Sweet Daisy has passed - Iatrogenic Cushings/Calcinosis Cutis/Liver Blood Clot

[Crazy Daisy]

Hi! Wow I don't even know where to start with my beagle Daisy's medical history. She's about 11 years old now and we adopted her with her buddy Rocky when they were around 2. We lost Rocky when he was 7.5yrs to osteosarcoma of the spleen (after surgery and chemo) so we're no stranger to weird things. But up until recently I had never heard of iatrogenic cushings. Anyway... here we go and sorry this is so long... really long!

When we got Daisy we immediately noticed she had weird problems. She would be fine one minute and the next she would suddenly and frantically be licking anything and everything, eating fuzz and anything else she could get her mouth on, and doing this exaggerated gulping. She would go on and on like this and then start throwing up white foamy mucus. If I let her outside she would gorge on grass and sometimes throw it up and sometimes not. She was our very first dog when my hubby and I got married and we had no idea what was going on. We took her to vet after vet and even a specialist in Jacksonville, FL. No one knew what was wrong with her, the only thing we discovered was that a drug called Temaril P (prednisone + an antihistamine) stopped her episodes completely. Since it was prednisone the vets didn't want to keep her on it, but every time we would wean her off the episodes would start again. And they lasted hours!

Fast forward a year or so and we had moved not too far from Pensacola, FL and found a new vet. He sent us to Auburn University and they couldn't figure it out either after tons of testing. We decided with our vet, despite risk for possible side effects later on in life, and for her quality of life, we would keep her on the Temaril P, but found we could get by with half a pill to one pill a day (1-2mg of prednisone). She did great on that dosage.

Fast forward a few more years and we moved again (locally this time). Her face exploded into lesions. They were symmetrical on either side of her face and head and would bleed, scab, then bleed again. Our vet took biopsies and sent them to Auburn for review. Even Auburn pathology was confused about the results they were seeing. At first it looked like cancer then autoimmune disease. Then suddenly her lesions started going away without any additional treatment. Auburn came to the conclusion it was an autoimmune reaction to something at the new house but we didn't know what. The next year, it happened again at the same time but not as severe... and again the next year until it stopped altogether.

Fast forward to 2012. We found out she had a tumor on her spleen, which we had never even heard of. We had her spleen removed and thank goodness it was benign. It wasn't the last time we would deal with spleen tumors but that's another story.

Fast forward to 2013 Daisy suddenly became very ill. Ultrasound showed something wrong in her intestines so off to Auburn we went. Unfortunately the location was not in an area they could get to via endoscopy or colonoscopy. The only option was exploratory, which our vet did. Turned out she had an intestinal adhesion that occurred when her intestine adhered to the abdominal wall during her healing from her splenectomy. Our vet fixed that and decided while he was in there to biopsy her stomach and intestines to see if we could figure out her long time gulping/vomiting issue. Auburn came back and said she has inflammatory bowel disease! We finally had an answer! Unfortunately the standard initial treatment almost killed her. We had already tried hypoallergenic foods and other food trials to no avail. We decided to continue the low dose steroid as she did so well on it.

Fast forward a couple of months and I found a lump under her leg. It turned out to be a fibrosarcoma but our vet was able to remove it with good margins and she's had no further issues with that.

Fast forward to late 2015/early 2016. We noticed Daisy's coat getting worse (it had always been kinda crummy). Then she suddenly started losing weight rapidly. Our vet couldn't figure out why she had the weight loss but we thought we might lose her if it kept up. We had her on calorie supplements and increased her food (which she had no issues eating). Then as suddenly as it started, it stopped and she gained her weight back. She then had an episode of sudden loss of balance/weakness. It was a weekend so we had to get her into another vet who couldn't figure it out. She was fine by the next day and it hasn't happened since.

With the skin issues our vet was concerned about cushings. He was lost as to what to do next for her IBD which we needed to get a handle on in order to remove the steroid and reduce risk of cushings. We saw a different local vet who supposedly had more experience with IBD. He did a urine test on Daisy for cushings which was negative but found out her thyroid was low. So in summer of 2016 we started her on thyroid meds.

Then in October or November her skin started looking infected. We took her in and saw one of the other vets in our vets practice and they said skin infection. We started antibiotics but two weeks later it was worse. We switched to a different one and a week later... worse. We got in to see our regular vet and he said... this looks like calcinosis cutis. We checked her liver enzymes and they were elevated. Interestingly enough we plotted her numerous previous blood panels and it started spiking immediately after we put her on thyroid meds. Anyway, he ran an ACTH test and her values were non existent both before and after. He was completely confused and referred us to an IMS in Tallahassee who specializes in inflammatory gastric issues, etc.

Ok! Sorry again it's so long! So last Tuesday we had our appointment with Dr. Morales at Capital Veterinary Specialists in Tallahassee. She evaluated Daisy and reviewed all her records and her ever climbing liver enzymes even AFTER being on denamarin for more than a month (I think it was her ALT that was at 2500 by that point). She was extremely concerned about her liver and her skin. We talked about A LOT of possibilities, but she said the best thing was to biopsy the skin and aspirate the liver to try and get some quick initial answers.

Results: Definitely calcinosis cutis and iatrogenic cushings, no sign of cancer on skin or in the liver, possible early stage liver infection, no sign of toxins in the liver.

Initial recommended treatment: Start trying to reduce Temaril P SLOWLY. Switch to canned food (to try and reduce any risk of aflatoxin exposure - precaution); continue Denamarin and add Vitamin E; Reduce thyroid meds by half to try and decrease her metabolism which Dr. M said could be why she suddenly started having issues at that time; Start using DMSO on her skin to try and get the lesions reduced; Receive an antibiotic shot. Recheck her liver enzymes in 10 days and also check her calcium levels. This is Plan A to try and get her liver enzymes down. We will be talking with her more in the next week or so.

Oh my gosh that was longer than I thought... but I felt like Daisy's history plays so much into her health issues now. I had talked to Judy (who's on here) about all this prior to seeing the IMS so I was somewhat prepared for the diagnosis and that really wasn't a shock. I guess I just don't know what to expect now. And the DMSO stuff has me a little worried. I'm told you have to wear gloves and they don't recommend handling the areas of the dog you put it for 2 hours after! We also have four other dogs that sometimes tend to groom each... and we both work full time. So I'm trying to figure out the best time to apply it. Dr. M said we could put a shirt on her, but will that soak up the DMSO?

As a side note Daisy does not currently have a skin infection from her CC.

Any help, advice, or insight would be appreciated! Thank you guys for taking the time to read about my Daisy! My only saving grace in this (aside from both of us working and actually being able to afford all the vet bills) is that Daisy is such a happy girl. She's never stressed at the vet and actually runs inside to see everyone no matter which vet we go to.

Erin and my crazy Daisy
(When I figure out how to add a photo I'll do that lol)

[judymaggie]

Welcome to you and Daisy! :D I'm so glad you decided to post here in addition to Facebook so I get to greet you. There is absolutely no need to apologize for providing us with lots of details--we love them as it makes it so much easier to offer support.

