Cushings to Addison's to Cushings - Gracie has passed

[Gracie123]

****Gracie has passed*****


Hello,

I'm new to this forum. My 19 pound beagle, Gracie, was diagnosed with Cushing's in Aug of 2016. She was drinking and urinating excessively. All the appropriate tests were performed....ACTH, low dose dexamethasone, ultrasound, blood work, urinalysis... Her BUN had been running 60-70 for about a year, but the vets were not concerned since her creatinine was normal.

10mg Vetoryl daily was prescribed. Her symptoms of excessive drinking and urinating never went away. All was well until about 3 weeks ago. She went into an Addisonian crisis. 3 full days in the hospital correcting the Addisonian crisis and acute kidney failure. They stated her kidneys would function again once the crisis was corrected. They were wrong.

After taking her home from her 3 day stay at the hospital, she had a new diagnosis of Addison's. 2.5 mg of prednisone daily. She vomited 3 days later, so we gave her another 2.5 mg of prednisone that helped. A few days later she became lethargic and an extra 2.5 prednisone would not help. Back to the vet for more blood work and IV fluids. Her blood work showed that her BUN, creatinine, liver enzymes, and phosphorus were all elevated. All came down with 3 more days of IV fluids except for higher liver enzymes and slightly high BUN. New diagnosis of kidney failure with her Addison's. Along with her 2.5 mg of prednisone, we had to start treating her kidney failure with diet and sub q fluids.

When we took her back home, she was just as energetic as can be. But......she started having tremors and loss of control of both back and front legs. The vet contributed the tremors and loss of leg control to her past history of IVDD (back problems). We increased her prednisone dose to 3.75 mg a day and took her back for more test 2 weeks later with no improvement on her tremors/falling.

Blood work a few days ago showed even higher liver enzymes and all other values unchanged. They suggested trying Tramadol (pain killer) to help with the tremors/muscle spasms. She vomited on this med and acted very odd, so we discontinued. Then the vet put her on a muscle relaxant. The muscle relaxant made the tremors 100x worse. She could not stand or sit for more than 10 seconds before tremoring and falling down. We discontinued the muscle relaxant immediately. At this point, the vet is getting annoyed with all my calls and questions.

We go back into the vet next Wed. Her main vet thinks her adrenal glands may be pumping cortisol back into her system, thus the continued increase in liver enzymes. I've cut her dose of prednisolone (changed from prednisone) to 1.25 mg daily, and her tremors are actually improving. At one point, I thought she actually had Parkinson's her tremors were so bad.

I just wanted some thoughts on this case. She's been through so much in just 3 months. .... From a happy beagle that just drank and peed too much, to such a sick dog with tremors and falling. I'm hoping the tremors were from an overdose of prednisone as her Cushing's was returning. I'm not sure we want to even treat the Cushing's if it were to return with her kidney disease. The vetoryl really did some damage on her kidneys.

Thanks!
Betty

[Harley PoMMom]

Hi Betty,

Welcome to you and Gracie! I am so sorry that Gracie is having a rough time and I know you must be so worried about her. It would really help us to provide you with more meaningful feedback if you would get copies of her tests and post the results. With respect to the CBC/chemistry blood panel we need only those values that are abnormal with the normal reference ranges. Also we are very interested in seeing the results from those recent ACTH stimulation tests. Is Gracie receiving any kind of supplemental mineralocorticoid?

Prednisone can cause the same symptoms as natural ccurring Cushing in a dog so I'm not quite sure how the vet knows that Gracie`s adrenal glands are producing cortisol again without performing an ACTH stimulation test. And since Prednisone will interfere with a cortisol assay test Gracie would need to be off the Prednisone for at least 24-48 hours. Seeing that Gracie is Addison stopping the Prednisone would not be a good idea right now but she could be given dexamethasone in place of the Prednisone so that an ACTH test could be performed as dexamethadone does not cross react with a cortisol assay test.

Addison can have a negative effect on the kidneys and most times once the dog becomes stable the kidneys will function normally but this may take some time. Now having said that, it is possible that Gracie may be an Addison dog permanently, also there are different forms of Addisons. One type is the dog will need both a mineralocorticoid hormone and a glucocorticoid supplementaction or she may need just only the glucocorticoid supplement but this can only be diagnosed with an ACTH stimulation test.

So, if this were me I believe that I would want to make sure that Gracie`s adrenal glands are producing enough cortisol on their on. I am saddened to hear that the vet is getting frustrated that you are asking questions, that is not right. You are your girl`s only voice and advocate and I commend you for wanting to be so involved with Gracie`s well being. This disease requires a vet that is willing to be a team player and you should be able to talk with the vet and ask as many questions that you have, I am so sorry that this is not happening with Gracie`s vet.

I am glad you found your way here and we will help in any way we can.

Hugs, Lori

[Gracie123]

Awww, thanks Lori! Your reply brought a tear to my eyes.

You know so much about Addison's! We are going back in this upcoming Wed for more blood work and the ACTH test. The vet only stated that Gracie would need to fast before the ACTH test. Her liver enzymes have tripled since we did her first round of blood work 3 weeks ago. That's the reasoning for the vet believing her adrenal glands are pumping again.

Gracie was given the DOCP shot at the time of her Addisonian crisis. They were hoping that her kidneys would start working again after the 3 days of IV fluids. But, since she started to crash shortly after, they think the crisis caused permanent kidney failure. Lori, have you seen kidneys function normally again after a few weeks post crisis??

