Angel's Keeper
03-05-2016, 07:42 AM
Hello all! I don't know where to start. I had a 7 year old maltese that passed away 2/25/16 due to complications from Cushing's but she did not have the typical symptoms. I'm looking for some closure and have her sister from the same litter with concerns. I will try to sum it up:
-4/2015 had increased urination/drinking
-5/2015-Vet completed 3 tests and confirmed Pituitary Cushings, no diabetes, ruled out other concerns with full CBC, other blood work. Started Trilostane 6 mg for 14 days.
-6/2015-ACTH still not in normal range. Increased dosage to 13.5mg for 14 days, completed ACTH Stim Test, still not in normal range. Drinking and urination improved.
7/2015-Increased Trilostane to 20mg for 14 days. ACTH Stim test still not normal but slightly improved. Increased to Trilostane 25mg for 30 days.
8/2015-ACTH Stim test, only slight improvement. Started noticing Angel was lethargic, losing appetite and mouth odor out of norm.
Advised Vet and noticed cracked tooth, suggested cleaning and extraction. Placed on antibiotics.
9/2015-Mouth odor gone, eating slightly improved. Additional ACTH Stim test with no improvement. Vet at a loss at this point and I become frustrated. Angel has lost a few pounds at this point from 13-11 pounds. Was told by Vet she cannot treat to referred to Specialist and continued on Trilostane 25mg.
9-10/2015-Additional blood testing to rule out other factors, liver enzymes elevated but to be expected as side effect from meds. Ultrasound completed to look at adrenal glands, stomach, increase size of salivary glands. Specialist not concerned. Loaded her on Trilostane 20mg every 12 hours for about 1.5 months.
10-11/2015-Angel completely stopped eating. We had to coax her to eat, started making homemade diet of anything she was willing to eat such as chicken, hamburger meat etc. Angel lost another 2 pounds at this point. Hair thinning, weakness in hind legs, no longer able to jump up to bed, couch, etc. Urinating started again in the house.
11/2015-Specialist reduced Trilostane to 20mg every 12 hours. Angel still not eating well.
12/2015-Specialist reduced Trilostane to 25mg once daily. Angel started eating a little better, still urinating in house. Still weak, frail, hair loss, still losing weight. Specialist reduced Trilostane to 20mg once daily. ACTH stim test completed, "right smack in the middle" of where she needs to be. Appetite not improving and noticable odor. Referred back to Vet for teeth cleaning.
12/2015-Angel's weight declined from 13 pounds to 9.6 pounds. Requested different/more tenured Vet. Confirmed Cushings controlled, right where it should be:
PRE ACTH 5.8 UG/DL
POST-ACTH 10.7 UG/DL
Vet found mouth ulcers during dental cleaning/check to determine reason for odor, dx "chewing syndrome" and removed tissue. Sent for biopsy and returned benign. Placed on amoxicillin 50mg and continue with Trilostane 25mg once daily. Also ran Catalyst One test, gave Sola-Ker Gel for build up of nose tissue due to impacting breathing.
12/14/15 Catalyst One
GLU 145 mg/dL HIGH
BUN 30 MG/dL HIGH
CREA 0.7 mg/dL normal
BUN/CREA 45 Interval Unk
TP 6.3 g/dL normal
ALB 3.1 g/dL normal
GLOB 3.2 g/dL normal
ALB/GLOB 0.9 Interval Unk
ALT 187 U/L High
ALKP 750 U/L High
Catalyst One Reference Intervals
GLU 74-143
BUN 7-27
CREA 0.5-1.8
BUN/CREA 45 Interval Unk
TP 5.2-8.2
ALB 2.3-4.0
GLOB 2.5-4.5
ALB/GLOB Interval Unk
ALT 10-125
ALKP 23-212
1/2016-Angel mouth has healed from surgery almost completely but is still not eating on her own without coaxing and syringe feeding her some days. Vet changed her to Trilostane 12.5 mg morning and evening. Ran additional in house test. Angel starting to act strangely at night. Unable to sleep, stares into space, very weak.
