clinical symptoms combined with ACTH results - Sammi is now in heaven

[sammisam]

Hi, we are new to this group and are so appreciative that it's here. My husband and I are the ones who diagnosed Cushings or suspected it, long story short, our Boston was diagnosed last March 2016.

We are not trying to be vets or micro manage but it seems our findings have always been consistent with what is going on with our animals and we try to research, ask questions, gather info so we can help the vet make the best choice. Again, we were the ones to diagnose Cushings long before the vet. We also didn't agree with our 1st vet giving Sammi 35mg once/day Trilostane because she became almost incoherent. The minute we went to 10mg 2x/day she was like a new healthy dog.

She has been on Trilostane (compounding pharmacy) 10 mg. 2x/day and it has made a world of difference. I'm going to post her ACTH tests that were done 3 times since last year, because even though her results are in the "normal" range if you were looking at them solely by themselves, they are DIFFERENT compared to HER previous tests and her clinical symptoms are different the past 3-4 weeks.

She was on Trilostane starting March 24, 2016. The 1st ACTH stim test was done about 6 wks later. Clinical symptoms during this time were great. Taking Trilostane 10mg 2x/day

3/22/16 First test to determine whether she had Cushings or not. First ACTH to see how Trilostane was working (below).

RANGE
5/6/16 pre - 3.2 1.0-5.0 ug/dl
post - 4.8 (LOW) 8.0-17.0 ug/dl

Next ACTH done 10/18/16 and again her clinical symptoms have been great. Taking Trilostane 10mg 2x/day

10/18/16 pre - 4.4 1.0-5.0 ug/dl
post - 4.4 (LOW) 8.0-17.0 ug/dl

Most recent ACTH test, taking Trilostane 10mg 2x/day, clinical symptoms worse and acting different (symptoms below)

3/11/17 pre - 1.0
post - 2.7 (LOW)


Sammi has been different the past three weeks, more lethargic, head sinking down lower than ever before (almost to the floor) and then catching herself, pulling her head back up, and the same process over and over. She also seemed very confused, very weak in her back legs, and just different. Weight loss and spine showing more (was 13 lbs. over a year ago, she is now 11 lbs- slowly lost over the year) Eating and drinking were normal but more urinating immediately after drinking and not on her wee wee pad (she always tries to make it to her wee wee pad but sometimes she just goes a few steps and pees right there)

The main issue that was scaring us was her breathing. I don't think it was panting, it was more like she sticks her tongue out very stiff and breathes in and out with a snorting sound (its NOT reverse sneezing, we know what that is.

We first noticed this breathing problem on the car ride to the vet back in Oct./2016 we didn't put 2 and 2 together until we took the next car ride to the vet. the breathing episode happened again. We figured out that she now has aanxiety in the car so we started giving her Trazadone before the car ride. This breathing episode ONLY happened in the car until two weeks ago.

She did it again (breathing episode) at night and then it stopped after a minute or two. 4 days ago it happened again but several times throughout the day and enough that we took her to the vet and THIS, combined with her other clinical symptoms prompted us to do the 3rd ACTH which was done 4 days ago.

Her results were this... Taking Trilostane 10mg 2x/day (clinical symptoms changed -everything i described above)

3/11/17 pre - 1.0
post - 2.7 (LOW)

on the test results from lab it says "post-trilostane: pre and post cortisol levels between 1.5-9.1 ug/dl indicate optimal control

Well, the 1.0 is NOT in that range and again the pre and post are very different from her past 2 ACTH tests along with something not being right with her the past 3 weeks

we cant help but think that even though the vet said these results were in the "normal" range, they are much different than both of her previous ACTH results, and her clinical symptoms worsened.

We are wondering if that would indicate and increase in Trilostane, a decrease in Trilostane (we think a slight decrease from maybe the 10mg 2x/day to 5-7.5mg 2x/day) or keep her on the same dosage.

If looking at the most recent ACTH stim test by itself, one could assume "normal" as the vet said, but in comparison to HER past ACTH stim tests and her clinical symptoms worsening, I can't help but think there's some thing we need to adjust (vet just called and is now agreeing to lower her Trilostane to 8mg instead of 10mg 2x/day).

3/12/17 We took her back to the vet the day after the ACTH test because of the breathing episode and she was sedated for them to take a chest xray (which looked fine) and she had a steroid injection.

3/13/17 she had BLACK explosive diarrhea in the morning and then again at night - we brought it to the vet -results not back yet.

Today she still has some diarrhea but it is normal in color.

We thought this was the end for her (two days ago) but yesterday and today she is doing 95% better. Alert, doing her usual waiting in the kitchen for food, getting in her bed, going to the wee wee pad. Just looks like a tummy ache and still a tiny bit of diarrhea. She hasn't had a normal bowel movement since Saturday morning. I want to add she has bouts of colitis from time to time.

She has only had her Trilostane once on Saturday morning before her ACTH test and once Monday eve, (vet said hold back Trilostane because of the diarrhea).

Also, is it possible that these breathing episodes could be anxiety and then more she tries to breathe the more frightened she gets. She'll stop to drink in the middle of an episode, she'll also calm down when we pet her chest. Just wondering if a very low dose anti-anxiety daily pill or one as needed will help. When it happened yesterday we gave her a tiny dose of Trazadone (12.5 mg) and it relaxed her and no breathing episode since.

BLOOD TEST BELOW (i'm only posting high or low) and she did eat a small meal before test (JUST REALIZED THIS BLOOD TEST IS FROM 12/27/16!!) I'LL POST THE MOST RECENT FROM 3/12/17.
I've compared all results next to eachother.

12/27/16

ALT (SGPT) 100 -------------------- 12-118 IU/L (3/12/17 level is now 123)
Alk phosphate 132 (high)----------- 5-131 IU/L (3/12/17 level is now 170)
GGT 43 (high) ---------- 1-12 IU/L (3/12/17 level is now 41)

Total Bilirubin 0.1 ------------ 0.1-0.3 mg/dl (3/12/17 level is same)
BUN 48 (high)------------ 6-31 mg/dl (3/12/17 level is now 24)
Creatinine 0.6 --------------- 0.5-1.6 mg/dl (3/12/17 level is now 0.4)
BUN/Creatinine ratio 80 (high) ------------ 4-27 (3/12/17 level is now 60)
Phosphorus 6.5 (high) ------------- 2.5-6.0 mg/dl (3/12/17 level is now 4.8)

Cholesterol 569 (high)------------ 92-324 mg/dl (3/12/17 level is now 286)
Triglyceride 473 (high)------------ 29-291 mg/dl (3/12/17 level is now 150)
Amylase 186 (low) ------------- 290-1125 IU/L (3/12/17 level is now 2820

PresicionPSL 53----------------- 24-140 U/L (3/12/17 level is now 290)(tummy is hurting but no more black watery diarrhea but still small amt that's normal in color but no good bm since Saturday 3/11/16)

Total T4 <0.5 (low)---------------- 0.8-3/5

HGB 21.6 (high) 12.1-20.3 g/dL (3/12/17 level is now 20.1)
HCT 66 (high) 36-60 % (3/12/17 level is now 59)
Platelet count 504-----------170-400 (3/12/17 level is now 541)

************************************************** ***********************
3/12/17 blood work

ALT (SGPT) 123 --------------12-118 IU/L HIGH (was 100 last time on 12/27/16)

Alk Phosphatase 170------------- 5-131 IU/L HIGH (was 132 last time on 12/27/16)

GGT 41-----------------------------1-12 IU/L HIGH (was 43 last time on 12/27/16)

BUN 24-----------------------------6-31 mg/dL (was 48 last time on 12/27/16)

Creatinine 0.4--------------------- 0.5-1.6 mg/dL LOW (was 0.6 last time on 12/27/16)

BUN/Creatinine Ratio 60-------------4-27 HIGH (was 80 last time on 12/27/16)

Phosphorous is 4.8 normal-----------------2.5-6.0 mg/dl (was 6.5 high last time on 12/27/16)

Amylase 282------------------290-1125 IU/L (LOW) (was 186 last time on 12/27/16)

PrecisionPSL 290---------------- 24-140 U/L (HIGH) (was 53 last time on 12/27/16)

PrecisionPSL elevations correlate closely with abnormal PLI concentrations. In dogs with appropriate clinical signs, a PrecisionPSL result >216 is supportive of, but not definitive for, a diagnosis of pancreatitis

Platelet Count 541------------------170-400 10 /μL HIGH (was 504 last time on 12/27/16)

HGB 20.1 ---------------------12.1-20.3 g/dL (was 21.6 last time on 12/27/16)
HCT 59-------------------------36-60% (was 66 last time on 12/27/16)

T4 0.8 -------------------------------0.8-3.5 μg/dL (was <0.5 last time on 12/27/16)
The Total T4 result is less than 1.0 mcg/dl.
A Free-T4 by equilibrium dialysis may be helpful in supporting the diagnosis of hypothyroidism in patients demonstrating clinical signs compatible with hypothyroidism

Specific Gravity
1.039
1.015-1.050


Protein------------3+--------------------Negative HIGH

I was reading about protein spilling into the urine. Sammi eats chicken (white meat) and pumpkin and occasional carrots, brown rice and I'm wondering if this is contributing to protein in the urine.

We want to feed her what helps her the most and I don't know if chicken is the right thing.

If anyone knows anything about any of these levels going up or down in comparison to her previous tests please let us know.

The PrecisionPSL went from 53 on Dec. 27, 2016 to 290 on March 12, 2017 - and it has something to do with pancreatitis.

I would think the vet would have compared her previous blood test done 2 and a 1/2 months ago to the one taken just three days ago. I'm not a vet and I'm not a doctor so does anyone please have any input as to whether this is why Sammi might be having some of her symptoms - tummy pains, lost a little weight, lethargic, occasional trouble breathing, just to name a few that i think are associated with Pancreatitis.

Thank you so much!

[Squirt's Mom]

I have manually approved your post so members can start replying to you. Please check your email, maybe in the spam or junk folder, for a message from k9cushings. You will need to reply to that message to free your membership unless an Admin sees this and does it for you.

Welcome to you and your precious baby, Sammi! Those familiar with Vetoryl (Trilostane) will be along shortly to chat with you. Til then, know we are glad to have you and look forward to learning more as time passes.

Hugs,
Leslie and the gang

[labblab]

Welcome from me, too! I apologize that I have only a moment to post right now, but I wanted to tell you that I have now manually approved your membership, as well, so you don't need to worry about watching for the email confirmation. I will try to return later today and add a more substantive reply.

Marianne

[sammisam]

oh thank you so much. We've been sick and crying and thought this was it. We've done so much research on our own I'm so happy to see that our thinking is in alignment with many of the posts here.

It's amazing that Sammi has been improving and walking better in the past few days AND she's only had 2-3 doses of her Trilostane in the past few days, instead of her usual 2x/day (only because we couldn't give it to her while all of this was happening but I don't think it's a coincidence)

She will now only be taking one 10mg of the Trilostane daily (not sure why the vet doesn't want to do 5mg 2x/day). We even reached out to the makers of Vetoryl to get info. We'll see how she does on that but keep a close eye and possibly split it up and do the 2 daily at 5mg.

My fear is that I'm literally walking on eggshells waiting for her to have the breathing episodes again and I'm so scared we're going to have another day like Sunday and Monday.

So far, so good, she just hasn't gone poo poo (only a little bit of diarrhea twice this morning but it was normal in color and not black). Thank God she's eating and acting a little more like herself. She is our life and there's nothing we wouldn't do for her.

[sammisam]

Her ACTH test is in my original post.

I isolated the blood tests from my original post to compare them. Does anyone have any input as to the levels going up or down COMPARED to her last blood test (I'm only talking about out of range numbers)

When someone looks at an isolated blood test they could just assume "oh this is consistent with a Cushing's dog" but that is what I DON'T want. I just want the vet or anyone to look at what the blood test results were then compared to now, regarding high/low "out of range" just to see if there's any other recommendations, suggestions, etc.

For example PrecisionPSL WAS 53 and now its 290.

I'm getting so frustrated and want to cry because I can't understand how this couldn't be relevant. I want HER blood test results to be compared to HER blood test results if that makes sense.

Please tell me that someone understands what I'm talking about. And I'm only referring to levels that were either in range last time and not in range this time or that were not in range last time AND this time AND significantly changed.