The sub q fluids as well as the kd diet we have her on is keeping her numbers stable. I absolutely HATE giving her the sub q fluids. It almost hurts me as much as it hurts her. The BUN is about 47.... a little high. Her 2 liver panals were roughly 400 and 1000. I forget which number was which value. I'm hoping these values will decrease once we figure everything out.

I've read on a few posts about some dogs having tremors and also falling with Cushing's. Gracie's tremors are almost non existent early in the morning before she is due for her next prednisone dose. I am hoping its the overdose of steroids that is causing these strange tremors. The vet thinks they are neurological and suggests an MRI/CAT scan of her brain.

I'll be back on Wed to post all the new numbers.

Betty

[Harley PoMMom]

Hi Betty,

I have responded within the body of your post because I'm a bit lazy today but mostly to keep myself on track. :eek:;)




You know so much about Addison's! We are going back in this upcoming Wed for more blood work and the ACTH test. The vet only stated that Gracie would need to fast before the ACTH test. Her liver enzymes have tripled since we did her first round of blood work 3 weeks ago. That's the reasoning for the vet believing her adrenal glands are pumping again.

Trust me, I'm no expert on hypoadrenocorticism, however Addison's is the exact opposite of Cushing's and they do share similar symptoms so it is with this reason I'm a bit familiar with Addison's. On the forum we have seen quite a few dogs with Cushing's go into an Addison's crisis, mostly this is from a too high of a dose of the medications that are used to treat Cushing's but sometimes not.

Elevated liver enzymes are also seen in a dog with Addison's so the only way to tell if it is from an excess production of cortisol is with an ACTH stimulation test, which I see that one is scheduled for Wednesday and I am glad that this will be done.


Gracie was given the DOCP shot at the time of her Addisonian crisis. They were hoping that her kidneys would start working again after the 3 days of IV fluids. But, since she started to crash shortly after, they think the crisis caused permanent kidney failure. Lori, have you seen kidneys function normally again after a few weeks post crisis??

Yes, on the forum I have seen a number of dogs have their kidneys negatively affected from a sudden Addison's crisis and once they became stable their kidney function improved greatly.

Generally an Addisonian dog will have an imbalance in their electrolytes so once you get a copy of Gracie's most recent chemistry blood panel I'll be anxious to see what her electrolyte values are, the ones that I am mainly interested in seeing are her sodium, potassium, and chloride. Also could you see if the albumin and creatinine are abnormal? Another thing :eek: did they run an urinalysis? And if so, what is her urine specific gravity?


The sub q fluids as well as the kd diet we have her on is keeping her numbers stable. I absolutely HATE giving her the sub q fluids. It almost hurts me as much as it hurts her. The BUN is about 47.... a little high. Her 2 liver panals were roughly 400 and 1000. I forget which number was which value. I'm hoping these values will decrease once we figure everything out.

I have had to give sub q fluids to one of my boys and I was an emotional wreck because I kept thinking that I was giving him so much discomfort in doing that, but really, it didn't seem to bother him near as much as it did me.


I've read on a few posts about some dogs having tremors and also falling with Cushing's. Gracie's tremors are almost non existent early in the morning before she is due for her next prednisone dose. I am hoping its the overdose of steroids that is causing these strange tremors. The vet thinks they are neurological and suggests an MRI/CAT scan of her brain.

I'll be back on Wed to post all the new numbers.

Betty

Tremors/shaking are noted as a side effect of Addison's and also can be attributed to a high dose of prednisone, it can be so confusing. :eek::eek: The usual recommended prednisone dosage for an Addison's dog is 0.1-0.2 mg/kg/day, and to find Gracie's weight in kg you divide 19 pounds by 2.2 which comes out to 8.6 kg. Now, at 8.6 kg, that calculates out to be only 0.86 mg/day, up to a maximum dose of 1.7 mg/day. So the 2.5 mg Gracie is getting just may be too much.

One thing that is very important with taking prednisone is that it should not be suddenly stopped because it causes the adrenal glands to decrease cortisol production. It should be tapered off slowly as a gradual reduction in prednisone dosage gives the adrenal glands time to resume their normal function.

Please do keep us updated and hopefully sweet Gracie will be feeling like her ole self real soon.

Hugs, Lori

PS: You'll see that I've moved your thread here to our main discussion forum. This way, our members are more apt to see your thread and have the opportunity to write to you. ;)

[DoxieMama]

Hi Betty,

Welcome to you and Gracie! I'm so sorry for all the issues that she has been going through, but am standing alongside Lori in hoping that they will resolve and she'll feel better soon!

Hugs,
Shana

[Gracie123]

Thanks so much for the extra info!

Here are Gracie's numbers as of last week.

ALB 4.4 (2.2-3.9)
ALKP 1066 (23-212)
ALT 407 (10-125)
BUN/UREA 47 (7-27)
CREA 1.4 (.5-1.8)
Urine gravity 1.012

Her ALKP and ALT have increased in the past 2 weeks. Her BUN creeps up to over 100 and creatinine creeps up around 3.4 when not on fluids. Her potassium was high and sodium low during her Addisonian crisis. K, Na, and Cl are normal at this time.

Vets want to run another ultrasound and MRI/cat scan which I will not do. We just did an ultra sound 3 months ago. I don't have pet insurance and we are well past $4000 in under 4 months for tests, hospital stays, drugs....

Thank you for the 1.7 dose info on the Prednisone. I had her down to 2.5mg. I tried 1.25 yesterday, but she definitely showed signs of lethargy at 3:00am, so I gave her another 1.25 with good response.

Will update on Wed.

