Dusty the cowdog has Cushings

[lsedd1220]

Well, I've been following this forum for awhile, knowing that I would soon be participating. I am a doxie mom. I've owned them for many years, and just 3 months ago I had three of them: Scooter, age 13; Baron, age 13, and Dusty, age 12. Scooter passed away in April, after months of terrible seizures, and we had to help my sweet Baron to the Rainbow Bridge just last month, when he suddenly went into acute renal failure. Now Dusty has been diagnosed with Cushings, and I am terrified that I am going to lose him too.

Here's his background: Last December, he started moving very slowly, not wanted to jump up or go out the dog door, and having numerous accidents in the house. He also had a pot bellied appearance, and his backbone was protruding. The vet took an xray, which showed some problem with the disks in his back (I expected this, since doxies tend to have back issues, and I assumed he had injured himself.) He was put on rimadyl and prednisone for a few days, but the vet said that if the issues didn't resolve themselves, we should look at testing for Cushings. He recovered, and everything was fine until recently.

Then we started with the very dilute urine, frequent urination, and accidents in the house again. These, along with the pot bellied appearance and slight weakness in his hind quarters, were the only symptoms of Cushings he had. However, we were also dealing with digestive problems and depression. I couldn't separate the symptoms, since I knew he was also grieving the loss of Baron, who had been his bonded companion since I brought him home from Texas as a puppy (thus the cowdog name).

I put him on I/D dog food, which took care of the vomiting and diarrhea, and intend to keep him on it indefinitely. We went ahead with the Cushings test (Low dex), and he tested positive. The vet recommended an ultrasound, which we had done yesterday.

As it turns out, Dusty has an adrenal tumor (right, I believe), about 1 cm in diameter. It appears to be contained. Since the results came in late on a Friday, my vet is calling the U of I in Champaign on Monday to consult with the vets there. She tells me that, historically, Trilostane is not as effective in treating adrenal tumor Cushings. However, I know that the surgery is very risky.

Dusty has come out of his depression. (I think the adaptil collar I got him last week has helped, or maybe time passing, since Baron has been gone for a month now). He is happy again, tail wagging and barking. There have been no more accidents in the house, and he's not drinking nearly as much though his urine is still dilute, and he usually has to use the puppy pads during the night. I haven't observed the weakness in his hindquarters and he uses the dog door regularly. The pot belly isn't as noticeable, maybe because he has lost some weight due to the low fat diet. He has never had the hair loss or skin issues common with Cushings. My vet says she intends to do some in depth research this weekend before calling the U of I on Monday. I have been doing the same.

My husband and I have discussed the various potential outcomes of the adrenalectomy, and we are conflicted. Dusty has no other health conditions, and his kidneys are healthy. I am scared to consider the surgery and scared not to. On the one hand, I could lose him as the result of complications from surgery; on the other, I could lose him due to ineffective drug therapy because of the type of Cushings. If I do nothing, I'm afraid the tumor will continue to grow, and I will lose him sooner.

[Harley PoMMom]

Hi and welcome to you and Dusty!

I am so sorry for the loss of dear Scooter and Baron and my heart goes out to you and your husband.

How long was Dusty on the prednisone and what was/is the dose, is he taking it now? When the LDDS test was performed was Dusty having back problems, was he stressed at the vets? Could you get a copy of those LDDS test results and post them here? Was a CBC/chemistry blood panel done, and if so, would you post those values that are out of range with their reporting units and reference ranges?

Cushing's is not a death sentence for a dog, it is a treatable disease. The two medications generally prescribed for Cushing's are Lysodren (Mitotane) and Vetoryl (Trilostane) and they both can be used to treat the pituitary or adrenal form of Cushing's. Cushing's is one of the most difficult disease to diagnose, and unfortunatey, it is often misdiagnosed. It is challenging to diagnose because there's not one test that is 100% accurate at identifying it, and other non-adrenal illnesses can skew the test results for Cushing's. In order to validate a diagnosis for Cushing's multiple testing is generally required.

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

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

We all know how stressful times like this can be so please know that we are here to help you in any way we can. Please be sure to check out our Helpful Resource section. There is a ton of information there, including a great thread for folks new to the disease. Here's a handy link: Helpful Resources for Owners of Cushing's Dogs (http://www.k9cushings.com/forum/forumdisplay.php?f=10) and Trilostane/Vetoryl Information and Resources (http://www.k9cushings.com/forum/showthread.php?t=185) Feel free to print anything out and do not hesitate to ask all the questions you want.

Hugs, Lori

Here are links to other member's threads whose dogs have an adrenal tumor or have had an adrenalectomy:

Hi-New Memeber- PHEO - Need Info and Advice Please (http://www.k9cushings.com/forum/showthread.php?t=5904)

Flynn 11 y/o Foxie Cross - Right adrenalectomy, 3rd Dec 2012 for Pheochromocytoma (http://www.k9cushings.com/forum/showthread.php?t=4242)

adrenalectomy scheduled Nov 4 (http://www.k9cushings.com/forum/showthread.php?t=6731)

Meet Kaibo :) 7 y/o toy poodle - Diabetes, adrenalectomy; now PDH and CC (http://www.k9cushings.com/forum/showthread.php?t=4648)

[molly muffin]

I would do the surgery consult and go through the list of questions with vet and surgeon especially and them evaluate the answers.
It is true that the surgery risks is usually complications afterwards. But if they make it through them they are fine. I guess the other question would be what sort of life span are you looking at without surgery.
This is a very hard decision to make either way you go so you want to have all the facts at hand and then make your decision. This list is really excellent. I wouldn't go to any surgeon without it.

[lsedd1220]

Thanks for the input and the excellent resources. I will call the vet's office in the morning and get the test results to post. Dusty had a CBC and complete blood panel on June 27, and I don't think there was anything alarming in it, though I had it done to rule out any kidney problems (because of the drinking/frequent urination) before I left town for a few days, having just lost Baron the week before. I know his kidney function was fine, and the vet didn't mention any other issues. We put him on Clavamox to deal with any potential UTI, since we couldn't get a urine sample, and talked about having the Cushings test when I returned, if the symptoms persisted (which they did). He had the dexmethasone suppression test on July 8. He was not having any back problems when he had the test, but he was still stressed, still having vomiting and loose stools, as he had since Baron first got sick. In fact, that's when the Cushings symptoms (excessive drinking, diluted urine, frequent accidents, lethargy, etc, first presented) Dusty has always been very sensitive, and Baron's illness and death hit him hard. Anyway, I will get all of those numbers to post, along with the report from the abdominal ultrasound on Friday. As for the steroid question, he was prescribed 5 mg predisone 2 X daily for 10 days on 12/23/14. He has not had any since then. One interesting note: Dusty has not been drinking a lot nor urinating more than normal, for the last few days. There have been dry pee pads the last 3 mornings at 6:00 a.m., and that's after going out for the last time at 9:30 p.m.

