Recovery time - Sweet little Ayla is gone

[Ayla's Mom]

Hi all. I'm Ayla's Mom :D Ayla my 10 yr old Shih Tzu baby girl that has had problems, starting with food allergies to poultry, beef, corn and wheat, cataract surgery at one year old, a detached retina and seizures that we have been able to control with Taurine.

We started noticing little things but it wasn't until felt lump on stomach that took to vet. He said Xray showed her liver was enlarged due to her age, but no tumor. Week later, brought her back to check liver enzymes when family member mentioned problems with her dog. Once her belly got bigger and muscles atrophied, I found Cushings myself by googling that and saw all the additional symptoms she was showing were listed too.

I read that the way to know that the medication is working is that the excessive drinking, eating and urinating will stop. It stopped almost immediately. She also wasn't breathing as hard.

Our vet said that it will take a couple months for her stomach to go down. He agreed that swimming therapy would be good for her muscles so she gets to swim in the bathtub couple times a day. She is still weak, preferring to lay on her side then to walk, grunting when she wants us to help her move around but is getting slowly stronger.
We have been encouraged that her stomach is getting smaller... she lost two pounds of the three she had gained but she has gone back to being picky about eating making feeding her a chore.

Today, we were worried. She ate only a little yesterday and not at all today, even refusing her favorite treat of bacon. It looked like she tried to poop a couple times yesterday but would fall into sitting so I started to think she was constipated. Gave her a glycerin suppository but nothing happened so made appointment with vet.
I decided to try some ground buffalo with some green beans and she wolfed it down like nothing was wrong.
She has always been a picky eater but totally refusing food she had been eating is new. Nature's Variety lamb or venison frozen, canned, kibble and freeze dried. Have even coated the canned with the freeze dried.
Refusing bacon is really unusual. She did eat it finally later in the day.

I kept the vet appointment to make sure she was okay and was excited about showing him her improvements not realizing my vet was not in and I would be given an associate.

She determined that Ayla was not constipated but was not listening to me about anything else. She stated she believes that Ayla did not have Cushings arguing that she didn't show symptoms, dismissing when said she was getting better, but also saying symptoms were different then everything I've read about Cushings. Also saying that my regular vet was wrong and that Ayla has a tumor in her liver because it was large and hard. I think she made her decision even before coming into the room.
I had a whole rant going on here but it was super long and irreverent so erased it.
Was annoyed she upset us so and I had to pay her besides!

I am going to call my regular vet when he gets back but I am asking all of you your opinions and help.
How you get your dogs back into condition?
How long did it take?
Did the liver stay larger and hard for a while longer once stomach went down?
Any tricks to make it easier?

Thanks for your help

[mytil]

Hi and welcome to our site - I am sorry you and your girl are having these troubles. Poor Ayla she sure has been through a lot. I am not familiar with Taurine.

I surely am glad to hear you will be talking to your regular vet. From your post the associate sounded incredibly ignorant and arrogant - especially without conferring with your regular vet.

Sorry for the questions here but is your Ayla taking any medication for Cushing's? If so what and how much?

Is she taking any medication for her allergies?

When you get the chance post any test results (the liver values as well as any other elevated values). These tests include an ACTH, a LDDS and even if an high resolution ultrasound was done.

Regarding your question it does take a while for the symptoms to recede including the strengthening of the muscles - each case is different.

Have other conditions been ruled out or tested for - i.e. thyroid problems and diabetes?

Post the additional information here.
Terry

[labblab]

Hello and welcome to you and Ayla from me, too. Wow, the associate vet sure sounds like a piece of work!! You have to wonder what kind of private feud the two vets have going on between them to inspire that kind of open disrespect. :rolleyes:

It definitely sounds as though you will want to check in with your original vet as soon as he is available. In the meantime, I am hoping you can give us some more information about Ayla. Contrary to what the associate vet has said, most all of the symptoms you describe are indeed consistent with Cushing's. The one thing I am not sure about is the "hard lump" you are describing on her stomach. The typical Cushing's pot belly is a general swelling or distension of the stomach and not a hard lump. So I am not sure what that is about. You mention that your vet took x-rays, but an abdominal ultrasound is a much better imaging tool to assess changes in the internal organs of the body including the liver, kidneys, spleen, and also the adrenal glands which are a central concern with Cushing's. So in the presence of the hard lump, I would think an ultrasound would be a very good idea. This may take a referral to a specialty vet, however.