B

[Gracie123]

Shana,

I just read your thread. I'm so sorry for your loss. Never gets any easier... I lost my very first beagle baby at the age of 5 years. She went in for a routine teeth cleaning, and her heart stopped. With my 2 current elderly 14 year old beagles, I'm thankful they are able to stay with me for many more years. Boy, these 2 were naughty growing up. The husband and I are preparing for this upcoming year being a tough year with Gracie having Cushing's/Addisons and kidney failure, while sister Nicki has an inoperable liver tumor.

These fur babies are just so fortunate to have mommas that love them so much....

[kaibosmom]

I hope things with Gracie improve soon! I am interesting in your thread because my dog is being treated for Addison's but I don't think he has it. Good luck with the ACTH on Wednesday.

Nikki

[Gracie123]

I've been reading so many posts on this forum non stop. I have actually started to feel a bit angry with my vet for not thoroughly explaining the pros and cons of treating Cushing's.

There was never an option not to treat the Cushing's. I was never told that treating the Cushing's could cause the tumor to grow quicker...which I believe has happened. She never gave me Prednisone as a net in case there was an Addison's crisis....which there was. She as well as another vet at the clinic were never concerned with the high BUN Gracie had for over a year...which now turns out to have been the beginning of kidney failure.

As I sit here watching Gracie tremor and fall when she's tired, I'm reminding myself I need to go heat up her fluids for her sub q fluids now that she has stage 2-3 kidney failure.

We went from a thirsty/peeing energetic beagle....to a tremoring Addisons beagle with kidney failure....in just 3 months. I'm not even sure what will take her first, the pituitary tumor or kidney failure....all escalating from treating her Cushing's with Vetoryl.

[Joan2517]

Hi and welcome from me too. My vet also never explained things to me. He never gave me any prednisone either. He only said we'll give her pills and she'll be fine. Didn't even tell me to give them with a full meal...she died two months after her diagnosis.

You have to be informed and outspoken, especially if your vet is not as up on Cushing's as you need them to be. I learned more on this forum than I did from my own vet of 15 years, and if your vet gets annoyed at your questions, find another. I am still with my vet's group, I just ask for another one in the group who is more responsive and I trust.

I hope Gracie gets better...you're a good mom!

[labblab]

Hello from me, too. I received your message and have now read through your thread. I'm so sorry Gracie is having these problems. However, my best bet is that the tremoring/falling is not a result of the pituitary tumor rapidly enlarging, but instead some sort of systemic imbalance. Bear in mind that I'm not a vet, and of course the only way to know for certain would be to perform expensive head imaging. But the fact that these issues started suddenly and subsequent to her hospitalization would lead me to believe that problems with her kidneys, liver, or abnormal blood chemistries are more likely the cause.

Since Gracie's BUN was elevated even before starting the Vetoryl, it's possible that there was already an underlying kidney issue in place. If so, her body may not have been able to excrete the metabolites of Vetoryl efficiently, and in turn that may have made an overdose more likely if the drug was building up in her system.

In your message, you asked about my boy and what made us suspect an enlarging pituitary tumor. He became lethargic, lost his appetite, started pacing aimlessly around the house, toileted in the car and house (which had never ever happened previously) and finally stopped drinking water as well. He never suffered from seizures nor episodes of falling down, although he did act uncoordinated at times. Also, if you've read my posts, he did suffer from tremoring episodes early on. But they had stopped by the time these other neurological problems emerged, and we never tried any medications to address them.

I wish I could be of more help to you right now. But if Gracie is still consistently needing Sub-Q fluids, then my guess is that the kidney dysfunction remains her primary issue. It certainly may be good to find out about her cortisol status right now. But I do need to repeat the warning that Lori wrote about earlier: supplemental prednisone or prednisolone will skew the ACTH results higher than they would otherwise be. So as she says, asking your vet about possibly switching Gracie to dexamethasone for at least a couple of days before the test seems important.

Please do keep us updated, though!
Marianne

[Gracie123]

Thank you, Marianne!

Yes, I called and asked if Gracie would need to be taken off the pred prior to the new ACTH. One of the vets should return my call.

I always suspected kidney problems, especially when her breath smelled like ammonia. But, since her Creatinine was either 1.6 or 1.7, they didn't think it was a kidney problem. Now I find out you can have kidney disease with 1.4 creatinine.

I hope you're right about the pituitary tumor. My feeling is that during her Addisonian crash, there was no cortisol to keep the tumor at bay...so the tumor grew. She's fine when she's alert, walking, and eating. But, when she's standing or sitting, she starts to convulse and falls over. The husband and I whistle when we see this happening and she snaps out of it.

I'm going to look for an internal med vet that I feel more comfortable with...

Betty

[Harley PoMMom]

There is a relatively new kidney test that the IDEXX laboratory carries and it is called the SDMA test. Now when kidney disease is suspected this test is more sensitive than the creatinine with diagnosing kidney disease.

Here's a blurb regarding the SDMA test:
SDMA increases earlier than creatinine in chronic kidney disease (CKD). On average, SDMA increases with 40% loss of kidney function and as early as with 25% kidney function loss. However, creatinine does not increase until 75% of kidney function is lost. SDMA will enable veterinarians to diagnosis CKD months or even years earlier than traditional tests

I'm including a link that has questions and answers about this test and where that blurb was found: https://www.idexx.com/files/small-animal-health/solutions/articles/sdma-faqs.pdf

Hugs, Lori

[Gracie123]

Thanks, Lori.

They never used that new test....which is too late now, since the Vetoryl sent her into stage 2-3 kidney failure.