12/27/16

ALT (SGPT) 100 -------------------- 12-118 IU/L (3/12/17 level is now 123)
Alk phosphate 132 (high)----------- 5-131 IU/L (3/12/17 level is now 170)
GGT 43 (high) ---------- 1-12 IU/L (3/12/17 level is now 41)

Total Bilirubin 0.1 ------------ 0.1-0.3 mg/dl (3/12/17 level is same)
BUN 48 (high)------------ 6-31 mg/dl (3/12/17 level is now 24)
Creatinine 0.6 --------------- 0.5-1.6 mg/dl (3/12/17 level is now 0.4)
BUN/Creatinine ratio 80 (high) ------------ 4-27 (3/12/17 level is now 60)
Phosphorus 6.5 (high) ------------- 2.5-6.0 mg/dl (3/12/17 level is now 4.8)

Cholesterol 569 (high)------------ 92-324 mg/dl (3/12/17 level is now 286)
Triglyceride 473 (high)------------ 29-291 mg/dl (3/12/17 level is now 150)
Amylase 186 (low) ------------- 290-1125 IU/L (3/12/17 level is now 2820

PresicionPSL 53----------------- 24-140 U/L (3/12/17 level is now 290)(tummy is hurting but no more black watery diarrhea but still small amt that's normal in color but no good bm since Saturday 3/11/16)

Total T4 <0.5 (low)---------------- 0.8-3/5

HGB 21.6 (high) 12.1-20.3 g/dL (3/12/17 level is now 20.1)
HCT 66 (high) 36-60 % (3/12/17 level is now 59)
Platelet count 504-----------170-400 (3/12/17 level is now 541)

************************************************** ***********************
3/12/17 blood work

ALT (SGPT) 123 --------------12-118 IU/L HIGH (was 100 last time on 12/27/16)

Alk Phosphatase 170------------- 5-131 IU/L HIGH (was 132 last time on 12/27/16)

GGT 41-----------------------------1-12 IU/L HIGH (was 43 last time on 12/27/16)

BUN 24-----------------------------6-31 mg/dL (was 48 last time on 12/27/16)

Creatinine 0.4--------------------- 0.5-1.6 mg/dL LOW (was 0.6 last time on 12/27/16)

BUN/Creatinine Ratio 60-------------4-27 HIGH (was 80 last time on 12/27/16)

Phosphorous is 4.8 normal-----------------2.5-6.0 mg/dl (was 6.5 high last time on 12/27/16)

Amylase 282------------------290-1125 IU/L (LOW) (was 186 last time on 12/27/16)

PrecisionPSL 290---------------- 24-140 U/L (HIGH) (was 53 last time on 12/27/16)

PrecisionPSL elevations correlate closely with abnormal PLI concentrations. In dogs with appropriate clinical signs, a PrecisionPSL result >216 is supportive of, but not definitive for, a diagnosis of pancreatitis

Platelet Count 541------------------170-400 10 /μL HIGH (was 504 last time on 12/27/16)

HGB 20.1 ---------------------12.1-20.3 g/dL (was 21.6 last time on 12/27/16)
HCT 59-------------------------36-60% (was 66 last time on 12/27/16)

T4 0.8 -------------------------------0.8-3.5 μg/dL (was <0.5 last time on 12/27/16)
The Total T4 result is less than 1.0 mcg/dl.
A Free-T4 by equilibrium dialysis may be helpful in supporting the diagnosis of hypothyroidism in patients demonstrating clinical signs compatible with hypothyroidism

Specific Gravity
1.039
1.015-1.050


Protein------------3+--------------------Negative HIGH

I was reading about protein spilling into the urine. Sammi eats chicken (white meat) and pumpkin and occasional carrots, brown rice and I'm wondering if this is contributing to protein in the urine.

We want to feed her what helps her the most and I don't know if chicken is the right thing.

If anyone knows anything about any of these levels going up or down in comparison to her previous tests please let us know.

The PrecisionPSL went from 53 on Dec. 27, 2016 to 290 on March 12, 2017 - and it has something to do with pancreatitis.

I would think the vet would have compared her previous blood test done 2 and a 1/2 months ago to the one taken just three days ago. I'm not a vet and I'm not a doctor so does anyone please have any input as to whether this is why Sammi might be having some of her symptoms - tummy pains, lost a little weight, lethargic, occasional trouble breathing, just to name a few that i think are associated with Pancreatitis.

Thank you so much!

[labblab]

I am so sorry I did not make it back here earlier today, and now I have got to head to bed :o. But you've done an amazing job of typing all this out, and I promise I'll return tomorrow to look things over. And I'm betting some other folks will, too. So hang in there, and we'll do our best to sort through things together!

Marianne

[labblab]

OK, I'm back again this morning. First off, I definitely agree with you re: your concern about pancreatitis. Given Sammi's GI distress in combination with the elevated PrecisionPSL, I would think acute pancreatitis would have to be a consideration. Does your vet not agree? Please bear in mind that I am not a vet myself, but I would think you'd want to completely withhold the trilostane until the diarrhea is resolved and Sammi is able to eat and process her food normally. In treating pancreatitis, feeding several small meals throughout the day of very bland food such as boiled chicken and very mushy white rice is recommended.

As far as the trilostane you are correct that, technically, her most recent ACTH would be considered OK. However, you are also correct that it is significantly lower than her previous tests, so obviously her cortisol has been trending downward even though the dose had not been changed. Actually, it is not unusual for dosing changes to become necessary over time and I think a decrease is indeed warranted, given the downward trend in her cortisol.

By any chance, does the change in Sammi's behavior correspond with getting a new bottle of trilostane? Research has shown that there can be variability in the effectiveness and dosage accuracy of some compounded trilostane products. So I am just wondering whether there may be a problem with this bottle of trilostane itself, either in terms of dosage or perhaps a reaction to some change in the liquid suspension.

I'm afraid I cannot be of much help re: the breathing issue. It's a good thing if her chest x-ray is clear, at least. Do you think it may be an allergic issue of some sort?

I have a couple of questions about Sammi's urine. Do you know whether the protein result came from a dipstick check done in the office by your vet? Also, has she been checked for a urinary tract infection? If she has an infection, this could explain her new issues with peeing. Also, if she has an infection, the irritation can result in blood cells in her urine which could also register as elevated protein. If she doesn't have an infection and the protein was measured by dipstick, then I would encourage your vet to perform a more specialized urinalysis called a "UPC" (urinary protein to creatinine ratio). Cushpups can be vulnerable to kidney issues that result in abnormal amounts of protein being passed into the urine. If this is happening, then certain medications may be recommended along with some moderate dietary protein restriction. In terms of diet, though, right now I think the possible pancreatitis is by far the more pressing issue. So chicken and white rice should be fine.

In terms of additional diagnostics, one thing you might consider is an abdominal ultrasound. That would give you a better idea as to the health and status of many of Sammi's internal organs including her pancreas, liver, kidney, spleen, gallbladder, and adrenal glands. Was an ultrasound performed at the time she was first diagnosed with Cushing's? If so, you'd have a basis for comparison with a current image.

OK, that's enough questions for now! Once again, welcome to you and your girl, and I surely hope she is continuing to improve today.

Marianne

[sammisam]

Thank you SO much for respondidng! You are so insightful and knowledgable. Oddly enough (or not so oddly) the vet has mentioned NOTHING about her PSL levels being so high this time compared to last time, and it's bothering me because we thought he's so thorough.

I sent him an email asking about "possible pancreatitis". It's upsetting because we switched vets last year because we were unhappy about our previous vet. We are taking her to a completely different practice (VCA-in West Los Angeles - huge facility) and she was seeing the internist since last year.

But, since she had her dental surgery Feb 1st (general vet), and since we thought he was very thorough (he diagnosed Mange and prescribed a one time drug that she was given on Feb 2 and it cleared up (I forgot the name but it's for mites, heartworm prevention) so we stuck with him.

WE brought up about the Trilostane dosage change (lowering) and he suggested going from 10mg - 2x/day to 10mg - 1x/day. I still don't know if that's the best, as opposed to 5mg 2x/day instead of the once a day 10mg.

It's interesting that you mention the latest Trilostane prescription. We go to the same compounding pharmacy and her last Rx was on 2/11/17.

I would say her more severe symptoms started around 3/4/17 and really bad on 3/9/17 so that IS a possibility. She is taking the capsule.

Something worth mentioning. She started on Simplicef 2/27/17 and that's when I really noticed her getting worse. It may be coincidence, I don't know. The reason they gave us Simplicef was because she had a UTI a couple of months ago and they said the Clavamox wasn't working or she was resistant? and she had crystals in her urine. They based this off of a "free catch" sample.

When I noticed the symptoms of a UTI on 2/26/17 we just called the vet and that's what they gave to us but they hadn't done any urinalysis, they just based it off of us telling them we think she has a bladder infection (was squatting, not peeing, or kept going to pee but very little came out).

That was probably our fault for just assuming she needed the same meds. Also, we use a vet thats right around the corner when she gets her UTI's so we can drop drop a urine sample off and get meds immed. if needed. We just hadn't done that this time.

The VCA is about 20 miles away (but that could be 1-2 hours with L.A. traffic).

Again, maybe it's coincidence but once she got on the Simplicef it seemed like she started going downhill a few days later (although when she had it a few months ago she was fine) But it could also correlate with some of the Trilostane pills (new rx was 2/10/17)(symptoms started around 3/4/17 but got really bad around 3/9/17)).

This most recent urinalysis was done at the VCA and I'll have to ask about the "dipstick".

She's had an ultrasound in Nov/2015 and Jan 11, 2017. I'm going to try and post the findings in her profile.

The breathing thing really scares me the most. Now she had it last night but then it was dinner time, she ate, was fine, no breathing episode. She also has had the breathing episode and she'll be able to get some water in between but then it continues again.

The only other time she has the breathing episode, on cue, without failure, is when we get in the car. And that just started back in October (already on Trilostane for 7 mos.).

I'm going to see what the vet says about her PSL but I feel like if I hadn't mentioned this to him and if I hadn't mentioned the Trilostane decrease, it would've never been addressed.

I think it's smart to just stick with the internist at the VCA but what ends up happening is that we end up in the emergency room and another vet sees her or what happened this last time (she had the dental done by the general vet there and we liked how thorough he was with some things and we also liked his thinking with not wanting to lower her dose AND switch to the liquid).

But now I'm questioning that he's not so thorough with other things. It's so difficult but we definitely speak up when needed so we'll figure out how to proceed with the vet and which one.

She still has not had a BM (last was good on 3/11/17)
3/11/17 - was good
3/13/17 - black watery diarrhea in the morning and then the same in the evening (she also had the ACTH 2 days prior, sedation for chest xray, trazadone for car trip) and threw up that day too.
3/15/17 just a little bit of diarrhea, normal in color

But that's it.

We are giving her chicken and rice and her usual diet is Chicken, pumpkin, occasionally rice, occasionally carrots.

She hears my husband in the kitchen now and has come to see "is there something for ME"... this makes me cry because it's her usual self.

I will try to post the ultrasound and any other relevant tests onto her profile unless there's a better way.

Thank you so much again, it really helps me get through the day when I at least understand some things and I think this site is so amazing!

[labblab]

If you are able to take a digital photo of the written test results using your cellphone or a camera, you can create a personal photo album on your profile page, and then upload your images there. That would save you from having to type out all the results here.

By any chance, were you seeing Dr. David Bruyette there at VCA? He is really a nationally known Cushing's expert, and given all the question marks about Sammi's current condition, I believe I would indeed book a return visit to him (or whichever internist you were seeing there). I know it's a long drive, but I think I'd want to consolidate all the diagnostic and medication decisions with a Cushing's specialist again for the time being.

Marianne

[judymaggie]

Hi -- I just wanted to add my "welcome" to you and Sammi! Marianne has provided you with very thorough analysis and recommendations --- much better than I could have done. I am hoping that you will be able to sort out Sammi's issues soon and get moving forward in a positive direction.

[molly muffin]

Hello and welcome from me too. I could be a stronger batch in the last prescription of trilostane, it could be both drugs together aren't working for her (Simplicef and trilostane) but I would venture to guess that not feeling good with a bout of pancreatis and her cortisol being lower than it is normal is making her feel awful. This could contribute to a panic type of breathing (my thoughts only)
So what I'd do is no trilostane until the pancreas is normal, she is eating fine and no diarrhea. Then start back at 10/5 or 5/5 dosage to see how she does and then retest after starting at the normal protocol.

To have a firm diagnosis of protein loss via urine, you want to have 3 consistent UPC test, taking about 2 weeks apart. I prefer first urine of the day, as that is easiest and you can do a drop off at your close vet and have them run the test. If all 3 consistently test high, then you can look into a food with lower protein in it and see how that works. (they should have a dietician at the VCA)

She might be hanging her head due to the pancrease as quite often you will see a sort of hunch with that, from the pain and hurting.

[sammisam]

SAMMI WAS DOING GREAT ALL DAY AND NOW SHE'S BREATHING REALLY FAST WHILE SHE'S SLEEPING. HER MOUTH IS CLOSED AND SOMETIMES ITS NOISY (A LITTLE LIKE SNORTING) AND THEN SOMETIMES IT'S JUST THE FAST BREATHING.

ITS REALLY SCARING ME. SHE HAD 10MG Trilostane this morning and 5mg last night and 5mg yesterday morning.

The fast breathing will stop for a little and then start again, but all while she's sleeping.

We were seeing Dr. Bisignano (internist) at the VCA and then we started seeing Dr. Kaplan (general) only because he did Sammi's teeth and a month later (just the other day) is when she was tested again (ACTH) and we just stayed with him. But I think we're going to stick with the internist there (Dr. Bisignano)

Dr. David Bruyette is not with the VCA anymore as far as practicing but ironically, when I was panicking on Sunday and Monday I was researching who are the best Cushing vets and Dr. Bruyettes name came up.

On a fluke, I emailed him and he called us back and we've been emailing back and forth ever since. He really helped us get through the day on Monday. My husband and I offered to take him to dinner and drinks because we couldn't get over how much time he took in answering our questions.

He looked at her blood work and her past blood work and mentioned a few things about her BUN/creatinine and it could be from a few things but he believed muscle wasting.

I don't want to wear out our welcome by asking him so many questions and he's definitely answered them all but I was wondering what the opinions were as far as Sammi taking 10mg 1x/day vs 5mg. 2x/day. she was taking the 10mg Trilostane 2x/day and now the general prac. recommended lowering the Trilostane to half of what she was taking (which I agree with) but he said just do the once a day dosing.

I don't know why that's bothering me because I thought it was better to do 2x/day and just make it 5mg. It's still only 10mg/day but more equal dosages.

I don't really understand about the pituitary tumor. I understand the difference between the adrenal type and pituitary type but is he saying that this tumor could be growing and that's whats causing her symptoms and how would coming off of Trilostane help it.

(I copy and pasted below what Dr Kaplan said)
__________________________________________________ ______________
"No….changing the formulation could change absorption and throw another variable in there you do not need. I would just decrease to 10 mg once daily and see how she does……patients with Cushings secondary to pituitary tumors sometimes do better with higher cortisol levels for the reason previously discussed—ie sometimes it is better to deal with symptoms of Cushings if it decreases symptoms from the pituitary tumor."

"I would not get caught up in trying to normalize Sammi’s blood values because I do not believe that would make her feel any better--- and that is what this is all about. I believe that her weight loss, lethargy, etc is due to a pituitary tumor pressing on her hypothalamus. The definitive treatment would be radiation to shrink it. If that is not in the cards, then we might find it advantageous to totally take her off the trilostane if cutting the dose in ½ did not reverse her current malaise. By taking her off the trilostane, we may further increase her cortisol levels which might decrease swelling of the pituitary tumor—assuming she actually has one."

