been some signs of improvement. If she continues to improve over the next week, we will wean Abbie back to once a day tramadol (she now gets it 3x a day). If there is not improvement, then we will probably add the gabapentin at that point. He agreed that the two drugs used together enhance the benefits of gabapentin.

I asked the vet whether he thought a treatment with the chiropractor would help and he said "yes". I called her last night and was able to get Abbie in to see her this morning. Abbie was "grumpy" when I tried to get her off the bed to get in the car. She tolerated a 25 minute treatment and her reaction to stimulus on her back was definitely diminished by the end of the treatment [that's a good thing ... :)]. Chiropractor wants to see her in a week so we go back next Wednesday. Abbie's reaction to treatment is to sleep quite a bit for the rest of the day so probably won't see if it has helped until tomorrow.

Sharlene -- I hope the gabapentin will help Molly. She and Abbie do have a lot of parallels. Your guidance about proteinuria has been so helpful. I sure do wish our pups didn't have these commonalities!

[molly muffin]

I know what you mean. As I was typing to you earlier, I was thinking, these two seems to be on a similar path all the time. :)

We are doing 8 days of the gabapentin and see if this won't correct on that alone and then will reevaluate if tramadol needs to be added in. We just aren't starting there. Sort of like you already being on tramadol, so waiting to see if the gabapentin is needed or not. I do see improvement, but the appetite has taken a dive while on it. She doesn't want Anything that is good for her and not eve many of her treats. If it's not one thing it's another. :)

Hoping the treatment holds and helps Abbie.

[judymaggie]

Hi, all! Just an update and I wish I had better news about Miss Abbie -- her pain level has not diminished at all and seems to have increased. I have seen muscle spasms a few times and, at the chiropractor, she demonstrated pain in more areas than at the last visit. So ... after a long consultation with the vet, we are adding gabapentin and Deramaxx to her regimen. My vet no longer carries Deramaxx and the gabapentin is only available locally in large doses so both are being ordered. Hopefully, I will get them early next week.

Additionally, Abbie's drinking and peeing have continued to escalate. Since her cortisol is controlled and we ruled out a UTI in last month's testing, I decided to do more reading about diabetes insipidus (DI). Since she has dysfunctional glomerula of her kidneys, I was particularly interested in learning about nephrogenic DI. Unfortunately, this is not easy to treat. I mentioned the possibility to the vet tonight and he said it is very rare -- then he added "but we do know Abbie is unique"! Interestingly, anti-inflammatory drugs are one of the medications mentioned so the vet and I decided we will see if the PU/PD lessens any after she starts the Deramaxx. We are doing at least two trips a night outside and too many to count during the day so really want to find out what is going on. Abbie even peed in the car on the way to the chiropractor even though she had gone shortly before leaving. Thankfully, she was sitting on a thick towel ...

We are in the midst of hurricane Hermine so definitely not fun for Abbie or me to have to get her out to pee!

[Harley PoMMom]

We are in the midst of hurricane Hermine so definitely not fun for Abbie or me to have to get her out to pee!

Yikes! :eek: Be careful and I hope that Hermine calms down soon.

My neuro put me on gabapentin for the pain in my leg and it does help I can finally sleep 4-5 hours before my leg pain wakes me up, although my bladder would wake me regardless :eek::D

[molly muffin]

Try Costco for gabapentin. Much cheaper if the vet will write a prescription for you. I know you can get it here at Costco anyhow. I agree it does help. Molly is doing better on it.

Stay safe!!!!

[Squirt's Mom]

I hope the Gabapentin helps along with the Dermaxx. Gabapentin is what helps most with my legs after having the nerves severed in surgery. They tried switching me to Lyrica but the Gabapentin works best so I am back on it. Hopefully it will bring your sweet girl some relief as well.

