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

[Squirt's Mom]

Just dropping in to give some hugs and belly rubs - You and Abbie can decide who gets which. :D

[judymaggie]

Hi, all! Abbie spent a few hours at the vet Thursday -- the only test result we have so far is with regard to her blood pressure and, unfortunately, both the systolic and diastolic levels have gone up 20 points. That was an average of five readings. This was the first BP check since we switched one of her meds (from telmisartan to benazapril -- she is also on amlodipine).

What happened from the time I picked her up was bizarre ... the tech who works with her brought her out to the waiting room and told me that, unfortunately, he was unable to get her to drink any water as I had asked him to make sure water was available. He said he put down a full bowl of water and Abbie proceeded to knock it over -- towards him so he got wet, she didn't! He then put down more water and she did exactly the same thing. :confused: Abbie has never done something like this before. So she had been there about three hours without access to water. I took Abbie outside and harnessed her in the car. Usually Abbie lies down and sleeps after being at the vet -- this time she would not sit still and was extremely agitated for the entire 20 minute ride home.

As soon as we got home she ran into the kitchen and drank her entire bowl of water! :eek: I honestly didn't even think about it being a problem until she went up on the bed and proceeded to throw up a huge amount of white foamy liquid. She was still quite agitated and took a flying leap off the bed -- it was not a soft landing and I was so afraid that she had hurt herself. Thankfully, she seemed okay with regard to her neck/back but still wouldn't rest. I decided to give her melatonin and, about a half hour later, she finally laid down. The rest of the afternoon and evening she was fine and has been fine since.

I have been doing a lot of reading about DI but didn't find anything with regard to why a dog would act this way, whether related to DI or not, when water was withheld. Anyone ever seen anything like this?

The rest of her test results (UPC and chem panel) should be available Monday or Tuesday. The vet decided to add a urinalysis to again check the specific gravity.

[Harley PoMMom]

My Harley was a bit particular with his water, when he would come home from the groomer he would drink the entire bowl of water and I know his had water available to him at the groomers. The only thing I could think of why he did this is because at home he was given distilled water only, it made me wonder if the water at the groomers had a taste that he did not like. :confused:

[molly muffin]

I only had a couple times where mollys bp was controlled while on the amoldipine and benazepril. We just didn't have as much control as I would have liked on that.
Maybe what Lori said is right, she didn't like something about the water at the vets. Maybe if she has to go back again, take a thermos of water from home for her?
Is she still on gabapentin? How is her back doing?

[judymaggie]

Hi! I had a long conversation with the vet last night, going over Abbie's latest test results. Only change on super chem is that her potassium is now even more elevated (6.4 compared to 6.0 on 8/6; range, 3.6-55). The UPC continues to be extremely high at 6.1 (compared to 6.6 on last check). In light of the increase in blood pressure and potassium levels, we decided to take Abbie off of benazepril and, for the time being, just continue the amlodipine. I will take her back to vet in two weeks to recheck her blood pressure and electrolytes. (It will be a short visit and I will wait for her to try and avoid water issues.) If neither has come down, we will have to figure out a different game plan. I just wish the telmisartan was affordable as the combo of that and amlodipine seemed to be a good one. Nothing we have tried has brought down the UPC so that goes on the back burner for now.

The vet said that elevated potassium can affect quite a bit in a dog's body and it is his hope that, if we can get it down, her PU/PD will improve. Interestingly, her urine is definitely concentrated now so that rules out diabetes insipidus.

Sharlene -- I never had to start the gabapentin. The combination of three times a day tramadol and deramaxx has worked great in terms of pain control. Abbie has a lot more energy (she even went for a 30 minute walk yesterday), is interested in food again and is very willing to get off the bed to go outside. We went to the chiro today and, although she still has discomfort in the lumbra sacral area as well as around one rib (probably left over effect from neck surgery), overall she has improved. We have an appointment for next week and, if everything is stable, we will go to every other week treatments. The vet said we can leave Abbie on the tramadol and deramaxx indefinitely.

[Harley PoMMom]

Hydralazine is another medication that is used for high BP, an excerpt from an article:
Hydralazine, a direct arterial dilator, is often considered an emergency drug due to the rapid reduction of blood pressure after parenteral administration. This drug has been used after renal transplantation surgery in cats to control hypertension.33 Hydralazine can be used orally in dogs and cats as an alternative antihypertensive drug when amlodipine and ACEIs do not satisfactorily control patient hypertension. The possible adverse effects of hydralazine include symptomatic hypotension and tachycardia; therefore, it is particularly important to initiate hydralazine therapy at the low end of the dosage range and gradually titrate upward to effect.
http://www.vetfolio.com/cardiology/treatment-of-systemic-hypertension-associated-with-kidney-disease-compendium

Lori

[judymaggie]

Hi, all! Abbie is having minor surgery tomorrow to remove a wart on the top of her head. It has been slowly growing for several months and, because of that slow growth, we were just on a "watch and wait" plan. However, yesterday it started to bleed. I am not certain if Abbie rubbed her head on something to aggravate it or if it started bleeding spontaneously. Either way my vet and I agreed it was time to take it off -- it really does look kind of nasty at this point. The vet is going to give Abbie a sedative rather than anesthesia and then give her a shot to reverse the effects when done. I am going to ask him to do a quick teeth cleaning if he has time. I brush her teeth but there is some tarter on them.

Before he starts the surgery the vet is going to check her blood pressure and take blood for an electrolyte check (which were already scheduled for tomorrow).

I am hopeful that she won't need to have a collar on -- she would be so much happier without it. Think good thoughts for my baby!

[Harley PoMMom]

Tons and tons of good thoughts and positive energy being sent your way. Give our dear Abbie some extra hugs and kisses from her Auntie Lori ;)

[Joan2517]

From all of us as well....

[DoxieMama]

You got it! What time is the surgery?

[judymaggie]

Thanks, folks!

Shana -- I will take her in for 9:00 but vet has another surgery scheduled so not sure she will be first.

[labblab]

Me too, me too (sending positive thoughts)!!!!!

Please keep us updated as you are able, Judy.

[Squirt's Mom]

How is she doing?

[judymaggie]

Leslie -- Not sure if you mean generally or because of surgery but, if latter, surgery is tomorrow. :D

[DoxieMama]

Thinking of you and Abbie this morning! Will check in later to see how she (and you!) are doing. :)

[molly muffin]

Good thoughts heading your way!

[Squirt's Mom]

:o:o:o I misunderstood and thought the surgery was yesterday. :o:o:o

Soooo now that I am on the right boat - I hope all goes well with the surgery today! :D

[DoxieMama]

Checking in. :)

[judymaggie]

Hi! I just got off the phone with the vet -- Abbie is resting comfortably and I should be able to pick her up in a couple of hours.
The wart (vet calls it a tumor ...) was removed completely and, fortunately, only involved skin layers so no internal stitches needed. The vet said that he doubts she will need a cone. Hooray! :D:D He tried to make the shaved area neat but did need to make sure he got clean margins so it does cover the top of her head ... :( Stitch removal will be in 10 days.

Her blood pressure was unchanged so still high and, unfortunately, her potassium has gone up as has the BUN (I'll get exact numbers when I pick up Abbie). The vet said that, although BP is still high, he was glad that it had not gone up since we stopped the benazepril. For now, no changes in meds. He will check electrolytes again when we go back in six weeks for nails/glands.

We did have a rough night because of "no water or food after 9:00". Abbie got up at midnight to get water and started pacing when she couldn't find any--at 2:00 I gave in and gave her a tiny bit of water. She slept until 6 when she started pacing and barking and barking and barking. This lasted until she got in the car at 8:30! Maybe I should have taken her for a drive in the middle of the night ... There has got to be a reason for this bizarre reaction when there is no water available. It is not like she stands in front of her water bowl all day -- when she drinks it is only a small amount at a time. I have a strange dog ...:confused:

Thanks to everyone for your good thoughts!

[Joan2517]

Good news! Glad it is over and she will be home shortly.

[DoxieMama]

Woo hoo! Not having to use the cone is the icing on the cake.

[Squirt's Mom]

Glad all has gone well! I hope the recovery at home goes by without a hitch!

[Harley PoMMom]

So glad to hear that the surgery went well and that Abbie is doing good!!!

[labblab]

YAY for Abbie!!!!!!!! :) :) :)

[molly muffin]

Very glad to hear that Abbie's surgery went well and hopefully she is doing well with recovery.