In order to lead others to your story, I am going to take the liberty of amending the title of your thread to include a reference to CC (our short cut for calcinosis cutis). I am on my tablet now but, when I am on my computer later, I also want to provide you with the link to Renee's thread as she is our "in-house" expert. She is not a fan of DMSO so you can learn about other treatments she has tried.

Again, so glad you are here--this is a great family to be a part of even though we all wish we didn't have a reason to be here!

[Crazy Daisy]

Thanks Judy! I meant to go back and add the CC to the heading but couldn't figure out how. LOL

I'm looking forward to getting support here for my Daisy girl! Hopefully we can get her past this thing!

I think I saw Renee's thread but I didn't see anything about the DMSO. I'll go back and look.

[judymaggie]

Erin: I changed your title -- this is something that admin folks have to do for members.

I did a search for Renee's posts and found this one very applicable -- it addresses her thoughts about DMSO in cases of iatrogenic Cushing's:


We have had a few people that have prednisone induced cushings symptoms (iatragenic) which included CC. I am going to contradict my own advice in dealing with CC, and recommend you use DMSO in conjunction with getting your girl completely off steroids.

I'm not normally a proponent of DMSO, because in a traditional cushings dog, tight control over cortisol is what you really need, everything else is just arbitrary. In the case of iatragenic, you simply need to taper safely off the steroid and these issues reverse. I believe this distinction is why the use of DMSO may be more successful for iatragenic cases. I cannot remember the thread, but we had someone in your situation on this forum, and they had success using the DMSO while also eliminating the prednisone use. The DMSO is a solvent that works to break down and help dissolve the calcium crystals. It's nasty stuff though, be warned.

The CC lesions themselves do get worse before getting better, unfortunately. Don't be surprised if they bleed, look raw, and get very angry. As they steroids leave her body, they will eventually begin to dry out. If she's not on abx, get her a course of them. The lesions are highly susceptible to secondary infection when they are uncontrolled.

Here is the link to Renee's thread -- keep in mind that her dog does not have iatrogenic Cushing's:

http://www.k9cushings.com/forum/showthread.php?t=5908

[Crazy Daisy]

Thanks, Judy! We picked up the DMSO today but I haven't applied it yet. Daisy's back looks bad but it's not all bloody like it was since we cleared the infection up.

[Crazy Daisy]

I asked about using minocycline as there is some research showing it can help in CC treatment plans, but Dr M is concerned it could affect her liver which would be bad right now.

[Crazy Daisy]

Also... the DMSO jar says it's a solvent??? And any idea why it's nasty?

[judymaggie]

Erin -- I'm sure you have been doing research on CC and may have come across this forum but am providing you with link just in case -- it has some good first person feedback about DMSO/CC:

http://www.secondchanceaihadogs.com/forums/topic/bad-case-of-calcinosis-cutis/

[BrittanyandJJ]

HI There!
Im so sorry to hear about Daisy and her extensive vet experiences! My baby has been through many vets as well and it is hard to watch our little ones suffer. JJ's liver enzymes are also elevated and he is also suffering both Cushings and CC. Let's see. I started JJ on Trilostaine a month ago to start treating the Cushings even though his liver enzymes have been elevated for a couple of years, I have repeatedly asked vets if this is a problem but none of them seem overly concerned with it... I am going to pose the question to the specialist I am seeing when I speak with him next. JJ's CC has started to clear a bit in my opinion although it is still prominently there it is no longer bleeding. To help prevent infection I fill a tub with warm water weekly and bathe JJ with a medicated shampoo called KetoHex. I put a bit of it in the water too and have JJ soak in the water as long as he will allow it. While he is in the tub I gently ladle the water over his body and use a cotton ball on his head both to Shampoo and rinse it gently. The day after the baths I see a bit of relieve on his end. Also, at the first sign of possible infection I start JJ on oral antibiotics as well as a probiotic treat called VetriScience Probiotic to try and offset the antibiotic effect on his natural flora. Upcoming JJ has an appointment with a dermatologist to address the CC and I will let you know if I learn anything that may be useful to you.

Best Wishes to you and Daisy!
Brittany and JJ

[Harley PoMMom]

Hi Erin,

A belated welcome to you and Daisy and thank you so much for your detailed post as this can help us to provide meaningful feedback. OMGoodness your sweet girl has been through so much and I can see why the veterinarians are puzzled with her case and I can only imagine how worried and frustrated you must be. You mentioned in your post that the standard initial treatment for the IBD almost killed her, could you elaborate more about this treatment for me? Thanks!

Regarding her diet having one formulated for her could be an option, I did this for one of my Poms because he had multiple health issues.

Corticosteroids like prednisone will elevate liver enzymes especially the ALP, could you tell us exactly which liver enzyme/s are high?

I apologize that this post is so short, unfortunately I am at work, but I will try to get back later.

I am so sorry for the circumstances that brought you to us but so glad to have you here and please know we will help in any way we can.

Hugs, Lori

[Crazy Daisy]

Brittany - I'm so sorry you're dealing with this too! Is JJ on any supplements for liver support? The vet hasn't said anything about medicated shampoo but I've been keeping a close eye on her skin looking for any signs of infection. I've got Skin Soother from the natural dog company which I really like for small cuts, etc. but I haven't really tried it on her CC. I was planning to ask the IMS about a probiotic for Daisy. In the past it hasn't seemed to help her much but I've heard amazing things about VSL. With her IBD I always worry about giving her additional stuff since I don't really know what triggers it. We've never been able to figure it out. It's so hard to watch them struggle that's for sure!

Lori - I'm so tired, as I'm sure many people here are! I feel like it's a few steps forward and then five steps back. I'm always holding my breath waiting to find out what's wrong next time. So prior to Daisy's official IBD diagnosis we tried all kinds of different foods. Novel proteins, hypoallergenic, etc. and nothing worked. Typical initial treatment of diagnosed IBD is high dose steroid to try and calm the inflammation then tapering off and at the same time adding probiotics, special diet, Tylan powder, etc. When we put Daisy on the high dose steroid, I want to say it was 20mg a day (she's 17lb) or something like that and within a couple of days she crashed and I really thought we would lose her. The vet was so concerned he immediately stopped her steroids cold turkey and told me she just couldn't handle the high dose. I feel like at that point we were all at a loss. We had tried the things Auburn University had suggested and they didn't work so we just went back to the low dose steroid on a daily basis.

When I talked to the IMS about her IBD and explained all her history, she didn't seem to think it would a food related/triggered problem so we kind of put food on the back burner for the moment. Well aside from switching her to canned food to reduce risk of aflatoxins, even though her liver aspirate was negative for that. I guess just a precaution.

Her liver enzymes didn't go up until after she started her thyroid meds which the IMS said is probably because the meds increased her metabolism. I'm going to post a photo of her last bloodwork results in her album so you can see it there. ALT, ALKP, GGT are all elevated significantly.

Thank you all for replying, it's so hard dealing with this but helps to know that I'm not alone.

http://www.k9cushings.com/forum/album.php?albumid=1150

[molly muffin]

Hello and welcome from me too.

In the end, the answer will be to try and wean her off the steroid completely, however, to do that, you have to find a food that she will tolerate with the IBD.
Lori's suggestion of a diet formulated for her could be a good answer and they should have a dietician at the university. First I'm thinking would be to discover if there is a novel protein that works for her. Like rabbit, etc.