I had an appointment for the ACTH tomorrow. I left a message yesterday stating Gracie is on pred for her Addison's and asked if she needed to be off the pred. I didn't get a call back until today saying she needs to be off the pred for 48 hours. That's it!! No mention of dexamethasone! So I had to have the receptionist tell the vet she can't be off the pred without a substituted dexamethasone....

I have an appt with a new IM vet. Clearly the current vet is not experienced enough in Cushing's/ Addisons. She was the same vet that told me that Vetoryl was completely safe, and she never had an animal go Addisons on the med....

[Joan2517]

I hate it when they are so sure of themselves and we take their word for it because we think they know what they're talking about...never again for me. I hope you have a better experience with the new IM vet.

[Gracie123]

Tech just called back saying the doctor didn't think Gracie needed the dex shots, that she would be ok without pred for 48 hours. WTF?!

I explained to the tech that I attempted to taper Gracie down to 1.25mg, but she started to act lethargic after 18 hours. So, 3 appointments....2 days for dex shots, and 1 day for ACTH.

I'm really upset and disappointed with myself and this vet. I agree, I had 100% faith in her and never questioned anything about her diagnosis and treatment. When she was testing for Cushing's or kidney disease, I was so sure it was kidney that I went out and bought kidney diet months ago. Gracie was only on Vetoryl less than 1 month when she started losing the use of her back legs....twice. I thought her dose was too small....10mg for a 19 pound dog. The vets stated it was her back problems flaring up.

The last time she took her Vetoryl, she actually collapsed but got back up. She was still eating fine, but seemed very lethargic. She had vomited that day, and her food was still solid. I had no idea she was starting to crash. I didn't know what an Addisonian crash looked like....and I feel so guilty for giving her another Vetoryl. She went into crisis mode the very next day....the vet actually had to call an IM vet because she didn't know what to do.

When we were transferred to the 24hour ER vet hospital, all the vets agreed that she probably had kidney disease for some time.

I wish I had found this forum months ago...:(

[Joan2517]

OMG! We all have those guilty feelings...you can only do what you know at the time. I also wish I had found this site sooner. I had total trust in my vet at the time and never questioned him, even though I was so nervous about the whole treatment process. Only as Lena started to get worse, did I start questioning, but by then I think it was too late. He never told me about Addison's either. Never told me I didn't have to treat her at her age. I have so many regrets.

But it will never happen again. I question everything now, luckily the vet I request now is very thorough, answers all my questions, tells me upfront about side effects so that I don't panic when they start to happen, doesn't poo poo my concerns, and doesn't run unnecessary tests just to jack up the bill.

And I come here and run my concerns by everyone here, who I happen to trust completely.

[judymaggie]

Hi, Betty -- I just wanted to say "hello" to you and Gracie from another beagle Mom! My Abbie is going to be 14 soon -- she is my second beagle Cush pup.

When is your appointment with the IMS? Hopefully, he/she can help you prioritize Gracie's issues and get her back on track.

Hugs to you and big "a-r-o-o-o" from Abbie to Gracie!

[Gracie123]

Hi Judy!

Your Abbie looks like my other beagle, Nicki. Nicki is 14 with liver cancer/tumor. Oy....these babies get so sick when they get old.

Just came from the vet. I won't get the ACTH until tomorrow, but I got great news from Gracie's blood work.

Everything was normal!!! Except BUN of 51 (7-27) down from 115. Creatinine is down to 1.1 (.5-1.8) from 3.4. And 550 (23-212) for ALKP...down from over 1000. ALT is 110 (10-125) down from 400.

Best numbers she's had yet! I'm always wondering why this clinic has a normal max creatinine of 1.8 when the ER hospital max norm was 1.4. Do the norms vary from clinic to clinic? I'm just happy we can go to sub q's every other day. Gracie just hates the needle!

[Harley PoMMom]

I'm always wondering why this clinic has a normal max creatinine of 1.8 when the ER hospital max norm was 1.4. Do the norms vary from clinic to clinic?

Yes, unfortunately reference ranges do vary from lab to lab. Different laboratories use different kinds of equipment and different kinds of testing methods for analysis, which means each laboratory must determine its own reference ranges.

That is great news that her chemistry blood levels have come down!!

Hugs, Lori

[Gracie123]

Got the ACTH...

Pre .2
Post .5

Still Addison's. Her electrolytes were normal, so no DOCP shot. Vet wants Gracie to come in every week to test her electrolytes! So tired of going to the vets office...

[labblab]

She's still going to get daily prednisone, though, right?

Marianne

[Gracie123]

Yes.....sticking to the 2.5mg daily.

I'm just frustrated with the weekly bloodwork. Her Na/K is normal, so she wants us back once a week to make sure the electrolytes stay within range. Isn't that overkill?

[puhmuckel]

If all Lytes are WNL , then I do not see why they cannot be done every other week.

[Harley PoMMom]

The thing with chemistry imbalances is that they are difficult to detect by observation so regular monitoring is recommended. I would definitely want the electrolytes rechecked in a week and if they are still normal than I probably wouldn't retest for a couple more weeks. And if at that time they are unchanged than I would think that checking them at least 2-3 times a year would be appropriate, but I'm no vet so this is just my opinion.

Hugs, Lori

[Gracie123]

Checking the electrolytes next week for sure, since we are headed out of town for the holiday. We have an appt with IM vet 01/04/2017. I'll feel better getting a second opinion from a more experienced vet.