1/26/15 Catalyst One
GLU 126 mg/dL
BUN 14 mg/dL
CREA 0.8 mg/dL
BUN/CREA 18 Interval Unk
TP 7.3 d/dL
ALB 3.4 g/dL
GLOB 3.9 g/dL
ALB/GLOB 0.9 Interval Unk
ALT 90 U/L
ALKP 130 U/L
2/2016-Angel is declining rapidly. Weight decreased from 9.6 to 7.4 pounds. Vet concerned with enlarged neck arenal glands, completed biopsy per our request and turned out to be enlarged salivary glands that were plugged and Angel had numerous sores in her mouth on sides of cheeks and tongue. No further treatment for salivary glands. Have been in contact with Vet throughout the month of January as Angel is not eating or drinking much at this point. He ran additional test below and found her to be severely anemic. Said if she drops any lower will need immediate blood transfusion. Explained platelets/red blood cells out of whack, liver enzymes high, placed on liver pills to repair damage to liver, appetite pill for 14 days, antibiotics, placed on prednisone to promote healing, IV fluids. Placed her immediately on Iron drops with Vitamin B-Complex, stopped Trilostane and after awhile on prednisone will change to low dose Mitotane. No improvement to energy, can hardly walk/balance. Constant waking throughout the night to go to the bathroom but unable to. Seems to stand and stare at the wall confused.
2/9/16 Chemistry
ALKP 374 U/L High
ALT 163 U/L high
BUN/UREA 31 mg/dL high
2/13/16 In Clinic Hermatology
HCT 12.5% critical
HGB 13.0 g/dL normal
MCHC no results
WBC 5.61 K/uL normal
LYMPHS .95 K/uL normal
%LYMPHS 16.9%
MONOS 2.17 high
% MONOS 38.7%
NEUT 2.05 K/uL normal
%NEUT 36.5%
EOS .40 k/uL normal
%EOS 7.2%
BASO 0.04 K/uL normal
%BASO 0.7%
PLT 75 Very low
Retics 9.7 k/uL normal/low
%Retics 0.6%
RBC 1.62 M/uL critical
MCV 77.1 fL high
MCH 80.4 pg critical high
RDW 14.6% low
2/23/16 Emergency Vet visit to vet on call-not normal Vet. Angel was collapsing. Vet ran tests to see if blood transfusion needed but stated blood results show improvement meaning no anemia. Suggested full CBC be run and continue with prednisone and said to not start Mitotane until next Vet visit scheduled for 3 days away. Also suggested 3 mg Melatonin twice daily to help Angel sleep. Gave IV fluids.
2/23/06 Lab Hermatology:
HCT 24% Very Low
HGB 8.2 g/dl Very low
MCHC normal
WBC 16.87 normal/high
LYMPHS .43 K/uL low
%LYMPHS 2.5%
MONOS 2.79 high
% MONOS 16.5%
NEUT 13.23 K/uL high
%NEUT 78.4%
EOS .38 k/uL normal
%EOS 2.2%
BASO 0.05 K/uL normal
%BASO 0.3%
PLT 795 Very High
Retics 26.5 k/uL normal
%Retics 0.9%
RBC 3.03 M/uL Very Low
MCV 79.0 fL high
MCH 27.1 pg normal
RDW 15.2% normal
2/24/16-Angel was not moving unless I moved her. Watch her sleep restless. Had to take to pad to pee. She could barely stand at this point. She had her first what I think was her first seizure...large eyes, stiff legs, severe shaking/trembling more than usual...lasted several minutes. Then seemed out of it and in pain when I tried to pet her softly on the head. She then had several more seizures throughout the night and fell asleep. She jumped off the bed when I was asleep and was whimpering. Her head was low hanging, she peed on her pad and as I picked her up she was crying out in pain. I cradled her and calmed her downAt this point it was almost 6am. I rushed her into the Vet on duty, cradled in my arms...they said the only thing they could do was refer me to a neurologist. The vet said her full CBC came back and showed immuno disease.....can't remember what else. It was all such a blur and I don't have her last results. We decided it was time to let her go...she was in horrible pain at this point and couldn't even hold up her head without my help. We put her to sleep in my arms. She stopped crying and knew I was going to make it stop and that I loved her. One of the saddest days of my life.
I just don't understand what happened. Why was she losing weight even though her levels were controlled? The only concern I had was the drinking and peeing. Other than that she was a happy dog full of life until the Trilostane. She was never overweight or pot bellied according to the Vet. What was happening to her, to her neck? Should the Vet have changed her meds immediately...did we wait too long. Everything I have read says weight loss is not a typical side effect but something the medication could have caused. I just need closure and to understand where I went wrong. Please, anyone, if you can provide me with some guidance. Thank you.