Well you know, when they want something, they want it right then and there. :)

[judymaggie]

Hi, all! With Novifit still not available, I have decided to try another option for Abbie called "Senilife" (http://www.senilife.com/). It is described as "a nutritional supplement for the signs of brain aging in elderly dogs which can provide an improved quality of life for the elderly pet ..." The capsule can be given whole or it can be cut open and put into food. I did the latter tonight for the first time -- I was concerned Abbie wouldn't like the taste but she had no negative reaction. It is suggested that a two month trial be given -- I ordered a month's supply just in case it didn't agree with Abbie.

Abbie is sleeping much more and, most of the time, is not interested in going for walks, even though our weather is much more pleasant now. She is eating but I usually have to really encourage her to go to her bowl -- if I try to add in a little bit more food, she leaves it in the bowl. She has lost three pounds and really don't want her to lose any more. I am hoping to see some increase in activity and alertness.

Has anyone else tried this product?

[molly muffin]

Anypril, which is for cushings and works in some dogs for that (small percentage) but is Also for dog senility and I think is what novofit contained. You can get that online.

Maybe have a chat with your vet about that.

[judymaggie]

Sharlene -- I was aware of the use of Anipryl for senility but was concerned that, on top of using Vetoryl, might lower Abbie's cortisol levels. With the IVDD pretty active, I really want to keep her cortisol level on the high end (it was 8.3 at last ACTH in August). Thoughts?

[labblab]

I am confused...I just Googled Novifit and it looks as though it is simply SAMe. I know there are other veterinary versions of SAMe -- is there something about Novifit that set it apart from the other SAMe options? ( And I apologize if this was discussed earlier in your thread!)

[molly muffin]

Maybe I was thinking it was anypril but maybe I was thinking sam e. Grrr. Never rely on memory. Marianne is right. It is sam-e.

This had a good article. http://www.southcoasttoday.com/article/20100131/LIFE/1310312

And reading it I think I Would try the senilife first. Basically antioxidants

[judymaggie]

Hi, folks! Abbie is on day four of taking Senilife. Still on an up and down pattern -- one day she wants to go on three walks, the next she doesn't want to leave the bed so I don't think I have see the Senilife making a difference yet. I've been sick myself so have no problem laying down with her for a nap!

We go to the vet this Thursday for routine nails and glands as well as another electrolyte check. Will be very interested to see what her weight is. I also need to have the vet check her ears as she has been scratching like crazy but, after flushing them, I don't get any residue -- may just be allergies.

Abbie is due for her next ACTH in December but am thinking I will push it out to January. She continues to have to urinate very frequently but no other symptoms of uncontrolled cortisol. All past urinalysis/cultures have come up negative so I do think this is more related to age/senility. She will go out to pee and an hour later pee right in front of me ...

[molly muffin]

Awww, poor thing. It's sucks to get older. It might be age related. Especially if they can't find anything else going on with her. Kidneys or cortisol is about all I can think of.

[judymaggie]

Hi, all! Just wanted to post an update on Abbie -- she started losing weight rapidly (had lost 5 lbs. over the last two months including 1 lb. in just a week) and had no interest in eating. We added mirtazapine (an appetite stimulant) to her regimen and, within two days, started to show some interest in eating. That was two weeks ago and, at a weigh-in yesterday, she had gained a pound! :D

To make certain that low cortisol was not the cause of the inappetence, we did an ACTH two weeks ago. Numbers pretty much the same as one done three months prior -- pre is 3.3, post is 8.8 (prior numbers were 3.1 and 8.3). Because of Abbie's severe IVDD, we have been purposely keeping her at the high end of acceptable range.

Yesterday we also did a chem panel -- BUN and potassium continue to climb but creatinine still in normal range.

The vet came in to speak with me when everything done -- I knew something was up because there really was no reason we had to talk. Sure enough, Abbie has a new problem -- "gingival hyperplasia" ... I had never heard of it but, basically, her gums have grown over her teeth. Some of the teeth you can't even see! This happened very rapidly as, when we were at the vet five weeks ago, he was checking her over and found a tumor on her gum. There was no sign of the hyperplasia at that time. Also, I have been brushing her teeth and she has been getting regular dental cleanings. The vet told me that, because of the need to avoid infection, she would have to have a procedure to cut away the extra tissue. At the same time he would remove the tumor (not considered to be related to hyperplasia). We talked about doing the surgery at the end of January.

Of course, when I got home I did some research and discovered that one of the causes can be long-term use of a calcium channel blocker -- Abbie has been on amlodipine for a long time. There was even a study done on beagles -- when the amlodipine was stopped, the guns receded!! I am very surprised that my vet didn't mention this as a possible cause -- I know that we will have a hard time finding another BP med that will work as we have already gone through several but I would much rather try to do that and, hopefully, avoid surgery. My vet is out until after the New Year so will talk with him about it then.

[Harley PoMMom]

I completely forgot that gingival hyperplasia can be a side effect from amlodipine. When Harley was taking it we kept a watch out for that side effect and luckily it never surfaced, I am so sorry Abbie is going through this latest issue. :(

Glad to see her appetite picked up and that she gained some weight.

Sending you both huge loving hugs, Lori

[Squirt's Mom]

I am so glad Abbie is gaining a bit of weight and pray the trend continues. And I'm with you all the way on changing the meds to see if that helps before agreeing to surgery.

[molly muffin]

I guess Addie is just one of the unlucky ones that has the side effect with the gums. :( Poor baby. I'd see if it is possible to change the meds also. It could be worth a try anyhow to avoid further surgery.

Awesome that the appetite stimulant worked and she is slowly regaining weight.

Merry Christmas and Happy New Year!

[molly muffin]

hi Judy, thought I'd check in and see how you and Abbie are doing.
Did you come up with an alternative treatment to try and get the gums to recede naturally?

[judymaggie]

Sharlene -- thanks for checking on us. Unfortunately, my vet is on vacation until after the New Year so no changes yet. I hate giving Abbie the amlodipine knowing that is causing her problem. Abbie's gums are continuing to cover her teeth. The only teeth that are visible now are the large ones in front. I think pretty soon she will be chewing with her gums! I have found several studies which recommend stopping the amlodipine and waiting a month to see if the gums will recede. If not, then one surgical procedure is done and the gums will not grow again as long as the amlodipine is not given.

Trick will be finding a BP med that we haven't tried yet. I am thinking we should do a BP eval before stopping the amlodipine to get a base line for the new med and then we would do another one ten days after starting the new one.

[molly muffin]

I would do a BP evaluation too. That makes sense, but then start looking for a different BP med. She can't go back on amoldipine no matter what if the gums are going to grow over like that.

I didn't get a chance to read up on these medications, as I had to stop in the middle of typing this to give a cat pain meds. (boy are dogs ever easier to give meds to than a cat!!!!) but it might be a place to start and then have some ideas to discuss with your vet.
If I ever get any time to look through it myself, I've saved the link to read over.

http://www.peteducation.com/category.cfm?c=0+1303+1464

[Harley PoMMom]

Hey Judy,

I found this study (humans) regarding gingival enlargement titled "Management of amlodipine-induced gingival enlargement: Series of three cases" I haven't read it as it is 17 pages, here's the link: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3118083/

Another one: http://www.jorr.org/article.asp?issn=2249-4987;year=2016;volume=8;issue=1;spage=23;epage=26; aulast=Gittaboyina

[judymaggie]

Lori & Sharlene -- thanks for the links. I will read them -- I have several other studies done with dogs and the general consensus is to stop the amlodipine, wait a month and, if the hyperplasia has not receded, then a gingivectomy is necessary. As long as the amlodipine is not restarted, there should no reoccurence of the hyperplasia.

I do have a call into Abbie's IMS and hope that he will call me back -- the receptionist was doubtful since my last visit with him was in 2015. I want to pick his brain about the hyperplasia and also ask him about the surgery should it be needed. Most of the surgeries I read about were done by veterinary dentists. There are some in my area, including at Blue Pearl where my IMS is the medical chief. My vet said he could do the surgery using laser equipment although he did say that he has not seen many cases. From what I have read, this is a major surgery at least from a dental perspective. With Abbie being almost 14, I am, of course, concerned about anesthesia and am thinking it might be better for her to be in a hospital setting if she does need surgery.

Today is the last day for the amlodipine -- we weaned off over the last week. It is very unfortunate that we are in this position as her blood pressure taken last week was perfectly normal! I will take her in to the vet in a week for another BP check. If it has spiked, we will have to start her on a new BP med.

I am a bit concerned about her eating -- we went to the chiropractor this morning and she has lost the one lb. she gained after we started her on an appetite stimulant. Looking at her mouth it is hard to believe that she is comfortable eating. I am adding more canned food mixed in with her dry food to make it easier for her to just swallow without chewing.

[Harley PoMMom]

I have several other studies done with dogs and the general consensus is to stop the amlodipine, wait a month and, if the hyperplasia has not receded, then a gingivectomy is necessary. As long as the amlodipine is not restarted, there should no reoccurence of the hyperplasia.