[Gracie123]

Marianne,

I think you were correct about Gracie's tremoring and falling. As I stated previously, they started out of the blue on her second round of IV fluids. That was about 2 weeks ago. The vet was adament at that time it was neurological because her electrolytes were normal. They even prescribed Gracie a seizure med. I picked up the med, but haven't started it because of the potential side effects.

Last couple of days, both the husband and I have noticed very little tremors. She's gone from tremoring and falling most times she sits or stands for more than 5 seconds....to maybe 1 or 2 a day.

Her liver enzymes have dramatically improved now that we're on a consistent lower amount of Prednisolone. She was prescribed 2.5 daily. I've tried to decrease it to 1.25ish, but she doesnt seem herself around 18 hours. The pills are 5mg, so maybe I'll try splitting it into 1/3 to get roughly 1.7?

Thank you so much for all the information.

[Gracie123]

Sooooo.....

Last Wed, Dec 14, after 4 consecutive weeks of blood work, Gracie had a 27 Na/k ratio. 29 Na/k the week before, and 31 the week before that. I spoke to the vet and didn't understand why we had to come in every week. She stated that Gracie's electrolytes were "normal", and did not need a shot of DOCP. I questioned the 27 being bottom of normal and how her potassium was slowly creeping up. Vet replied that her sodium levels did not change much.

Well, today Gracie could barely hold herself up and vomited twice. Back to the vets office where her potassium was high, normal sodium, and Na/K of 23. A different vet went ahead and gave Gracie her DOCP shot....31 days after her first shot.

Is that protocol??? Or standard of care?? Wait until your dog's level are low enough to make her sick before they give the DOCP shot?

[Harley PoMMom]

Is that protocol??? Or standard of care?? Wait until your dog's level are low enough to make her sick before they give the DOCP shot?

I am so sorry to hear that Gracie was feeling poorly, and no, she should not be feeling ill in order for her to receive the DOCP. I'm including an excerpt regarding Addison's from the blog of a renown veterinary endocrinologist, Dr Peterson:
Initially, serum kidney and electrolyte concentrations should be monitored at approximately 2-weeks intervals in order to determine the drug’s peak effect and to help make necessary dosage adjustments. Once stabilized, serum electrolyte and creatinine concentrations are checked every 3 to 6 months. Because DOCP is a pure mineralocorticoid and has no glucocorticoid activity, it is essential that dogs receive concurrent glucocorticoid supplementation

http://www.animalendocrine.info/2011/04/treating-dogs-with-hypoadrenocorticism.html

How is Gracie feeling now?

Hugs, Lori

[Gracie123]

Lori,

Thank you for the information. What I concluded based on speaking with the 2 vets was that they were waiting until the electrolytes became abnormal to see if and when she needed the DOCP shot. I mentioned the potassium creeping up, but they stated they mainly go off the sodium levels. Sodium was normal even when the potassium was high enough to give a 23 Na/k ratio......so that standard procedure makes no sense to me.

Gracie vomited again last night, so I'm thinking she must have vomited some of her pred out earlier that morning. I gave her another 2.5mg which helped. Her tremors and falling are back, so it feels like we have taken an unneccary step backwards.

Betty

[molly muffin]

Oh dear, I'm sorry that Gracie is having these problems and that the vets aren't being proactive about the potassium creeping up. It does to me at least signify that she will need a shot.

Can you see the vet that went ahead and gave her the shot last time you went in?

Maybe pred isn't the drug for her, maybe there is a different one that will work better.

[Gracie123]

Thanks for the replies! I think the prednisolone is working ok for her. She definitely still has Addison's. We give her sub q's every other day, and her kidney values are still improving. I'm hoping this might be a sign that the Addisonian crisis gave her acute kidney failure and not chronic kidney failure. We have an appt with an IM vet Jan 4th. I'm hoping to not return to the regular vets' office.

Happy holidays!

B

[molly muffin]

Crossing fingers that the kidney values will continue to improve and eventually you'll be able to get off the sub q fluids. No fun giving those for sure.
I used my IMS almost exclusively once we started going to her. Definitely a life saver for us.

[Gracie123]

So frustrated....

We still have an IM appointment this Wed. As I mentioned before, Gracie started having tremors/seizures and falling over during and shortly after her Addisonian crisis/kidney failure mid November. The tremors were consistent for a few weeks and then started to improve. The vets waited until her Na/K numbers were off about 2 weeks ago before giving her her DOCP shot, so now the tremors and falling are back full force. They did give me an antiseizure med to try, but I'm reluctant to try it because of the side effects...possible drowsiness and stumbling. I just feel like once we get her stable, there's another step backwards.

[labblab]

Gosh, I'm so sorry you guys keep having these setbacks! I wish I had some words of wisdom to share, but I'm afraid I'm struggling for answers the same way you are :o. I'm glad you've got the Wednesday appointment scheduled, and we'll be very anxious to hear whether the IMS has any new thoughts or suggestions.

I know it's hard, but try to hang in there and please give Gracie a big hug for me, OK?

Marianne

[molly muffin]

I'm really hoping that at the Wednesday appointment the IM can come up with a real treatment plan that will help Gracie.

Belly rubs from me to Gracie :)

[kaibosmom]

I hope you get answers on Wednesday! I feel so bad for you to have to go through this!

[Gracie123]

You all are so sweet!!! I joined an K 9 Addisons group on FB. They have been so helpful. They all agree that the vets should NOT have let her Na/k numbers go abnormal before her DOCP shot. I posted Gracie's numbers, and a few stated she should have had her shot 2 weeks sooner!

She's eating and drinking fine now, but the tremors have increased. I'm starting to think this may be do to her unstable K levels. High K levels can cause the brain/nerve to misfire and cause muscle tremors.