[labblab]

I'm so glad you got the chance to correspond with Dr. Bruyette. He is really amazingly generous with his time! A few years ago, he joined our forum here as a member and for a short time answered questions on the forum. He no longer does that, but he still makes himself available to us via email, too. I sometimes contact him with questions, myself, that are stumping us. I believe he's still the Medical Director at VCA, right? But I guess he no longer has the time to see patients directly. That's too bad!

Anyway, on to your questions. I think it would be fine to try shifting to the once daily dosing. There are reasons why some clinicians generally prefer once daily dosing and others generally prefer twice daily dosing. But once daily dosing isn't harmful, and remains the recommended dosing pattern of Dechra, the maker of brandname Vetory, unless it appears as though the drug is wearing off too quickly within a 24-hour time period.

In Sammi's case, yes, I think the vet is suggesting that her pituitary tumor may be growing and thereby placing pressure on the areas of her brain that control hunger, alertness, etc. So for her, there may actually be an advantage to allowing her cortisol level to increase a bit overall, and also specifically within the course of a 24-hour time period. The increase in cortisol may help control swelling of the tumor and ease inflammation of the surrounding brain tissue -- as he says, IF the tumor is indeed actually expanding. That may not be the case at all, but this would be an approach to try if it is.

Did you happen to ask Dr. Bruyette his opinion re: the dosing switch? You might do so, but based on an actual answer that he posted here on the forum back in 2009, I'm betting he'd be fine with it.


With regards to once vs twice a day dosing if we look at all the studies throughout the world you will see that about 80% of dogs do well with once daily dosing. One huge advantage of once daily dosing is owner compliance which goes up substantially when owners only have to dose once a day. While twice a day dosing may result in a lower amount of trilostane being used pre day it will require closer monitoring as the ACTH stimulation tests tend to be lower so we have to look for both hypocortisolemia and electrolyte abnormalities.

Marianne

[sammisam]

Thank you for explaining that!

One of my other concerns is the compounding pharmacy Trilostane. We use Valley drug but we'd be willing to switch pharmacies or even switch to Vetoryl if anyone had any suggestions on that.

I did read where Dr. Bruyette wrote about compounding but I don't know if things have changed since he wrote that.

[labblab]

We are familiar here with an internet pharmacy, valleyvet.com, that sells Vetoryl. However, I don't believe they provide compounded trilostane. So perhaps your Valley Drugs is a local pharmacy there in your neighborhood?

Overall, I think the same general questions remain re: compounded trilostane -- it may be the case that there is variability in the effectiveness or consistency of some compounded meds. That's why it's important to use a reputable pharmacy. If VCA recommended your compounding pharmacy, though, they ought to be reliable. As an alternative, a lot of our members get compounded trilostane from an internet pharmacy, Diamondback Drugs in AZ.

If you're considering making a switch, though, you could indeed always try a month or two of brandname Vetoryl, just to see whether that makes a difference in Sammi's monitoring results or behavior. There are several reputable online pharmacies that sell Vetoryl at prices less than what many vets charge.

Marianne

[sammisam]

Sammi has another bladder infection confirmed by a urinalysis. The vet is prescribing something for her and hopefully we can start that antibiotic asap.

This is now day 5 of her taking the 10mg Trilostane, once a day, in the morning (instead of 10mg 2x/day that she was taking for the past year).

Every evening she has a breathing episode (with the exception of one night - which was last night). She is also breathing very fast in addition to her holding her mouth open with her tongue sticking out, breathing hard. She isn't making the snorting sound as much but I also don't believe it's panting. Just as I said this the heavy breathing in with the snorting sound started.

She is able to to drink during these episodes and if you distract her for a moment the hard breathing will sometimes stop. It's killing me every time this happens because I can't stand if she's in any sort of discomfort.

We gave her 12.5 mg. of Trazadone (this is the second time since last Thursday) and it does seem to help, but I don't know if it's the Trazadone OR the breathing episode is just stopping on it's own.

I have also noticed a little bit of lip licking, sometimes followed by a little burp, and an odd smell when these episodes happen. It's not her teeth because she just had nine extractions and her teeth cleaned 7 weeks ago.

I'm wondering if it could be acid reflux OR post nasal drip. I'm just trying to figure anything else it could be so I can try to fix it!.

Does anyone have any clue what these breathing episodes could be and is it possible that part of it is acid reflux or post nasal drip (or anxiety?).

I'm trying to figure out if there's any correlation to the Trilostane in the morning and then 12+ hours later, the breathing episodes start. But, she also had these episodes while on 2x/day Trilostane.

This is so upsetting, but right now, I think the 12.5 mg Trazadone is helping her relax because she looks like she's sleeping and snoring peacefully.

[Harley PoMMom]

These breathing episodes have been noticed by other members in their dogs while on Trilostane and respiratory signs (coughing, congestion) are listed as a side effect in Dechra's product insert: Dechra's U.S. Product Insert (http://www.dechra-us.com/Admin/Public/Download.aspx?file=Files%2fFiles%2fProductDownload s%2fus%2fvetoryl-5mg-pack-insert.pdf)

The lip licking and that odd smell is more than likely due to nausea and/or the reflux as you mentioned, medication for gastric relief, such as Pepcid AC, is generally recommended by veterinarians. I also found this statement in an article:
Brachycephalic breeds, which are those with a very short, flat muzzle and a wide head, are predisposed to developing gastrointestinal gas, primarily because they swallow excess air while eating due to the unusual shape of their skull.

These breeds include the Boston Terrier, Boxer, Bulldog, French Bulldog, King Charles Cavalier Spaniel, Pekingese and Pug, among others http://www.petwave.com/Dogs/Health/Gas/Symptoms.aspx

Hugs, Lori

[PeteysMom]

We're having some of the same issues with our 14.5 yr old doxie. I wanted to share some of our symptoms and findings in case it may help your situation. For your little one, I think the breathing is a stress related symptom. I think as they age stress affects them more.

Our Petey has been on lysodren for 3 yrs and has done great with it, only 1/4 a pill per day. UNTIL, he had surgery 4 weeks ago to take off some infected wart/mole-y areas and a dental that stemmed 3 teeth to be pulled. He has had several surgeries in his life but he has never been in so much pain. Appears that the stress of the surgery upset his cortisol levels and the lysodren dose is too much for him. At first we thought it was back pain with the hunch back look. The more research I did looked like pancreatitis. After more research it looks like lysodren toxicity. Research said Pancreatitis can be a symptom of lysodren toxicity. He had all symptoms but vomiting.

When he was first checked it showed glucose in his urine so they tested him all day and it showed normal, the vet said glucose could spill over in his urine from the stress. He was rechecked the next week after I asked the vet if he could have pancreatitis. Tests showed he did, they gave him IV fluids and meds this past tue&wed. I had skipped his lysodren 3 days before that. He appeared to be getting better and she asked that I start him back on the lysodren so we could do the stem test after he was on his normal dose for 2 weeks. He's had 4 days of being back on the lysodren and his stool is totally runny and he's got a bit of hunch back starting again.

I feel that maybe his stress level is not back to normal yet so his normal lysodren dose may be too much for him right now. Before surgery you would never had known he was 14, he was as spry as a pup. I feel I should hold his lysodren again, I'm calling the vet in the morning.

I pray that they figure out how to help your baby get back to normal. I'll be looking for your updates.

[Squirt's Mom]

Hi Petey's Mom,

One thing I wanted to let you know about stress - it can actually RAISE the cortisol making the need for the med stronger, not less. This is one reason this is such a difficult disease to correctly diagnose - a pup who gets stressed simply going to the vet can skew the test results causing false-positive. ;) I am concerned however that his cortisol level may be too low since your vet did not do an ACTH. I would as that that be done asap.

I also invite you to start a thread for Petey. That way we can talk to you about him there without confusing things. :) We like to keep all info about each pup in their own thread making it easier on both members and parents. But PLEASE do continue posting to other members!

Hugs,
Leslie and the gang

[PeteysMom]

I am sorry for the delayed response. Thank you so much for the info and for this forum Leslie. I'm not sure how to start a new thread but I'm fixing to look.

Hugs to all the pet moms,
PeteysMom, Tara

[sammisam]

Does anyone have any suggestions on the best cranberry tabs for Sammi (11 lbs).

The vet recommended that Sammi start taking them.

Any suggestions or experience with any type of Cranberry tab will be helpful.

Sammi thanks everyone in advance ;-)

[Squirt's Mom]

Why not try actual cranberries, either fresh or dried? I used to give my Crys dried cranberries and she loved them. She had urinary crystals that required we keep her system acidic and dried cranberries were part of our regime. I never used commercial tabs so I can't recommend that but I would suggest trying the actual fruit. Not all dogs will take them but it's worth a shot since you know that is all they are getting - the fruit.

[sammisam]

I'm so worried again. Sammi was doing so much better for the past two weeks. She wasn't having her breathing episodes for at least 10 days straight. As of a couple of days ago her back legs starting getting weak again, with her spine looking pointed and she's having another breathing episode tonight.

This is exactly what happened about a month ago when we she was not doing well so we took her to the vet to do the ACTH test and that's when the vet lowered her Trilostane to 10 mg/once a day (she used to take 10 mg twice/day).

She responded almost immediately once we lowered the dosage. I don't even know what to do right now.

Is it possible the 10mg is too much now?
Is it possible the compounded Trilostane is not accurate (I don't know if it's that because when she gets her breathing episodes it's almost like clockwork at 10-11 pm (around 12 1/2 - 14 hours after her morning Trilostane dose)?

Its also the back leg weakness that's scaring me. I noticed it's gotten a little worse each day but much more in the past 2-3 days.

Any help would be so appreciated. I can't sleep because I feel like if I go to sleep I won't be able to monitor if she's in distress. we just gave her 25 mg of Trazadone to relax her.

One question I do have, is this...

She had these symptoms almost a month ago (and i thought she wasn't going to make it) but then she recovered really well...

Is this something that could come and go and maybe we have a few bad days and then more good days? Kind of like ups and downs.

Is it possible that now the 10mg/Trilostane could be TOO much? Maybe the compounding pharmacy is not making it correctly or their Trilostane is not an accurate 10mg.

I HAVE read about compounding Trilostane and I really do believe this is a good pharmacy (recommended by our first vet) but I guess you can never be sure (Valley compound in Encino).

Sammi is 11lbs, and like I mentioned she's taking 10 mg/in the morning. I remember reading something about when the back legs get weak, suspect too much Trilostane.

Forgot to mention lowering the Trilostane was also is response to Sammi's last ACTH test done a month ago, which was pre 1.0 post 2.7. This last tests pre and post numbers were much different than the past 2 tests she has had over the past year which was pre 3.2 - post 4.8 on May 6, 2016 and pre 4.0 - post 4.4 on Oct 18,2016 (but a month ago is was the pre 1.0 and post 2.7)

One more question... is rescue remedy (alcohol free) safe to give to Sammi?

Thank you everyone for always responding.

[Harley PoMMom]

I'm so sorry to hear that Sammi is having some issues and I hope she is feeling much better real soon.

Now, lets see if I can answer some of your questions. A dog's cortisol can drop too low on any dosage strength even if no dosage change has been made. The only way to tell for sure is to have an ACTH stim test performed, and if a dog is acting off than having the electrolytes checked is a good idea. Since Sammi is experiencing some of the same symptoms before her dosage was lowered you could stop the Trilostane and see if that helps and if it does than it would point to that the 10 mg is too high for her. Some dogs do better when their cortisol runs a bit higher than the ranges that are recommended.

As far as the accuracy of compounded Trilostane, Marianne's reply regarding that was spot on so I'm including it here ;)


We are familiar here with an internet pharmacy, valleyvet.com, that sells Vetoryl. However, I don't believe they provide compounded trilostane. So perhaps your Valley Drugs is a local pharmacy there in your neighborhood?

Overall, I think the same general questions remain re: compounded trilostane -- it may be the case that there is variability in the effectiveness or consistency of some compounded meds. That's why it's important to use a reputable pharmacy. If VCA recommended your compounding pharmacy, though, they ought to be reliable. As an alternative, a lot of our members get compounded trilostane from an internet pharmacy, Diamondback Drugs in AZ.

If you're considering making a switch, though, you could indeed always try a month or two of brandname Vetoryl, just to see whether that makes a difference in Sammi's monitoring results or behavior. There are several reputable online pharmacies that sell Vetoryl at prices less than what many vets charge.

Marianne

Unfortunately even when a dog seems to be stabilized on their Cushing's medication there very well may be that tweaks are needed along the journey, so yes, it can be a roller coaster ride. :(

As far as the Rescue Remedy I'm not familiar with that supplement, your vet might know something about it so I believe I would ask them for their opinion.

I sure understand how worried you must be, just remember we are here for you and Sammi.

Hugs, Lori

[molly muffin]

As Lori said it is definitely possible that even 10 is too much for her, but it is impossible to know for sure without the ACTH. However, stopping it to see if she improves could give you an idea.

I'm sorry to hear that she is having those breathing episodes again, as I'm sure it is distressing for her and you.

[sammisam]

Not sure if I'm posting this in the correct place but we actually switched over to the Vetoryl 10mg/2x day and that just about eliminated the breathing episodes.

Sammi also regained a lot of strength in her legs and she wants to go out for walks and she's engaging a lot more.

I remember the vet saying something about once a day dosing can help shrink the tumor and I'm wondering if her suddenly going blind and not hearing has to do with the tumor increasing.

She started having vision problems about 2 months ago but in the past two days it seems like she can barely see. The hearing loss seemed like it happened in the same time period.

She's been on the Vetoryl for about 3-4 months now and since my last post is when her dosage was increased to the 10mg 2x/day.

Its so heartbreaking ringing the doorbell and she doesn't move, watching her walk right up against the wall or walk around confused.