[lsedd1220]

Well, I did not get all the information from the vet today. As it turns out, the blood panel done on the 27th was not complete. I'm going to take Dusty in tomorrow to have another one done, so I have more recent numbers. Also, the report from the ultrasound has not yet been emailed to my vet. So the only numbers I have are from the low dose dex test (DEX13) on July 8: Initial level: 8.6, 4 hour: 1.5, 8 hour: 3.5. These were the results that prompted the ultrasound where the adrenal tumor was located. Hopefully the vet will have the report when I see her tomorrow. We have not discussed potential surgery yet.

[Harley PoMMom]

Dusty's LDDS test results are indicative of the pituitary type of Cushing's (50% cortisol concentration suppression is present at the four-hour time point), generally dogs with a functioning adrenal tumor do not suppress at any time during the LDDS test.

I am anxious to see the findings of that ultrasound, wishing you the best on the vet visit tomorrow, my dogs were not keen on going to the vets :eek:

Hugs, Lori

[lsedd1220]

Took Dusty in today for fasting comprehensive profile
Here are the numbers:
ALB 3.6 (2.5-4.4)
ALP 89 (20-150)
ALT 36 (10-118)
AMY 836 (200-1200)
TBIL 0.3 (0.1-0.6)
BUN 8 (7-25)
CA 10.8 (8.6-11.8)
PHOS 4.3 (2.9-8.6)
CRE 0.8 (0.3-1.4)
GLU 102 (60-110)
NA+ 138 (138-160)
K+ 5.4 (3.7-5.8)
TP 6.3 (5.4-8.2)
GLOB 2.7 (2.3-5.2)
QC OK
HEM 0 LIP 1+ ICT 0

The vet and I were very pleased with these numbers.
Didn't do a CBC today, since they did one on June 27, and the only abnormality was a slight elevation in HGB and HCT.

The vet still has not gotten a report on the abdominal ultrasound, other than the phone call from the testing vet who said she saw a tumor on one of the adrenal glands. My vet is checking tomorrow and will call me when she gets the reports and pictures so that she can examine them. She did talk with the vet at U of I, and is concerned with the mortality rate with the adrenalectomy (25%). I too am very concerned, and frankly only want to go down that path as a last resort.

Since Dusty is not presenting any Cushings symptoms at this time (no excessive drinking or urination) and is active and in good spirits, we have decided to adopt a "wait and see" stance. (Assuming she does not see something alarming in the ultrasound reports). If he begins to have symptoms again, we will start on a low dose of Vetoryl and go from there.

Obviously, I don't want to take chances with Dusty's health, but I also don't want to take any unnecessary risks in terms of treatment, and I certainly don't want him to go through any more stress or suffer like Baron and Scooter did. Am I doing the right thing?

[Harley PoMMom]

I totally agree with the "wait and see" approach, it would be exactly what I would do too.

Keep us updated, ok ;)

Hugs, Lori

[molly muffin]

These are very good results. I'd definitely want to see exactly what that ultrasound report says. It might be a nodule on the adrenal gland that isn't malignant.
My molly has one of those and what we are doing is to have an ultrasound every so often to make sure there are no changes with it. No growth, no spreading, nothing to make the IMS think that it might be changing.

Molly is being treated with trilostane for high cortisol.

[lsedd1220]

Well, here we are one month later, and I think it's time to start Dusty on meds. The urination is not the problem. He still usually gets up a couple of times a night, but uses the puppy pads I put out. (although last night, after I had the vet order meds, he slept straight through--go figure). During the day, he can go outside at will, since we have a dog door, but the last few days has been reluctant to use it, which was when I began to notice the rear leg weakness. I am concerned about the increase in muscle wasting,(his cute little bow-legged back end is so thin!), weakness in his back legs, and lethargy. I collected a urine sample and took it in yesterday and it was normal. No UTI or diabetes, thank goodness. (He had a UTI a couple of weeks ago). CBC was also normal, so no infection. So it would appear that his Cushings is progressing, and it's probably time to start him on meds. The vet had a chance to read his ultrasound report and look at the films. She said the tumor on his adrenal glad was about 1cm x 1 cm x 2 cm, and appeared to be contained, with no vena cava involvement. She did say he had a small cyst on one of his kidneys, so we have started him on k/d, to try to head off any potential kidney problems. Other than that, she saw nothing alarming in the report or films. I am still not wanting to consider surgery at this point. If we can achieve some success with the Vetoryl, I want to stick with that, and not put my 12 year old baby through the stress of a very risky surgery. We are starting Dusty on 10 mg of Vetoryl daily (he weighs 17 lb) initially, and will see if that makes a difference. My vet prefers a conservative dose to start. They are a small town office, and have to order the Vetoryl, since they don't keep it on hand, so we will be starting Dusty's dose later this week. Any thoughts?

[molly muffin]

That is a nice conservative dose to start with. It is possible that you will have to go up in dosage, but base that on how he is doing and on the follow up ACTH number. Controlling adrenal tumors can be tricky as they like to slip control sometimes. You'll know better a couple months down the road whether he will stay controlled or you'll have to go up. Usually you test at 2 weeks and 30 days after starting medication. Don't raise the dose after the 2 weeks unless the cortisol is ridiculously high as it usually will continue to drop for 30 days on any given dose.

[lsedd1220]

Thanks Sharlene. The meds are in at the vet's office, and I will be picking them up today. However, I'm going to put off starting Dusty on them until Monday. If he does have any kind of reaction, I want to be able to take him to my vet, not the emergency clinic. I'm so nervous about this. Wouldn't you know, Dusty has been symptom free the last few days (no nighttime or frequent urination, using the dog door, and steady on his hind legs). However, the pot belly and muscle wasting is just so evident when I look at him, and it's heartbreaking. How soon after starting meds should I see results, negative or positive?
Linda

[molly muffin]

Well, a few days at least before you'll notice anything, it really depends on the dog and how they take to the medication and if the dosage is right or not.

10 days is a very general time frame if dosage is spot on, but some have had more days and others less. So, it does vary.