[Gracie123]

Just wanted to do a quick update...

Saw the IMS on Wed. Luckily I brought all the bloodwork info because she did not receive all the faxes. Results...

The tremors are most likely due to pred overdose. Started at 5mg, now we are at 1.5mg and hoping to taper more.

Her K levels continue to trend up after each DOCP shot, so most likely permanent Addisons.

Went ahead and gave another DOCP shot only after 16 days after her second shot....higher dose. Usually the DOCP should last for 28 days, but her K keeps rising. She doesn't think it's from the sub q fluids, since she's on such a low dose. I'm cutting back on some of her high K foods. Wondering if it has something to do with her kidney disease and not being able to filter everything as a normal dog. We go back for more blood work in 2 weeks...better than going every week as before and getting no where.

[Crazy Daisy]

I'm new to this group but beagles have a special place in my heart. I'm here for my 11 year old girl. I'm glad you were able to see an IMS. Sometimes I think we forget that our regular vets can't know it all, me included! If it were me I would consider switching regular vets... it doesn't sound like your current regular vet is wanting to help field all your questions ando that's what they are there for. Did your IMS give you a plan moving forward? Are you able to contact them directly with questions?

Erin

[Gracie123]

You know.....I've received more answers on websites like these as well as FB groups. I had no idea Gracie was getting way too much pred causing the tremors. The 2 vets working on her never mentioned it nor mentioned tapering especially since she has kidney failure now. The plan is to just find the correct dose of DOCP and pred now to manage the newly diagnosed Addisons. I want her on least amount of pred possible, so these darn tremors will stop.

[molly muffin]

Crossing fingers that you can get to a perfect dose of the pred and DOCP.

She certainly has been on quite the trip now. How is her K doing since this last shot? When do you retest?

[Gracie123]

Hi Sharlene,

We retest lytes next week. She's on day 3 of 1.5mg of pred. She's eating and drinking with gusto, but shes much more tired than before the Cushing's treatment, Addisonian crisis, and diagnosis of Addison's/kidney failure. All her kidney values were within normal limits except for a high BUN. Her hind legs are getting much weaker. It's like we've pushed her back into Cushing's with all this Prednisone. I'm hoping once we get the pred to the lowest amount, we can start building those running legs again.

[Gracie123]

I'm back....

Gracie doesn't seem to be any better. We now see an IM vet and have her DOCP shot managed. She's on .5mg Prednisone. We are so excited when she has days where she wants to run around the block like she did before her Addisonian crisis. She is still very tired and still has the muscle tremors that wax and wane. We're using a nutritionist now hoping that a better diet will help her energy level. Her hearing is bad as well as her vision. She has poor peripheral vision, so I'm pretty convinced her pituitary is growing.....possibly causing these tremors. We're also still giving Gracie sub q fluids for the kidney disease that came along with the Addisonian crisis.

Betty

[molly muffin]

Awww, sorry to hear that Gracie is still having some problems, but it is good that her DOCP is now managed and that she has some lively days.

My molly had tremors with her cortisol and later worse with her kidney disease. So it might not be the pituitary tumor growing but could be attributed to her kidney disease.

[Gracie123]

I just realized it’s been exactly 1 year since I last posted. I’ve returned today because my Gracie has started circling/pacing non stop. I had to confine her to a small hallway with a comforter to prevent her from injury herself. I know this is a macroadenoma increasing in size. She started having small head tremors last year that we couldn’t really decide if it was due to the pituitary tumor or her prednisone dose. She had an Addisonian crisis shortly after her treatment with Vetoryl and was left permanently Addisons.

I plan to increase her dose of prednisone in hopes the circling will decrease. I plan to talk to both her vets about other possible neurological medications. She’s had such a rough year....Cushing’s, Addisonian crisis, Addisons along with kidney disease, perianal adenocarcinoma and surgery, and now major neurological signs from her macroadenoma.

Betty

[Joan2517]

I'm sorry that Gracie is having such a tough time, Betty. I hope the increase in Pred gives her some relief.

[Squirt's Mom]

Hi Betty,

Good to hear from you again but so sorry for the reasons. I want to offer a couple of other things to consider - vestibular disease which causes our pups to circle like you describe and dementia which can also present with this sign...tho with dementia we usually see other things like getting stuck behind doors or furniture, going to the wrong side of the door to go out and so on. My itty bitty man, Brick, developed vestibular, which common in older dogs and in fact referred to as "old dog disease", and he circled constantly to the left. He couldn't get anywhere he wanted to go due to the circling. His vet gave him some meds and for the life of me I can't remember what right now but they did help a little bit. What helps most with vestibular however is simply time. It DOES get better with time for most pups. Here is a link about vestibular disease - https://vcahospitals.com/know-your-pet/vestibular-disease-in-dogs

I just did a search for Brick and his vestibular on this site and found where Doc started with an injection of Dexamethasone, hoping it was inflammation in the ears, which didn't help so then Doc gave him Vetalog and 2 days later he was doing a bit better. It took a couple of months for him to return to an almost normal state for him - BUT Brick had hydrocephalus so his progress may well have been slowed by that condition and a dog without hydrocephalus would get better much quicker. ;) You can read about his vestibular journey at this link, starting with a post toward the bottom, Page 18, post #176 (#'s found in the upper right hand corner of posts) - http://www.k9cushings.com/forum/showthread.php?3151-It-s-a-boy!!!!!!-Brick-has-crossed-The-Bridge
(Fair warning...Brick passed away not long after the post in Ap where I say he is doing better with the vestibular so don't read further unless you just want to. :( I miss him so. :( )

Hugs,
Leslie

[Gracie123]

Leslie,

Thank you so much for the information. Gracie does circle just to the right. She has gotten stuck in the corners of the house and can't always figure out how to get out. I didn't think it could be vestibular because she doesn't have a head tilt or nystagmus. She has been walking with her right side against walls to help her not circle right, so she's adapted quite quickly. I would love for it to be just a vestibular problem that will resolve on its own.