Does anyone have any suggestions on if it would be helpful to go down to once a day dosing and if so then that would mean 20mg once per day, which seems like a lot at once but I'll listen to anything you wonderful people have to say.

You have really comforted us these past few months!

[labblab]

You are posting in exactly the right place, and welcome back to you and little Sammi, although I'm very sorry about her new problems with her vision and hearing. I surely understand why this feels very upsetting to you, and I am hoping that some of our other members who also have experience with loss of sight/vision will be stopping by to give you some support and tips.

Unfortunately, I do believe it's possible that an enlarging tumor in her brain could be the cause. Dogs such as Bostons who have flat faces may be more vulnerable to the effects of enlarging pituitary tumors due to the shape of their skulls. However, if this is indeed the cause, I doubt that switching to once daily dosing would likely have any great effect. However, anything that would allow the cortisol to increase during the course of the day -- including lowering the overall trilostane dose -- might have an anti inflammatory effect that could ease the swelling and pressure caused by the tumor. In some cases where large pituitary tumors are known to be present (via imaging of the head), trilostane may be totally discontinued and/or prednisone prescribed. However, the downside to this is that conventional Cushing's symptoms will likely rebound, and in Sammi's case, I know her breathing is a real concern to you.

Are you still seeing the vets at VCA? What do they think about these new issues? Also, can you tell us the results of any recent ACTH testing at this newer increased dose?

Thank so much, in advance, for any additional information. And once again, welcome back to us.

Marianne

[sammisam]

Thank you as always for responding. I can't thank everyone enough for the invaluable education and advice that has really helped us through this.

I understand everything that you're saying and I was thinking we should get a new test done so we can see the numbers since Sammi has switched to the brand Vetoryl and her dosage was increased to the 10 mg 2x/day.

My husband doesn't want to put her through driving to the vet, leaving her there alone during the test and I can definitely understand where he's coming from but I also understand it would be nice to see where those numbers are.

I will say that based on clinical symptoms it does seem that the increased dosage has helped although some other symptoms have appeared.

Ex - If we went on clinical symptoms alone, since taking Vetoryl only and increasing dosage and frequency (twice a day vs. once a day) this has happened...

*wants to go for walks
*drinking and peeing less
*MUCH more engaging (instead of only sleeping and seeming very out of it)
*back legs have gotten SO much stronger
*no more nightly breathing episodes

But this has also happened...

*Lost more weight
*Lost a little more hair and skin is drier
*hearing loss (we think its 99% gone)
*vision loss (slowly degrading over the past 3 months but as of the past
2 days it seems as though she can barely see anything if at all)
*walking into corners (most likely because of vision loss)
*walking all over as if she's lost or confused (most likely because of
vision loss)
*walking right up to the cabinet touching it with her head (NOT head
pressing though)
*off balance (most likely due to hearing loss)

I think a lot of the symptoms such as "confusion" and off balance are from her not being able to see and hear.

So I know we shouldn't just go messing with her medicine but I know my husband just does not want to take her to have the test to measure cortisol levels. We will email the vet and see what he has to say.

Her last ACTH test was when her numbers went down significantly (cortisol suppressed TOO low) and we thought we were going to lose her (I still believe her Trilostane from the compounding pharmacy was "off" and that's why we also switched to Vetoryl only - I wanted to take THAT variable out of the equation).

I know I posted those numbers in a previous post and that's the last test we did but again going on clinical symptoms alone we can definitely see it has helped.

We are willing to decrease the dosage if need be and I guess if her symptoms come back too severely we can always increase the dosage again.

Is there a way to tell if she's completely blind because sometimes we think she can see a little bit but as of lately she wont follow a crumbled up paper towel when i move it from side to side?

She does seem to respond though when i put an object in front of her and she blinks if I put something very close to her eyes so maybe it's just shadows that she's seeing.

Well thank you again and we're open to any input!

[Joan2517]

Hi, you don't have to leave her. I used to sit with Lena in the waiting room, take her for a little walk and just hold her for the two hours of testing. It was less stressful for her, and me~

[molly muffin]

Hello to you and Sammi.

When my dog started to lose some of her sight, I would do follow exercises to see if you could follow my hand with her eyes. Hold a treat in your hand, make sure she smells it so she is aware and then see if she will follow the hand.

Also try throwing the treat just a bit in front of her so she has to walk a few steps to find it. Does she find it with her eyes or with her nose to the ground smelling for it? I would gauge how molly was doing by doing these things daily.

The balance issue can be from the loss of hearing of course, loss of eyesight, or an enlarging pituitary tumor. (they get stuck in corners, act confused, etc)

As the ACTH can be done in a couple hours, you could definitely try staying with her during this time. Taking her for a walk outside, sitting under a tree, killing time till you go back in for the second draw, as Joan suggested.

[sammisam]

So we're taking Sammi tomorrow to test her levels but the more important reason is because of the following symptoms and I'm wondering if anyone has any experience with this.

She never had a problem eating but lately she just licks the chicken for a second but won't eat it. Or if she does decide to eat it she'll just move it around her mouth but not swallow it. Sometimes she will but lately she won't. She is drinking and swallowing water though. After not really eating for 2 days we decided to mush her food up like a paste and she did better with that (but it was liver - small amount - and then hot dog because we usually give her chicken and pumpkin but she wouldn't touch the chicken) We also went and got high quality canned food just to see if that consistency was better and my husband told me she ate it up and swallowed it. I wasn't home so I didn't see exactly what she did but my husband said she definitely swallowed it and took her meds (we hid them).

I was researching oral dysphagia but I have no idea.

The other concern is that about 3 weeks ago I pulled this brown greasy waxy substance from above her nose and it had this odd smell. The substance isn't there anymore but her skin still has an odor above her nose and it's greasy and she itches it like crazy sometimes. It's not really a "fold" but it's depressed because she's a Boston. I researched "yeast infection" and Sammi also had mange a few months ago back in Dec - Feb (vet gave her a one time med and it cleared up immediately).

I was just thinking is it possible she has some kind of yeast infection IN her nose or mouth that's causing her to not want to swallow how she used to.

She had her teeth cleaned back in Feb and they also did 5 extractions so I don't think (not sure though) it's her teeth. She also licks her lips but it's not really licking her lips it's more like she just smacking tongue and her mouth up and down. Hard to explain but it's as if you had a bad taste in your mouth and and sort of took your tongue to the roof of your mouth several times. I tried to look in with a flashlight when she yawned but didn't really get to look everywhere but also didn't see anything obvious where I was able to see.

Any ideas on why she just spits her food out and doesn't want to eat the chicken or anything in pieces like she used to or the other issues she has.

She's doing ok and we really think she has gone blind or lost 95% of her vision and 99% of her hearing.

Thanks everyone!

[labblab]

I'm so relieved to know that Sammi is going in to be tested today. I think that's probably the single most important thing you can be doing right now: checking to see whether her cortisol level is either too high or too low. Also, it'll be good to let the vet see her forehead because a yeast infection does sound like a possibility.

So let's see how her vet visit turns out today, and then we can go from there. As I wrote last month, I do remain concerned that her pituitary tumor may be enlarging and putting increasing pressure on her brain. It seems to me that could account for her confusion, blindness, deafness, and now her problems with eating. But I don't want to be borrowing trouble, so as I say, let's first see what your vet has to say and how her testing turns out. Please do report back to us as soon as you can, OK?

Marianne

[sammisam]

Update so far...

We took Sammi today and for the first time she did not have an anxiety attack in the car and zero breathing issues and she took NO trazadone! She has been loving and EATING the new high quality canned food we got her (2 days now)!

We've fed her chicken, pumpkin, sweet potato, carrots, etc. pretty much her entire life but I think she just doesn't like the consistency anymore because she was licking it but then spitting it out. We're just happy she's eating and the vet said if she's eating and drinking and swallowing then he has no concerns about oral dysphagia.

A yeast infection was also confirmed so he gave us chlorhexidine wipes and a bacterial ointment for a couple of spots near her eye.

She is such a trooper! We were there for 4 hours today because we had to wait for another vet to look at her skin. We see Dr. Bisigiano at the VCA for her Cushings (he's the internist) and then she had to get a bunch of skin scrapings to determine what was going on with her.

They also did a urinalysis and another blood panel. It's unbelievable that every time we take her it's over $1,100 but this is the vet clinic (the big VCA in Los Angeles) we chose and they know her so I just want her to have the best chance of success. Her previous vet somewhere else never diagnosed Cushings and then overdosed her on the Vetoryl in the beginning, so I'm not complaining about the VCA prices.

She has lost more weight (she's 3.75kg/8.2 lbs) but she also hasn't eaten much in the past week, with the exception of the last 2 days. She had lost and then gained and now lost weight again so I'm curious to see the stim test results.

I think she is just exhausted right now cause she's been sleeping since we've been home (she did eat her new lunch though the minute we got home).

I guess we'll wait for the tests to come back but also noticed an hour ago and yesterday that she either coughed or gagged and a very sticky mucous came out that had a little brownish color to it??? It was just a couple of pieces.

Does anyone know anything about using apple cider vinegar for yeast infections? We have to skinguard chlorhexidine wipes for her face and nose, so we'll use that but just wondered about vinegar also, now that we know it's yeast.

She is just snoring away right now! We love her SO much.

OH!!!!!!!!!!!!! Forgot.... the vet said she is not completely blind!!!! We def. agree with that because sometimes we think she can still see a little bit. She still mis-judges and falls and I'll post pics of what we did in the living room to keep her safe. it also helps her climb up and down the couch.

[molly muffin]

Hmmm, if she has an infection though won't her cortisol levels rise due to that?

I'd definitely have a vet and even an oral specialist take a look at her nose area, not just for an infection outside but inside too, up inside. As this sounds like it is affecting her mouth inside. It could be that she got an infection during or just after the cleaning, that is now manifesting outward signs too, so they really need to look into that.

Let us know what the vet says!

[sammisam]

Vet called yesterday and said to lower Sammi's Vetoryl to 5 mg daily (she was taking 20mg per day (10mg 2x/day) so he's lowering it 75%.

I just got the actual results back and her numbers were much lower than usual...

cortisol sample 1 (i guess thats the pre?) 0.6
cortisol sample 1 (i guess thats the post?) 0.9

She seems to have a cold and she's very lethargic, she's thrown up over the past 2 days since the test. I don't even know if we should give her the 5mg this morning. She's sleeping right now so we don't know if she wants to eat yet.

She seems really weak and wobbly but maybe that's just because she's thrown up. A couple of days prior to the test she threw up a little bit one or two times over a few day period and there were a few sticky pieces of mucus that had some brown in it. Then the day after the test (yesterday) through this morning she's thrown up about 4 times and it has gone from brownish to yellowish and now it's clear.

The vet doesnt want to give her antibiotic he wants to work itself out on it's own.

She only ate breakfast yesterday and took a 10mg because we didn't hear from the vet until later. She didn't want to eat dinner and we definitely didn't give her any Vetoryl last night knowing the new 5mg once daily recommendation.

She has been drinking little bits of water though.

I believe in my earlier posts I wrote all of her previous stim test results but these are definitely the lowest.

Her bloodwork also shows these results (i'll only write the out of range)

Total protein 4.6 5.0-7.4 g/dL LOW
Albumin 2.6 2.7-4.4 g/dL LOW
BUN 44 6-31mg/dL HIGH
BUN/Creatinine Ratio 40 4-27 HIGH
Magnesium 2.7 1.5-2.5 mEq/L HIGH
Potassium 6.2 3.6-5.5 mEq/L HIGH
NA/K Ratio 22 27-38 LOW
Glucose 60 70-138 mg/dL LOW

Urinalysis

specific Gravity 1.009 1.015-1.050 LOW

I'm really worried about her stim test results though and wondering if that has anything to do with her losing weight over the past few months and her confusion she has at times.

Thanks so much for any input!

[labblab]

With a stim result that low along with the elevated potassium, I don't think Sammi should have any more Vetoryl at all right now!!! Combined with her symptoms of lethargy and vomiting, I am very worried that she is in an Addisonian condition and may even need supplemental steroids (including prednisone) to stabilize her. Please call the vet back immediately and tell him about her lethargy and vomiting. I am very worried about her, too! Please, please no more Vetoryl until you get this straightened out.

Marianne

[sammisam]

Ok, going to do that right now.

She did not want to eat this morning either.

When they do the stim test are they giving her something that would mess with her levels at all, either increase or decrease something?

[DoxieMama]

And that Na/K ratio being low bothers me, too. That was my boy's issue... and we kept lowering and lowering his dose. I wouldn't be giving this little one any Vetoryl at all until she's eating and acting more normal, if then.

[sammisam]

Vet said to keep her off the Vetoryl for a week and if she doesn't improve to bring her in. Even if she does improve he wants to see her and re-test in 2 weeks.

If she doesn't eat in the next day or two I think i'm going to take her in.

She is lethargic but she does get up to get some water and go potty on the wee wee pad, but she doesn't even want to lick any food right now.

I'm definitely keeping her off the Vetoryl for now.

Is there anything that we need to watch for to know if it's a true emergency (everything is an emergency to me with her)?

[Squirt's Mom]

This is an emergency!!!!

Call for an electrolyte check now!!!

[Joan2517]

I wouldn't wait...get her to the vet NOW!

[labblab]

Since her electrolytes (blood chemistries) were just tested on Friday along with the stim test, we already know they're out of whack with the potassium being high, and the potassium/sodium ratio being off.

Given her vomiting and lack of energy and appetite, I truly don't understand why the vet is not at least prescribing some prednisone to try and perk her up. If she still is acting just as yucky by late afternoon, if you can't take her back in, I'd at least contact them before they close and request an Rx of prednisone to be called in to a pharmacy near you so that you can give her some tonight. And if that doesn't help, for sure get her in tomorrow.

Marianne

[molly muffin]

I would definitely want a rescue dose of prednisone for awhile. Forget starting back on vetroyl until she has symptoms again, and I didn't see as I was readying fast, but did they give her fluids to get her electrolytes balanced?

If not, ask them about doing that too.