[lsedd1220]

I started Dusty on Vetoryl 10 mg on Monday. The vet suggested I keep a daily journal, which I started a few days prior to starting him. He vomited 2 times on Monday, but seemed to be OK after that. Appetite remained good, no excessive drinking/urination for several days (although I had not been seeing that prior to starting the vetory either). Friday morning, there were 3 pee spots on the puppy pads I put out every night. Plus, he had pooped in the floor as well, something he hadn't done for some time. He vomited in the morning, and had 2 accidents in the house later in the day. He was outside frequently during the evening, and I'm afraid he may have been vomiting again. I gave him a cerenia tablet at 9:00 p.m. I have not seen anywhere that there could be a drug interaction with the trilostane, so I felt I could do that safely. I was also seeing more drinking Friday (and since then). Saturday morning there were 3 spots on the puppy pads again, but no episodes of vomiting. His appetite was still good. I was out of town all day, but my husband didn't notice any problems (although he tends not to notice a lot of things :( ) When I got home about 6:30, Dusty had just had another accident in the house. Shortly after, my husband had him outside and said he had a loose stool, followed by diarrhea. Overnight, Dusty had another vomiting episode, which I found this morning. I woke up this morning with him up against me in the bed, shivering. Dusty sleeps on my bed, but never right next to me, and NEVER shivering. When I got up, there were several wet spots on the puppy pads as well as a couple of diarrhea spots, and another couple of spots of either urine or vomit in the hall. His appetite is still good, but I did not give him the Vetoryl this morning and I am calling the vet in the morning. I am just at a loss. The vet and I had talked about just holding the Vetoryl until he started presenting symptoms again, since his back leg weakness and polydipsia had basically stopped for a week or so. I wanted to be proactive, though, and 10 mg seemed to be a conservative dose (Dusty weighs 17 lb) However, it almost looks like starting him on the meds actually caused the polydipsia to increase ( unless this is just a huge coincidence), as well as causing vomiting and diarrhea. I am scared of throwing him into hypoadrenocorticism, which I know can occur on even low doses of trilostane.

[Squirt's Mom]

The reaction to such a low dose once again brings the question of a pheo to the forefront. Has that been completely ruled out?

[lsedd1220]

Actually, the type of tumor was never discussed. I will ask the vet tomorrow if she has considered a pheo. I am assuming the two factors to consider are blood pressure and location of the tumor?

[lsedd1220]

Dusty has vomited 3 more times today, at 10:30, 12:30, and just now, 1:30 pm, the last 2 just clear liquid. I have no more Cerenia to give him. I really do not want to take him to the emergency vet unless absolutely necessary. I want his vet to see him, but it's only early afternoon, and I obviously can't get him to his vet until 8:00 a. m. Once again I'm in a quandary and trying not to panic. No more diarrhea since early this morning. He hasn't had any Vetoryl since 6:00 am yesterday.

[Harley PoMMom]

Pancreatitis can cause vomiting, and when vomiting plus diarrhea are involved pancreatitis is the first thing I think of. If Dusty does indeed have pancreatitis it can be life threatening, the way to diagnose it is with a spec cPL test which I highly recommend having performed.

The Vetoryl needs to be stopped since Dusty is feeling poorly and not restarted until he is back to feeling normal...no vomiting, diarrhea. Keep us updated.

Hugs, Lori

[lsedd1220]

I haven't given Dusty any Vetoryl since yesterday morning at 6 AM. Dechra says to discontinue and contact vet in case of adverse symptoms. Dusty has had no diarrhea since this morning, but since noon is having hourly vomiting episodes. In between, he's lying on my lap trembling. He has been drinking water after each episode and I'm wondering if I should curtail that. I'm also wondering if I should go ahead and take him to the emergency vet or wait this out until morning. Since I feel that this is related to the trilostane, I really want her to see him, and I don't want him getting treatment that might be contraindicated with his cushings and medicine he's received so far. But I don't want to risk his health by not getting him emergency treatment if it's called for. I've lost 2 senior doxies in the last 4 months. Dusty's my last, and I'm scared.

[lsedd1220]

By the way, I'm Linda. Keep forgetting to sign my name. :D

[Squirt's Mom]

As much vomiting has he has been doing I would be on my way to the ER. Better to be safe than sorry. Let us know how he is doing!

[Harley PoMMom]

Trilostane has a short half-life and leaves a dog's system rather quickly, if these ill side effects are from the Trilostane than Dusty should of been feeling better by now.

[lsedd1220]

Well, Dusty has not vomited in over 4 hours. He's on my lap right now, and still trembling, but since there's been no more vomiting or diarrhea, I've decided to wait until morning and take him to my vet. He's pretty upset that he didn't get dinner when the other dogs did, so he obviously still has his appetite. I'll post tomorrow after his visit.

[Harley PoMMom]

Glad to hear that he has not vomited lately and that he still has an appetite, that's a good sign that, hopefully, he is feeling better. Please do keep us updated as we are a bunch of worrywarts. ;)

Hugs, Lori

[Squirt's Mom]

Let us know what the vet says and I hope he had a better night.

[lsedd1220]

Hi all, and thanks for your concern. Dusty had s few more vomiting episodes after my last post yesterday, the last one at 2:30 am. I took him to my vet first thing this morning and she ran a full blood panel and CBC. Everything was normal, thank goodness (I was afraid of acute kidney failure since that's how I lost my last doxie), with the exception of amylase, which was elevated. Probably pancreatitis. There's no way he got into anything in the house, and he's on a diet of k/d and I/d, so he must have gotten something in the yard. (The vet does not think its related to the Vetoryl at this point) My husband and I have decided to do away with the dog door, so that we can see what he's doing when he's outside, instead of letting him come and go at will. We will do another blood panel on Friday, and if everything looks good, start him back on the Vetoryl and see where that takes us. In the meantime he's getting small amounts of canned I/d for the next couple of days. He got subcutaneous fluids and an anti nausea shot at the vets, so he's feeling fine (and very hungry) thanks again for all of your concern and advice.
Linda

[Jenny & Judi in MN]

I just saw your post and thought pancreatitis. you must have caught it quickly if he was able to come home with you. yay for that.

A couple of dogs on the diabetes forum were trolling under the bird feeders in the yard for dropped bird seed. Just a thought

Judi

[molly muffin]

Just don't start back the vetroyl until he is fully back to himself.