Betty

[molly muffin]

I'm not really familiar personally with vetibular but we have had a lot of dogs on here that have had it, so I wouldn't rule it out necessarily. I know we would all rather it be vetibular than a macro tumor.

Does she still eat okay? Is she able to put her head down? Does she do head pressing? Those are all things that can be show up with a macro.

[Gracie123]

She only circles to the right. No head pressing, and no walking with her head down. She does have a decreased appetite, but she also has kidney disease. I spoke to both her regular vet and internal med vet, and both agree it’s the brain tumor. I have increased her prednisone with no improvement. Her IM vet stated I could increase the prednisone significantly, but she has already started with the panting. If there is not improvement over the weekend, we start Kepra on Monday.

[Gracie123]

I have now increased Gracie’s prednisone to 4mg daily with no improvements on her spinning. I’ll up it to 5mg tomorrow and then start Kepra on Mon. Her IM vet told me we could go as high as 5 mg twice a day. 10mg a day just makes me very anxious.

[Gracie123]

I think we’re going to decrease her prednisone. Gracie is on 4mg for the second day and has been panting the entire day. She has also been restless all day with no improvements in her spinning. I am so hoping the Keppra she starts tomorrow will help. Luckily, she is still eating. Otherwise, we would have to consider that big decision.

[Squirt's Mom]

Let us know how the Keppra works for her. I am so hoping it helps her regain some of her former self.

Hugs,
Leslie

[Gracie123]

Gracie received her first dose of Keppra this after noon after I reduced her prednisone from 4mg to 2mg. Her IM vet stated the Keppra would take 5-7 days to take effect. I don’t know if it’s the reduction in pred or the Keppra, but she is no longer panting and pacing because she can barely stand up. I’m hoping her legs are just exhausted from pacing/spinning nonstop for the last 48 hours.

[molly muffin]

Oh poor baby. I really hope the keppra helps her. I can see being exhausted. :(

[Bluester]

I hope Gracie is doing and feeling better.

Laura

[Gracie123]

Thank you! Gracie is still very lethargic, but she actually started walking in a straight line occasionally. I made the mistake of going on the brain mass FB forum where the admin insisted I go see a neurologist and consider cyberknife/SRS. She also was aggressive about Gracie being prescribed Keppra. She insisted that Gracie should NOT be on Keppra because she doesn’t have seizures. It really questioned my decisions on Gracie’s treatment.

I’m going to keep Gracie on the Keppra because it does seem to be decreasing her spinning. I’m hoping the lethargy is temporary. We have an appointment with a holistic vet tomorrow to see if there is anything else we can do to improve Gracie’s comfort.

[molly muffin]

Facebook has some not so great groups and some very good groups. I think Darrel pointed you to another group that is much better on Facebook.
At 15 and all Gracie has been through, if the Keppra helps then that is a good call. There are only so many options out there to help with neurological symptoms, whatever the cause may be, so worth it, and Gracie's experience and treatment may help others who encounter the same thing.
she looks like such a sweetheart.

[Gracie123]

I didn’t know you were on the same Cushings FB group!��. Yes, Jill Bruno has been very kind and supportive during this period. Gracie and I saw the holistic vet today for some ozone treatment and Chinese herbs. She seems to be acclimating to the Keppra and isn’t as lethargic. We did go from 1 mg to 4 mg then back down to 2 mg of prednisone daily. She’s zonked from the Keppra the first 3-4 hours, then she’s wired from the prednisone. The holistic vet sugggests I just go backback down to her usual prednisone dose of 1 mg, so she doesn’t wake up in the middle of the night wired and wanting to stumble through the house.

So for now....1mg prednisone daily, Keppra 3x a day, Chinese herb tablet daily, and ozone therapy 1x a week.

[molly muffin]

I'm there but I spend most of my free time here on the forum. Yes, Jill and all the admins there are very knowledgeable and helpful. We have to cover all basis when it comes to cushing. :)

Let us know how she is doing on this dosage.

[Gracie123]

Day 5 on Keppra.... Gracie sleeps most of the time and has lost control of her hind legs many times. On occasion, she seems to snap back to normal. I have a feeling she may be spitting out her pill at times. I called her IM vet who stated that the lethargy can be increased in dogs with brain tumors, although it does take 5-7 days for the dog to acclimate to the Keppra. I think we will decrease her Keppra to 1/2 tab 3x a day, so her hind legs do not suffer more.

[Squirt's Mom]

My Trinket had pneumonia that we just could not get under control. Come to find out the little stinker was spitting the pills out! I found 7 one day so we finally knew why she wasn't getting better. She'd eat the wrap from around the pill then spit the pill out when she had all the good stuff off. LOL I found them in her spots like under the end table and between the mattress and wall where she slept on the bed. :D

I hope Gracie adjusts to the meds and you see some improvements soon,.
Hugs,
Leslie

[molly muffin]

How is Gracie doing now? Any improvement?