You can't just take her off the steroid, she has been on so long, but would have to be under a vet supervision.

The next thing I want to say, is that cc gets worse before it gets better. The cc is basically calicium deposits that push up through the skin. This causes the sores and any that are there now, need to come up and push through. clipping the hair around the sore might help to prevent bacterial infections of the sores.

The really hard thing is going to be working on getting the IBD controlled so the steroid isn't needed and then the weaning off. I expect that to take a long time, and she has been on even the low dose long enough that you want to make sure that the adrenal glands are working alright and producing the right amount of cortisol.

You have already been through so much with your precious girl. I'm hoping that the vets can get you started on finding the best diet for her and then reducing the steroid.

We'll be here too so you do have support. Judy is great isn't she and very smart and knowledgeable. :)

[Crazy Daisy]

We are now seeing a vet in Tallahassee who specializes in inflammatory type gastro illnesses. She wasn't convinced that her IBD stems from a food intolerance but of course we aren't 100% sure. We've just never had relief from previous diets. We are slowly trying to reduce steroid because of the cushings and CC symptoms but now of course she's exhibiting her IBD symptoms. I emailed the IMS last night and she wants to start her on inhaled budesonide. I will say I don't think her skin has gotten worse over the last week so that's good I guess.

[judymaggie]

Erin -- just read a bit about budesonide as I had not heard of it before. From what I have read, it sounds like it might not have the side effects of more traditional steroids. Hopefully, that includes causing iatrogenic Cushing's and its symptoms. Will keep fingers crossed!

[Crazy Daisy]

Right. Budesonide is used in dogs with IBD who can't handle the prednisone. It's more local and in studies according to the IMS it hasn't caused cushings.

[labblab]

Hello Erin, and a very belated greeting to you and Daisy! Gosh, just like the others, I am taken aback by all the adversity that your brave little girl has weathered. She sounds like a sweetheart, and kudos to you and your husband for doing a wonderful job of advocating for her and obtaining the best veterinary care possible.

I surely wish I had a brilliant suggestion to add, but my own knowledge of IBD pales in comparison to the expert veterinary advice you are receiving. Also, I have not had to personally deal with CC, so I lack a lot of concrete suggestions in that regard, as well. However, as you are discovering, we do have other members with first-hand CC experience, so I hope you will continue to receive feedback from them as your journey continues.

Even though I don't have treatment suggestions to offer right now, I still want you to know how happy we are you've joined us. If nothing else, we can always be a soundboard for you as you consider the options that are presented to you. Also, Daisy's experience can be very helpful and instructive to others who may end up sharing similar issues. For instance, I've just now learned about budesonide from you guys! Like Judy, I was unfamiliar with it, but now we may be able to suggest it to other folks in the future. For the benefit of our other members, here's a link that tells more about the medication's potential value in treating dogs with IBD:

http://www.cliniciansbrief.com/article/budesonide-ibd

So once again, I'm so glad you girls are here, and please do keep us updated re: Daisy's progress.

Marianne

[Crazy Daisy]

Thanks Marianne! It's so nice to have support from people who have experience with this disease and others as well!

Good news is that Daisy's bloodwork yesterday finally has shown some improvement in her liver enzymes. I believe her ALT dropped from about 2500 to 1400. It's still super high but this is the first improvement we've seen in several months so I'm excited!

We are currently trying to get the liquid budesonide to try in the nebulizer to try. Fortunately our vet is letting us borrow one of theirs so I don't have to buy one in case it doesn't work. The meds are so expensive so I have mixed feelings about it. :( we are going to give it a shot just to see, we should know in about a week if it's helping her IBD symptoms. The IMS really doesn't want to start increasing the pred because of the cushings symptoms so here's praying the budesonide or one of the other drugs we can try works!

I'm learning so much as I go along and from others! I did find some roll on DMSO for those that use it. It's easier to apply and you don't have to stick your hands (gloved) down in the gel. The IMS said it was ok to use.

[labblab]

That's great news about Daisy's ALT! Even though it's still high, that's really a dramatic decrease! YAY!! :) :) :)

Yeah, I saw that budesonide was described as being quite expensive :(. For what it's worth, when I Googled it earlier, I saw a blurb about it on the website of a very reputable internet compounding pharmacy that many of our members use for their Cushing's meds: Diamondback Drugs in AZ. Don't know where you're getting the budesonide right now, but if it does prove to be helpful for Daisy, Diamondback generally has very competitive pricing and excellent customer service. I also see that they'll prepare the budesonide in many specialized forms: "[We offer] customized formulation of this medication through a qualified veterinary compounding pharmacy in dosage forms such as capsule, tablet, oral suspension, or transdermal gel."

That's also super interesting news about the roll-on DMSO. Can you tell us more about where you found it? That may be a great help to other folks who are wary about using DMSO because of the awkwardness of applying it.

[Crazy Daisy]

Thanks! I'll definitely check out the diamondback thing if we need this regularly!

I bought the roll on dmso from online at Jeffers pet supply. It's the only place I could find it. I do still wear gloves though just to be safe :)

[lulusmom]

Hi Erin and a belated welcome to you and Daisy.

I've actually followed your posts on the fb group and I apologize for being late to the k9c party. :) I am super glad that Judy invited you here and just between you and me, I believe she led you to the very best canine cushing's support group on the web.

Now for that sweet girl of yours who has not had an easy time of things, the one thing that got my attention on the labs you posted is the ALT which is very, very high. I'm glad it has come down but wow, there is still a whole lot of room for improvement. Did the IMS mention that this is most likely due to active IBD and/or possible secondary infection of Daisy's CC? I'm curious because I've never seen prednisone alone push that enzyme up that high.

CC can be a nightmare to gain the upper hand on and quite frankly, I'm not really quite sure if resolution of CC caused by iatrogenic cushing's is much the same as naturally occurring cushing's. I would think so but your IMS would probably be a good source to ask. If you could share that information with us, it would certainly be helpful for future reference for future members who may find themselves in your shoes. I've seen plenty of dogs with CC caused by naturally occurring cushing's and I can tell you that resolution in most cases is not quick and it usually gets worse before it gets better. I can also tell you that in my experience, there is no silver bullet treatment that is effective for all dogs. We've seen good reports and bad reports on DMSO. Minocycline treatment is relatively new to me for treatment of CC so I'm unable to draw any conclusion as to it's efficacy with member dogs. I have attached a study in pdf format entitled "Minocycline as a treatment of dog with calcinosis cutis" which you may find helpful.

I've also included a link below to one of our threads where multiple members discussed their pups' respective issues. You may have already found this thread in your searches through our forums but if not, take a look in case you run across something enlightening. The thread is dated and some of the members are no longer active but I don't think there have been any breakthroughs in any miraculous treatments since then so any information you glean from it should still be current.

http://www.k9cushings.com/forum/showthread.php?t=6093

928

I hope this helps and I look forward to your updates.

Glynda

[Crazy Daisy]

Thanks glynda! I'm glad Judy told me about it too. 😊

So the liver enzymes. The ims checked her for severall liver issues outside of the cushings and ibd but they were negative. The weird thing was that she's been on pred for years with nice liver problems and she's had ibd for years. The ims thinks that when she started the thyroid meds her metabolism increased and she became sensitive to the meds and possibly the ibd as well in relation to the liver. I'm just glad they've come down at least a little. We will consider a full biopsy tho if we can't get them down more.