[lsedd1220]

Sharlene, you can be sure that we will not start Dusty back in the Vetoryl until he is 100%. Right now he is only getting a couple of tablespoons of I/d at meal time. He's still a little shaky and I will be taking things slowly. We haven't had any more vomiting episodes, nor any diarrhea. Baby steps.

[lsedd1220]

Dusty is still sick, and I still have not started him back on the vetoryl. After the first vomiting episodes and the elevated amylase in the blood panel, I kept him solely on I/D, canned. He would be OK one day, and not so good the next, but never normal. (Well, as normal as a Cushingoid dog can be). I took him back to the vet on Tuesday of this week for another blood panel, and his amylase was even higher. The vet said to continue with the low fat diet, give him Cerenia every day to stop the vomiting (which he was still having sporadically), and give him liquid Albon, to help coat his stomach and deal with any intestinal bacteria that might be lurking. He's having several bowel movements a day, not normal, but no diarrhea (soft but formed, normal color). Today was day 3 of this regimen, and since last night, Dusty is VERY weak and lethargic. He's walking very gingerly, as though he is in pain. I could tell he was nauseous this morning, so I gave him a Cerenia first thing (6:00 am). He ate, but not as much as usual. Vomited around 11:30. Reading the literature on Cerenia, I think I gave it to him improperly, so I just gave him a little I/D at 1:00 (he does still have an appetite, thankfully) and will give him another Cerenia at 2 or 2:30, to get him on a different timetable, since he's supposed to get it once a day, an hour after a light snack. Dusty has lost 2 lb. since all this started, (possibly because he is not getting enough calories on the I/D), and I am worried that we are not going to be able to get his numbers back to normal in order to start the Vetoryl and deal with his Cushings. And of course we are worried about potential liver disease too, with the amylase level climbing. I'm waiting for the vet to call me back. (She wanted an update today, and I have little positive to report to her, unfortunately). I'd appreciate any input. I'm just at a loss.

[Harley PoMMom]

Dusty's symptoms are indicative for pancreatitis and I would ask the vet to perform a spec cPL test which can diagnose pancreatitis. Pancreatitis can be life threatening and it also can be really painful, giving pain medication is crucial when dealing with this disease.

Pancreatitis requires a dog to be fed several small meals throughout the day and the diet has to be very low in fat. Keeping them hydrated helps with the healing of the pancreas.

Hoping Dusty is feeling better soon.

Hugs, Lori

[Renee]

This sounds like pancreatitis to me as well. I would probably not wait much longer for the regular vet to call, but rather head to the emergency vet. He may need to get on fluids right away. Pancreatitis, as Lori said, can be very painful, and also life threatening. My own cush dog had a bout last winter. It took weeks to recover and she spent a few days in the ER on fluids.

[lsedd1220]

Thanks all. I did talk to the vet and she told me to go ahead with another dose of the Cerenia. Also gave me some stomach coating meds to give him twice a day. She doesn't want Dusty on anti inflammatory pain meds because of the Cushings. She thinks that the excess steroids in his system could also be contributing to stomach acid and the nausea. I will be feeding him 3 times a day instead of morning and night. He has not vomited again since this morning. Getting plenty to drink and no diarrhea. This is like a vicious circle. He needs to be on the Vetoryl but can't until he's not sick, but some of his symptoms may be caused by the Cushings that we can't treat until he's not sick. So frustrating.

[lsedd1220]

So now I have a dilemma. I've been giving Dusty Cerenia once a day for vomiting, as well as a stomach coating agent twice a day. I'm feeding him 4 times a day: one fourth can of I/D at each feeding. He gets nothing else. He's still very lethargic and walking gingerly, but his appetite is good, and he has had no more vomiting. He has several bowel movements a day, not diarrhea, formed but soft. The vet talked last Friday about starting him back on the Vetoryl today or tomorrow because she thinks the excess cortisol may be causing stomach upset, and she doesn't want to put him on anti inflammatory pain meds because of the possibility of stomach ulcers. (Tramadol makes him sick.) Should I ask about other pain meds he can take until we get through this, and hold off on the Vetoryl? WILL we get through this if the excess steroid is contributing to his stomach pain and upset? Or is going back on the Vetoryl necessary to get him through it? I'm worried about starting him back on it while he's obviously still sick, but I'm also worried about the effect this is having on him. He's obviously losing weight, and he's obviously hurting. He was on a low dose (10 mg/day) of Vetoryl and weighed 14.6 lbs at the vet last week. (down 2 lb since this started )
Linda

[labblab]

Boy, if only we had a crystal ball to guide us here! I really understand your indecision and only wish we could know, in advance, which approach would be better. But for what it's worth, if Dusty were my dog, I'd probably opt to restart the Vetoryl, and this is why.

When I tell folks to hold off on giving Vetoryl to a sick dog, for me the context is an important factor. If we don't yet know whether low cortisol is a problem or whether kidney/liver issues are flaring, then it seems much safer to withhold the Vetoryl until those contraindications to the drug are ruled out. However, if it's determined that the dog is sick for reasons unrelated to the Vetoryl, then I would shift my worry to the problems that could be caused by letting the cortisol spike again. It sounds as though that is your vet's line of reasoning, too, and she is feeling as though it is now a greater risk to leave Dusty untreated for the Cushing's. Under these circumstances, if Dusty were my dog, I believe I would restart the Vetoryl. Elevated cortisol is linked to both pancreatitis and also higher risks of GI issues associated with the use of NSAIDS. Since those are Dusty's primary problems right now, I'd want to try to lower his cortisol again.

So that's my two cent's worth! No matter what you decide, I'll surely hoping that Dusty soon feels a lot better.

Marianne

[lsedd1220]

Thanks, Marianne. We are starting Dusty back on Vetoryl tomorrow. 10 mg every other day to start. I know that is not protocol, but the vet wants to ease Dusty back into dosing slowly. He will continue getting Cerenia for nausea and Carafate for stomach coating. I'm a little apprehensive about the Carafate because now Dusty is constipated, and I'm sure it's the cause. He's been on it for 3 days, and he hasn't had a BM today, even though he has tried several times, straining to no avail. I feel so bad for him because now he's dealing with another kind of pain. Any advice? Maybe I should skip his morning dose of Carafate?

[molly muffin]

I hope Dusty is doing better today.
It's hard to know what to do when they are right on the cusp of which way to go to do the best for him. You could certainly try him with the cushing meds and see if that helps with the other gastro problems.
I'm always a bit leery of giving molly anything if she is throwing up.
It is hard to know exactly what to do at a given time.