Turning back to the Cushing's, a diagnosis cannot be based upon outward symptoms and elevated liver enzymes alone. This is because a number of illnesses/disorders can be responsible for similar symptoms. I am hoping Ayla was given a diagnostic blood test that is specific to Cushing's? This would either be an ACTH stimulation test (takes 1-2 hours to perform) or a LDDS test (this takes 8 hours to perform). If so, can you please get the test results and post them here along with any abnormal values on her regular blood testing. This is also where an abdominal ultrasound can be very valuable, because the adrenal glands for dogs with Cushing's will typically show specific abnormalities. If the Cushing's is caused by a tumor on an adrenal gland, the mass should show up on the imaging. If the Cushing's is instead caused by a tumor on the pituitary gland, both adrenals will commonly be enlarged.

Since Ayla has already started treatment, can you tell us what medication she is taking? From what you describe, I am guessing it may be trilostane (Vetoryl)? What dose is she taking, and how much does she weigh? It is great that you have seen improvement in her behavior and appearance, but you want to make sure her cortisol does not drop too low on the drug. In order to make sure the dosage is correct, ACTH stimulation tests must be given periodically to monitor the drug's affect on adrenal function. The first test should be given no later than 30 days into treatment, and it is safest to actually run the first test after 10-14 days on the drug. Of course your goal in treating Cushing's is to reduce excessive thirst, urination, and hunger. But a lack of appetite can be a symptom that cortisol has dropped too low. Other worrisome symptoms are diarrhea, vomiting, or excessive lethargy. Any time that occurs, the trilostane should be halted at least temporarily, and the cortisol level needs to be checked.

I see I've burdened you with enough questions at this point! So I'll end this note for now. But we will be very anxious to learn more about your girl, and once again, we are so glad you've joined us. :)

Marianne

[Ayla's Mom]

I am sorry, I was not totally forthcoming with all the information I had... I believe after that associate vet, it made me a little held back and I wanted to see some answers first so please forgive me.

Ayla's "medication" is simply milk thistle. We started giving it to her before we found the symptoms of Cushings and since had immediate improvement, started to believe it is Iatrogenic/Accidental Cushings so I told the vet I wanted to wait on any additional testing.

Ayla is on avoidance diet so not on any steroids.
She is on eye drops for life time...Flurbiprofen, non steriod and Tacrolimus, which is a glucocorticoid for organ rejection. Both eye surgeon and regular vet assured neither would cause Cushings.
The only thing that keeps coming back to us is she started showing the problems when we started giving her a pet quality fish oil. One vet said no, another vet said yes to possible cause.
I truly believe it is.

This is the blood test that was taken to check liver only. I'm not sure which ones are liver so listing the high stuff.

AST (SGOT)... 73 U/L , normal 15-66
ALT (SGPT) ... 259 U/L, normal 12-118
Alk Phosphatase ... 1239 U/L, normal 5-131
GGTP .. 67 U/L , normal 1-12
Phosphorus ... 6.5 mg/dL , normal 70-138
Potassium ... 5.8 mEq/L, normal 3.6-5.5
Lipase ... 316 U/L ,normal 59-895
RBC ... 35.3 , normal 4.0-15.5
NRBC ... 4/100 WBC, normal
Platelet count... 672 , normal 170-400
Neutrophils ... 86 , normal 60-77
Absolute Neutrophils... 30358/ul ,normal 2060-10600
Absolute Bands ... 706/ul, normal 0-300
Absolute Monocytes ... 2118/ul, normal 0-840

Humm, I did have that nicely spaced for you.
As you can see, white blood cells was high so put her on antibiotics and something that started with a D but was SamE for glutathione.
Glucose come out low at 11 mg/dl so suggested different test.

Also had a bile test 9.4 umol/L - 9.7 umol/L so was not stent.

Have appointment to see regular vet in the morning. Told him about the associate and he kinda laughed at first like he knew about how she is... but I think more I told, it started to get to him. He wants to, as he put it, puts hands on Ayla and possibly another Xray to see where we are right now.

Thanks for your kind words and I'll let you know what happens

[labblab]

Hmmmm...given this new information, I have to say I am now much more sympathetic to the associate vet's opinion :o. Since there has been no diagnostic testing that validates Cushing's and there are so many irregularities in Ayla's labwork consistent with liver issues, I would now be much more concerned about the hard lump you are describing. It is good that her bile acid test was normal, but I would now definitely be wanting an ultrasound (not x-ray) of her liver.

The thing is, she has a number of blood abnormalities that I would not know how to explain. All of her liver markers are elevated. She also has marked elevation of all her blood cells, red and white alike. Conversely, she has an extremely low level of phosphorous. Taken all together, I do not know how to interpret all of these changes, but something is definitely imbalanced for her.

I also want to mention that Tacrolimus is actually not a glucocorticoid. It is indeed a strong immunosuppressive drug, but it does not fall in the category of a glucocorticoid. So your vets are correct that it ought not be related to Cushing's. I do wonder whether it may be related to any of these lab abnormalities, however. I do not know enough about it to be able to say.