Yes, stopping the amlodipine and substituting with another drug is what is recommended, some of these drugs I'm not familiar with such as losartan and atenolol.

[judymaggie]

Abbie was on a BP med, telmisartan, in the same "family" as losartan, but the cost became too prohibitive after the compounding pharmacy where I was purchasing it went out of business. I take irbesartan myself but, unfortunately, the low doses of a lot of these meds are not readily available for dogs. I'm not familiar with "atenolol" -- will have to look that one up. One complication is that Abbie's potassium has been elevated for a while now and has been climbing up over the last few months. Many of the BP meds will make this even worse.

P.S. Just looked up atenolol -- seems pretty inexpensive. Will have to make note of that one -- also looked up prazosin. It is an older drug so might be less expensive. Of course, the amlodipine was free at my local grocery store pharmacy!

[molly muffin]

Any luck with the alternatives?

I'd think anything not in the same family as amoldipine might be worth a shot.

And as long as their side effect isn't a gum issue! Don't need that with a different drug either.

[judymaggie]

Sharlene -- we have not yet started any new BP meds. Abbie had her BP tested again this past Tuesday. All the numbers went up 10 pts. but still within normal range. The vet and I were both glad that there were no spikes -- she had been off of amlodipine for two weeks. We will recheck her BP in a couple of weeks. We go in next Thursday for glands and nails and the vet will do a thorough check of her mouth. After a quick check on Tuesday, he did not notice that the gums had receded. Keeping fingers crossed that, with more time, they will recede--I am really dreading the possibility that Abbie will need the oral surgery.

Unfortunately, Abbie has lost weight again -- although the mirtazapine stimulated her appetite as soon as she started on it, it no longer seems to be working. The vet asked me to stop it for a few days and then restart it, hoping to trigger her appetite. I made some pasta today and am going to see if she will be interested in her food tonight with that added in. I suspect the anorexia is a combination of kidney disease and cognitive dysfunction.

[molly muffin]

Good you haven't needed any new bp meds.

I understand. The kidney isssue really played a number on Mollys appetite.

I do hope those gums start to recede too. Fingers crossed

[judymaggie]

Her, guys--just had another thought re anorexia. Do you think it would be worth it to stop the trilostane to see if that is causing it? With it having such a short life, I would think it would be obvious pretty quickly.

[molly muffin]

You can always stop it for a few days and see how she does. I did that with Molly more than once. Sometimes it helped others it didn't.

[Squirt's Mom]

With waning appetite, I think it is well worth a try! Let us know what you decide.

[Harley PoMMom]

Stopping the Trilostane is an option I would try. From searching the K9kidney group I found that Cerenia is used by many to stimulate their dog's appetite. I'm also including this long list of foods that K9kidney members have used as food enticements: Angelfood cake with warm maple syrup an butter
Pop tarts
Ox tail
Prescription diet fried in chicken fat
Broth made by “nuking “ meat and water
The “breading” part of breaded pork chops
Cantaloupe
Fruit leather
Bread soaked in meat juice
Sherbet
Carrots with brown sugar and butter
Frosted mini-wheats cereal
Add maple syrup or honey to prescription diet
Cliff bars (from health food section in grocery store)
Baby food (try different brands/combos and different flavors
Home made no salt broths, gravies and meat drippings
Fish juice – i.e., from canned tuna, clams, sardines, mackerel
Other canned dog or cat foods
Garlic
Freeze dried liver
Salmon treats
Cheese
Deli meats (usually the more expensive the better!)
Scrambled eggs
Yogurt
Cottage cheese
Applesauce
Pasta
Rice
Toast
Bagels
Rye bread
Corn flakes
No salt crackers
No salt pretzels
Sweets (avoid chocolate) – vanilla cremem cookies, sponge cake, donuts etc
Oreo bits (in small quantities because of the chocolate)
Peanut butter cookies

[judymaggie]

Thanks, everyone--I have a call in to the vet re stopping trilostane for a few days. Abbie turned down chicken this morning--always her go to food. :(
She is still on tramadol and deramaxx and both could affect her appetite. Would consider stopping all meds but I know she won't eat if in pain--so hard to figure out.

I appreciate the list of food enticements--I will admit that I have negative memories of trying to get Maggie to eat and always having several options in the frig and being so frustrated when she would refuse one after the other ... I have to say I laughed at the "prescription diet fried in chicken fat"--can't quite picture that.

[Squirt's Mom]

If you haven't tried FreshPet, give it a shot. It is in the cold food sections at Kroger now as well at places like PetCo. That was one Squirt would usually eat and I've had good luck with my other ailing old babies eating it, too. It comes is these tubes and you cut off the pattie size you need or they now have it in bite size little pillows - several flavors, too. It freezes well so that was a bonus for me.

https://freshpet.com/our-foods/our-brands/

[Crazy Daisy]

Poor Abbie girl :( Remind me again what she's on the pain meds for?

[Whiskey's Mom]

So sorry Abbie isn't feeling well. Hope you can get her to eat soon, I know well the frustration of trying anything and everything to get our pups to eat. And the next day they change their minds again. I didn't see hard boiled eggs on the list but Whiskey never refuses them, or pizza or Cheetos(especially the ball shaped ones!) I've never tried Fresh Pet but sounds like it's worth a try. Hope she feels better soon!
Annie and Whiskey

[judymaggie]

Erin -- Abbie has pretty severe IVDD. Although the cervical discs were all cleaned out when she had surgery for a ruptured disc in her neck, the discs in her lower spine are causing her pain and neurological issues. I take her for a chiropractic treatment every month but the effects don't last very long. I had to drop her tramadol to twice a day because she can't seem to take any pills mid-day without regurgitating them along with the cheese/chicken ball.

I did speak with the vet this afternoon and he agreed that we should stop the trilostane for a few days with the hope that her appetite will rebound. He thought tuna fish would be a good thing to add and ... drum roll, please -- Abbie scarfed down her food tonight with the tuna fish added in! :D He also said to restart the mirtazapine tomorrow morning and call him on Monday to give him status.

[Harley PoMMom]

Abbie scarfed down her food tonight with the tuna fish added in!

YESSSSS!!! Way to go Abbie!!

[Whiskey's Mom]

Yayyy! That's great news! Tuna it is then!

[Joan2517]

Tuna! Love it...me and my guys all just love tuna! Whatever works!

[judymaggie]

Hi, all! Abbie is continuing to eat her food -- granted, a great deal of it is tuna and chicken but there is also some kibble, some canned food and pumpkin. She even sat right next to me this morning as I mixed everything up rather than lying on her bed and taking 15-30 minutes to get off and move into the kitchen.

She has been off of trilostane since Friday night and her energy level is much improved. I'm sure some of the change is due to finally eating and getting energy from that but I think there is too big a change to be just from the food.

We had a little incident yesterday -- I was working in the yard and Abbie was outside with me. Usually she just lays down on the driveway and takes a nap. Not this time ... she heard some kids playing a couple of houses away and then some dogs barking. She took off -- she was moving so fast I couldn't catch her and I was running! She ran right up to a shih tzu and started growling -- there was also a chihuahua, a 6 month old german shepherd and a german shepherd puppy along with four kids and a couple of adults. Abbie had met all the humans before so they knew her and didn't panic and all the dogs just stood there -- Abbie never let me catch her but I was able to herd her home. It all could have gone really badly but I honestly was pleased that she showed some spunk and had the ability to move so quickly! I was concerned that all that movement might have a negative effect but I couldn't see anything that bothered her.

On a negative note, I don't see any change in her gums and I am sure they are bothering her -- she is rubbing her mouth between her front paws fairly often.

We are hunkering down with a severe storm on the way -- just really windy and terribly humid so far. Forecast is for 40-60 mile an hour winds, thunderstorms, heavy rain and the possibility of tornadoes. Hope they are wrong!

[Harley PoMMom]

Awwww, I'm happy to hear that our Abbie was feeling frisky!! However I realize that her reaction may have caused her Mom to grow some gray hairs :eek: :D :eek:

How's her appetite? Is she still liking the tuna?

In an another article regarding medications for proteinuria, maybe you've already seen this article, it lists these ARB drugs that can be used instead of ACE inhibitors:
Available ARBs include losartan, irbesartan, olmesartan, candesartan, valsartan, azilsartan, and telmisartan. In people, these drugs vary in maximum achievable decreases in mean arterial pressure or reduction of the UPC ratio, with telmisartan in particular having more potent antiproteinuric effects than losartan has....