[molly muffin]

I'd skip a dose and see if he will keep his food down with out it and then go to maybe a half dose after he has been able to have a BM.

[lsedd1220]

Thanks Sharlene. I'm going to skip the morning dose of Carafate and see if he is able to have a BM. I think the Cerenia is keeping the vomiting at bay anyway. He hasn't vomited since we started it last week.
Linda

[lsedd1220]

So Dusty had a BM overnight, so I went ahead and gave him Carafate this morning, but I split the pill. The vet said it was fine, and he is regular again, so half a dose seems to be appropriate. I gave him his first Vetoryl this morning too. So we will see what happens. Fingers crossed.

[labblab]

Oh, our fingers are crossed, too! Surely hoping that all goes well. ;)

Marianne

[lsedd1220]

Oh my, what a time we have had! Dusty got doses of Vetoryl on 9/15 and 9/17. The problem is, I left town on Wednesday, 9/16 at noon. By 9/17, Dusty was refusing to eat. My husband was at his wit's end, trying to come up with something to give him. He was on the phone to me and to the vet several times a day. He finally got him to eat some canned chicken breast. I told him not to give Dusty the Vetoryl on 9/19, because I did not know whether this was causing the problem. I did not return to town until Sunday morning, 9/20, and was appalled at Dusty's condition. I woke him from a deep sleep, and he cried and cried. So did I. He was literally skin and bones. I immediately boiled some chicken and rice, and he began slowly eating again, probably because I was home. This past week has been one of trying to get him back to eating and putting on weight. He has been doing sort of OK, but still refuses any canned or dry dog food (He had been eating a can per day of I/D, not will not touch it, or Royal Canin gastro/low fat, which I also bought to try to tempt him). All he wants to eat is chicken breast and a little rice. I have been giving him a pet tab crushed up each day to try to supplement. Yesterday, he actually ate pretty good all day (chicken and rice), and showed some of his previous spunk last night. I had not given him Cerenia since Friday, since he has been on it for so long, and it is not recommended long term. (He still gets Carafate 2X daily). Then at 4:00 a.m. I heard him up vomiting (clear liquid). I immediately gave him a Cerenia, but his appetite was almost non existent this morning. He ate a very small amount of chicken and rice, kept acting like he wanted more but his stomach was not cooperating. I finally gave him a little bit of low fat frozen yogurt, hoping that would soothe his stomach, and he did lap it up. He is now lying in his kennel, a place he usually only goes when he wants to be alone. (an indication that he is sick, since he usually wants to be on my lap). We were going to start him back on the Vetoryl this morning, but I didn't give it to him, given his current condition. I am going to take him back to the vet today for evaluation. I just don't know what to do. I'm thinking maybe he should be on IV feeding, but my vet is small town and does not do that. I'll see what she recommends. I'd appreciate any input from anyone on the forum, since I see you all as the experts. I feel like my boy is slowly slipping away.

[molly muffin]

oh my goodness. What a horrible thing to come home to. I'd be crying too.

So, sort of sounds like he might have a bit of pancreatis. Of course the recommended feeding for that is several small meals daily of chicken and rice, and no vetroyl until he is back to normal feeding.

Did you go to the vet today? What did they say?

[lsedd1220]

OK, went to the vet yesterday, 9-28. I was in tears, feeling like I was losing my boy. What a surprise to find: A) He had not lost any more weight, still at 14.68. B) He had no temp, thus no infection, and C) His numbers on his comprehensive panel had actually IMPROVED. (On 8/31 his amylase was around 2500, and on 9/8 it was over 3300. Yesterday it was 1740. Normal is 200-1200) She did give him a B12 shot, along with an injection of Cerenia. She also gave me a can of I/D to try that is a chicken stew, to see if that tempts him. Brought him home, gave him the I/D, and he immediately gobbled up a half can of it! At dinner, he ate the other half can, and even growled at our other dog when he tried to lick the bowl. I was so heartened! Then this morning, we were back to not wanting to eat. :( I gave him his syringe of carafate. He made several trips outside to poop (His poops are actually looking totally normal now), and was shivering. I suspected nausea again, so gave him a Cerenia at 7:00. It is now 8:45, and he still has no interest in eating, but is sleeping soundly. The vet says the Cerenia pill takes at least 2 hours for full effect, so I am going to see if he will eat a little later. Yesterday it was noon before he was interested in food. I'm thinking he may need 2 doses of Cerenia (10 mg each) a day, but since the vet says dogs can take up to 60 mg/day of it for motion sickness, I'm not too concerned. Just want to get him on a normal eating cycle before we put him back on the Vetoryl. All in all, I'm feeling much more hopeful today than yesterday!
Linda

[molly muffin]

Well this is excellent news. It does sound like pancreatis and that he is on the road to recovery from it. No weight loss, numbers all looking better. Eating some.

Now I have a dog that I have a hard time getting to eat in the mornings, so understand that is a tough one.

[Beaglelover]

Linda

You are doing a great job keeping up on Cowdogs :) treatments and symptoms. I am deeply sorry you've lost two fur babies recently, I can't even imagine, and now Dusty is not feeling the best. Hang in there. Take it one day at a time. You have a tremendous support group here. Keep us updated on Dusty.

Big hugs
Tammy ( Jenna's mommy)

[Squirt's Mom]

If this is pancreatitis the appetite will not be "normal" til the inflammation is gone. They feel just awful and are in pain. Sounds like things are improving which is GREAT to hear! I hope he starts eating a bit better soon!

[Beaglelover]

Sending positive thoughts your way - keep us posted.
Tammy

[lsedd1220]