[sammisam]

How would I get her to take a pill when she won't eat? We've tried to give her pills without eating but we could never get her to take them.

They didn't get the test results back until a day or two later so they didn't do any fluids.

The vet we see is a specialist in Cushing's but please tell me why it's an emergency (not that I'm questioning because you guys are always the ones that are correct).

Are her levels or electrolytes that off and/or is it her symptoms combined with that which is making this an emergency?

How can we get her to take a pill without food?

[labblab]

If your VCA vet is a Cushing's specialist, then I would have to defer to his assessment that the lab abnormalities are not "off" enough to constitute an emergency at this time. But if Sammi continues to vomit and doesn't eat, there has to be a cause for this, and her low cortisol level could be that cause. If nothing else, I would worry about her becoming dehydrated from ongoing vomiting. Hopefully, stopping the Vetoryl completely will help elevate her cortisol level. But if she is still vomiting tomorrow or looking worse in any way, I would want to take her in if she were mine.

Marianne

[sammisam]

Thats exactly what I asked him!

I counted her heart rate and if I counted correctly it was 75 beats per minute at rest. I told my husband to get the pet tube ready in the car and I'm just waiting to hear back from the vet.

She won't walk, she just stands there and wobbles and I placed her in her bed and she's just sleeping. She did throw up (she's just throwing up clearish colored liquid) again but she definitely has thrown up less than last night (twice today).

I have a feeling we're just going to take her and we're just waiting a couple more minutes to hear back from the vet.

Is there something she could get at a vet we've seen right around the corner?

We don't usually go there with the exception of emergency or urine test but if there's something the vet around the corner can do for her I can take her right there.

I hate that the traffic may be a 90 min car ride as opposed to a one minute ride for her. I also asked the vet if he can make the recommendation for the vet around the corner.

[sammisam]

what is the name of the drug they usually give (i guess its an injection). We're just going to the vet around the corner and I want to make sure she's doing the correct thing.

She said dexa something?

[labblab]

Yes, dexamethasone. That's a steroid replacement when cortisol is low. I'm very glad the vet is considering that!

[labblab]

The vet may also give her some IV fluids to replace what she's lost by vomiting, and also to get those blood chemistries more closely back to normal.

[sammisam]

They had said 1cc of dex over the phone because i called to make sure prior to coming that they had Cushings experience.

Sammi is 8 lbs.

[sammisam]

They're giving her the dex and they're also giving her subcutaneous fluids and vitamin B. Poor little thing is so listless. I really hope this helps her.

This vet office is like nothing I've ever seen but i can't complain right now because she's here getting the right help. I just want to cry.

[labblab]

I really think you've done the right thing, getting Sammi this help. Good job, mom!! We'll anxiously await more updates.

[sammisam]

Thank you! I really think it was the right thing to do. I'm afraid to ask this in case it doesn't happen in amount of time that someone answers, but how long does it usually take to start feeling better and perking up?

Also, is it normal for her back to be all wet after they administered the sub q fluids? Now I'm wondering if they didn't do it properly and it leaked out or didn't go in at all.

OMG she just walked out of bed!!!!!!! She actually got up and walked around, went pee pee on the pad in the bathroom but she still doesn't want to eat. She's still a little wobbly, especially in the back legs it looks like.

I'm happy that she actually got up out of bed and started on her way to the bathroom but I just want her to eat ;-(

They said they were giving her 1cc when i spoke to the vet on the phone (remember, a different vet) and it said 2mg/ml on the bill so I don't know how much they actually gave her. Not sure if it's something that she may need more of???

[sammisam]

Just heard from the internist at the VCA and he said he would also recommend Prednisone in addition to the Dexa injection.

How can we get her to take a pill when she may not eat?

He didn't say a pill so I'm just assuming because he did say he can call in a script.

[labblab]

Hi yes, the prednisone does come in pill form, but at least they're not big pills. Hopefully, by the time you read this, Sammi will be a bit more interested in food. Also, I'm guessing the dexamethasone will last for at least 24 hours before you need to start giving the prednisone? So hopefully she'll be more willing to nibble something by then.

I've always had success by buying some of those soft American cheese squares, tearing off a little piece, and wrapping the pill in the cheese. All my dogs have been willing to eat cheese out of my hand, no matter what. But if worse comes to worst, there's a technique whereby you forcibly open a dog's mouth, place a pill on the back of the tongue, and then clamp the mouth shut again while tickling the throat. This prompts the swallow reflex. So that may be an option, too. But let's see how she does today. You may see her appetite return with the dex. Also, that notation you saw on the vet bill was the formula they used to calculate the correct dose given her weight.

Also, I wouldn't worry too much about the wet back. That may just have been overflow. If Sammi is peeing, that means that she's got fluid inside.

So all in all, we'll be awaiting today's report and hoping that she's doing better now!

Marianne

[Joan2517]

The leaking is nothing to worry about, that happens a lot. Her getting up to pee is a good sign.

[DoxieMama]

I'm so glad Marianne was here for you yesterday. It sounds like such a stressful day for you! I surely hope you all got some much needed rest and your little one is feeling a bit better this morning.

[Squirt's Mom]

Oh I am so very glad you got her in to a vet and that she got the Dex shot. Dex lasts much longer than pred and it doesn't go to work quite as fast as pred so hopefully today you will really see a difference in her, an improvement. I would still get the pred pills in case she still needs a bit of help as the Dex wears off....plus it is always a good idea to have some on hand when we treat our babies just in case. ;)

I hope to hear good news today and I know you want to share good news so we will be standing by. :)

Hugs,
Leslie

[sammisam]

Well Sammi has been getting up on her own and walking around. She's doing more wandering, but her first stop is to drink, drink, and drink and then pee, pee again a few min later, and then pee pee even more.

She's still a little wobbly but she's absolutely holding herself up and drinking on her own. Yesterday she could only take little sips and I had to hold her up, but today, drinking as usual.

I would say there's def an improvement since yesterday but she still doesn't want to eat which is making me nervous. This is also the longest she's gone without throwing up (19 hours) which is good.

She wanted to come up on the couch with us last night instead of just staying in her bed (we watch tv and have been sleeping on the couch for the past year because she doesn't like being up high in the bed).

She's also doing that thing where she's sitting and then slowly starts falling downward as if she's going to lay down but then catches herself plops back up and then the same process happens again. Kind of like someone falling asleep at the wheel.

She just now got comfy and is laying down.

The vet said the prednisone comes in liquid form so that will be so much easier.

Hoping today will be better (i think it's a start) but the internist is back tomorrow so thats when he said he do the prednisone. I emailed him last night and told him we'd pick it up today, but he said Wednesday.

Not sure why he couldn't just write it even when he's not there or there was just miscommunication. Here's the email because I don't know if there's some reason he wanted to wait until Wednesday???

From: Joseph Bisignano <Joseph.Bisignano@vca.com>
To: traceylacey11 <traceylacey11@aol.com>
Sent: Mon, Oct 16, 2017 8:06 pm
Subject: Re: Sammi update

Not tomorrow. I’m back Wednesday and yes we have a liquid.


On Oct 16, 2017, at 8:03 PM, "traceylacey11@aol.com" <traceylacey11@aol.com> wrote:

How would we give her the prednisone if she's not eating? We've tried to do the back of the throat thing with other pills but she'll either gag it up or it won't go down.

Maybe if someone shows us how or I don't know if there's another way to give a pill if she's not eating. Do they make liquid?

So should we wait to see how she's doing tomorrow and if she's not doing better we can come pick up the prednisone tomorrow?

Thanks,

Tracey


-----Original Message-----
From: Joseph Bisignano <Joseph.Bisignano@vca.com>
To: traceylacey11 <traceylacey11@aol.com>
Sent: Mon, Oct 16, 2017 7:29 pm
Subject: Re: Sammi update

Glad to hear but she should also be on Prednisone and not just the one injection of Dexamethasone. I can script this out on Wednesday if needed.

Sent from my iPhone

[sammisam]

And I also wanted to say THANK YOU so much to everyone here.

You have helped us so much and relieved some of the stress of wondering what to do, what not to do, why to do it, EVERYTHING!

Thank you from the bottom of our hearts!

Now let's just pray Sammi starts eating.

[sammisam]

Sammi just showed a tiny tiny interest in food. She took a couple of licks of creamed corn off of my finger (just the juice) and she took a couple of licks of her food but nothing else.

Before she was just turning her head away.

It was really a minute amount and no food, just the juice, and barely any juice but I guess a start. Definitely drinking a LOT and peeing.

Please, Sammi, eat eat eat!

Does seem to be getting some of her strength back.

[labblab]

YAY!!!!! This may only be a baby step, but still -- IT'S A STEP! :) :)

Thank you so much for today's updates. I definitely think you did the right thing yesterday, and I hope she'll keep on improving now.

I don't know why your specialist wouldn't authorize the prednisone pick-up until tomorrow, although perhaps he wants to wait and see whether there's anything else she needs in addition. Her response to the dexamethasone today may help determine that.

Anyway, I'm really glad you can get the prednisone in liquid form -- that should help make things easier. Hang in there, and keep these updates coming! You're doing a great job for Sammi. ;)

Marianne

[Squirt's Mom]

Oh YAY!! A step forward is a step forward! YAY!! Have you tried any home made chicken broth? Most pups love the stuff and it can help ease his digestive system back to full function. As she eats the broth more willingly, add a little bit of white or brown rice. ;)

I'm so glad she is at least showing some interest and pray the trend continues forward and quickly picks up speed!

[sammisam]

We'll try the home made chicken broth but do you mean home made as in I make it myself? The only soup I've ever made is with the concentrate that comes in the jar.

We've gotten some at the grocery in the past and we always look for the healthiest kind. Do you think that would be ok?

She took a couple of licks of some mashed up egg salad I made for her with just the eggs and a drop of mayo to make it smooth. But just a about 6 licks and I really didn't think she got much at all.

My husband just went to get baby food and are making sure it has no onion or garlic or anything else she cant have.

She sure is drinking water!

Thank you so much for helping us through this. My heart is just sinking and I can't even concentrate.

[molly muffin]

Low cortisol will cause drinking/peeing just like high cortisol will. So as she evens out, this should become less and less.

You can get one of those rotisssiere chickens, bowl the bones, strain all the bones and stuff out and give her the broth. This will probably be the most nutrious route for her and the plus is that you can try to give her some chicken if she will eat, and make chicken salad or something for yourself. (leave out any onion in case she wants some too at some point)

Come on Sammi!!!!

[sammisam]

Ran to the store and got the Rotisserie and tried some of the broth but she didn't want it. We're also making more broth as I write this.

We put a few pieces of skin and chicken bits and she licked the skin a couple of times but didn't want to eat it. It seems like she wants to eat at first but then turns away and isn't interested.

When my husband went to take our other lil monkey out Sammi looked over and started to walk to the door to go out. We took her out and she pee pee'd and went one little poo poo. Her first one since Saturday afternoon.

She walked around a little and seemed to want to be doing her usual things. She is definitely more alert and engaged than yesterday with the exception of the eating. She still a little subdued but stronger than the past two days. It's also been 28 hours since she's thrown up too. Still drinking and peeing.

I just wish she would eat. We've tried hot dog, her new dog food she liked, eggs, chicken, chicken skin, chicken fat, chicken broth... I even tried my mac and cheese.

Could it be that she's nauseous, but hungry, so she tries to eat but then turns away.

Do you think adding the prednisone may help the vet make a better determination as to what she needs or do you think adding the prednisone may help her want to eat by raising the cortisol levels?

She's so content laying right next to husband with her head rested on his arm. So precious!

[sammisam]

Sammi finally licked a little bit of broth just now at 11:45 p.m and she also had about a tablespoon of the broth with chicken in it.

First time she showed a little bit of interest in food and actually ate it.

She would only eat it out of our hands cupped but that makes me feel a little better. It wasn't as much as we'd like her to eat but I'm so happy it's a start!!!!!

C'mon Sammi!!! A little more, a little more!

[sammisam]

Ate a little more this morning but nothing close to what i would consider a meal. It seems like she's hungry and wants to eat.

She did have a tiny bit more solid chicken this morning and being that she licks the juice a lot, I pulverized the chicken with the broth so she could get more protein.

What is it that the prednisone pill/liquid will do. Is it because that will raise her cortisol levels?

I now see why she CANNOT have the Vetoryl right now because that will do the opposite of what we want. We want to RAISE, not lower her cortisol level, right?

I do believe the vet said prednisone.

[labblab]

Boy, I sure wish she'd eat more, too :o. At least she's heading in the right direction, though, and hopefully her appetite will continue to grow.

Yes, you're exactly right, we're hoping the prednisone will continue to stimulate her appetite. By discontinuing the Vetoryl, we hope that Sammi's natural cortisol production will start increasing again on its own. We don't want it to get super high again, and for that reason the Vetoryl may be restarted again a bit later on to keep it under control. In the meantime, though, the prednisone is a steroid substitute for cortisol -- it has the same action in the body as does cortisol. So it serves as a replacement or a "bridge" until Sammi's natural cortisol gets a bit higher while she's off the Vetoryl.

I'll be hoping that we see even more improvement today!

[sammisam]

That makes complete sense now that I've learned so much!

So how does one know if Sammi is producing cortisol or if it's the steroids producing cortisol?

I would imagine it's a back and forth of watching symptoms and stim test results.

We're getting both the liquid and pill form so if she starts eating she can take the pill and until she starts eating she can take the liquid. That way we'll have it on hand at all times!

How long does the dex shot usually last? She's 8 lbs (she was 13 lbs a year a half ago) and they gave her 1cc they said.

She is definitely drinking and peeing and is with it enough to climb down from the couch and go into the bathroom to use the wee wee pad. She also seems like she wants to eat because she comes into the kitchen anytime one of us goes in there and starts clanking around pots and pans and cooking. That's her usual m.o., lol!