Adjunctive administration

Based on the recognized benefits of ARB therapy in people with proteinuric nephropathies, many veterinary nephrologists consider adjunctive administration of these drugs to dogs with persistent proteinuria despite treatment with ACE inhibitors. First-line therapy with ARBs is not recommended as of yet, as it is still unknown whether long-term prognosis worsens, improves, or does not change in affected animals.

The generic formulation of losartan is affordable by most owners and has been used by many veterinary nephrologists as an adjunctive treatment in dogs with refractory proteinuria. An initial losartan dosage (0.125 to 0.25 mg/kg b.i.d.) can be administered as an adjunct to an ACE inhibitor (continued at the standard dosage discussed above) for four to seven days, followed by measurement of the serum creatinine concentration to confirm that azotemia has not markedly worsened. The losartan dosage can then be titrated up in a step-wise fashion, based on continued reduction of the UPC ratio, to a maximum of 0.5 to 2 mg/kg b.i.d., rechecking the serum creatinine concentration and UPC ratio after each dosage adjustment.

Reversible gastrointestinal side effects have anecdotally occurred in some dogs, although it is unclear whether this is due to concurrent use of losartan with an ACE inhibitor or due to the ARB alone. In people, concurrent use of ACE inhibitors and ARBs increases the risk of severe hyperkalemia.

So, unfortunately as you mentioned previously, the use of these medications can cause a rise in potassium. :( Full article can be found here: http://veterinarymedicine.dvm360.com/practical-guide-antiproteinuric-drugs-dogs?id=&sk=&date=&&pageID=1

[molly muffin]

Go Abbie! LOL She sure can move when she wants to it sounds like. :) That's always a good sign and I'm glad that she didn't hurt her back during her adventure.

[judymaggie]

Shana/Lori -- it is good to know that Abbie has some spunk in her! There was a lot more noticeable gray when I got my hair cut yesterday ...:eek:

I did already have a copy of the dvm360 article -- at one time Abbie was on enalapril and telmisartan. Her BP was controlled with that combination. Unfortunately, the pharmacy where I was able to purchase the telmisartan at an affordable cost went out of business and I can no longer afford it. Now that Abbie's potassium has been elevated for several months I doubt that the ACE inhibitor/ARB combo is a good idea at this point. Hopefully, her BP won't continue to rise.

I spoke with the vet on Monday -- Abbie was continuing to eat her food at that point in time but was also quite restless. The vet said to start 10 mg. trilostane in the a.m. without the mirtazapine. I wondered if making two changes at the same time was wise but decided to go with what he suggested. Last night Abbie was not interested in her food -- she would eat a little bit and then walk away. With encouragement she would go back and eat a little more but finally just left the rest in her bowl. This morning, after getting the mirtazapine, she cleaned her bowl. She has been less restless today. It will be interesting to see if she will eat tonight. Not sure what is affecting appetite/restlessness. We go to the vet tomorrow so will try to figure it out.

I also talked with the vet about Abbie's gums -- I "quizzed" the vet about how many of these surgeries he had done and whether he felt comfortable doing Abbie's (or whether a dentist/hospital would be better). He said he definitely feels comfortable doing the surgery (based on past experiences, he would definitely tell me if he didn't feel this way). He has done several of them, including some dogs who had the same reaction when on clyclosporine.

[judymaggie]

Hi! Abbie had a round of tests last week so I thought it was a good time to give an update. Overall, Abbie has had a remarkable turn-around over the last two weeks. I have no idea what prompted it but guess that it is a combination of things – third month on Senilife, trilostane cut in half and finally landing on a food that she is eating. She is alert, energetic and interactive with me and others. I rarely have to plead with her to get off the bed to go out or eat or go on our evening walk to the neighbor’s house. On a few walks I have not been able to keep up with her – she has actually been running! Everyone who sees her has commented on the positive changes. I am just thrilled!

Only negative is that she continues to lose weight. In order to maintain her weight on the food she is eating (Hill’s Prescription i/d low fat chicken, rice and vegetable stew) she would have to eat five 5.5 oz. cans a day --- she is eating 1 ½ - 2 cans a day, sometimes mixed with pumpkin and Royal Canin gastro low fat canned food and sometimes with a little chicken sprinkled on top. Twice a day she gets some cut up chicken and also a couple of Blue Buffalo treats. She is down to 20.6 lbs. from a high of 26.5 lbs. That said, her muscle mass is good and she is having fewer instances of her rear legs collapsing. She is having some episodes of strong tremors in her hind quarters – if it was happening all over her body, I would think they were seizures. If she is standing and I am not nearby to hold her up, she will fall over.

The vet and I decided to cut her trilostane from 20 mg. to 10 mg. a day, thinking that the anorexia was a side effect. I didn’t see any Cushing’s symptoms return since we cut the dose. We did an ACTH last Tuesday – pre was 2.6 (down from 3.8); post was 9.3 (up from 8.8). I was very pleased that the cortisol did not spike after the dose reduction.

Main concern on the labs is that potassium levels have continued to rise, albeit slowly. The latest result is 6.4 (range, 3.6-5.5). There are still some kidney markers: urea nitrogen, 40 (range, 6-31) but down from 59 at last check; BUN/creatinine ratio, 36 (range, 4-27) but down from 45; Na/K Ratio, 23 (range, 27-38). All liver tests are normal. Her last UPC was 6.1 – we have opted not to retest for the time being as we have not been able to lower it in spite of trying several different medications. Since stopping amlodipine, Abbie’s blood pressure has been normal.

BEST NEWS: the gingival hyperplasia (tissue grown over her teeth) caused by amlodipine has begun to recede on its own and Abbie no longer needs surgical intervention!! I am thrilled for Abbie (and my pocketbook).

I had been worried that Abbie might not make her 14th birthday which is coming up in May but am now much more optimistic!

[labblab]

Oh Judy, all in all, this is a super good report and thanks so much for sharing it!! :) :)

We're definitely gonna plan for a super duper Happy Birthday party come May! ;) :D

[LaurieS]

Happy to read the good news about Abbie! I know the frustration about the weight loss, Charlotte is so skinny and still not eating enough to put on weight. At least Abbie is eating dog food, Charlotte wont touch kibble or canned. But tonight she ate 2 helpings of white bean chicken chili and cornbread. Heres to hoping for a big bday celebration in May!

Laurie

[LaurieS]

Judy I have a question. You mentioned the tremors in her hind quarters, has anyone ever told you what is causing this? Charlotte has them over her shoulders, (worse when on dex, more mild on pred, but always there) and none of the vets have been able to tell us why this is happening to her. The thought is it's neurological and being caused by a macroadenoma but we haven't had a CT or MRI to prove or disprove that. With Charlotte it started before her cushings diagnosis so she wasn't on any meds then. It got worse on trilostane and then continued after off of trilostane and on the steroids. It's driving me crazy not to know what exactly is causing this. I'm wondering what your vets have told you about Abbie's tremors?

Laurie

[Gracie123]

Laura and Judy,

I came back this forum because my Gracie still has muscle tremors. She was diagnosed with Cushing's 09/2016. She had an Addisonian crisis secondary to Vetoryl and undiagnosed kidney failure. She is now permanently Addisons and has more advanced kidney failure. Her tremors started 1 week after her crisis. They were so bad at one point that's she would fall over. They started to improve when we started tapering her Prednisone, but still have not gone away. She's so tired all of the time now. I don't know if it's the Prednisone or if it really is from her pituitary tumor.

Betty

[judymaggie]

Ladies --- I really haven't focused too much on Abbie's tremors since she has had so much else going on. I did mention it to her chiropractor that gives her a treatment once a month and she felt that it was most likely neurological related to the IVDD since that involves pressure on the nerves in her spine. This makes sense to me and, since the tremors do not bother Abbie at all, I would prefer to focus on those things that affect her quality of life.

[Gracie123]

Judy,

I feel your pain. Gracie has gone from Cushing's to Addisons/kidney failure 2 months later. I've been trying to stabilize her for the past 3 months. I was noticing your Abbie's K is pretty high. When it goes above normal range, dogs do not feel well. The ER vet even told us the dogs feel "drunk". Gracie gets her percorten shot when her Na/K ratio hits 27. She vomits and loses control of her legs when it hits 23.

Just read you had an ACTH recently. Have you had an SDMA test run? That tests for early kidney disease, which can cause K to rise along with kidney values.

Betty

[LaurieS]

Ladies --- I really haven't focused too much on Abbie's tremors since she has had so much else going on. I did mention it to her chiropractor that gives her a treatment once a month and she felt that it was most likely neurological related to the IVDD since that involves pressure on the nerves in her spine. This makes sense to me and, since the tremors do not bother Abbie at all, I would prefer to focus on those things that affect her quality of life.