-4/2015 had increased urination/drinking
-5/2015-Vet completed 3 tests and confirmed Pituitary Cushings, no diabetes, ruled out other concerns with full CBC, other blood work. Started Trilostane 6 mg for 14 days.
-6/2015-ACTH still not in normal range. Increased dosage to 13.5mg for 14 days, completed ACTH Stim Test, still not in normal range. Drinking and urination improved.
7/2015-Increased Trilostane to 20mg for 14 days. ACTH Stim test still not normal but slightly improved. Increased to Trilostane 25mg for 30 days.
8/2015-ACTH Stim test, only slight improvement. Started noticing Angel was lethargic, losing appetite and mouth odor out of norm.
Advised Vet and noticed cracked tooth, suggested cleaning and extraction. Placed on antibiotics.
9/2015-Mouth odor gone, eating slightly improved. Additional ACTH Stim test with no improvement. Vet at a loss at this point and I become frustrated. Angel has lost a few pounds at this point from 13-11 pounds. Was told by Vet she cannot treat to referred to Specialist and continued on Trilostane 25mg.
9-10/2015-Additional blood testing to rule out other factors, liver enzymes elevated but to be expected as side effect from meds. Ultrasound completed to look at adrenal glands, stomach, increase size of salivary glands. Specialist not concerned. Loaded her on Trilostane 20mg every 12 hours for about 1.5 months.
10-11/2015-Angel completely stopped eating. We had to coax her to eat, started making homemade diet of anything she was willing to eat such as chicken, hamburger meat etc. Angel lost another 2 pounds at this point. Hair thinning, weakness in hind legs, no longer able to jump up to bed, couch, etc. Urinating started again in the house.
11/2015-Specialist reduced Trilostane to 20mg every 12 hours. Angel still not eating well.
12/2015-Specialist reduced Trilostane to 25mg once daily. Angel started eating a little better, still urinating in house. Still weak, frail, hair loss, still losing weight. Specialist reduced Trilostane to 20mg once daily. ACTH stim test completed, "right smack in the middle" of where she needs to be. Appetite not improving and noticable odor. Referred back to Vet for teeth cleaning.
12/2015-Angel's weight declined from 13 pounds to 9.6 pounds. Requested different/more tenured Vet. Confirmed Cushings controlled, right where it should be:
PRE ACTH 5.8 UG/DL
POST-ACTH 10.7 UG/DL
Vet found mouth ulcers during dental cleaning/check to determine reason for odor, dx "chewing syndrome" and removed tissue. Sent for biopsy and returned benign. Placed on amoxicillin 50mg and continue with Trilostane 25mg once daily. Also ran Catalyst One test, gave Sola-Ker Gel for build up of nose tissue due to impacting breathing.
12/14/15 Catalyst One
GLU 145 mg/dL HIGH
BUN 30 MG/dL HIGH
CREA 0.7 mg/dL normal
BUN/CREA 45 Interval Unk
TP 6.3 g/dL normal
ALB 3.1 g/dL normal
GLOB 3.2 g/dL normal
ALB/GLOB 0.9 Interval Unk
ALT 187 U/L High
ALKP 750 U/L High
Catalyst One Reference Intervals
GLU 74-143
BUN 7-27
CREA 0.5-1.8
BUN/CREA 45 Interval Unk
TP 5.2-8.2
ALB 2.3-4.0
GLOB 2.5-4.5
ALB/GLOB Interval Unk
ALT 10-125
ALKP 23-212
1/2016-Angel mouth has healed from surgery almost completely but is still not eating on her own without coaxing and syringe feeding her some days. Vet changed her to Trilostane 12.5 mg morning and evening. Ran additional in house test. Angel starting to act strangely at night. Unable to sleep, stares into space, very weak.