[labblab]

So how does one know if Sammi is producing cortisol or if it's the steroids producing cortisol?
That is an excellent question! An ACTH test cannot distinguish between the effects of cortisol vs. prednisone. For this reason, a dog should not receive any prednisone for 24-48 hours prior to an ACTH test -- that way, you know it's only the natural cortisol level that is bring measured, and not the added effect of the prednisone as well. I'm guessing your specialist will want to retest her within a couple of weeks or so?

As far as the duration of the dexamethasone, you'll need to rely on your specialist's instructions as far as how soon to start the prednisone. I don't know the answer to that.

Continued good luck!

[sammisam]

Oh wow! Glad to know! Hopefully the vet will tell us that UNLIKE when they tell you to fast your dog but give them the Vetoryl 4-6 hours prior to the stim test!

We've always fed Sammi prior to her stim test only because I learned that here!

Well my husband went to pick up the prednisone and hopefully, hopefully her appetite will come back. She now doesn't even want to lick the juice since breakfast. She at least hasn't thrown up in over 24 hours!

For anyone where their dog will lick and not eat I found that the immersion blender made liquid soup out of some broth and actual large chicken pieces! Hopefully she'll want some later like she did this morning where she actually ate a few little chicken pieces.

When we tried to feed Sammi this morning, we were on the floor with her and chicken pieces, ground beef, soup, wet dog food all over the place (she seems to like to lick and eat it out of our hands). Food and liquid was all over the floor, the wall, on the feeding towel, on Sammi's back, on Sammi's head, on our legs, our feet, everywhere!

But... we have a reddish-brown garbage disposal that cleans up all the mess without even turning the switch on. His name is Taylor (our other Boston Terrier), lol!

C'mon SammiSam.... eat lil girl, eat.

[Harley PoMMom]

I know how worrisome it is when your furbaby doesn't want to eat. I'm including these two posts with the hope that they may help with Sammi's appetite.


Some food toppers I have used are: tripe, grated parmesan cheese, yogurt, warm meat broth, baby food (make sure it doesn't contain onion or onion powder), scrambled eggs, and boiled potatoes.

Medications used to stimulate an appetite: meclizine, mirtazapine, cyproheptadine. And a new prescription drug manufactured by Aratana Therapeutics Inc was just approved in 2016 called capromorelin (brand-name Entyce.)

Entyce product insert: http://www.aratana.com/wp-content/uploads/2016/12/ENTYCE-Pkg_Insert-8_5x11-FINAL.pdf


A good information source regarding inappetence can be found on the DogAware site: http://dogaware.com/articles/wdjinappetence.html#meds


Sometimes just heating up the food was enough. If not, then other ideas I have tried in small amounts were canned dog or cat food, or fish (tuna, sardines). I've also cooked meat such as chicken or turkey, steak, meatloaf with lowfat burger/turkey burger and fresh veggies.

A supplement that you may want to try is slippery elm bark (SEB) which I and others have used with success. One caution note with SEB is that it slows down the absorption of other drugs or herbs so it is recommended that it be given 2 hours before or after other herbs or medications. I'm providing a link with information regarding SEB: http://www.littlebigcat.com/health/slippery-elm/

I hope that Sammi's appetite picks up real soon.

Hugs, Lori

[sammisam]

Oh thank you so much!

Sammi just ate a good amount of ground chicken!!!!

It's been the most she's had and I would say at least three to four good size tablespoons! When she's done, she's done because she just turns her head and doesn't want one more bite, but I'm really relieved she actually ate some solid food and more than just a thread size piece!

Just waiting for my husband to get home with the prednisone but I hope she keeps eating more!

[molly muffin]

I'm wondering if she doesn't feel nauseous from the food when she eats and maybe that is why she only licks a bit or takes a sniff and walks away.
If so hopefully the pred will help with the appetite and then once she starts eating regularly that feeling will go away. Like the empty stomach I feel sick thing us humans get. That's just a thought.

Even eating a little bit is a big help to her system. Yay!! Come on Sammi!

[sammisam]

Woo hoo... Sammi went back for a few bites two more separate times since that little bit she ate earlier.

She went to the plate all on her own!

Got the liquid prednisone in her too! She took the bites prior to the meds and then after we went for a little walk/stand outside (20 min after giving it to her she ate a few more bites).

That actually makes sense. . not eating for 3 days so little licks and bites would be like a meal and she probably can only stomach tiny bits at a time.

That would match up with what she's been doing. Now how would we know if her cortisol starts to go too high?

Cushings symptoms reappear? Thats hard when some of the symptoms are similar but i think we know her well enough to notice... Hopefully.

Vet gave her .05 for the liquid and she's 8.25 lbs. I have to check the pill dosage.

I'd say she's steadily improving compared to the past three stressful days.

Thank you so much for helping us through this rough time. Really does help tremendously!!!

[DoxieMama]

Now how would we know if her cortisol starts to go too high?

Cushings symptoms reappear? Thats hard when some of the symptoms are similar but i think we know her well enough to notice... Hopefully.

I believe so. The only way to know for SURE is to test, but watching for symptoms is a good indicator of WHEN to test.

C'mon Sammi! EAT!

[sammisam]

Oh my God this is such a roller coaster. Sammi kept readjusting and licking her lips all afternoon and all night. She just got up and went in the bathroom and threw up.

It looked like it had small dark brown flecks and I remembered something about ground coffee beans but I'm not sure if thats even what it was. There were only a few spots of them but there's nothing she licked or ate that would've been that color.

She didn't want to eat since her last few bites this afternoon but being that she just threw up and has been licking her lips I'm guessing she didn't want to eat anymore because she was feeling sick like you mentioned.

I don't even know what to do. She's lying down right now so hopefully it's just because of her licking different foods (but she barely licked enough of anything in my opinion and mostly ate the ground chicken and ground beef).

The only other thing she had was the liquid prednisone???

[sammisam]

Sammi just threw up again and there's definitely those brown specks and more of them that I would describe as coffee ground looking. I did also notice her stool being very dark yesterday (before any prednisone today) All I keep reading about is possibly a lower intestine ulcer but I don't know if it has anything to do with the prednisone she just got.

I also noticed on her bottle of the liquid prednisone they have her weight as 4.5kg and she's 3.75kg which means their formulating her prednisone for a dog weighing slightly more than her. Don't know if this makes a difference or not.

I'm just really worried now because that's twice she's thrown up now with those brown specks.

[sammisam]

i was reading that prednisone taken on an empty stomach can cause stomach irritation but i don't know if her throwing up twice last night is from that. I don't know how she can take it if she's not eating but needs it to start eating.

I'm also not happy that the .05 may have been too much for her being that it was calculated for 4.5kg weight dog when Sammi was 3.75kg. they must've not looked at her recent weight just the other day.

Can prednisone be given by injection but would it then be a daily injection?

I'm so upset right now and she's sleeping and I don't hear her licking her lips as much but I don't know how she's going to feel today.

[labblab]

Oh dear, I sure understand why you're worried. Yes, it's true that prednisone can cause stomach irritation, and that it's commonly recommended that it be taken with food and/or a stomach soothing medicine for that reason. If Sammi's stool was already dark before taking the prednisone, then some bleeding may have started even before the prednisone, though. It's really hard to know. :(

I would definitely not give any more prednisone by mouth right now. I'm afraid you do need to call the vet right back and tell him what's going on, because they may want to add a GI soothing med and forget about the prednisone altogether, or instead give another dex injection. Now that the Vetoryl has been stopped, hopefully her cortisol will quickly start rebounding more on its own. And I wouldn't worry too much that she may have gotten a bit larger dose than expected, although you can also mention that to the vet. I doubt that it's the dose that was the issue -- probably more that she was getting the prednisone on a mostly empty stomach.

My heart does go out to you, as I know how incredibly stressful this is. Just like you said, a huge rollercoaster that jolts you around from top to bottom. Hang in there, OK? We're all pulling for you guys!!!

Marianne

[Squirt's Mom]

Please let us know what the vet says!

Something to think about that has done wonders for my dogs as well as cats and dogs of friends of mine. It's an herb called Slippery Elm Bark. It comes in a powder form that you mix with water and give to help with digestive issues. It acts like a band-aid and forms a protective layer over the intestinal track. It has literally saved the lives of some of these pets. Here are some links about SEB:

https://vcahospitals.com/know-your-pet/slippery-elm

https://www.whole-dog-journal.com/issues/5_5/features/5455-1.html

(This one is about cats but has great dosing info that can be used for any animal)
http://www.littlebigcat.com/health/slippery-elm/


And some links on where to get quality SEB: (these are the two I use and I always use loose powders not capsuled for ease of measuring)

https://www.mountainroseherbs.com/products/slippery-elm-bark-powder/profile

https://www.nowfoods.com/supplements/slippery-elm-powder
(You can get the NOW brand powder on Amazon and other suppliers.)

This is definitely worth a shot...and when it goes to work the appetite typically return in spades. ;)

Anxiously awaiting word on the vet visit!
Hugs,
Leslie

[sammisam]

this is what the vet said... i sent pictures of what she threw up with the little brown specks. there weren't a lot but enough for me to notice.

"Yes this looks like blood and it sounds like she is very sick. She needs to be evaluated and probably hospitalized. Please schedule an appointment with one of the medicine doctors today. Dr. McGlinchey should have openings so please schedule with him. I’m away the rest of the week so will not be in the office. Dr. McGlinchey will take good care of Sammi"

I really don't want her to be hospitalized and now I'm really scared. I'm going to put some breakfast down for her, see if she'll eat and then I'm guessing we'll probably have to take her????

[labblab]

I'm so sorry for all that you're going through, but if Sammi is bleeding internally, I do think you must take her in. Also, it's probably best not to feed her because they won't want her to risk vomiting up food and choking on it if they need to do a procedure on her.

I know your head must be spinning right now, and I'm afraid that Sammi may be quite a sick little girl. The hard part is that there may be multiple issues here. In looking back, I see that as far back as last spring, the specialists were fearing that she may have an enlarging pituitary tumor. I know I've written about that possibility, too. That could definitely explain her prolonged lack of appetite and other odd behavior. So the internal bleeding may be yet another big problem for her right now.

I do think you need to take her in, and hopefully the vet can help sort out options for you. It will be your decision whether or not to leave her there to be hospitalized. But hopefully they can help you make a judgement as to the best path forward.

Sending strength and lots of hugs to you all!!!

[sammisam]

I just made the appointment and we're going in an hour. If we left now we'd just be sitting in traffic and get there the same time anyway. I'll always do what's best for her.

She improved so much since the dex shot but then right after the prednisone she started getting more nauseous and thats when she threw up again although who knows if that would've happened anyway.

Ill let you know as soon as we know. The other vet is an internist so I'm happy about that.

We wont feed her but I'll bring some food with us in case the vet wants to see if she'll eat.

[labblab]

Sounds like an excellent plan. We'll be anxiously waiting to hear!

[Squirt's Mom]

I know how scary it is for both you and Sammie. Take an old shirt of yours or one of her blankets in case she has to stay. That way she will have something that smells familiar in her cage while she's there. That can be very comforting to them lessening their stress. ;) Most vets are happy to let you do this.

My prayers are with you both. Please let us know as soon as you can how things are going and what you have learned.

Hugs,
Leslie

[DoxieMama]

I'm also waiting in the wings for an update. Thoughts with you!

Shana

[sammisam]

Yes I will, I'm trying my hardest to hold back the tears buts it's almost impossible. We always bring her blankets and I even brought a bed one time (for our little angels Darla and Veronica) but they told me only her blanket.

I will let everyone know once we see what is happening.

[Joan2517]

Sending you lots of hugs! You're doing the right thing by taking her. It's hard, I know...we all know.

[sammisam]

Ugh...

Well Sammi is home with us, the vet said we can treat her as out patient right now and see how she does.

She had another blood panel to check electrolytes and they looked about the same (labs vary in calibrations but he felt they were similar).

He felt she wasn't dehydrated and this is what they gave her... It's not on the bill and I think I remember correctly but I'll get a copy of the actual chart. I'll def have to check her chart as I didn't want to question an UNDER charge being that this vet clinic is incredibly expensive.

She got an anti-nausea injection, and an injection of DCOP and Prednisone (I remember the name percortan also).

He sent us home with an anti-nausea pill and an appetite stimulant if she isn't eating by tonight, and told us to get prilosec for her.

I'm going to look into the slippery elm also.

She's home and she looks very sleepy and wants to lie down and I'm not sure but I vaguely remember reading that the anti-nausea med may have some sedative properties. She was walking around when I took her outside while waiting for the meds at the vet.

We don't start the prednisone until tomorrow (because she had an injection a little bit ago) but he wants us to increase the prednisone to 1.0mg for 3 days and then down to the .5

My husband went to pick up the prilosec and some fresh ground chicken for her. For us... muffins, creme brulee, cookies, cheesecake factory dinner for tonight, thai iced tea. That is my stress relief! And a half of a half of a half of xanax for me (I think a minimal dose helps me, maybe less than 1mg)

I'm just happy she's home with us even though she looks very sleepy.

[labblab]

Oh, I'm so glad she's home, too!!!!!

What did they say about the bleeding? I guess they're thinking it's coming from her stomach and the Prilosec will help ease it?

[sammisam]

Yes. I believe that is what the Prilosec will help with. I always have a million questions and then forget to get clarification again, but I definitely brought pictures of what she threw up and the actual vomit in a plastic wrap.

He could see what he needed from the pictures so I'm pretty sure he mentioned something about GI issues exacerbated with steroids. I just hate that she's sleepy and possibly is lethargic again. She got up for a second, walked a feet feet and then got back in her bed so I'll try not to read into that just yet.

So stressful and we've come to the realization that we never want her to suffer but it's the "not knowing" where she is right now and if she'll get better. I guess we'll see how she responds.

I KNOW everyone understands completely and we can't thank everyone enough for all of the education, support, and love.

Sammi is just the sweetest, toughest, little bounce back monkey and we just adore our animals. They are really our children!

[DoxieMama]

I'm happy to hear she is home with you. Have been, and will continue to, keep you all in my thoughts.