Be careful with Hermine! I was in Isabel in 2003 - my first and only experience with a hurricane...and one I hope to never have again! :eek:

[judymaggie]

Hi -- thanks for encouraging words about the gabapentin. Sharlene -- no one here has anything less than a 100 mg. capsule. My vet wants to start Abbie on a very low dose (25 mg.) and obviously can't divide the capsule so am getting it compounded into a tablet by Diamondback. Getting the Deramaxx from California Pet Pharmacy. I really like working with both of these companies -- they called me very quickly after the vet had called them and got shipments out last night so should see the meds early next week. I think I want to start one at a time just in case of a negative reaction -- will start the gabapentin first.

Any thoughts about the nephronic DI or "regular" DI? Anything else you think might be going on re PU/PD?

Hurricane Hermine has moved on from here -- lots of strong squalls over night. Abbie slept fine but I didn't ... she went for a short walk this morning (her two day post-chiropractic energy boost) and there is lots of small limbs and leaves all over the neighborhood but nothing more severe. There was a tornado last night a short distance away that hit some trailer homes. I lived through hurricane Hugo in St. Croix (a level 5 hurricane) with over 200 mph winds so this kind of thing is not a huge worry but the idea of a tornado coming at night is still scary. I do have a NOAA weather radio and there were no warnings for my zip code.

[Squirt's Mom]

We live in "tornado alley" and have several each year. I also have a NOAA radio....it is in a closet somewhere. I had it set by Radio Shack, by a NOAA representative that was set up at a local store, and by one of the so-called experts with a local news station and it never would sound off when a storm was in my county....but it would sure go off when there was one 100+ miles away! :p So I just gave up. Living in a mobile home it really doesn't matter if I know one is close or not...we don't usually have enough time to get some place safe regardless. When I know they are popping up I empty out the hall closet and put crates and other necessities in there then hope to get a clue in time. I do have a battery operated radio but I don't keep fresh batteries in it half the time. I guess we just get used to living with the furies of Mother Nature, huh? ;)

[Harley PoMMom]

This is probably a long shot ~ I read a study a looong time ago that rats drank water as a soothing agent, it was published October 14, 2009 and is titled: Comfort food: Chocolate, water reduce pain response to heat


....The study, published Wednesday in the Journal of Neuroscience by authors Hayley Foo, PhD, research associate professor of neurobiology at the University of Chicago, and Peggy Mason, PhD, professor of neurobiology, is the first to demonstrate that this powerful painkilling effect occurs while the animals are ingesting food or liquid even in the absence of appetite.



http://www.uchospitals.edu/news/2009/20091014-pain.html

So maybe Abbie is drinking more water to help with the pain? :confused: Like I said, it's a long shot.

Hugs, Lori

[DoxieMama]

Been thinking of you and Abbie this weekend... (((hugs)))

[judymaggie]

Shana -- thanks for thinking of us! I know I haven't posted too much about Abbie lately. She (and I) are on kind of a roller coaster. Some days she sleeps all day and only eats a small bit of chicken. Other days she is a bit more energetic and will go out for a short walk but she is still not particularly interested in food. I was feeding her three small meals in order to give her mid-day meds with some food. This week I am only feeding her twice a day and give mid-day meds with a small amount of chicken with the hope that she will be more interested in eating if only getting two meals. Her weight has dropped from 24.8 to 23.2 lbs. Her urination and thirst have increased exponentially. She has had several accidents in the house, even shortly after she has been outside to pee.

This Thursday she will spend a few hours at the vet so they can evaluate her blood pressure, run a UPC and a chem panel. The vet and I have talked frequently over the last couple of weeks, trying to figure out what is going on, particularly with increased PU/PD, but we want to see test results before deciding what to do next. I have asked him what he thinks about DI -- I have read as much as I can about this and, from what I can discern, even if present, treatment when a dog has any kind of kidney disease is not usually successful.

[DoxieMama]

I hope you can figure out the issues and get off the roller coaster soon! Let us know what you find out from the tests Thursday.

[Harley PoMMom]

As a treat my nephew gives his pugs "Frosty Paws" it looks like ice cream and his boys just love it, maybe Abbie might like it: http://www.nestleusa.com/brands/ice-cream/frosty-paws