So here it is Friday, and things have gone downhill again. :( On Tuesday morning about 10:30 I looked for Dusty and found him standing in the kitchen staring at his food dish on the counter. I gave it to him and he ate it right down. Then at dinner he finished the can of I/D. I was thrilled--thought we were going to be OK, though he did have terrible gas Tuesday evening. Wednesday from 4:00 am on, he was restless, couldn't get comfortable, shivering, stomach gurgling, had a couple of loose stools and some diarrhea. I gave him his carafate and cerenia, and he seemed OK by 9:00. Refused to eat, but finally ate a little of his I/D at 11:00 after I mixed some baby food chicken&gravy in it. He at a little more of the I/D at 1:00, and finally (almost) finished the can in the evening, though not with the gusto he had exhibited Monday and Tuesday. I gave him his first dose of VetriScience probiotic GI restore at 5:30. Yesterday he was up at 1:15 to pee and poop, and the poo was soft and loose, with some dribbling. He was outside again at 1:30 to try to poop and was shivering. I gave him a cerenia, and he was very restless and uncomfortable for a couple of hours, then finally settled down to sleep. I gave him a dose of the probiotic GI restore at 6:45 and his carafate at 7:45. He still would not eat. I was gone from 9-1, and he slept the whole time, going outside once to pee and poop. I gave him another probiotic dose and his Cerenia in the afternoon. He still refused his I/D, and I began a parade a foods to try to tempt him. Boiled chicken-no, rice-no, rice with baby food chicken-no, mashed potatoes-no. Finally he ate a little bit of canned chicken breast. Then I mixed some mashed potatoes with some more canned chicken and he ate that. That was it for the evening.
Now here we are on Friday morning. The good news is that the GI restore seems to have worked, in that he had no overnight episodes of soft poop, diarrhea, gas, and very little stomach gurgling, and the pooping he did do yesterday evening was normal. However, he also has absolutely no appetite. He has had his carafate and cerenia. I have boiled some extra lean hamburger to try to tempt him in a little while, maybe with some mashed potatoes. I won't be giving him any more of the GI restore, since it is not for daily use, just episodal. I am going to look into a probiotic daily supplement, assuming I can get him to eat. Looking back over the week, I am wondering if the B12 shot had anything to do with his temporary (3 day) return of appetite. The vet says she can give them to him weekly if they help. Has anyone had any luck with them? Also, what about the probiotic? Could it be helpful? And anyone have success with any other food? So far, now that he's refusing the I/D chicken stew, he is refusing I/D low fat, Royal Canin gastro low fat, boiled chicken and rice, ANYTHING with rice, or rice by itself, plain boiled chicken, plain mashed potatoes.
Linda

[Squirt's Mom]

Yes, B12 shots have helped some of my fosters when their appetite was off.

[molly muffin]

Remember inflammation with pancreatis can come back, and they need several small meals a day rather than a couple bigger meals as it makes them hurt and feel sick.

I use florifora probiotic. My dog seems to like it.

[lsedd1220]

I took Dusty into the vet on Saturday morning and she gave him another B12 shot. It does seem to help his appetite. He's in the kitchen wanting to eat every few hours (I'm feeding him 6 small meals a day), but he still has no interest in any canned food. What he has decided he likes is boiled extra lean ground turkey. And frozen yogurt (lowfat). So I have decided to trick him by making meatballs with rice in them with the extra lean ground turkey. Seems to be working. And for 4 of his meals, I give him a little frozen yogurt with 1/4 pet tab vitamin/mineral supplement smashed and mixed in. I'm feeling like we are slowly getting through the pancreatitis. I haven't given him a Cerenia (anti nausea) in a couple of days. His poop is normal, and he has had no gas or stomach gurgling. Interestingly enough, he also has had no overt Cushings symptoms. He is not drinking excessively, and has slept thru the night the last 4 nights without trips to the pee pads. So, other than continued lethargy and the pitiful muscle wasting, you wouldn't know he was a Cushingoid dog. But of course he is, so getting him well and back on the Vetoryl is our goal. And if I need to fix homemade meals for the rest of his life, so be it.
Linda

[lsedd1220]

Sharlene, I have 2 questions for you. I know that Molly has an adrenal mass like Dusty. I also know that you did not start her on trilostane immediately. At what point did you decide to start the regimen? And you said you have ultrasounds regularly to check the growth of the mass? How often do you schedule them? It's been 3 months since Dusty's ultrasound.

[molly muffin]

Her is a nodule, not very large and hasn't changed much. It depends, if for some reason I see symptoms coming back or something different I schedule the recheck of the ultrasound, if nothing is changing, we do it every 3 - 6 months.

Recently her cortisol while on the same dose of trilostane went up, so her next appt in a week, we'll do an ultrasound to see if it is the nodule changing, secreting or if it is something else, like the compound of trilostane, or possibly even the kidneys that have caused the jump. Her creatinine went up also which is kidney specific, so we'll just have to see.

[molly muffin]

I think the summary would be that we do regular ACTH testing and regular blood test and I let the numbers on the test and how molly herself is acting guide me to what to do next. It's about quality of life and how to get the best for her, same as for Dusty, so if something is increasing or she acts different, that guides me in what to test. Drink more water - schedule a kidney check, UPC, BP (for molly that is often connected to her cortisol and kidneys), and an ACTH. Pee more, definitey check acth and kidney. If anything is off in those tests, then ultrasound recheck.

[lsedd1220]

Thanks, Sharlene. Dusty has done so well the last few days, I was thinking about revisiting putting him back on the trilostane. Then this morning he had several bouts of vomiting again and is refusing to eat. Stomach gurgling too. Gave him Cerenia and a dose of the GI restore. Guess it's one step forward and two steps back. :(

[Beaglelover]

Linda I was so happy to read Dusty was doing better until the vomiting episode yesterday. Do you know what caused the vomiting?
How's Dusty today?

Tammy (Jenna, Charlie, Sandie's mommy)

[Squirt's Mom]

How is our cowdog this morning?

[lsedd1220]

Hi all, and thanks for asking about my boy. I've been busy with grandkids the last couple of days, so haven't been on the computer. Dusty is somewhat better, at least no vomiting. I've been giving him several small meals a day of ground turkey and rice meatballs, along with a Cerenia pill to keep the nausea at bay. He will eat, but really hasn't much of an appetite. He is VERY weak, will only walk a few steps before stopping to just sit or lie down. I'm taking him back to the vet tomorrow for another b12 shot, since those do seem to give him a little energy and increase his appetite. I'm wondering if I should ask the vet to do an ACTH test. It's been 3 months since the low dose dex test and ultrasound. We've tried twice to put Dusty on trilostane, and both times he has started vomiting within days and we've taken him off. I just feel like I need to know what's going on here. Any advice?

[Renee]

Poor Dusty. He must be miserable.

I know the pancreatitus can take a very long time to recover from. If you think his cortisol may be too low, maybe getting a baseline draw (rather than an ACTH) would be a better use of your money and provide the information you need. Just my opinion.