I totally agree Judy, we need to focus on the things that affect their quality of life. But because we don't know what is causing the tremors I worry there is something that is undetected in Charlotte that we should be focusing on. And since there are others who have pups with similar tremors I was wondering if anyone had ever really been told what is causing them. I guess they could be for different reasons in different dogs. It never seems to just be one thing. UGH, this is such a horrible disease! My best to you and Abbie!

Laurie

[LaurieS]

Laura and Judy,

I came back this forum because my Gracie still has muscle tremors. She was diagnosed with Cushing's 09/2016. She had an Addisonian crisis secondary to Vetoryl and undiagnosed kidney failure. She is now permanently Addisons and has more advanced kidney failure. Her tremors started 1 week after her crisis. They were so bad at one point that's she would fall over. They started to improve when we started tapering her Prednisone, but still have not gone away. She's so tired all of the time now. I don't know if it's the Prednisone or if it really is from her pituitary tumor.

Betty

Ah poor little Gracie. I'm so sorry she is having to deal with so much. The prednisone does make Charlotte a little tired but it's so hard to know exactly what is causing the lethargy. Has Gracie had a CT scan or MRI? We haven't been able to afford one for Charlotte so we are unsure exactly what we are dealing with which is frustrating. But we have tapered down on the pred too and the tremors aren't as bad.

Laurie

[judymaggie]

Just read you had an ACTH recently. Have you had an SDMA test run? That tests for early kidney disease, which can cause K to rise along with kidney values.

Betty

Betty -- we are not running SDMA tests on Abbie. We know she has kidney disease (glomerulonephritis) based on an extremely high UPC (6.1 at last test). We have never been able to get the UPC to lower significantly (in spite of trying many, many medication combinations) so have stopped running UPCs. Vet is doing a chem panel at least every three months to check on potassium -- he is concerned about it. Thankfully, so far the creatinine is normal.

[judymaggie]

Hi, all! Abbie is back to having very little interest in eating, has had a drop in energy level and has also had a couple of incidences of liquid diarrhea. I have decided to stop the trilostane. My vet is out of the office for two weeks so couldn't run this by him but know he will concur as we had discussed doing this when we ended up cutting Abbie's dose in half. I am hoping I will see improvement soon!

[Squirt's Mom]

I hope so, too, Judy! Let us know how she is doing!

[Harley PoMMom]

Oh Judy :( hoping that withholding the Trilostane will do the trick and our sweet girl will get her appetite back...do let us know how things are going

Hugs, Lori

[Whiskey's Mom]

Me too! I'm right there with you - trying different things-anything so they'll eat.

[LaurieS]

I'm so sorry Judy! I know the frustration, I struggle daily to get Charlotte to eat and she is on steroids! I sure hope stopping the trilo will help Abbie!

Laurie

[Carole Alexander]

Gracie, Laurie, and Judy,
Just to weigh in on the tremoring issue: Skippy was diagnosed in 11/16 and started tremoring shortly before starting Vetoryl. The tremors have continued off and on since. Last week we increased the dose from 20 to 30 BID and after the third day, Skippy began tremoring very badly, i.e., all over body tremors. Stopped the Vetoryl for 3 days and restarted last Monday. Only a little tremoring but still very lethargic, reluctant to eat and I don't think his cortisol is under control from two weeks ago Stim. He has not had an MRI or blood panel and kidney function test since December. He will see another specialist in two weeks. Yes, different reasons in different dogs. I second the UGH and wish your pups the best.

[LaurieS]

Thanks for the info on Skippy Carole, the tremors look so awful and I just hope they aren't causing our pups any pain. I read through your entire thread yesterday and I feel so bad for your poor little guy. This is such a devastating disease!

Laurie

[judymaggie]

Hi, all! Abbie had a chiropractic treatment today -- vet said that her muscle mass is still pretty good except for her chest area but also said that her muscle tone has decreased. Unfortunately, she has lost another pound so now weighs 19.2. She had a good treatment -- vet used something new -- a ring that emits electronic waves. It was strange but I will say that Abbie usually is tired after treatment and this time she had a lot more energy when we got home.

I called my vet's office and spoke to the head tech to let her know that Abbie had lost more weight and that I had stopped the trilostane and re-started the mirtazapine. My vet contacts her fairly regularly when he is out of the office. Abbie has eaten small meals yesterday and today as long as I sprinkled her favorite treat on top, crumbled up Blue Buffalo Kitchen Cravings Chicken Meatballs.

[labblab]

Judy, I'm so glad she is eating a bit more for you today. I understand why you're concerned, though, and I'm rooting for you both.

Big hugs to you girls.

[molly muffin]

Yay for eating! Even small meals is good. I remember how hard it was to get molly to eat sometimes and it just literally would drive me bonkers trying to find what she eat on any given day.

I like the idea of the ring, especially if she came out of it having more energy.

[judymaggie]

Hi, folks! Abbie peed in the house yesterday --- I had left her home for a little more than two hours so thought the time alone was just too much for her. Then today she was alone for only a half hour and she had another accident. Both were in the bedroom which is very unusual for her. I decided to call the vet's office and see if someone was there who could look at a urine sample and then send it off for a culture. This afternoon she had a cysto and, sure enough, had bacteria in her urine. The vet and I decided to start her on Clavamox and then send off the sample for a culture. Hopefully, the Clavamox will kick in quickly.

Her weight was at 20.6 which I was pleased about but also surprised since she has barely been eating anything. The mirtazapine does not seem to be working. I will probably have to hand feed her chicken in order to get enough food in her before taking the Clavamox.

[molly muffin]

Well at least there is a reason for the accidents and not cushings! whew I always find that to be a bit of a relief.

Amazing she hasn't lost weight, but good too. As long as she'll keep taking the chicken (LOL) hard to give meds with food with a finicky eater isn't it. I remember that oh too well.

[judymaggie]

Hi, all! Abbie had a vet visit today for vaccines, heartworm test, etc. as well as discuss current issues. She is only willing to eat ground beef mixed with minced chicken or the chicken on its own. Amazingly, she has not lost more weight and remains at 20 lbs. Unfortunately, her bowel movements over the last week have been in the “pudding” mode even though I had increased the metronidazole to twice a day. The mirtazapine does not seem to be helping with her appetite. Arthritis in her right hip is affecting her walking as well as standing and balance. The vet did an in-house electrolyte panel as we have been worried about increasing potassium levels. We were both surprised that the potassium is now in normal range but creatinine is now at the very upper level of normal and the BUN has doubled. I will take her back in three weeks for another check of these levels as we are concerned about her kidneys.

Going forward we are going to add Proviable paste which is designed to help firm up stools and also add omeprazole (Prilosec). Abbie currently gets Pepcid twice a day so she will now get that once a day and the omeprazole once a day. Unfortunately, Abbie has not wanted to eat the beef/chicken when mixed with anything else, including forti-flora and/or pumpkin, both of which were helping to control the loose stool.

Like Whiskey and Charlotte, Abbie’s lack of interest in food is very frustrating. I thought the scrambled eggs with cheese I made for her tasted delicious!

[Harley PoMMom]

Glad to hear that her weight has remained stable but sorry to hear that her BM are not of the right consistency. :( On the kidney forum I belong to there are members whose dogs just love those Arby's roast beef sandwiches and Nilla wafers...just thought I'd mention this.

Hoping that the new meds will firm up that poop. Sending huge loving hugs to you both, Lori

[LaurieS]

Oh how I feel your frustration! I don't dare add anything unusual to Charlotte's meatloaf because it's all she will eat and I can't afford to turn her off of that. Unfortunately now the eating isn't our biggest problem since she won't drink on her own. I don't wish that on anyone!

I will be thinking of you and little Abbie!

Laurie

[Whiskey's Mom]

Poor Abbie! Sorry you're into food frustration too ... We know it well. I'm super patient with Whisk, it's not his fault, but it's so hard coming up with meals for him. His diet is totally unbalanced, but He eats. His BM consistency ranges from semi-firm to soft to pudding, but it wasnt all that different when he was on a more stable diet. I don't have him on any meds right now, the metronidazole didn't really change things in the past, nor did Proviable(we sprinkled it on his food-never heard of the paste). May I ask why she's on Pepcid and Omeprazole? I know what they're basically for I'm just curious if it's something I should try with Whiskey. Best of luck with the feeding- Whiskey has THE wackiest menu but I'm willing to share if you're looking for suggestions. Going to hit up Arby's as Lori suggested! Sending hugs & belly rubs.
Annie & Whiskey

[Squirt's Mom]

Well a mixed bag but I am happy she hasn't lost any more weight in spite of the digestive upsets and lack of appetite. You are a great mom and doing a wonderful job! I know sweet Abbie is so glad to have you on her side.