As far as the Cc. We are using the DMSO now. I asked her about the minocycline but she is concerned about the affect it could have on her liver so we are holding off. The cc from iatrogenic cushings is basically curable if you can bet them off the steroid meds but it can take a while to heal. Fortunately her skin is no longer infected and it doesn't appear to be getting worse.

We did her first inhaled budesonide treatment tonight. If she doesn't have any ibd episodes in the next week we will drop her steroid another 1/4 pill per day. We are going super slow lowering her dose. She did great with the nebulizer so that's Good at least. Lol

Thanks for the links :)

[molly muffin]

Going slow in lower the pred dose is really important as their bodies have to adjust to the lower steroid levels. People have the same issues with it after taking it for awhile.

I do hope the budesonide helps her long term. It can take a bit for liver enzymes to come down, so as long as you see if trending downwards, I would think you are on the right track.

[Crazy Daisy]

Thanks sharlene! It's been several months of climbing enzymes so I was thrilled to see any decrease :) im really hoping that the budesonide helps too!

[BrittanyandJJ]

Hi There!
JJ had a dermatology appointment yesterday and some good came of it. The CC should clear when I get the cortisol under control (which I knew). In the interim JJ was prescribed a topical medicine called Douxo for the lesions. This is supposed to soften the skin around the calcium so that it is less inflamed. Since applying it just twice so far I can see that the lesions are less red and angry! Also, since JJ had bloody spots last month it was suspected that he may have surplus mites. This happens often with CC because of the immune system being impaired. It was discovered through a hair plucking test that he had a few adult Demodex mites and thus was prescribed a monthly oral med (for fleas and ticks as well) called Simparica. If Daisy has bloody patches I would suggest this simple test as the CC itself should not cause bloody patches and the clumping hair loss... come to find out that was due to the mites! :-) Dermatologist seemed very insightful and the 2 things he prescribed are easy to apply and not overly expensive.

Sidenote that I have used 2 different compounding pharmacies in AZ Diamondback and RoadRunner Pharmacy. I was not displeased with Diamond back but I find I really like Roadrunner Pharmacy. They are very nice and they have a website I can refill prescriptions from etc. Check it out. :-)

Oh, and yes JJ takes a liver supplement called "Liver Happy" :-)

[labblab]

Hey Brittany, I believe Douxo is just the name of the manufacturer -- can you tell us exactly what else is on the label of the topical? Douxo makes lots and lots of different products, including a wonderful chlorhexadine shampoo that I use on my nonCushpup who has suffered from recurrent staph infections on her skin. If the topical is helping JJ's lesions, we'd really like to know exactly which Douxo product it is. Thanks so much!

Marianne

[Crazy Daisy]

So glad jj is doing better! Fortunately daisy doesn't really have any angry looking patches. Hers is just crusty looking. They checked for infection with the biopsy and didn't see anything. Our ims also discussed with the dermatologist there so I'm happy about that :)

[Crazy Daisy]

Also another friend mentioned roadrunner so I will check it out!

[lulusmom]

Erin, it sounds like your IMS is on top of things. I am very impressed that he consulted with a dermatologist and with you at the helm, I think Daisy has one heck of team on her side. Hopefully her ALT will continue to improve and that the CC does not progress. I'll be staying tuned for your updates.

Glynda

[BrittanyandJJ]

Labblab you are right.:-) Here is more info:

http://www.douxo.us/documents/DOUXO-SEBORRHOEA-SPOT-ON.pdf

[Crazy Daisy]

Glynda yes I really really like her. Her name is Dr. Morales and she's with capital veterinary specialists in Tallahassee. She also let's me email her directly and isn't against hearing my thoughts on my own research etc. I recommend her to anyone in that area. She's about 2.5hrs from us.

Thanks for the info about duoxo brittany!

[molly muffin]

One of the hugest battles it seems is in finding a good vet, who knows what they are doing and who is willing to work with you.
Kudo's on finding such a vet. That's all important and I personally think makes a huge difference in how the dog ends up doing.

[Crazy Daisy]

I'm so discouraged right now. We re-ran daisy's bloodwork on Tuesday and found that her liver enzymes are going back up again (they never were normal). Neither myself or my vet have been able to get a response from the IMS other than she's slammed right now at the hospital. I know she's busy but I feel like we're drowning and she could take 10 minutes to review daisy's bloodwork. It's not like it's easy for me to just make an appointment and go see her (she's a 2.5hr drive from me). In addition Daisy's thyroid levels are bottomed out (normal is 2.5-6 she's <0.5). She has zero energy and I'm having a hard time even getting her to eat, which is totally not like her. She used to be my food hound. She just sleeps and barely has any energy to even come see me. I know this can be from low thyroid but my vet isn't comfortable changing her meds without talking to the IMS. But we can't freaking get a hold of the IMS. I'm so heartbroken seeing my normally happy girl so sluggish and lethargic. I'm sitting here trying to avoid even feeding them dinner because I don't want to watch her turn her nose up at it. Anyway... just needed to vent...

[Whiskey's Mom]

Hi! just posting to say that I really feel for you. :( How frustrating And sad to wait and watch your poor sweet girl feeling so ill. My boy has high liver enzymes too and some days he's just not himself. Hope you get some answers soon. All the best,
Annie and Whiskey

[Crazy Daisy]

Thanks, Annie! May I ask how high your boy's enzymes are? What are you doing to try and get them to come down?

[judymaggie]

Erin -- how frustrating that you or your vet can't get a hold of the IMS! From what you describe, it does sound like Daisy might need a thyroid adjustment. I know you are worried about the liver enzymes, too. Hopefully, you will hear from the IMS soon.

[Whiskey's Mom]

I forgot to get copies of his latest blood work. I'm afraid to know actually. In August ALT was 125 (12-118)
All Phosphatase 920 (5-131). GGTP 34 (1-12)
He's on Hepato support and we just started daily Metronidazole because of more frequent bouts of diarrhea. I'm not really sure that he ever had Cushings, if he did he now has no symptoms and is no longer being treated. I stopped Vetoryl in the summer because he really wasn't himself at all and is much better without it. At least outwardly -But untreated Cushings could be the reason for the high liver values. He's 14 and doing pretty well so we're just keeping him happy and as healthy as we can without going to extremes. Whiskey is my lifeline and I didn't make any of these decisions lightly, believe me. We're just greatful for every day with him.

[molly muffin]

I'm more concerned about the low thyroid than the liver enzymes right now.

Is there another IMS your vet can call and fax the info too? Anywhere?

All the symptoms you are describing can be attributed to the thyroid being that low I'd think.

[Crazy Daisy]

Sharlene, I finally heard back from the ims last night. She was originally concerned with liver enzymes but in her email she did tell meit could be thyroid related. It's so hard to do this through email I think next week I'm going to see if I can have a phone consultation. She said we could bump her steroid back up but she doesn't really want to do that anday neither do I. I've asked her if the budesonide could have increased her liver enzymes but am waiting to hear back, it's not supposed to have systemic effects but who knows, I just feel if I talk to her versus email I'll get better results. My vet could call one of the ims vets at Auburn but they wouldn't have her whole history.