1/26/15 Catalyst One
GLU 126 mg/dL
BUN 14 mg/dL
CREA 0.8 mg/dL
BUN/CREA 18 Interval Unk
TP 7.3 d/dL
ALB 3.4 g/dL
GLOB 3.9 g/dL
ALB/GLOB 0.9 Interval Unk
ALT 90 U/L
ALKP 130 U/L
2/2016-Angel is declining rapidly. Weight decreased from 9.6 to 7.4 pounds. Vet concerned with enlarged neck arenal glands, completed biopsy per our request and turned out to be enlarged salivary glands that were plugged and Angel had numerous sores in her mouth on sides of cheeks and tongue. No further treatment for salivary glands. Have been in contact with Vet throughout the month of January as Angel is not eating or drinking much at this point. He ran additional test below and found her to be severely anemic. Said if she drops any lower will need immediate blood transfusion. Explained platelets/red blood cells out of whack, liver enzymes high, placed on liver pills to repair damage to liver, appetite pill for 14 days, antibiotics, placed on prednisone to promote healing, IV fluids. Placed her immediately on Iron drops with Vitamin B-Complex, stopped Trilostane and after awhile on prednisone will change to low dose Mitotane. No improvement to energy, can hardly walk/balance. Constant waking throughout the night to go to the bathroom but unable to. Seems to stand and stare at the wall confused.
2/9/16 Chemistry
ALKP 374 U/L High
ALT 163 U/L high
BUN/UREA 31 mg/dL high
2/13/16 In Clinic Hermatology
HCT 12.5% critical
HGB 13.0 g/dL normal
MCHC no results
WBC 5.61 K/uL normal
LYMPHS .95 K/uL normal
%LYMPHS 16.9%
MONOS 2.17 high
% MONOS 38.7%
NEUT 2.05 K/uL normal
%NEUT 36.5%
EOS .40 k/uL normal
%EOS 7.2%
BASO 0.04 K/uL normal
%BASO 0.7%
PLT 75 Very low
Retics 9.7 k/uL normal/low
%Retics 0.6%
RBC 1.62 M/uL critical
MCV 77.1 fL high
MCH 80.4 pg critical high
RDW 14.6% low
2/23/16 Emergency Vet visit to vet on call-not normal Vet. Angel was collapsing. Vet ran tests to see if blood transfusion needed but stated blood results show improvement meaning no anemia. Suggested full CBC be run and continue with prednisone and said to not start Mitotane until next Vet visit scheduled for 3 days away. Also suggested 3 mg Melatonin twice daily to help Angel sleep. Gave IV fluids.
2/23/06 Lab Hermatology:
HCT 24% Very Low
HGB 8.2 g/dl Very low
MCHC normal
WBC 16.87 normal/high
LYMPHS .43 K/uL low
%LYMPHS 2.5%
MONOS 2.79 high
% MONOS 16.5%
NEUT 13.23 K/uL high
%NEUT 78.4%
EOS .38 k/uL normal
%EOS 2.2%
BASO 0.05 K/uL normal
%BASO 0.3%
PLT 795 Very High
Retics 26.5 k/uL normal
%Retics 0.9%
RBC 3.03 M/uL Very Low
MCV 79.0 fL high
MCH 27.1 pg normal
RDW 15.2% normal
2/24/16-Angel was not moving unless I moved her. Watch her sleep restless. Had to take to pad to pee. She could barely stand at this point. She had her first what I think was her first seizure...large eyes, stiff legs, severe shaking/trembling more than usual...lasted several minutes. Then seemed out of it and in pain when I tried to pet her softly on the head. She then had several more seizures throughout the night and fell asleep. She jumped off the bed when I was asleep and was whimpering. Her head was low hanging, she peed on her pad and as I picked her up she was crying out in pain. I cradled her and calmed her downAt this point it was almost 6am. I rushed her into the Vet on duty, cradled in my arms...they said the only thing they could do was refer me to a neurologist. The vet said her full CBC came back and showed immuno disease.....can't remember what else. It was all such a blur and I don't have her last results. We decided it was time to let her go...she was in horrible pain at this point and couldn't even hold up her head without my help. We put her to sleep in my arms. She stopped crying and knew I was going to make it stop and that I loved her. One of the saddest days of my life.
I just don't understand what happened. Why was she losing weight even though her levels were controlled? The only concern I had was the drinking and peeing. Other than that she was a happy dog full of life until the Trilostane. She was never overweight or pot bellied according to the Vet. What was happening to her, to her neck? Should the Vet have changed her meds immediately...did we wait too long. Everything I have read says weight loss is not a typical side effect but something the medication could have caused. I just need closure and to understand where I went wrong. Please, anyone, if you can provide me with some guidance. Thank you.