[Gracie123]

Hi! Gracie is doing ok. Her appetite is worse, so we have started trying Entyce. There are days she will sleep for over 12 hours and then wake up alert and hungry. Cutting the Keppra was a good decision. When she was on her full dose, she was lethargic the entire day. She is also still on 1.5 mg pred, Tramadol, Prilosec, and Chinese herbs. We went in for the second round of ozone therapy today. Not really sure what to expect from the alternative medicine. She still spins/circles, but not quite as bad. Hoping she continues to stay strong...

[Squirt's Mom]

Glad to hear she is doing a bit better with the lower dose! I hope she continues this trend and find a higher level of "normal" function where she can plateau and enjoy her life! And you as well! ;)

[Gracie123]

Well, Gracie developed pancreatitis a week ago. She had become pretty picky at eating, so when my husband found out she liked pizza crust....

Luckily she was only really ill for 48 hours. I took her off the Keppra, since the pancreatitis along with the Tramadol and gabapentin made her extremely lethargic. As she started to recover from the pancreatitis, we noticed her spinning had stopped. Maybe it was just vetebral or temporary inflammation, I thought?

Alas, we were not that lucky. Almost a week since we stopped the Keppra, she is slowly starting to pant and spin again. So, we are on year 2 of keeping this little girl alive. All the hiding of medications for Addisons, kidney disease, brain tumor, and arthritis....in treats hoping she doesn’t spit them out, making multiple bowls of food she won’t touch, sub q fluids that sometimes goes smoothly, waking up 3-4 times at night when she needs to go outside to urinate or pace. Some days I feel like I’m torchering her.....

[molly muffin]

Oh I'm so sorry. Poor little girl, she has had a right time of it. So, she stopped spinning for a bit, then started again?
It's really hard trying to find that fine line when there are multiple things going on. We just do our best for them. It's all we can do.

I'm sorry that as she got better from the pancreatis that the other things came back too. That is frustrating. :(

[Gracie123]

We lost our Gracie last night. She started refusing food a few days ago and became very lethargic. I took into the regular vet and found that she had skyrocketing kidney values. We attempted 4 days of IV fluids and antibiotics with no improvement. I brought her home and planned to have her let go today in our home. She went from not eating and acting lethargic to not being able to stand by the time she came home. We ended up taking her back to the ER because she was in so much pain from kidney failure. How did she go from stage 2 KD to end stage complete failure in 5 weeks, I’ll never know. Was it the added neuro meds for her brain tumor? Was it all the little Addisons crashes?

She was so sick these last few months. I do hope it’s true that continue on to an afterlife free of pain and suffering. Thank you for all your support.

Betty

[Joan2517]

I am so sorry, Betty. Poor little Gracie is at peace and pain-free now. Many, many hugs to you and your family.

[labblab]

Oh Betty, I’m so sorry, too. You’ve all been through so much together, and I know how hard you worked to keep Gracie as healthy and happy as you possibly could. She was a lucky little girl to be loved so dearly. You were so lucky, too, to share your life with such a sweetheart, and I know you will miss her terribly. We hope it may bring you a bit of comfort to know that Gracie will always be honored here on our special memorial thread:

http://www.k9cushings.com/forum/showthread.php?8846-Remembering-All-Who-Have-Left-Us-(2018)

I will be contacting you soon to see whether it would please you to also include a photo link to Gracie’s line. In the meantime, please know my thoughts and my heart are with you.

Marianne

[Squirt's Mom]

Dear Betty,

I am so sorry about Gracie. We are never ready for that day, especially when we have fought as hard as you and Gracie fought. I know Gracie left this life on the wings of your love and devotion to her, filled with gratitude to be saved from pain and suffering thru that love. Please know we understand how you feel and we are here anytime you need to talk, cry, vent...whatever, we are here.

My deepest sympathy,
Leslie



I'm Still Here

Friend, please don't mourn for me
I'm still here, though you don't see.
I'm right by your side each night and day
and within your heart I long to stay.

My body is gone but I'm always near.
I'm everything you feel, see or hear.
My spirit is free, but I'll never depart
as long as you keep me alive in your heart.

I'll never wander out of your sight-
I'm the brightest star on a summer night.
I'll never be beyond your reach-
I'm the warm moist sand when you're at the beach.

I'm the colorful leaves when fall comes around
and the pure white snow that blankets the ground.
I'm the beautiful flowers of which you're so fond,
The clear cool water in a quiet pond.

I'm the first bright blossom you'll see in the spring,
The first warm raindrop that April will bring.
I'm the first ray of light when the sun starts to shine,
and you'll see that the face in the moon is mine.

When you start thinking there's no one to love you,
you can talk to me through the Lord above you.
I'll whisper my answer through the leaves on the trees,
and you'll feel my presence in the soft summer breeze.

I'm the hot salty tears that flow when you weep
and the beautiful dreams that come while you sleep.
I'm the smile you see on a baby's face.
Just look for me, friend, I'm everyplace!

Author Unknown

[Gracie123]

Thank you so much! That would be so sweet! Gracie was rescued 12/24/2002 and passed 04/11/2018 from complete kidney failure.:(We lost her beagle sister, Nicki, this past Christmas Eve from a liver tumor. Both were 15 years and 3 months went they left us. The house has been uncomfortably quiet. I spent the last 20 years with my beagle babies with the last 3 years tending to their illnesses. I am trying, with difficulty, to adapt to our new normal.

Betty

[Harley PoMMom]

I am so sorry for your loss and you are in my thoughts and prayers.

With Heartfelt Sympathy, Lori

[molly muffin]

Oh no, I've been away from the forum and just now seeing that you lost your precious Gracie. I am so very sorry. :(

Kidney failure is what we lost our molly from also. :(

My sincerest condolences.