Daisy is also showing the classic pot belly now which I know can be associated with thyroid. Is it also a cushings symptoms? I was concerned it could be fluid retention from liver issues but our regular vet said her bloodwork didn't show protein is her blood which he said he usually sees with fluid retention. I know she's not blocked because she's pooping fine.

[labblab]

Oh gosh, Erin, how frustrating and upsetting for you! I'm confused, though... if the IMS agrees this could all be thyroid-related, is she not planning to address the thyroid?? Did she say anything at all about treating that?

Marianne

[Crazy Daisy]

Oh gosh, Erin, how frustrating and upsetting for you! I'm confused, though... if the IMS agrees this could all be thyroid-related, is she not planning to address the thyroid?? Did she say anything at all about treating that?

Marianne

Honestly I was pretty confused by her email. She did mention addressing the thyroid but didn't give me a recommended dosage. Daisy is already on thyroid meds but on a very low dose that clearly isn't enough. We originally reduced her dosage after our first visit with the IMS because she was concerned the increased metabolism could be exacerbating the liver issue and we wanted to reduce the enzymes as quickly as we could. Clearly though that isn't the problem so I'm assuming I can return her to her previous dose. It was pretty late when she emailed me and she said it had been a bad week so I don't know if she was just trying to send me some response vs. no response. Anyway, I emailed her to see if we could have a phone consultation next week. In the meantime I'm going to try and get a hold of my regular vet to see if I can just return her to her previous thyroid med dosage. It's all very confusing right now...

[labblab]

Yes, I agree. I think that's what I'd do, too -- get the OK from your regular vet to resume the original thyroid dosage. Try to hang in there, Erin. You are doing a great job of advocating for Daisy under very trying circumstances!

[Crazy Daisy]

Yes, I agree. I think that's what I'd do, too -- get the OK from your regular vet to resume the original thyroid dosage. Try to hang in there, Erin. You are doing a great job of advocating for Daisy under very trying circumstances!

Thanks! I was so frustrated last night... I appreciate all the support here!

[Crazy Daisy]

Yes, I agree. I think that's what I'd do, too -- get the OK from your regular vet to resume the original thyroid dosage. Try to hang in there, Erin. You are doing a great job of advocating for Daisy under very trying circumstances!

I received another email from IMS with more apologies and more info. She does want us to increase her thyroid meds to what we had her at before (which was sufficient for her T4 check to be normal).

She wants us to keep her steroid dose where it is and not increase it since we CAN get her to eat it's just not super easy all the time.

She also said we could try an antihistamine called Cyproheptadine. She said it can stimulate her appetite and can also help with pharyngitis.

And she said we can use the budesonide IF needed but it doesn't have to be used daily. This is to also help her IBD episodes if they happen.

My regular vet also called me (even though he's off today) and is going to call in her cypro prescription for me.

Phew! I'm feeling a lot better now that I'm getting responses from everyone.

[labblab]

I'm so glad you're finally get some responses! Keeping all fingers crossed that this combo of interventions will help sweet Daisy. It sounds like a good approach to me, so I really hope it will help.

Marianne

[Crazy Daisy]

So I haven't posted an update lately because I've been so exhausted. FYI this might be long! Daisy was NOT doing well recently. About a week and a half ago she got very lethargic, bloated looking, not wanting to eat. We've been back and forth at our vets office, via email with the IMS, and visiting the IMS a few hours away. This past Tuesday we had an appointment with the IMS because Monday our regular vet did bloodwork and an ultrasound (Daisy had been looking super bloated) and her albumin came up at 1.9 and her bilirubin at 1.1 and she had fluid in her abdomen. Our vet and the IMS were super concerned so off we went on Tuesday! At the IMS they did more bloodwork, another ultrasound, Protein C check, and Protein check in her urine.

On a good note, the IMS said her CC looked 50% better! And her ALT was "down" to 770 (previously it had been over 2000). Her ALP had come down some to, the 2000's (previously in the 3000's). Her ALB had also improved to the normal range along with her bilirubin. She DID have low protein fluid in her abdomen, but the IMS didn't see anything wrong with her heart. Her thoughts are liver related which makes sense. We got the Protein C results back and it was low normal at 70%. Urine results indicated no loss of protein through her kidneys so that's good.

Basically the IMS thinks she threw a clot to the portal vein of her liver. She said with the steroids, low thyroid, that it was a perfect storm for a clot. She didn't SEE a clot on the ultrasound though and with the improvement in her bloodwork the IMS was hopeful that she will be ok.

We've started her on reglan to help move things along with her tummy in case that's contributing to the bloating (and of course she has IBD). She still isn't completely herself. We've had to switch her food because she is now refusing to eat her duck zignature (NOT like her). The IMS thinks that because some of the meds she was on (Budesoide and DMSO) can cause weird tastes in the mouth, that she's associated the food with that. We've gotten her the Kangaroo and she seems very interested so hopefully she's on the upswing.

She will start Clopidogrel (Plavix) tomorrow as a precaution until we can get her off the steroid. Apparently long term steroids make them prone to clotting!! I never knew this!! And low thyroid can also make them prone to clotting.

We've adjusted all her meds: removed the additional budesonide steroid, added cyproheptadine (antihistamine/appetite stimulant), increased her thyroxine, added reglan, will add clopidogrel and tomorrow we are supposed to cut back her steroid another quarter pill (leaves on a quarter a day).

She is definitely still not herself. She gets rechecked no later than Wednesday. They want to rerun the thyroid, bloodwork, and she also wants to "stem" her. I should have asked but I think that's the ACTH test??

Has anyone dealt with blood clots or removing a dog after being on long term steroids? We're doing it very slowly but I'm worried, what if her adrenal glands don't kick in?? How will we know? Will the ACTH test show that?

[labblab]

Hi again, Erin, and omigosh I'm so sorry for everything you've been through! However, I think the short answers to your questions are these. Yes, unfortunately we are aware that high levels of circulating steroids are associated with an increased risk of blood clots. That's another known complication of Cushing's. But I think the best approach is the one you are taking: continuing to try to lower the prednisone and placing Daisy on a blood thinner in the meantime.

The ACTH stimulation test is indeed the best diagnostic to assess adrenal function secondary to longterm steroid use. For dogs who need time to allow their adrenals to kick back in on their own, I think you just continue on with a carefully monitored pred tapering schedule until you do reach a point where the adrenals have rebounded normally. So don't give up hope, OK? And I'll be rooting for things to go more smoothly again!

Marianne

[Squirt's Mom]

Hi Erin,

I have merged the new thread you have started for Daisy concerning the CC and blood clot into her original thread. We like to keep all information about each pup in their own thread so all the history is one place - that makes it easier for us and you to look back and see the bigger picture. ;)

I also took the liberty of changing her thread title to reflect everything she is now dealing with. That will allow members who may be facing some of the same things to find her story and share theirs with you.

Hugs,
Leslie

[Crazy Daisy]

Thank you Leslie!

And thank you Marianne! I'm praying we can get her through this!