Bottom line is that I would want to have a better idea as to what is going on internally for Ayla. I really recommend an abdominal ultrasound performed by a specialized professional. As I say, this will likely require referral to a specialty vet practice, but that may actually be very helpful -- to get a second opinion to help sort out all these abnormalities. At this point, I am not convinced it is Cushing's, either.

Marianne

[mytil]

Thank you so much for posting the additional information! I too step back from my comments on the associate.

In light of this I would consider this is could very well not be Cushing's related. Taking an immunosuppressive can cause infections and imbalances as the normal immune response is hindered.

I certainly would talk at length with my vet on the side effects of Flurbiprofen. Here is a link to the information sheet on this drug ... https://vetrxdirect.cis.naccvp.com/?e=46ba91b22b1a1cb6b53d959aff792449z3c&m=cis_plain&prodNum=6300327.

Keep us posted,
Terry

[Ayla's Mom]

We were able to see the Specialist today.

Taking deep breath....

Ultra sound found masses in her liver and one on adrenal gland. She said the amount of masses usually means cancer but has taken a sample.
She believes Ayla does have Cushings and has taken a blood test.
She also believes Ayla has a bad kidney infection and is more worried about that at the moment. Urine test
We will know all results tomorrow.

She gave Ayla antibiotic shot and fluids at the office and sent home with antibiotics and will see how she does on it. If we do not see a change, she will need a stay in the hospital with IV antibiotics.

She told us that if she has cancer in her liver, it does not necessarily mean a death sentence, that once the infection is cleared, we will treat the Cushings and she believes Ayla could have a good quality of life.

Marianne, thank you so much for your input. It was your concern for the lump that had me go to the specialist.
I also copied the Phosphorus wrong... 6.5 mg/dl normal 2.5-6.0

Terry, Taurine is a vitamin suppliment and the specialist was happy that it was working for her seizures.

Doctor Ward put in her Consultation notes to us that Ayla is a sweetie and she is sorry she is not feeling well. Isn't that nice?
I'm still not happy with the attitude and answers from the associate vet. She said Ayla did not have Cushings because she would be running around if she did; that she has gastrointestinal problems because we have been feeding her greasy buffalo, even though I kept telling her I only gave it to her that day; and calling her an old girl when she is only 10, saying their life span is 12-14 years when it is closer to 16. That was only couple things she said that I did not agree with sooo
I do give her credit for the mass in liver though... made me reach out to you all.

I am just confused that no one can tell me why she seemed to get better... stopping the excessive drinking, eating and urinating, and was breathing easier... on the milk thistle. I would not have waited if it didn't' seem like she was improving.

Little baby is exhausted from all the tests, excitement and drive

[molly muffin]

Hi and welcome. I don't think I've had a chance to say hello yet to you on your thread.

The milk thistle is a liver support and it might have helped with the liver issues but I don't think it would normally be responsible for her stopping excessive drinking and all the other symptoms.

Okay so what did the test results show about kidney infection? Those can be very serious and so yes, I think treatment for that is most important, along with dealing with the tumors found.

We've had one of our dogs that had an adrenalectomy for a pheo tumor, also have a couple places removed from his liver and made a full recovery, so that is hopeful if it comes to that.

I'm glad the vet had a favorable prognosis going forward.

One thing is that cushing tests can have false positives if there is another chronic problem going on, which the tumor on the liver could be. So that is a thought. I think the other things need to be addressed prior to go full out cushings. Kidney infection can cause the excessive drinking and peeing and while cushings could be a factor, it is risky to start treatment until you know for sure.

Welcome again to the forum. I'm glad you saw the specialist. When it comes right down to it, they are usually the go to when cases get complicated or when vets don't seem to have a good handle on what is going on and treatment.
I use my specialist for all things serious and my gp only for the very basic things now.

[Ayla's Mom]

Hi Sharlene and thank you for the welcome.

She was better after the antibiotic shot and fluids so we decided to bring her back for a second treatment Saturday. The doctor was there and told us that Ayla was sepsis and was dying when she came in so she was encouraged that Ayla looked more active and alert.
We did not know she was that sick.

She still isn't eating but we were told not to worry because she got the fluids and like people when they are sick, they just don't want to eat. She needs to stay hydrated more then food.
The doctor told us Saturday that she was really sick so we have to give her time for the antibiotics to work.
Today she had an appointment for another treatment. She woke up looking weaker then the day before but better then before that. The tech said that she thought Ayla looked the same as yesterday so that helped encourage us a bit.

I made a mush out of some of her canned food, added the Nutracal and milk thistle and squirted it in her mouth... was like feeding a toddler with it going all over until I got the hang of it but she would drink it down once in her mouth.