I'm especially glad to know you're doing what you need to take care of YOU too. That's incredibly important.

Hang in there!!

[sammisam]

So Sammi has gotten up and she's showing interest in eating and wants to eat but she keeps taking it in and then trying to chew but spits it out.

She's seeking it out when hit drops off of the plate, we've tried pulverizing it, mashing it, making into any consistency we can but she just won't chew and swallow. When she does try, she shakes her head to one side and tries to chew on that side. It's heartbreaking.

I CANNOT believe we didn't have the vet open and check her mouth! I am a dental hygienist and I'm trying to open her mouth and look but I can keep it open long enough.

She DOES seem to have an appetite now and it's killing us that she wants to eat and she's obviously hungry. Everything points to something with her mouth (possibly) and she did just have cleaning and extractions back in Feb. I know we still have the low cortisol issue but I still think something else is going on with her mouth and its the same thing she was doing last week until we found that dog food. She doesn't want that food now.

I could kick myself for not having the vet look today (thats what we wanted last week but no one ended up looking) because we were just concerned that she wasn't eating and lethargic so we didn't even get to the fact that she's back to spitting it out.

And the last thing i want to give her is an appetite stimulant if she has her appetite back because if she doesn't want to chew for some reason it would be torture to make her even hungrier.

Does anyone know what this could be?

[sammisam]

I haven't noticed her yawn lately (i thought i remembered her yawning the other day but i'm not sure).

I wonder if it hurts her to open but then I would think she'd at least lick the juice. I'm going to try and get a picture with her mouth open so i can zoom in and see if I notice anything.

[molly muffin]

When do you go back to the vet for a follow up? I'd have them take a look at her mouth, just to be sure there isn't some sort of infection going on.

Poor little Sammi and oh my gosh, you guys are just on a roller coaster, that you want to get off of I'm sure. I hope that things start to look up in the coming days. I really do. She is just such a cutie.

[sammisam]

I don't even want to think what was mentioned before but is it possible that the tumor is growing and it's causing neurological issues and they're showing up with Sammi in the form of this eating issue.

She'll either try to eat as she did earlier but just spit it out, or she'll turn her head and not want any. I gave her a few crumbs off the top of a muffin and that's the only thing she licked but didn't really eat. It was literally a half of a dime size.

I was reading about dogs with macroadenomas and some of them had similar eating issues. Not exactly the same but still similar. So it's like she's starving to death right now.

She was actually picking pieces off of the towel earlier and looking for food but then wouldn't eat it. If that's the case we can't let her suffer like this but I don't want to make that decision if that's not whats going on.

I don't even know whether to give the appetite stimulant because if she's looking to eat like earlier but just won't eat it then that's just going to make it worse. I'm sure the stimulant makes her interested in food but if she is already acting interested I don't see that it will help.

We're giving her the prednisone tomorrow morning but she can only go so long without eating so I hope she'll just eat and I hope this is all not because its neurological from a tumor.

Is that what a growing tumor can possibly do?

[labblab]

I am so sorry to tell you that loss of the ability to eat and/or drink can indeed be caused by an enlarging macrotumor. This is because the growing tumor can cause pressure and inflammation in the area of the brain that controls hunger, thirst, balance, coordination, etc.

My husband and I had to release our own Cushpup because he stopped eating entirely and seemed unable to drink water on his own. He would approach his water bowl and bend his head down -- but not far enough. So he ended up just lapping at air instead of the water. Among other changes, he also started pacing aimlessly around the house, and acting lethargic, "lost" and distant. It was the lack of food and water that became the crisis for us, though, and forced us to make that heartbreaking decision.

We did not know for certain that the tumor was the problem, because the only way to know for sure is to have imaging of the head done -- either a CT scan or MRI. Either of those tests is quite expensive and requires anesthesia, and for various reasons, we did not have the testing done. But based on his symptoms and behavior, we and our vet felt certain that an enlarging tumor was his problem.

I am so sorry to say that I'm fearful that this may be the same issue for sweet Sammi. If so, allowing her steroid level to elevate through a combination of rebounding cortisol and supplemental prednisone may help to buy her a bit more time. This is because the higher steroid level in the body can act as an anti-inflammatory on the tissue of the brain and reduce swelling associated with the tumor. Over time, the tumor will continue to grow, however, unless direct intervention is undertaken either in the form of surgery or radiation treatment. Again, unfortunately those treatments are also very, very expensive.

If there is no problem with Sammi's mouth but she remains unable to eat, I do fear that the tumor is a very likely cause, especially in combination with her lethargy and issues with falling backwards. Having lived through this myself, I wish so much there was something I could say or do to make things easier for you. But I do fear that this is a distinct possibility, and if Sammi doesn't improve, I do encourage you to talk about it with your vet. If the vet also thinks this is a likely possibility, then it may affect other treatment decisions along the way, with a focus on just keeping Sammi as comfortable as possible as opposed to other involved diagnostics or hospitalization. But no matter what direction you end up going, please know we'll remain right by your side.

Continuing to send tons of healing hugs your way,
Marianne

[sammisam]

I know how hard it must have been to watch your little one go through that but he is helping us and Sammi right now.

As hard as this is it actually helps me feel better because my fear is letting her go if she would've gotten better with this treatment or with that treatment. I don't know what today will bring and I'm hoping she's going to respond to the injections she had yesterday.

She's supposed to have the prednisone but I read it should be given with food to avoid stomach irritation and if she won't eat what do i do?

She's not drinking and peeing as much as I thought she would (like she did after that first dex shot on monday). She's still sleeping right now so i'll see how she is today.

My husband wants to try and get some food (in the form of liquid) into her with a syringe.

What do I do if we can't get food in her? Should I still give the prednisone? I would think she really needs it.

[Squirt's Mom]

Personally I would not give the pred if she will not take at least a little bit of food with it after the apparent bleed the last time she took pred while not eating. I would not want her to go thru a repeat. :( Syringing broth and gruel is an option; I've done it more than once. It can kick start the appetite but I think in Sammi's case I would want her mouth looked at asap to rule out any possible connection there. That will help you see the picture she is painting more clearly I think. ;)

We are here with you all the way. You are NOT alone.
Hugs,
Leslie

[labblab]

I know how hard it must have been to watch your little one go through that but he is helping us and Sammi right now.

That is absolutely the sweetest thing you could have said to me, and I thank you from the bottom of my heart! My baby's name was Barkis, and he is the yellow Lab who is my avatar photo. We lost him clear back in 2004, but by staying here on the forum I am trying my best every day to honor his memory and his bravery. So your kind words touch me to my core. Thank you so much!

I wish I knew the right answer about whether or not to give the prednisone if Sammi won't eat. Did your vet give you instructions as to whether or not to give it anyway? Are you able to give the Prilosec, or is that too hard to do since she won't swallow? Perhaps your husband's idea about trying to syringe just a little bit of nourishment might help coat her stomach somewhat...

If only we had a crystal ball to tell us how things will turn out, one way or the other!! No matter what I decide, I always second-guess myself and that just makes things worse. I guess maybe the first step is just to see how she's feeling when she wakes up. That may help make the path clearer. For instance, if she throws up again, I believe I'd hold off on the prednisone. But if she's willing to eat something, then go ahead. So let's see how she does when she wakes up.

Marianne

[sammisam]

Barkis is GORGEOUS! And I sincerely mean what I said. It's never easy losing something, someone you love, but it's 100x worse and 100x more heart wrenching when you wonder has anyone else gone through this, had these symptoms, or what went wrong, could I have done more, did I not take her to the right vet, did they mis-diagnose, should I have done this or done that.

When I read what Barkis went through I felt this sense of calm come over me in that I will know what to do and when to do it should that time come and his beautiful picture is engrained in my head.

Barkis, and you of course ;-) are our little angels right now and have helped US more than you'll ever know!!!!

I thought Sammi wasn't going to move and just lay there this morning based on how she was acting last night but she got up, peed, drank water and is looking for food but wouldn't eat or lick from my finger (sometimes she would even do that in past month but then once she got going she'd eat).

We mixed a cooked egg, chicken broth, and solid chicken (no bones of course) in the immersion blender and then syringe fed it to her. I think she got a pretty good amount and she didn't fuss too much. She didn't spit it out and I think she liked having some warm food in her belly.

After we finished she went over to her plate looking for food and started eating... (sort of eating - licking - swallowing some - spitting some out).

She kept it down and we tried to give her the Prilosec. I think we went through 4 whole pills (16 quarters)! We cut it in quarters so she could only get 5 mg. and everytime we thought she swallowed it... it would reappear on the floor or hiding in her mouth. We tried for at least 30 minutes, and we tried EVERYTHING... butter coating it, putting in through the opening in her teeth, on her tongue, hidden in a piece of muffin, following it with the syringe broth...

I don't think she got it. I actually know she didn't get it because all pills are accounted for. We kept having to cut a new one because the coating kept coming off.

We didn't want to freak her out and then have her reject the Prednisone so we ended up just giving her the Prednisone and I think we're just going to order liquid Prilosec.

She wanted to go outside when we took Taylor and she went out, walked around and now she in her little bed.

We'll see how the day progresses.

I/We, and I'm sure everyone (but def my heart) is so thankful you stayed here on the forum!!!! You and Barkis have made an incredible impact on us not only now, but also going forward!

We are so grateful. SO grateful.

Tracey and Sammi and Adam

[labblab]

Oh Tracey, I'm so glad you were able to get some food in her!! Keeping all fingers crossed that now she'll have a better day.

Thank you again for your sweet thoughts. To this day, I still have bad moments when I wonder whether we should have done things differently with Barkis. But I try to accept that we did the best we could at the time, seeing what we were seeing. In a perfect world, I would have gotten that head imaging to know for sure about the tumor. But we were in crisis mode. My mom had just had a major heart attack, Barkis was failing more by the hour, and he'd become so fragile that I just couldn't bear sending him off to be hospitalized for yet more tests. I must be honest and admit that the expense was also an issue. We knew we weren't going to opt for radiation treatment even if the images showed a macrotumor. So it was hard to commit to the strain on him and the expense of the imaging itself, knowing there'd be no treatment anyway. I wished so much I could talk with him to explain things, to tell him what we were thinking, and to ask him what he wanted done himself! But of course we couldn't. So we just had to decide what we thought was best, as hard as it was to do.

I apologize for going on about myself, here in your thread. But I just want you to know that every single one of us here who has faced these decisions are supporting you and your husband and Sammi 100%. All we can do is go with our instinct and our love for our babies. That doesn't mean all the questions can be answered, and they may never be answered. But all we can do is the best we're able to, at that moment, on that day. And take comfort in knowing that, no matter what -- whether we make mistakes or not -- our babies know how much we love them. Because we do, so very much. And we always will.

[Squirt's Mom]

Oh I am so glad Sammi ate a little bit! At least she has some food in her tummy and showed interest in more even tho she couldn't quite handle it on her own yet. YAY!!!

[molly muffin]

Baby steps! You're doing a good job in trying to get her to eat and juggling everything going on!

[sammisam]

You can take up "my" thread anytime you want. It really... truly... really... does help us!

We read about the protocol for testing to see if there's a tumor and what size it is and then all of the radiation they have to go through and even with all of that there are no guarantees and they still don't have quality of life. Not to mention all of the hospital stays and going under anesthesia so I'm sure you're thankful he was with you and not alone in the hospital and having to go through all of that.

That makes me feel comforted that he knew you were right there with him, hearing your voice and right by his side.

I really don't know what's going to happen and if Sammi will bounce back and having all of you here by our side is easing some of the angst. She's just been sleeping all day and will occasionally get up to go potty and pee but I've never seen her like this for this long. I'm hoping the steroid injections and meds will help her bounce back.

It's just torture not knowing if she's ok. She's nice and cozy with us in the living room, in her bed where she wants to be right now. So far, holding everything down.

[sammisam]

Need some help! I don't want to get too excited because when I do it seems like we take a bunch of steps backward and I get scared.

Need some type of recipe resembling a biscuit (human biscuit thats soft) but with protein/healthy calories for Sammi.

Sammi got up a few times to pee pee and she went to her food dish that we just warmed up all on her own! She started licking the puree we made her and tried her best to chew the tiny crumbles of chicken (at least the puree is purely chicken, broth and egg) .

Any pieces that fall out of her mouth/she spits out/pushes out, she would then seek it out on the floor and either eat it or her tongue would push it out.

I'm thankful she is looking for food on her own and it looks like her "lil Sammi" appetite is coming back.

Disclaimer - we're careful and know the foods dogs can't have such as onion powder, garlic powder, etc. but we keep trying different foods to see if she wants them.

Adam went to get Cheesecake Factory and she went crazy for the breaded chicken. We gave her the equivalent of the size of a quarter cut up in a million pieces. Some of it she got in and some ended up on the floor. The pieces that went on the floor were not because she didn't want them but for the other reason we're trying to figure out. She also ate many pieces of biscuit that we crumbled.

I'm guessing there's not too much chewing involved with the biscuit. She is clearly wanting to eat!

We want to make something that would resemble a biscuit consistency when we crumble it but make it out of chicken or the main ingredient be the chicken puree she likes. It doesn't have to be chicken it just has to be something that would give her the nutrition and calories and protein.

The biscuit was very soft inside, almost cake like.

We will def be taking her when she has her check next week and the vet will be doing an oral exam.

I think she can't open her mouth wide and that's part of the problem.

She went back for food a couple of more times and licked a lot more of the puree and ate the few tiny bites that she could.

She's kept everything down so far but she just had very bad diarrhea and it was black. It didn't freak me out too much because this exact same thing happened in the same time period after her last ACTH test.

And, I remember she had a steroid shot a few days after that last ACTH test because she was having those breathing issues. That was around April I believe.

Last time it was actually worse and all liquid. It was still liquidy this time but a little firmer. I'll def let the vet know all of this but I've always thought she has an ulcer or maybe it's the steroids.

She's doing some of her usual Sammi things but still resting a lot. We're going to do another syringe feeding in an hour or so. I want to let her rest after she just had diarrhea.