[judymaggie]

Ah, Erin ... just when you needed resolution of her already long list of issues, the list gets even longer! :( I don't have any suggestions re steroids and related blood clots but Abbie and I are sending big hugs to all of you!

[molly muffin]

Holy Cow! You guys are sure covering a ton of issues. Clotting. So they didn't see a clot, they suspect a clot?

Marianne is right on the mark, steroids have to be tapered down, slow and steady and make sure those adrenal glands are still working on their own.

Boy nothing is easy is it :(

[Crazy Daisy]

Sharlene, yes they suspect a clot based on her symptoms and what her bloodwork did... And also the meds she was on and her low thyroid.

Her attitude today is better overall along with her energy, but she still looks bloated, especially after she eats. She goes back Wednesday for more bloodwork etc.

[Crazy Daisy]

So I took Daisy back to the vet yesterday because she was sooo bloated and wouldn't eat. Turns out she was fairly constipated. The vet gave her an enema which helped with the bloated look, but she was still not herself when we got home. I got her to eat her dinner but she didn't really want to. And she kept going outside and straining to poop and then standing all hunched like her tummy hurt. She woke me around 2am to go outside and strain some more. Then she came in and just stood hunched and shaking. I finally got her settled and back to sleep. Then this morning she didn't even want to get up and wouldn't eat anything. She's back at the vet today because I want to make sure she's not getting dehydrated. I THINK what's going on is that she is having side effects from the Reglan. I've read abdominal pain, constipation, and lethargy can all be symptoms. Has anyone experienced this? She can't afford to lose any weight so I'm hoping we can get it figured out. I didn't give her the reglan this morning as it was hard enough to get her other pills in her. Below is what she's currently on:

1/4 Tablet Temaril P once a day (this has been what we've been reducing... it has prednisone in it)
1mg cyproheptadine twice a day
.1mg thyroxine twice a day
Medium Denamarin once a day
200IU Vitamin E every other day
18.75mg clopidogrel every other day
2.5mg Relgan (metoclopramide) twice a day

We've recently switched her from Zignature duck to Zignature Kangaroo to try and get her to eat, which she did for a few days.

I will say her CC looks soooo much better. I just wish I could get the rest figured out! I will post bloodwork results as soon as I get them, which should be today.

[Crazy Daisy]

Another update:

We got her bloodwork back. Below are some of her values:

Albumin: 2.3 (2.5 last week)
ALT: 945 (Last week was 770, previously was 2550)
ALP: 2286 (similar to how it's been lately)
GGTP: 63 (Down from 210)

Total Bilirubin: 0.3 (0.6 last week)
Creatinine: 0.3 (0.4 last week)
Calcium: 8.6
Post T4: <0.5 (<0.4 last week)

The IMS is doubling her thyroid meds and she will be getting an antibiotic shot due to some other high values on her bloodwork. She is no longer constipated but my regular vet thinks she may have some abdominal cramping or colitis. My poor girl! :( She is not feeling well at all.

[Harley PoMMom]

I'm sorry to hear that sweet Daisy is not feeling well. :( That's great news in the decreases in her lab values!

The hunched position she is displaying along with the inappetance can be symptoms of a pancreatitis attack, has she ever been checked for pancreatitis?

I've taken Reglan on a few.occasions and it did "bind" me up, that sure is an awful feeling :( I hope Daisy is feeling much better soon.

Hugs, Lori

[Crazy Daisy]

Both my regular vet and IMS have looked at the labs done yesterday and no one has mentioned possible pancreatitis. I will ask though! She is at the vet right now hanging out for the day. Would that show up in the labs?

[Harley PoMMom]

There are 2 tests that are used in identifying pancreatitis: the PrecisionPSL , which is from ANTECH® Diagnostics laboratories; the other test is carried by IDEXX Laboratories and is called the spec cPL.

I recommend either one in diagnosing pancreatitis, I'm more familiar with the spec cPL test because my Harley had pancreatitis. Pancreatitis does cause elevations in those liver enzyme levels ( ALP, ALT).

How is she doing at the vets?

Hugs, Lori

[Crazy Daisy]

Hey lorie. My hubby picked her up and our vet said he did a psl test and it was normal. He didn't seem to think it was pancreatitis. The ims thinks she may have an infection. She is resting quietly now and did eat her dinner.

The liver enzymes are linked to her iatrogenic cushings etc we are pretty sure.

Thanks for the info about the pancreatitis tests! I didn't know about them!

[Crazy Daisy]

So she was definitely better last night when she got home. She wasn't super interested in her food but they had fed her at the vet. And she did end up getting up and going to her food after she'd napped a little. But then this morning she again didn't want her food. I'm really starting to think it's something to do with one of her meds, specifically the Reglan. I could be wrong but I've emailed the IMS to see if we can stop it and see how she does. It was sooo nice last night to see my baby girl again if that makes sense. She was following me in the kitchen hoping I'd drop something, which she really hasn't been doing the last week or two. I wish it had carried over to this morning! It gives me hope that we can get this figured out though.

[Harley PoMMom]

Cyproheptadine is another drug that is used as an appetite stimulant.

[Crazy Daisy]

I came home today and she's still not herself. A little blood in her stool but the worst is half of her belly looks all red, almost bruised!! A couple weeks ago she had all these smallish round spots that looked like bruising but they went away in about a day. This is half her belly :( will see if I can upload a photo.

[molly muffin]

oh my gosh! I think getting her off the Reglan would be my next discussion
Looks like she is already on Cyproheptadine.
Being that constipated isn't good and lord knows what all is going on inside her.
Is her WBC elevated and making them think infection somewhere?
Can you call the vet and tell them about her belly being that red?

[Crazy Daisy]

Yes her WBC count was up and and she Got a convenia shot. My regular vet has seen it and isn't sure. I emailed the IMS but haven't heard back yet. With concurrence from the IMS this morning we discontinued the Reglan as of tonight. They recommended mirilax to help with conatipation... she's had two enemas this week to help.

[Crazy Daisy]

Sigh. Daisy was having very rough morning. She ate a little bit then she was shaking and clearly feeling really bad. I took her temp and it was 98.5 so off to the ER. We are still here still waiting to be seen after nearly two hours of waiting. She's not shaking like she was but she's so lethargic which of course she has been lately. The specialist thinks her adrenal glands haven't kicked in yet so I don't know if we are going to have to increase her steroid again or what. :(

[Harley PoMMom]

Hope she is feeling much better soon, let us know how she's doing when you can.

Hugs, Lori

[Squirt's Mom]

What did the vet have to say yesterday? I hope things are better today?

[Crazy Daisy]

She did not appear to be in crisis at the time (she got her pill before we left). He checked her electrolytes potassium etc and they were normal. He said if she had been in full on crisis the potassium especially would be off. He and our IMS agreed we need to increase we steroid again. We are weaning her faster than her body can handle. We see the IMS Friday and she is going to switch her to liquid prednisolone so that we have more control over the dosage and can wean slower.

She always looks so bloated in the morning but then it gets better as the day goes on. Her temp was low again this morning when I took it so she's at our vet. He's having them take her temp every hour but said it was normal the first time. Maybe I'm doing it wrong but I don't think so because I took one of my other dogs temps and it was fine.