[judymaggie]

Annie -- I started giving Abbie Pepcid when she started on Lysodren and then Vetoryl. Even though she is no longer on Vetoryl, she is on Deramaxx which can be hard on digestion so have continued the Pepcid. Also, Abbie has glomerulonephritis (kidney filters do not function) which can cause nausea and lack of appetite.

(As an aside, the vet called last night -- he said he was thinking about the rise in BUN/creatinine and thought that it was best to try an every other day dosing of the Deramaxx. Another balancing act ... Abbie is moving very, very slowly today and only going out to pee. Am hoping soreness is from busy afternoon yesterday.)

Since Abbie has been on Pepcid for a long time, my vet thought that it was probably not as effective as it had been and decided to keep her on that in the morning and then give her Omeprazole in the evening.

Hopefully, with that change as well as adding Proviable, her bowel movements will firm up. The Proviable paste comes in a kit along with the prebiotic capsules. Wish me luck in getting her to swallow it -- the vet says it doesn't taste bad but I seriously doubt he has tasted it himself! ;)

I am going to add the Forti-flora and pumpkin to her pm meal even if end up throwing it away. The vet said he has done recent reading about Forti-flora and, in addition to helping with bowel control, it has been shown to have anti-inflammatory properties.

I also wanted to mention something for those whose dogs are taking mirtazapine (appetite stimulant). Originally the vet said to stop giving Abbie Zyrtec because mirtazapine is technically an anti-histamine. Yesterday he said that it is okay to give her that in the am and the Zyrtec in the evening. Glad he keeps up with the research!

[Whiskey's Mom]

Thanks for all the info! I sure hope Abbie improves with both her appetite and her movement, poor girl. Sounds like you have a great vet who really cares about her. I've never tried Fortiflora, I wish it came in a smaller package because Whiskey is so fussy now and if he sniffs it out & disapproves I'm stuck with it. I went on the website to ask for a sample but couldn't find contact info. Best of luck with everything.
Annie

[judymaggie]

Annie--I don't see any reason why you couldn't open up the Forti-flora packet, use a little bit and then put the packet in a baggie to use at next meal. I buy it on line but my vet does sell single packets. You might check with your vet on that.

Unfortunately, my attempt at re-introducing it failed. Abbie took one sniff of the ground beef/chicken mixture with the Forti-flora mixed in and walked away. I threw it out, fixed her another bowl of just the ground beef/chicken and she cleaned her bowl -- only about a half cup of food but at least it is something.

[Whiskey's Mom]

Oh no! Hey been there done that. Hate wasting food but sometimes there's no other way. We certainly don't want to eat it. :( I'm glad she at least ate something. In spite of the frustration you gotta laugh, our sweet adorable pups turning their noses up & walking away, like " I can't believe you expect me to eat this". :p
Sorry, What I meant was there are so many packets on a box, the smallest I found was a 30 pack.

[molly muffin]

I always hated how hard it was to get molly to eat sometimes. I was lucky in one thing, Molly Loved foraflora. Put it on her food and she would at the very least eat the top part, since I just sprinkled it on. It saved us many a day.
I guess dogs have their likes and dislikes just like us humans. Molly was young when she started getting the foraflora, due to digestive issues and I'd act like it was a treat she was getting. LOL It was quite comical sometimes.

I hope that you can work out something to get Abby's appetite back up. Everything seems to be a balancing act. We have all juggled so many things with our dogs it feels like we could be an act in the circus. LOL

[judymaggie]

Sharlene -- when Abbie's appetite was good, she wouldn't hesitate to eat her food with forti-flora and senilife mixed in. I've been giving it to her for several years. Now she just won't touch anything but ground beef and chicken -- not sure what I will do if she no longer likes these two things.

Now another issue has arisen -- she hasn't pooped since early Tuesday morning. She is having a lot of difficulty walking/standing so is not going for walks -- I thought maybe she just didn't want to poop in her own yard. This afternoon I coaxed her to walk past two houses but still no interest in pooping. No straining or anything -- she just doesn't make any effort. I spoke to Abbie's vet tech -- he said that the vet would be more concerned if she was straining and nothing was coming out. I am to call them tomorrow afternoon and give them an update.

[molly muffin]

Oh dear, will she take pumpkin? I don't know if that would help or not and you certainly don't want to go the other way either.

Will she eat pork maybe? lean white, like pork loin. Veal?
As some ideas to try and shake it up a bit for her.

[judymaggie]

Sharlene -- I had been giving Abbie pumpkin along with the Forti-flora and senilife. She loved it! Now won't eat ground beef/chicken if it has anything mixed in. I haven't tried any other proteins -- take that back -- she ate a piece of lean roast beef, hand fed in tiny pieces. Curious thing is that she will only eat the chicken, beef, etc. if it is minced. Anything bigger and she rolls it around in her mouth and drops it. I even have to crush up the one treat that she will still eat. She used to take a whole slice of chicken and chew it up. I was convinced that something was wrong in her mouth but the vet really thoroughly examined her mouth, throat, teeth, tongue, glands, etc. and all looked good. The gingival hyperplasia is very, very mild at this point. Abbie let the vet rub her gums and her teeth and nothing bothered her.

[Whiskey's Mom]

Whiskey is much the same with the larger pieces of food. He used to eat big things in whole bites, now he prefers the small pieces & his mouth & teeth are fine. He grew tired of the chicken & ground beef too. Now his chicken has to be breaded or very well seasoned, everything does. I made beef cubes (like for stew) in the crock pot with a few tablespoons of the dry gravy mix added (I know-salty & has onions) & he loves that. I also did lean pork much the same way & let them cool overnight to skim off any fat., He also likes chicken sausages & cold cuts. I know they are all seasoned but its the only way he will eat & it's keeping him going. Right now he is seriously addicted to Beggin Strips Littles. I never gave him those but a coworker brought them for him & he wont eat any other treats but those while at work. I know Abbie has kidney issues so maybe none of this is right for her, just sharing my things that worked for us.

[Joan2517]

I hate to say this, Annie, but he seems quite the gourmet!

[Whiskey's Mom]

Oh yes- we call him our little gourmet. Maybe Abbie is too, wanting more flavor in her food
Judy-I'm sure you know this also but Whiskey is fussy about the temperature of his food too. He prefers room temp or cold. I discover all of these things by accident so I'm willing to share if it helps someone else.

[judymaggie]

Annie -- yes, am very familiar with temp preferences. They do seem to fluctuate.

The vet tech called this afternoon to see how Abbie was doing -- still no poops. He said the vet would like me bring Abbie in to get some sq fluids to try and perk her up and help with kidney issues so did that a while ago. The tech commented on how quiet Abbie was although she did let out one "ar-o-o-o" when he brought her back to me. No change in affect at home and no interest in eating. I am supposed to call on Monday to give them an update.

[Squirt's Mom]

I know you are worried so (((((((((((HUGS))))))))))))).

[judymaggie]

Leslie -- I am worried and I appreciate the hugs! However ... we have poop!! :D:D It was far from normal -- black, sticky yuck (and I know the color and consistency is a concern) -- but poop just the same. Then Abbie came in and ate about a cup of ground beef/chicken. She fought with me violently when I tried to give her her pills so, after two tries, I gave up. Figured she was entitled to a break!

Abbie has a saggy belly from the fluids but definitely seemed perkier when out walking. Hopefully, the Proviable will arrive by Monday --- am hopeful that Abbie will allow me to squirt the stuff in her mouth and not spit it back out.

[Whiskey's Mom]

Yay for poop! Bet you're relieved (and Abbie too). Hope it returns to the normal kind and her appetite keeps improving.
Annie

[judymaggie]

Hi, all! We have had a couple of rough days (and nights). :( As I said, the poop color and consistency was concerning and led me to believe that there was a bleed somewhere internally. For the second night Abbie was very, very restless and neither of us got very much sleep. Before I even had a chance to call the vet this morning, Abbie peed a huge amount of liquid in the bed this morning -- I guess all the remaining sq fluids found a way out. She got off the bed and walked to the front door, pee dripping everywhere. Two loads of wash later and some carpet cleaning, we were back to square one.

I spoke with Abbie's vet tech and, after consulting with the vet, said that it was likely that Abbie had developed an ulcer from the Deramaxx, especially since she hasn't been eating very much to coat her stomach. He wanted me to stop by and pick up sucralfate and start that tonight. When I was at the vet, the tech said that, if Abbie had a similar poop on a day when they were open, to bring in a sample and they would send it off for a specialized test to confirm whether or not there was blood in it. Also, it is probable that the night time restlessness was due to her feeling uncomfortable.