Now, on the funny side, I made some popcorn and she was taking those pieces down like she was just fine. Don't worry, was only equal to less then one kernel of corn.

We are taking it one day at a time

[mytil]

Keeping you both in my thoughts!!!!!

Poor little sweetie. It sounds like there are a number of things going on with her.

Terry

[labblab]

Gosh, I am so sorry that Ayla is having such a rough time, too! :(

Please keep us updated as to how you all are doing, OK?

Sending many healing hugs,
Marianne

[Ayla's Mom]

My little Ayla is gone. We can't stop crying...

[labblab]

Oh my goodness, I am so very sorry! What ended up happening to your sweet little girl? :(

Marianne

[molly muffin]

Oh no! I'm so sorry. :(

My sincerest condolences.

[MiamiThom]

On no!!! So sorry to hear that. My thoughts are with you during this time.

[Ayla's Mom]

It all happened so fast.
Last year in July, she had a cyst removed and the blood work checked out perfect.
We started noticing symptoms in February.
In the middle of March, I felt a lump on her stomach. Vet Xrayed and said her liver was enlarged because she is getting older.
Muscles starting to atrophy...tummy starting to get bigger.
After Easter, had vet do blood work.
Checked for stent.
Gave her antibiotics. Seemed to get better on milk thistle.
Last week, she stopped eating and started getting weaker.
Vet took Xray and liver had doubled in size since last enlarge Xray. Took her right to specialist and she said Ayla had tumor on Adrenal that spread to liver but was more worried because she was sepsis.
Immediately started antibiotic injections and fluids under skin.
(We did not want to risk her dying alone in cage without us being with her)
After first treatment, she was more alert so brought her back each day for three days for antibiotic and fluids instead of giving oral because she still did not want to eat.
She was getting weaker but still alert.
She had two tiny seizures Monday because she wasn't eating, she missed her taurine that controlled them.
During last night she was having trouble breathing... the rattle....
This morning she passed in my arms as I held her.

The thing that I realized today when we returned to an empty house was that she had been slowly removing herself from us. She stopped sleeping with us, was not as cuddly and stopped barking at the door. I am sure she wasn't meaning to but it seems to make it a bit easier... although we can't seem to stop crying.

My husband and I were talking and wondered if the infection had been cleared, since the liver enlarged so fast, would vet have been able to be controlled thru Cushings treatments like the she said so that she could have a few more years? Or would Ayla have continued to have trouble breathing because the enlarged liver was pushing against the other organs?

We gathered all her stuff and food to donated to animal shelter but still find stuff which sets us off crying again. We miss her so much

[LauraA]

My heart breaks for you, it's the hardest thing about having these beautiful babies - letting them fly free when it is their time. It is never easy we miss them with all our hearts :(

[Gabriel]

Sorry that you are going through this. Our thoughts and prayers are with you xx

[mytil]

Oh I am so incredibly sorry!!!! My thoughts are with you!!!
Terry

[Squirt's Mom]

I am heart-broken to learn of Ayla's passing. You did all you could to help her and I know she is ever grateful to you for that and for the love you showered her with all her life with you.

Our thoughts and prayers are with you all,
Leslie, Trinket, Brick, Sophie, Fox, Redd, and all our angels


FRIEND

I lost a treasured friend today
The little dog who used to lay
Her gentle head upon my knee
And shared her silent thoughts with me.

She’ll come no longer to my call
Retrieve no more her favourite ball
A voice far greater than my own
Has called her to his golden throne.

Although my eyes are filled with tears
I am thankful for the happy years
She spent down here with me
And for her love and loyalty.

When it is time for me to go
And join her there, this much I know
I shall not fear the transient dark
For she will greet me with a bark.

~Author Unknown

[judymaggie]

I am so sorry that Ayla lost her battle -- this is such a hard time for those left behind but please know that she is now at peace and pain free.

[budindian]

I am so very sorry for your loss. I don't know what to say except I'm sorry.

[Ayla's Mom]

That poem was so sweet, I copied it. Thank you
Thank you all for your kind words.

We are still crying... things will suddenly set us off but we chose a beautiful picture frame urn with an angel on it so that we can keep her close.

[doxiesrock912]

My sincere condolences on your loss of Ayla. This is such a horrible disease.

[patches123]

I was so sorry to read of Ayla's passing. You really did so much for her but this disease is relentless. I like to think of your girl Ayla and our beloved beagle girl Patches who passed on 5/29/15 are romping together with no more health problems while they wait for us to join them. Your story is very similar to ours. Our sweethearts last days were filled with no appetite-weakness-then more vet visits and IV fluids all to no avail. God bless you.I just want to say again how very sorry I am.