[lsedd1220]

So lying awake last night and trying to go over in my mind all the things that might be going in, I came up with 2 things: 1.This week, during the day, Dusty is going out to pee about every hour, but is only doing small amounts and they are more concentrated than his usual urine. He has had a couple of accidents in the house when I was gone and they too were small puddles and more yellow. 2. The extreme lethargy and weakness with depression coincided with the Tuesday vomiting episodes and frequent small urinations. Now I'm wondering if he has another UTI. He had one this summer, but that one was easy to diagnose because his penis was inflamed and his abdomen was red and irritated. I'm going to try to collect a sample this morning before I take him to the vet. Regardless, I'm betting she will start him on a course of antibiotics. I'd really like to know what his cortisol levels are. I know that Cushings dogs are more inclined to develop pancreatitis and UTIs. Renee, I will ask the vet about a baseline draw.

[labblab]

Just wanted to add a quick note to say that if your worry is that Dusty's cortisol has dropped too low, I agree with Renee's recommendation that sometimes a baseline draw is used to make sure the resting cortisol seems high enough for safety's sake (above 1.5 - 2.0 or so). But a baseline draw alone cannot tell you the reverse: whether Dusty's cortisol is running too high. Dogs with even highly elevated post-ACTH levels may not exhibit an abnormal elevation in the baseline draw. So if you are wanting the overall picture, unfortunately you are stuck with the full ACTH stimulation test.

Marianne

[Renee]

Hmm... just to add another possibility to the mix, unfortunately. Small puddles of pee, going every hour..... is there a chance he has bladder stones? When was the last time he was x-rayed or had an ultrasound? UTI and bladder stones can make peeing painful or make them strain to go. If he's only able to empty his bladder a little bit, but going often, then he may actually be straining, in which case UTI or bladder stones could be a cause.

Marianne is correct - if you want to know his cortisol levels in terms of cushings, you'll have to do a full stim test. But, if your concern is that he may be too low, then the baseline could provide some information.

[lsedd1220]

Well, I'm kind of disheartened. The vet isn't really hopeful about Dusty's prospects. We seem to be in a "rock and hard place" situation. The pancreatitis and UTIs (yes, he has another slight one and is on antibiotics for 5 days) may be a result of the Cushings, but he seems to not be able to tolerate the trilostane to control the cortisol. There are no other treatment options for adrenal tumor Cushings, and she's afraid of the worst case scenario: That the adrenal tumor is malignant and is growing. We talked about doing another ultrasound, but really, there doesn't seem to be much reason for it. We are not inclined to do an adrenalectomy, especially considering Dusty's precarious health, and with the high mortality rate. I told her about wanting to know Dusty's cortisol level, and she agreed, but felt that the baseline was not really of that much value, since Dusty has a great deal of anxiety, and an elevated level could always be due to stress. We've decided instead to go with another low dose dex test next week. If Dusty's suppresses, that's great and we will proceed as though he doesn't have Cushings, assume that the trilostane in fact threw him into pancreatitis, and hope that he will eventually return to (sort of) normal. If he does not suppress, and his levels are higher than on the test 3 months ago, we will still continue (without trilostane) doing what we are doing now--treating the pancreatitis and any other things that arise (like the UTI) and trying to find foods that he will eat, but with the understanding that we are probably looking at hospice care. If anyone on here has any other advice, I am open to it. The propect of losing my little guy sooner rather than later is breaking my heart. (I knew with the Cushings diagnosis I didn't have years and years with him, but I was hoping for at least a couple.)

[lsedd1220]

This has been a roller coaster week. Dusty began vomiting again on Sunday, after eating (sort of ) regularly on Saturday. By Monday, the vomiting had stopped, through the Cerenia, I'm sure, but his appetite was gone again. He was also not drinking much, and his urine was very concentrated. I could get him to eat very little until I hit on canned chicken breast and canned white tuna. Even then he ate very little. By yesterday, I was at my wit's end. The vet had planned to do a low dose dex test this week because of my concern about his cortisol level (just couldn't get the potential Addison's out of my mind, since both of this awful attacks of vomiting, diarrhea, depression, anorexia came after attempts to administer trilostane). He was just too sick to do the day long test, though. Yesterday I took him to the vet. He was skin and bones, and also drinking very little. I was concerned that he was dehydrated on top of everything else, and I wanted a blood chemistry panel done. Now, I have 2 vets--one proactive, and one reactive. The reactive one has been treating Dusty's Cushings, since she's the one we saw when he was first diagnosed. She was gone yesterday, so we saw the proactive one. He did the blood panel, and Dusty's amylase was back to normal. What did stand out on the panel to him, was Dusty's ALP level. It was very low--at 9. He said that Cushingoid dogs tended to have higher levels, sometimes quite high (Dusty's have ranged between 89-159). I told him about my concern with Dusty's cortisol level. He drew blood for a baseline cortisol test (which will be sent off for evaluation). Once we get it back (in a couple of days), if it's low, we will do the ACTH stim test next week. He also gave Dusty subq fluids because he was dehydrated, then made a suggestion to me. Why not go ahead and give Dusty a dexmethsone shot? Of course, one would not do that with a Cushings dog, but right now Dusty is not acting like a Cushings dog--just the opposite, in fact. He didn't think it would make him sicker; after all, he's pretty sick right now. If it worked the way he hoped, Dusty's appetite would improve, his drinking would increase, and he would regain some of his energy. This vet is a former emergency vet, and he's used to making decisions based on desperate circumstances, so I trusted him to make this one. We went ahead with the shot. Last night, Dusty's appetite was much better, though he still pretty much wanted canned chicken. He was drinking more, and his urine is no longer concentrated. This morning Dusty ate his normal breakfast of canned prescription low fat dog food mixed with lowfat kibble. He ate most of it early, then a couple of hours later was standing at the counter wanting to finish it. And when he was outside earlier, he actually trotted back up to the door, instead of slowly and unsteadily walking. I don't know what next week will bring, but at this point I am thrilled. If we find that Dusty is now an Addisons dog, we will treat him as such. If he's not, we will make a new plan. I know the adrenal tumor is still there, maybe growing, but I'm prepared to just take each situation as it arises and deal with it, as long as my boy is relatively healthy, and as long as he is happy.

[labblab]

Thank you so much for your updates, but you are right -- what a roller coaster ride you've both been on!! I'm afraid I don't have any great suggestions to offer out at this point, because there are so many confusing pieces to Dusty's puzzle :o. But I'm definitely grateful that the steroid shot has seemed to help, and I certainly agree that it makes the possibility of Addison's seem more likely.

I'm really glad to hear that you've switched off the idea of a LDDS test in favor of an ACTH in the event that his baseline cortisol comes back low. As far as I know, the LDDS cannot be used to diagnose Addisons, no matter how those test results turn out. So under these circumstances, the ACTH seems to be the way to go.