It's all so frustrating! I'm still having a hard time getting her to eat her food... I'm always terrified changing with her IBD but she has to eat so I'm risking it.

[Crazy Daisy]

As a side note the bruise looking belly resolved on its own within two or so days. Weird.

[judymaggie]

Erin -- so sorry Daisy isn't feeling well. :( I know you really don't want to increase the steroids -- such a difficult balance. Am wondering if she would tolerate Nutri-cal -- in case you are not familiar with it, it is a high calorie nutritional supplement in gel form. Might be worth asking the IMS or vet. I am almost to the point of trying it with Abbie -- she is eating very little and even that quite reluctantly. I did add some water to her morning food today and, since I always heat it up in the microwave, it ended up having a little bit of "gravy". Abbie seemed to like it. Are you heating up Daisy's food?

[Crazy Daisy]

Thanks Judy... we haven't used nutrical but we have used another supplement that she did ok with... can't recall the name off the top of my head. I haven't recently tried heating her food up but I may do that tonight! She's super interested in this wet food I found but it's not a complete meal... it's supposed to just be a supplement. It's basically venison, venison tripe, quinoa, and blueberries.

And I'm sorry about Abbie not feeling too well :(

[molly muffin]

Awww, poor little daisy. I'm glad her bruised belly healed. That is weird, wonder what was going on. It is so very hard when they won't eat. I remember that what molly liked for breakfast she would usually have lost interest in by dinner time. I was just thinking too that they have gravy toppers for dog food, wonder if that would make it more enticing.

[Crazy Daisy]

GAH!!!! I just can't win. This morning daisy got out of bed on her own for the first time in a while. And she was excited about her food and her temp was about normal. I was pretty excited. Then about 1245 I checked our cameras and I could see she was having one of her IBD episodes... looking back it had been going on about an hour. I'm 35 mins from work. I finally decided to go home and try and work from home because once she starts her episodes it's hard to get her to stop without letting her eat grass. Anyway I go home and get her outside. I then proceed to clean up all the mucus vomit along with what she's licked off the floor. I then wander to a spare room to find she has somehow gotten a plastic baggie of screws... and she had eaten almost All of the plastic. Of course I have no idea how she got this and if she's eaten the screws so off to the vet we go (and hour away in an awful storm). Oh and somewhere in our spare room someone peed... probably gracee because she gets scared when it storms. Anyway... get to the vet finally and get the x ray and fortunately no screws. But she's still having her IBD episodes :( and my hubby is out of town so it's just me... sigh. So tired!

[molly muffin]

Holy cow! Why do things happen like that when you are on your own. Sigh. I'm glad no screws in her tummy. That is the last thing you or her need.

It is good though that she had a good morning. That is positive. :). We will take what we can get when it comes to good signs.

Hang in there. Tomorrow will be better. I hope.

[judymaggie]

Ah, Erin -- you guys, including Daisy, definitely need a break! How is Daisy feeling today?

[Crazy Daisy]

She was not great today :( she hung out at the vets so I wouldn't worry. Our vet is wonderful. He didn't even charge me last night for the x ray. I think he feels bad for us Lol

We have an appt with the IMS Friday. She has been at a continuing education class this past week and IBD was a discussion point so I think she has some new ideas to try. We shall see!

[Crazy Daisy]

Daisy saw the IMS yesterday.She now has more fluid in her abdomen and its turning yellow. The IMS says that means her liver is backing up. She now believes that daisy has multiple things going on. She has her IBD, she is cushanoid from the steroids.. but also she believes the steroid was holding back a larger problem with the liver and when we reduced it because of the cushings the issue was free to get worse. We don't know what's wrong at this point. We should get blood work etc back today but the IMS has decided unless the cytology shows obvious cancer, that daisy needs a liver/intestine biopsy. We were trying to avoid this but the IMS now feels we don't have a choice... we have to know what's wrong to figure out how to treat it if we can. They've put her on diuretics to try and reduce some of the fluid in her abdomen as it is affecting her by causing things like constipation... and it's just plain uncomfortable. She is scheduled for surgery next Wednesday. It's expensive but fortunately they can do laparascopy and won't have to open her up. I wish we didn't have to wait that long... I'm so tired! I just want an answer. I feel like this last month all I do is cry! I know I need to try and relax since we can't really do much until we get the biopsy results but that seems like it's so far away. I figured everyone here has probably been there so you would understand.

[Squirt's Mom]

Oh, I so hope they find the problem, and pray it is not cancer, and that they have a solution to offer that will finally bring relief and some rest to you and sweet Daisy.

Keep us updated and know we are right by your side all the way.
Hugs,
Leslie and the gang

[Harley PoMMom]

Oh I am so sorry that you are going this and my heart goes out to you. You and your precious girl are in my thoughts and prayers.

Hugs, Lori

[judymaggie]

Erin -- I am so sorry that you and Daisy are facing yet another challenge. It seems like just when you get answers to one problem, another arises. I know it will seem like an eternity until you get biopsy results. Hopefully, the diuretics will decrease Daisy's discomfort until you get some answers. Feel free to come here as much as you want to rant and scream!

[Crazy Daisy]

So the diuretics are working. Daisy is already about back to her normal size. She woke up at 5am and threw up... I didn't wake up and she proceeded to eat it again. She didn't feel well but perked up after a while. She's been fairly peppy this afternoon so I'm enjoying that for however long it lasts.

Her potassium was a little high on her labwork though... thoughts on that? Her thyroid was better but still low so we've bumped up her meds for that again.

[Harley PoMMom]

Glad to hear that she is feeling more peppy! What kind of diuretic is she on because potassium-sparing diuretics, such as eplerenone and spironolactone, can cause potassium elevations.

Hugs, Lori

[Crazy Daisy]

That's interesting. She's on furosemide and the spiron. One but that was after her bloodwork...

[molly muffin]

Oh my gosh! Poor you and poor Daisy. Last thing needed was more problems. Did a bile duct blockage show on the ultrasound?

[Crazy Daisy]

The vet couldn't see any kind of clot or anything on the ultrasound Friday. The cytology results came back today and showed no signs of cancer. The ims said that we will definitely need the biopsies now to fully understand what's happening. She is scheduled for that on Wednesday.

The ims did have us stop the spironolactone as she said it can increase potassium and hers is already elevated. Plus the fluid level in her abdomen has clearly decreased. We are still giving the furosemide.

Honestly her liver enzymes were the lowest they've been in a while but the liver is still backing up so hopefully the biopsies will give us our answer. It's going to be expensive so it BETTER.

She wasn't interested in her dinner tonight. I tried twould different wet foods, the dry food she ate this morning... I finally got her to eat some rice and she happily eats her treats... just didn't want regular food tonight. Ugh she can't afford to lose more weight. I'm thinking of adding a calorie supplement or maybe some yogurt to give her some protein. Oh maybe some peanut butter! If you had told me I would ever have trouble let getting her to eat I would have laughed...

[Harley PoMMom]

Liverwurst may be something she may eat. If my memory serves me right :eek: I believe I have read here on forum that some members had luck with that.

[Crazy Daisy]

I can't even believe I have to post this, I'm so completely devastated, like someone has ripped my heart out of my chest.