So ... will start the sucralfate tonight and go from here. I am praying that she won't give me a hard time with the syringe. If she does have an ulcer and we can get it under control, then I am hopeful her appetite will pick up. I got the Proviable today but don't want to start two things at a time so will wait on that. Obviously, no more Deramaxx ...

[DoxieMama]

Ah poo. Always something, eh? Hope things look up soon.

[Harley PoMMom]

Man, Judy, when it rains it pours :( I'm so sorry you both are going through this and will keeping you both in my thoughts and prayers.

[molly muffin]

Okay I'm back, holy cow you have some stuff going on there.
So do we have more poops? Is the consistency any better? Will she let you give her the syringe?
I had to syringe meds into molly more than once. She didn't like it but it worked better than pills sometimes.

Are you and Abbie getting any more sleep?

[judymaggie]

Hi, Sharlene! Yes, there is a lot going on--I got very overwhelmed this morning but doing better tonight. I just made a list of all of Abbie's meds along with the timing. The day started out poorly--Abbie wouldn't wake up even with me yelling at her. I made sure that she was breathing and just let her sleep. When she finally got up, I gave her the sucralfate--she doesn't fight the syringe , thank goodness. I give her time to swallow after each small bit. Unfortunately, she wouldn't eat any breakfast. At lunch time she did eat a small piece of bread (something she always loved but wouldn't eat the last couple of weeks) and a slice of lean roast beef.

The Proviable arrived today--I called the vet to find out if I should start it while Abbie is on the sucralfate and was told "yes". Instructions were to squeeze the paste into her mouth, more to the center than the sucralfate because it is thicker. Easier said than done! It is a very big syringe. I'm going to try and figure out something else--am thinking about putting it inside the beef.

For dinner I decided to try mixing a little bit of the canned chicken stew with the ground beef and cut-up chicken and ... the bowl was licked clean! :D Hopefully, I can get back to adding in pumpkin and forti-flora. After dinner we went for a good walk. In spite of only getting one dose of tramadol and no Deramaxx, her back legs are doing pretty good. No poop yesterday--did poop tonight. It was slightly more formed but still black. I wish she would poop in the morning so I could get a sample into the vet but I do think she is responding positively to the treatment.

So ... I think we're heading in the right direction. I was seriously thinking we were near the end but am more optimistic tonight. I am off to see the cardiologist tomorrow--not surprisingly, my blood pressure meds are not working!

[Whiskey's Mom]

Understandably overwhelmed! How scary that she wouldn't wake up. Great that she cleaned her plate and went for a walk. Hope it all continues. Please take care of yourself too!

[molly muffin]

Her heating getting worse you think? Or literally just not into waking up?
Lord you said cardiologist and at first I thought you meant for Abbie.
Lol. I can imagine your BP would be skyrocketing. Not sleeping, worrying.
Take care of yourself Judy

[labblab]

Hey Judy,

My cousin just went through an episode of esophageal bleeding (his symptom was also black tarry stools, and then confirmed with an endoscopy), and even though the bleeding spontaneously resolved after a day or two, he was significantly anemic afterwards -- they even considered transfusing him. So especially if the bleeding is still continuing for Abbie, her red blood counts may be low and that could definitely account for sluggishness on her part. My cousin was told to physically take it easy for a couple of weeks, so you may not want to push Abbie to do a lot, physically, until her stools are no longer black and her blood counts are normal. Just a thought...

Marianne

[judymaggie]

Marianne -- I appreciate the input as I had not thought of anemia being a concern. The next time I speak with Abbie's vet or vet tech I will mention this and see if they want to check her RBC. Thankfully, poop this morning was brown!! Still only slightly formed but definitely moving in the right direction. I was trying to figure out a way to get the Proviable into Abbie's mouth and remembered that I had a bag of popsicle sticks that I had used with Maggie when she needed to get Nutri-cal. I just put the paste on the end and scrape the upper teeth. This worked pretty good with the Proviable -- ended up just rubbing the stick on her tongue to get the rest off the stick. She wasn't thrilled but didn't gag so I don't think the taste is terrible. She ate a small bowl of food this morning -- I had to keep her waiting an hour after giving her sucralfate so she was barking at me for food! :D

Sharlene -- I love your auto-correct! :D I do my best to figure out what your intention is ... I have been letting Abbie dictate how far she wants to walk for a while now. Unfortunately, sometimes she has more energy starting out and doesn't realize that she has to get back home so I have to strongly encourage her to turn around. Usually she just wants to wander and smell everything.

[molly muffin]

ROFL!! It's a disaster when I try to type anything on either my phone or ipads.
I'm so grateful that you are all such great detectives and can figure out my meanings. Sometimes I look back at what I wrote and don't understand it myself. LOL

[judymaggie]

Folks--need all your prayers and good thoughts for my Abbie. She coughed all night and was very lethargic. I took her into the vet as soon as they opened--thankfully, her vet and vet tech were able to see her before they started surgeries. Vet is very concerned about cough, sounds in her left lung as well as some different beats in her heart. He will do x-rays and labs and call me later. Praying Abbie will be a "trooper" once again!

[Joan2517]

Praying for you both....

[Budsters Mom]

Of course Judy. We are right there with you and our sweet Abbie.

[Squirt's Mom]

Prayers rising, sweetie. Let us know when you can....the K9C angels are all around you.

[molly muffin]

Oh no Judy I hope she is going to be okay.
We'll be right here with you.
Come on Abbie! We're pulling for you!

[Harley PoMMom]

You both are in my thoughts and prayers, sending loving and comforting hugs.

[molly muffin]

Just checking in to see if any news yet.

[Budsters Mom]

Checking on your both. ;)

[judymaggie]

Hi, all! Thank you for all your good thoughts. Okay, bottom line is that Abbie has pneumonia in one lung. After the vet did x-rays, he said he was very concerned and needed me to take her to the hospital for a thoracic ultrasound and consult. That's where we were all afternoon. The critical care vets were very caring--there was a concern that there was a mass but, thankfully, that was ruled out by the ultrasound. They gave me the option of leaving her at the hospital for iv antibiotics and iv fluids or I could bring her home and treat her there. So ... she is home with me. She got a shot of cerenia for nausea and I will get more from my vet tomorrow. They gave me doxycycline with instructions to syringe water in her mouth followed by food. That's the catch as she really doesn't want to eat. Tonight I put the antbiotic in a cheese ball to try and get it past her esophagus as I guess it can cause erosion there. I am supposed to run a hot shower three times a day for the steam and massage her sides--I think I will go buy a vaporizer tomorrow which should be easier.

We go back to the vet on Monday afternoon for x-rays to see if any improvement. She will be on antibiotics for at least two weeks and possibly longer depending on how weekly x-rays look. Abbie is sound asleep with no coughing now--hope it lasts all night!

[Whiskey's Mom]

Oh wow-what a day for both of you! Glad Abbie is home with you & being lovingly cared for. Hope you both have a good nights sleep and Abbie eats for you. I'll be thinking of you both & sending love and prayers your way.

[molly muffin]

So glad you're u found out what is wrong and no mass was found. So that is good news. Now to get her past this pneumonia.
I hope you're u both get some rest tonight

[Budsters Mom]

Hoping the antibiotics kick in quickly and you're able to get her to eat.
Yes, definitely get some rest when you can.

Hugs,
Kathy

[Harley PoMMom]

Oh Judy, I am sorry for this recent setback and hoping the pneumonia is cleared up quickly...no mass ~ whew~...YAYA!!

Will be holding you both in my thoughts and prayers.

Sending tons of loving hugs to you both, Lori

[Squirt's Mom]

When Trink had pneumonia it was dang near impossible to get a pill in her and when I did she managed to hide it then spit it out. We ended up using injections of antibiotics to get rid of it. I never thought I could do that but I did and we made it thru just fine. So if the pills continue to be an issue ask the vet about injectible ABs. ;)

Prayers and healing energies flying our sweet girl's way!
Hugs,
Leslie and the gang

[judymaggie]

Folks: I think we may be on the way to wellness -- sh-h-h, don't want to say that too loud as it may be a jinx!

I took Abbie with me to Easter/Passover celebration at my best friend's house. Abbie is familiar with her cat and her home but I still figured I would go a bit early, help with the set-up and then stay long enough to say "hello" to everyone. There was going to be a crowd of 18 and Abbie didn't do too well at Christmas with a much smaller group so wasn't too optimistic. Abbie loves to ride in the car (as long as it doesn't end at the vet's office) so she enjoyed the hour-long trip. When we got there she went around the house, sniffing for the cat. As folks started to arrive, Abbie seemed quite comfortable. I took her out for a couple of short walks. She was barking a little but not the non-stop barking that she did at Christmas. When it was time to eat, Abbie came to me and seemed to be interested in what was on my plate. So ... I gave her some potatoes au gratin and she loved it. Over the next hour Abbie ate more potatoes, a couple of slices of salami, some cheese cubes and then a good amount of cheesecake! :D

She had a fairly good poop on one of our walks -- this past Saturday she still had just pudding and it had turned orangy-yellow. Not a good thing ... Yesterday it was slightly more brown. We came home mid-afternoon and everyone at the gathering said how good Abbie looked. No coughing although I heard her cough later in the day just a couple of times.