Do continue to keep us updated, OK?
Marianne

[molly muffin]

I think the ACTH is a better test for Dusty too.

He really is a complicated case. I guess the only thing an ultrasound might be able to show is like Renee mentioned, a possible stone. They too can contribute to multiple UTI's.

I do hope this week will be a good one for you and Dusty!

[lsedd1220]

The baseline cortisol came back at 4.2--normal. Both vets have decided that ACTH stim test is necessary to see where we are. Dusty is on a maintenance dose of 2.5 mg prednisone daily until they are able to secure cortrosyn, probably about a week. Then he'll need to be off the prednisone for 24-48 hours before the test is administered. We had to be away for most of the day on Saturday, and his stress triggered a negative reaction--he stopped eating and shut down. I screwed up by trying to get him to eat and fed him dog food which was too rich, causing vomiting and diarrhea. Took a couple of days to get him back on track. He's holding his own right now on a homemade low fat diet. B12 shot helped yesterday, but he has very little energy, back end weakness, and still very lethargic. He walks slowly and stops to rest every few steps. Accidents in the house because he can't get to the door quickly enough, and he's drinking more because of the prednisone. The vets are encouraged by his returned appetite, thoug, so we continue the protocol. All he wants to do is lie next to me wherever I am, and I am fine with that.

[Beaglelover]

Linda

I'm glad to hear that Dusty's appretite has returned, and I hope he continues to get better. I know how stressful it can be, remember you are doing everything you can. Give Dusty all the love you can to comfort him.

I hope Dusty can get leveled off soon and be on maintenance dose.

Keep us posted.

Hugs
Tammy (Jenna's mommy)

[molly muffin]

Yay for a return of appetite. How is Dusty doing now?

[lsedd1220]

You have all been wonderful, and this is such a great group. Dusty is not going to get better. He did not have the ACTH stim test. I was working on getting him healthy enough to take the test. (He has been steadily losing weight). Took him in last week for a chem panel and CBC to make sure everything was OK before doing the test. He had lost another 1/2 pound, even though he had been eating good. His chem panel was ok, except for the ALB still being low, and a low NA reading. However, the CBC was alarming. His WBC was over 60,000, and he was anemic (RBC,HGB, HCT low). Vet suspected cancer, and felt the adrenal tumor had metastasized. She gave me a week's worth of Clavamox, in case we were dealing with infection, and told me to bring him back for another CBC then, or sooner, if problems arose. She also cut his prednisone back to 1.25 mg per day, since it could contribute to bleeding. By yesterday, Dusty was having breathing issues, and his gums were very pale. He also had no strength at all, could only walk a couple of steps without stopping to rest. The vet did another CBC, and his WBC was even higher, at 90,000, and the anemia was worse. He had also gained a pound and a half, but it is obviously fluid, since his abdomen is distended. She says there is really nothing much more she can do, and that with the WBC as high as it is, Dusty will potentially pass on his own. I asked what I could do to make him comfortable. I'm not ready to assist him to the bridge, since he's still eating and drinking and eliminating normally. She was hesitant to give him anything for the fluid buildup, since she says if it's blood from the tumor, eliminating it will just encourage the tumor to bleed more. She did give me a small amount of lasix to give Dusty for 2 days. Last night I thought it was the end, since he was breathing heavily and he had a rapid heartbeat (the same thing Scooter did right before he died in my arms). I gave him the lasix, though, and he had a relatively normal night. His breathing was normal, and he even slept on my pillow, which he used to do before he got sick. This morning he was hungry, but just ate a small breakfast (the norm since we cut the prednisone in half). But he is breathing almost normally, and he is walking on his own when he needs to go outside. Looking back now, I think that Dusty probably does have a pheochromocytoma, (even though he didn't have the high blood pressure until very recently) and he probably should never have had the trilostane in the first place. Should we have had the adrenalectomy back in July when he was first diagnosed with the tumor? Maybe, but the odds against survival were just too great in my mind. I've still had him with me these last few months. He still wants to sit on my lap and snuggle, and that is precious to me. I have put my volunteering on hold for the time being so that I can be with him. As long as he's not suffering, I will sit with him every day, all day, if necessary. (I've loaded my Kindle with books) I'm also thinking that I should tell the vet that I want to continue with the lasix if necessary, since it eases his breathing issues. Do any of you who have gone through this have any advice for me?

[Squirt's Mom]

Hi Linda,

It's such a tough place to be but it can also be a place of deep closeness and communing. You will know when he has had enough just as you know when he is breathing better. Listen to Dusty, trust your gut, and just love him.

I got to spend the last year of my Squirt's life with her in that close communion - a year I didn't dream we would have when I made the decision that I had asked enough of her so no more meds or tests or vets. We would simply share our days for as long as those days were decent, and we did. A lot of that time she needed to be carried but that was ok; we would walk around the yard and field out back with her in my arms talking about all the places we had been, the people we had met, the things we had done. I told her all the things I wanted to be sure she would carry with her. When she felt like it, we went for short easy walks together off leash, just ambling along. Whatever she wanted to eat and could eat, she got. When she wanted attention she got it; when she wanted to be left alone, she was given that as well. When she felt like playing, we played; when she just wanted to lay and be touched, that is what she got. It was her time so whatever she wanted, I did my utmost to see she got.

I tried not to worry about what might be going on inside her - whatever it was I couldn't fix it this time. She had always given more than I asked and the time had come to simply let her live her days in as much comfort and joy as possible.

If the Lasix is helping I would ask the vet for more. Keeping him comfortable is paramount.

Our thoughts and prayers are with you and your sweet baby boy.
Hugs,
Leslie and the gang

[lsedd1220]

Leslie, thank you for your comforting words. I did talk to the vet, and we are going to put Dusty on the lasix every other day. It's a minute dose (6.25 mg) but it seems to keep the edema down. He's eating and eliminating normally. Yesterday was a good day. He went to the door on his own when he needed to go out and didn't seem to be as weak. His appetite was also good. Today he is more tired, so I may be carrying him around. That's ok. As the vet said yesterday, whatever the reason for his rallying, we'll take those good days whenever we can get them. I know I treasure every day he's still with me. Thank you again.

[molly muffin]

awww Linda. I'm sorry that Dusty isn't going to get better, but those good rallying days sure are nice.

The heart condition probably contributes greatly to his tiredness and I guess like many have had to do other the years, it is just one day at a time and see how he does. I hope though that he has many good days ahead of him. :)