Daisy took a huge turn for the worse yesterday. She ended up with really bad pancreatitis and her little body just couldn't take it. She started basically just shutting down and we made the crushing decision to let her go. I don't understand and it's not fair, she was supposed to be having a biopsy today... we weren't supposed to be planning her cremation. She's been my girl for over 9 years, my first dog when Jason and I got married. She is so special to me and I can't believe I woke up this morning and she's not here. I'm so heartbroken.

Thank you to everyone here for your support, I truly appreciate it.

[DoxieMama]

Oh oh, Erin... I am so sorry! As much as a shock this is to me to read, I know it is so much more for you. Please please be kind to yourself, you were the best mom that Daisy could have ever hoped for and she knows just how much you love her.

[Whiskey's Mom]

Oh no I'm so so sorry to read this. You've been an amazing mom to Daisy and by her side every step of the way. You have my deepest sympathy and I wish you comfort and peace.
Annie

[Squirt's Mom]

Dear Erin,

I am in shock reading your post this morning and can only imagine how you are feeling having post those words. :( My heart aches for you and Jason and your other babies as you learn to face each day forward without your precious Daisy. You were and are a great mom, a blessing in her life. You fought so very hard for her and with her...and when she could fight no more you gave her the greatest gift of all - freedom from her failing body.

Today Daisy is running in the Rainbow Fields with all our babies who have gone ahead and they are teaching her the ropes. Butterflies are there to chase, holes to dig, moons to bay at in the evening. But those are all just things to pass the time til we are reunited with our babies when our time here is done...and I firmly believe that to be true. Til that day, she will watch over all her loved ones with the same love and devotion given to her.

I have added her name to the In Loving Memory thread for 2017 where your sweet girl will always be remembered and honored as a member of our little family here at K9C. You can see the entry here -
http://www.k9cushings.com/forum/showthread.php?t=8383

Our deepest sympathies,
Leslie, Trinket, Sophie, Fox, Bud, and all our angels at The Bridge


Message From Valhalla

You were with me to the very end and even after I had "gone" you held me, and as my soul left my body and I looked down and saw you crying, I wanted so much to tell you that I understood. You did this for me.

I tried to tell you in my own way that it was time for me to leave, and I thank you for understanding. No other will take my place, but those I left behind will need your love and affection as I have had.

You will still think of me, and there will be times you try to hide your tear-filled eyes....but please...be happy and think not of sadness, but of how I made you happy and made you laugh at the funny and smart things I did.

There are no fences in Valhalla, for no one has the desire to "dig out".

There are no thunderstorms in Valhalla, therefore fear is never present.

There are no fights in Valhalla. Everyone is congenial.

There is no hunger. There is no thirst. There is much to explore. Many of us who are older take care of the little ones and guide them. It's fun watching them run with their ears flopping and their curly tails wagging.

We have four seasons in Valhalla, and most of us agree, winter is our favorite.

So you see, my loved one, I am very happy...

When it comes time for my friends to leave, I will meet them at the gates of Valhalla, and I will acquaint them with this beautiful and serene place, and I will take care of them for you.

Thank you for loving me, caring for me, and having the courage to let me go with dignity.

Jane S. Morris

[Harley PoMMom]

Dearest Erin,

I am so sorry for the loss of your precious girl, Daisy, and my heart goes out to you and your family. Please know we are here for you and always will be.

With Heartfelt Sympathy, Lori

[Joan2517]

I am so, so sorry for your loss of sweet Daisy...you did everything you could for her, Erin. I know that doesn't help right now, but hopefully it will give you some peace...she's now at peace.

I'm wishing you some peace and comfort during this difficult and heartbreaking time. My own heart is breaking for you as I write these words....

[judymaggie]

Erin--I am crying as I write this. I really thought Daisy was going to come through her multitude of issues--adding one more just tipped the scales the other way. Please give Jason a big hug from me--you are both such wonderful pet parents. Daisy had a life filled with love and joy!

[molly muffin]

Oh no Erin. :( I am so very very sorry. I too thought that Daisy would make it and just had to figure out what was the underlying problem. This feels like such a shock and I am sure it is for you.
We all understand how devastating it is to wake up to them not there. 5 months on and it still feels empty and quiet in the place that my molly use to be. They sure do make such a huge impact on our lives in so many ways.

Sending you big hugs and my sincerest condolences. :(

[Crazy Daisy]

I just wanted to say thank you to everyone for your thoughts and prayers. This week has been so difficult. Daisy was always such a trooper and fighter I really thought we would make it through this as we had everything else with her.

The specialist emailed me and explained that she thought whatever was going on with Daisy's liver had turned into a severe complication. The blindness and her disconnect from what was going on was probably caused by high levels of ammonia that were affecting her brain. From what I read it can sometimes be treated but the underlying cause is still there which may not even be treatable... and if it is it's a long road with not a great prognosis for good quality of life, including things like feeding tubes. I look back now and I was second guessing myself the whole time, but I think we made the right decision. It was excruciating but we were with her the whole time, holding her and telling her we loved her. I don't know if she knew if we were there which is the hardest part, but I pray that she did. We all loved her, including everyone at the vet, and we tried so hard for her.

Thank you for all your support over this last month or two.

miss you my sweet girl!!!

[DoxieMama]

I understand the second guessing... we probably all do. It's great that the specialist emailed you and provided that information. While the decision always lies with us, it is comforting to know that others agree and would do the same. My vet offered me the same comfort with Visuddha, which really helped. It didn't change the fact that I wondered and wished that things had been different, if I had waited ... but it helped.

[judymaggie]

...The specialist emailed me and explained that she thought whatever was going on with Daisy's liver had turned into a severe complication. The blindness and her disconnect from what was going on was probably caused by high levels of ammonia that were affecting her brain. From what I read it can sometimes be treated but the underlying cause is still there which may not even be treatable...


Erin-- My Maggie had severe liver disease at the end of her life and started to have severe seizures. My vet explained that they were most likely caused by high levels of ammonia affecting her brain, exactly what your vet described that Daisy had experienced. Looking back, I know that I kept Maggie alive too long, mainly for my sake and not hers. She had a vacant look in her eyes. When she stopped eating and experienced cluster seizures, I finally said "enough". I learned a lot from that experience and hope that I can, one day, do better by Abbie. Although you may have been able to keep Daisy physically with you longer, you truly made the best decision for her.

[molly muffin]

I experienced something similiar as Judy did with my molly when she stopped eating with the kidney disease. You know in your heart. My heart hurt like hell and still does I miss her so much but I did what was right for her and that is something that I have to be okay with.

[rainiebo]

Erin, it's so hard to let them go - especially if we see the character that we love so much still there. Just to add to what the others have said, you did right by your baby. I think we "know" instinctively when it's time. No one else can tell us - we just know. And, it sounds like you knew. Take care of yourself.

[Altira]

Hello Erin,

I just started a thread today for my Elly, in fear of Iatrogenic Cushings. We aren't in the situation you were. At least not yet. My God nobody should have to go through what you and your Daisy did! My heart brakes for you! Truly... I won't forget your story anytime soon. You were amazing!
You did everything possible... May that thought never leave your mind...Your heart. God Bless You... My dearest sympathy. I've lost five dogs over the years. I know... I know.. 8:::: Janis