I had read on the one of the dog.aware links re how to get a dog with cancer to eat that changing the bowl can sometimes make a difference as can making separate piles of the different foods. For dinner I decided to change to a plate and made a pile of ground beef, one of chicken and one of the canned i/d chicken stew. I mixed some forti-flora into the stew. Abbie cleaned the plate!! We both, thankfully, slept better last night. [She was so restless Friday night that I ended up giving her two doses of melatonin.] I repeated the plate of food this morning and Abbie ate it all except for a few pieces of ground beef. I've decided to move to more i/d and chicken and eliminate the ground beef as Abbie seems to be getting tired of it.

We go back to the vet this afternoon for follow-up x-rays. I do want to see if he has any sample packs of dry food -- I don't want to open up a 6 lb. bag of her dry food if she is going to refuse it. We have two more days of sucralfate -- will be glad when that is done but I do think that has done its job.

H-m-m... that ended up longer than I intended!

[Harley PoMMom]

What a great update on our sweet girl!! Regarding the dry dog food, I bet some dog food companies would send a sample of their feed if one would ask them....just a thought. ;)

[judymaggie]

Hi, folks! X-rays yesterday showed a little improvement -- the vet displayed last week's x-rays next to yesterday's so I could see the changes. There is still quite a bit of cloudiness. The vet also showed me the x-ray that showed her lumbar vertebrae -- he had told me that one of her discs looked really bad. After looking at it I do not know how or why she is still walking! There is no space in the disc and there is what appears to be a bone spur growing on the bottom. I really think the loss of weight, although not good for other reasons, has helped her with her IVDD. She has continued to lose weight and is now at 19.6.

Anyhoo, Abbie will be on antibiotics for at least three more weeks. The vet said her breathing sounded much better with no raspiness like she had last week. We go back on 5/4 for more x-rays and another exam.

I asked the vet about a sample pack of Abbie's dry food -- he said that Purina will accept any prescription food (and possibly other food) that a dog stops eating for any reason so I shouldn't hesitate to open the bag to try it. I did that a little while ago and put a few pieces on the rug for her to try and she chewed them up! I will continue to do that for a bit before I start adding them to her regular meal. She has continued to eat a few offerings off the plate. I ended up adding cheese to her ground meat and seems to really like that addition. Today is the last day for sucralfate -- hooray!!

[Whiskey's Mom]

Yay for Abbie! Baby steps and one day at a time, but sounds like she's feeling better so it's all good :D Bless her little heart with those xrays, she's a trooper.
Sounds like Abbie is following Whiskey's lead to gourmet dinners: salami, potatoes au gratin & cheesecake-a girl after my own heart.
Thanks for the hint on adding cheese to the ground beef, I'll try that soon.

[judymaggie]

Folks: Maybe I should have brought some cheesecake home for Abbie ... two days of better eating and then this morning back to just chicken. I prepared her breakfast before mine so am thinking maybe she was nauseous in spite of all the meds. Tomorrow morning I will make my breakfast first and see if that makes a difference. She seems tired today also so maybe feeling yucky from pneumonia and/or antibiotics.

[Squirt's Mom]

I'm so sorry.....I hope she eats better tomorrow for you. Maybe smelling your breakfast got her appetite kicked in?

[Whiskey's Mom]

I'm sorry too, the ups & downs are so disheartening and I totally understand. Tomorrow will be a better day. Maybe you could try banana muffins, (or corn muffins-which Whiskey had for dinner). Low fat recipes for both are easy to find online & quick to make. Hoping for a good appetite in the morning.

[molly muffin]

I also wonder if days when she is feeling some pain from that disc might have to do with her appetite being off.

Definitely hoping for a better day tomorrow.

[DoxieMama]

Judy, how's your girl? (And how are you?)

[judymaggie]

Hi, Shana! Thanks for checking on us. Abbie has been on a roller coaster in terms of health -- she is now being treated for another UTI and an ear infection. She is eating very, very little -- last couple of days, she will eat some canned i/d from a spoon as well as a little bit of chicken if I hand feed her. We cut the antibiotic dose in half as she was really lethargic after starting it. She is still basically sleeping all day but the accidents in the house and extreme drinking have stopped. The vet calls every few days as he is concerned about her.

The end of April I had a bad fall and ended up with a cracked rib and huge hematomas in several areas including my right eye socket. I landed on my tailbone also and am just now able to sit without that silly cushion. I wasn't able to sit at the computer so have been absent from here for a bit. I have gone back to tai chi so am definitely doing better!

[Whiskey's Mom]

Hi Judy, sorry about Abbie-hope she's feeling better & eating more for you. Glad to hear you're on the mend though. Keeping you both in my thoughts.
Annie

[DoxieMama]

Yikes! Sorry to hear about your fall. You've been missed, but the reason is completely understandable. Glad you're doing better... sending healing thoughts your way....for both of you.

[judymaggie]

Folks: Curious if anyone is giving their pup a cranberry supplement ... Abbie is having frequent UTIs and, although the antibiotics help with the PU/PD, she doesn't want to eat (even though taking antacids) or go on walks when taking them. I've been reading about Nutramax' Crananidin as I do like their products in general.

[molly muffin]

I like Nutramax's products too. I never gave the supplement to Molly but it was mentioned by one of her vets to try once when she had a UTI. So maybe it would help.

[molly muffin]

Judy, we haven't heard from you in awhile and I wanted to check in on your Abbie and see how you are both doing.

[Harley PoMMom]

Judy, we haven't heard from you in awhile and I wanted to check in on your Abbie and see how you are both doing.

Me wondering too!

[Squirt's Mom]

Count me in, too!

[labblab]

OK Judy, now I'm really getting worried about you girls. :o :o

Please do check in whenever you can. You don't have to write much at all -- hopefully just letting us know that you girls are OK.

We're all thinking about you...

[labblab]

On Judy’s behalf, I’m returning to add a final note to Abbie’s thread. Sweet Abbie is now at peace, and as her vet said so kindly, Maggie was surely right there to greet her. Judy’s loving care allowed Abbie to celebrate her 15th birthday on May 7th. However, her many problems finally overtook her this week, and she was released on Monday. Her spinal problems were causing unremitting pain, and the steroid injections that had helped in the past were creating new severe issues. Just as Judy had originally rescued her in 2010, Judy again rescued sweet Abbie’s spirit from the pain of her tired, worn body. And now we have another K9C angel to watch over us.

Fare thee well, little Abbie. And many thanks to Judy for the love she gave to Abbie and for all the help she’s given to our family here throughout the years.

In gratitude and loving memory, always.
Marianne

[Joan2517]

Such sad news, Judy...many, many hugs to you.

[Harley PoMMom]

RIP our precious Abbie. Sending loving hugs to her wonderful Mom, Judy.

[Squirt's Mom]

Oh Judy, I was so sorry to hear this when Marianne shared the news with us. My heart is aching for your loss and the pain I know you feel today. Abbie was met by not only her sweet Maggie but by Squirt and so many of our other babies. She is pain-free, energetic, and oh so grateful to her mom for giving her those precious gifts.

Don't forget we are here for you anytime. You remain part of us always.
My deepest sympathies,
Leslie



A Blessing For Absence
by John O’Donohue

May you know that absence is full of tender presence

and that nothing is ever lost or forgotten.

May the absences in your life be full of eternal echo

May you sense around you the secret Elsewhere which holds

the presences that have left your life.

May you be generous in your embrace of loss.

May the sore of your grief turn into a well of seamless presence.

May your compassion reach out to the ones we never hear

from and may you have the courage to speak out for the

excluded ones.

May you become the gracious and passionate subject of your own life.

May you not disrespect your mystery through brittle words or false belonging.

May you be embraced by God in whom dawn and twilight

are one and may your longing inhabit its deepest dreams

within the shelter of the Great Belonging.
(Eternal Echoes 275)

[molly muffin]

Judy I am so very sorry to hear of the loss of your precious Abbie. When I look back through the thread it reminds me of what a very long journey you and Abbie had and how we exchanged information and ideas when I was going through the kidney issues with molly.

I am very sorry that it came to the point where nothing was helping any more.

I hope that you are doing well and send you my sincerest condolences.