If anyone can think of some type of soft biscuit I could make for her using chicken and broth (and human biscuit ingredients) I think she might eat more.

I think she's feeling a little better today and we'll just go hour by hour.

[sammisam]

Forgot to add something that may help someone.

The vet said that he sees a lot of dogs cortisol go way down and into Addisons when they switch from the compounded Trilostane over to Vetoryl and the dosing stays the same.

That makes so much sense to me and something to think about when switching.

Knowing what we know now, I would either get the ACTH done a month or so after switching just to make sure the Vetoryl is the correct dose.

We switched back in June.

[sammisam]

But NO Vetoryl for Sammi and I don't know if she'll ever be at that stage of taking it again. We'll have to wait and see.

[Squirt's Mom]

I am so glad she is still trying to eat and especially glad she is taking some nutrients in on her own! YAY Sammi!!! Keep it up, baby girl!

[sammisam]

For the first time in a week...

SAMMI ATE A SIGNIFICANT AMOUNT OF SOLID FOOD ALL ON HER OWN!!!!!!!!!

She devoured the ground chicken breast up this morning. I chopped it up in tiny pieces and she loved it. I should've measured how much she ate, but it was the usual full amount that we would normally feed her, probably even more.

I'm still afraid to get excited but I'm happy she wanted to eat and most happy we didn't have to syringe feed her (even though I think she actually liked it or liked having warm food in her belly). She came into the kitchen like her old self just waiting to eat.

She took all of her meds (prilosec, anti-nausea, and prednisone). She walked to the door when Adam took Taylor out.... like, "hey, what about me".

The other thing I'm noticing that she did last night and has been doing the past few nights and some days, is lying down and wanting to put her head up. It's more like she wants her chin up which would make her head go back. She also keeps repositioning, moving forward, staying there for a little bit and then does it again. And sometimes her ears will be back (not flat back but more flat and backward than usual). I just don't want to ignore if she's in any pain.

She isn't doing it right now (she's just resting comfy on her flat bed) but she def has done it the past few nights. It's unusual for her, especially the moving around.

I've noticed since her hearing has deteriorated that her ears sort of stay twisted in a different direction but they have been laying flatter during the night, more so when she keeps repositioning.

Going to pray for her progress and improvement but as I've noticed this has been a roller coaster so I don't want to get my hopes up.

Go Sammi, keep up the good work lil munchkin!

[labblab]

Awww, this is great news! Keep it up, Sammi, keep it up!! :) :) :)

Marianne

[molly muffin]

That's an excellent report today. So glad she ate a normal amount and got some protein. I feel like that might be the prednisone helping.

Hmm, well if she has something bothering her stomach, the bleeding, that might make her uncomfortable and restless. Not able to settle. Are you still seeing any dark stools?

[sammisam]

Sammi is still eating on her own. She only wants ground chicken but I'm just happy she's eating.

Today, for the first time in a while, she started rolling around for about 30 seconds after she ate, trying to itch her face, which is what she always does. Unfortunately that's from the yeast infection on her face, but to see her go from listless to rolling around and wanting to itch her face makes me feel better. She's getting treated for that with chlorhex. wipes.

She still hasn't gone poo poo since her bout of diarrhea (which was dark brown-black) two days ago so hopefully she'll go today.

It does look like her belly might be bothering her a little but anytime we take Taylor she wants to go out too.

If she does have an ulcer I would hope that the Prilosec will help with that but when we see the vet I'm going to ask.

So being that she got the steroid injections and the daily prednisone does that mean her cortisol level is increasing (even though it's not "HER" cortisol... possibly)?

I guess, like you said, we'll have to see when she gets her test but that's scary to think that we hold back the prednisone so we can test, and after the test they can see if SHE is producing cortisol on her own.

I'd hate for her cortisol to go way down and she starts getting sick again but I guess we also would want to know if she's getting TOO much and her cortisol would be too high.

Well, at least today and yesterday I feel Sammi is coming back on line.

She's so cute that she climbs all the way up and down all the pillows we set up for her to get off of the couch and then walks all the way to the bathroom by herself to go pee pee.

My husband calls her "the land rover" because our living room looks like mountains and valleys of pillows. We have a hard time getting up and down and sliding and tripping, but whatever keeps Sammi safe!

I also just realized something something else. Sammi is not walking around confused at all. Granted, she just started walking around the past 2 days but she's had plenty of opportunity to "wander" and she hasn't.

Keep it up Sammi!

[sammisam]

So far so good.

Sammi ate some more ground again (we're trying to feed her small meals and more of them) and I was actually able to get her to eat some sweet potato - i added a little bit of butter and brown sugar and hated doing that but she ate it.

Finally made a semi solid poo poo (a little dark) but she has some vaginal discharge which is a little mucus -y and sometimes watery. It's not a lot but enough to notice the past day or so when I pick her up.

Does anyone know what that could be?

[molly muffin]

I'm not sure, as molly never had that kind of problem (vaginal discharge), but I wonder if a UTI, yeast, etc. Has she been scooting or licking?

Great she has a bit of a poop. Normal eating should get that back on track. Might take a few days though to get her system back to what it should be.

I know it's scary to think about, but you will want to know that her body is able to make it's own cortisol. You usually taper down the dosage of prednisone and give it a couple days and test and see where she is at.

When was it they wanted to test her again to see how she is doing?

[sammisam]

Still... so far so good.

The vet said she may be getting a UTI and we're taking her in this week.

She is now wanting to eat all the time! I'm sure it's the steroids.

I swear she's seeing and hearing better because when we talk to her she'll sometimes look up, and she's responding as if she's seeing and hearing better. Maybe?

I think she still has a little belly ache and maybe (maybe) nauseous because I catch her licking her lips sometimes. Still a little bit of diarrhea and I'm hoping that goes away. The color is not black-brown anymore it's more of a semi normal color but my husband is the one who cleaned it and sometimes I think he sees what he wants to see.

All she wants to eat is ground chicken and sometimes I can sneak in some sweet potato. I'm trying to sneak in some fiber and some rice.

She's also a tiny bit restless in that she doesn't want to sit in one place for too long or when she's resting she'll move around a lot and that's no like her.

I just want her to feel good and I guess we'll know more when she gets tested. I'm wondering if they'll want to test her without withholding the prednisone and then do another test a couple of weeks later where we'll hold back the prednisone???

Keep getting better my little Sammi, everyone is rooting for you ;-)

[labblab]

I'm so glad she's doing better!!

As far as the testing, if you all are worried about stopping the prednisone, one thing they might do is switch her to taking dexamethasone tablets or give her another dexamethasone injection during the couple days before the test. Dexamethasone does not register on the test in the way that prednisone does, so dex does not skew the results. The reading will only register the natural cortisol level. So you may want to ask your vet about that now, so that you can be prepared in advance of the test. ;)

Marianne

[sammisam]

Great advice!

I think it's better to get her in asap.

Can't do any switching of anything until the vet gets back in and that's tomorrow - he's been out and not taking any emails until until the 25th).

If we have to end up taking her in again a couple of days later we'll just have to do that because I really think she has some kind of vaginitis or UTI and I'd hate for her to wait another couple of days. I just left a message on his vmail.

She's gone poo poo a few more times and it's getting a little better and the color is also getting back to normal. Gave her some GasX last night and today and I see a difference in that she's not as restless.

I vaguely remember reading something about steroids and being MORE prone to infections or antibiotics not working as well or something???

I may be wrong but I hope they can give her something as I'm sure she has something going on with a UTI or vaginitis. Ugh... poor lil thing!

She is still wanting to eat but it has to be chopped up really small and crumbly and I'm trying to think of a vegetable to get some fiber in her.

I'll keep you posted and thank you as always!

Tracey

[sammisam]

I don't think it's my imagination but Sammi seems a little more listless today and today was her first day on the lower dosage of Prednisone.

Last week the vet prescribed .5 of the Prednisone but when we took Sammi back in 4 days ago the internist that was filling in for her usual doctor said to up the Prednisone to 1.0 for 3 days and then go back down to the .5 per day.

Sat, Sun, Mon she had the 1.0 and today, Tuesday. she only had the .5

Could this be a reason why?

[Squirt's Mom]

Yes it could cause her to be a bit less active as it wears off. How is she this morning?

[DoxieMama]

How about peas, green beans or carrots?

[molly muffin]

Yes she won't feel as great with less prednisone, but that is why you wean them off it slowly, which is what you are doing, not just taking it away from her.

[sammisam]

So frustrating! The biggest animal facility in L.A. can't run because they can't access their system so we have go and sit there with Sammi (could be all day) and HOPE that we'll get to see one of her internists (Adam and I have big mouths so we'll make sure we don't just see some random doctor that doesn't know whats going on with Sammi).

She has not come off of the Prednisone because we have not received any instructions about if they're even testing. The initial raising, then lowering from .5 to 1.0 back to .5 was when Sammi was throwing up the "coffee grind" looking stuff, still not eating, and still lethargic, last Thursday.

That's when the internist gave her the additional injections and said to increase the Prednisone for three days and then go back down to the .5 dose.

She's going to have to go in ASAP because of the possible UTI and now her eyes are very red and are forming a lot of goop, especially in the left one, so we just have to go there tomorrow and wait until one of her doctors are available.

Maybe they'll give her the stim test (knowing she's on the .5 Prednisone) to see how much cortisol the Prednisone is giving or I don't know if adjusting Prednisone is based more on symptoms. I guess they'll at least look at her electrolyte levels.

Then, I'm sure he'll give us instructions for another stim test in the next week to two or three weeks, where we'll stop the Prednisone how ever many hours you're supposed to (48?) prior to that stim test.

It's just frustrating that they don't have a back up system where they can see and make appointments so we don't have to go there and sit and wait. I don't even know if they can access Sammi's chart!

Sammi is still eating on her own but now the issue with the eyes and either UTI or vaginitis.

Because of the computer glitch at the VCA and not knowing when we could her in, we did a "free catch" (I'm getting really good at that) and brought it to the vet around the corner so at least they could test for a UTI.

I know free catch isn't the best but Adam doesn't want her getting poked and prodded AGAIN because she JUST had the culture less than 2 weeks ago, where they get it right from the bladder, when they did her bloodwork and stim test.

As I'm writing this Sammi is hunched like she has to pee but not peeing. I'm almost sure that's what she's doing. Exactly like when we have a bladder infection and think we have to go but nothing comes out.

I know they make stuff for us (AZO) to help with those frequency and urgency symptoms until you get to the doctor so I'm wondering if they make something for dogs. I hate to see her in pain until we go tomorrow.

VCA just called. System is back up. Appointment for 9:30 a.m. tomorrow. Going to email the vet about what she just now did but maybe someone knows if there's something out there similar to AZO but for dogs.

[Squirt's Mom]

Cranberries and/or cranberry juice is good for our dogs with infections in the urinary system but with her appetite off she may not want them at all. Some dogs like the fruit, some don't.

[molly muffin]

Uti or pancreatis they hunch like that too. Is usually a pain sign I think. Glad you got an appt.

[sammisam]

So... no UTI according to the free catch from the OTHER vet around the corner.

I was really hoping it was a UTI so we could treat it. The internist ended up having to do a urine culture and the results take 3 days but he did give her Marbofloxacin.

Was a total waste to do the free catch but we didn't know.

They also did electrolyte blood test (Nova something) and Sammi's potassium level is NORMAL!

It was high two weeks ago and last week but since the daily prednisone and the DOCP it's gone back to normal which I'm hoping is good (I think it is).

Does anyone think probiotics would be good for Sammi?

Her next appt is 28 days since the DOCP injection and that's when she'lll have her next stim test.

[molly muffin]

If they are having tummy troubles or on antibiotics, then I usually also give a probiotic. I use the foraflora one, but there are many out there.

Well a UTI is certainly something that you know what to do for at least. It's the unknown stuff that always makes me more concerned.

[sammisam]

It dawned on me that maybe, maybe it's the Prilosec causing some of these tummy ache symptoms? I don't know I'm just guessing.

I think I figured out the reason Sammy is not eating certain foods and chewing kind of funny and spits out her food sometimes. This really started about a month ago but much more recently.

I literally get down on the floor with her and video and watch what she's doing.

When I was wiping her eyes and mouth I noticed that a couple of teeth are missing that were there a few months ago. On the upper and lower she has her 2 canine teeth. She also has a few teeth on the upper in the front but no bottom teeth in the front so she can't really grip onto anything.

When she throws her head a little to the side to chew, she's getting the food to where she has opposing teeth on one side.

She doesn't like the consistency of pumpkin anymore because it's probably gets stuck to the roof of her mouth. I'm going to try to examine her teeth more if I can get in there to see but it all makes sense.

I'm just hoping they figure out where the mucus is coming from and why her eyes all of a sudden got so red and goopy.

Maybe it's just a cold or something due to her immune system being compromised.

I'm just happy the potassium is at a normal level and she's still wanting to eat.

[Harley PoMMom]

After a while pepcid ac did start to give Harley nausea so i switched him to slippery elm bark.

[molly muffin]

Has her white cell count been done since this issue with her mouth started? You want to rule out infection. Also find out why she is losing teeth like that.
I would probably call the vet and let them know. Just a side thought but an infection or serious dental issues can cause an increase in cortisol as the body fights pain issues.

[DoxieMama]

Dental issues can also be a cause of sinus or eye problems.

[Harley PoMMom]

Stopping the Prilosec may be a good idea, in people Proton-pump inhibitors (such as Prilosec) are linked to kidney problems.

[sammisam]

I looked at her chart from her dental visit last Feb. It looks like one of her teeth was in question but I haven't thoroughly looked in her mouth yet.

She still seems like something is making her uncomfortable but it's a drop better today. That's why I was so hoping for a UTI. There's still a chance that may be the case but we won't get the results until tom. or the next day.

Thank you for whoever recommended the mixed frozen veggies. I had to put a drop of Ricotta cheese on them because the ONLY thing she would eat was ground chicken so to give her a pill I put a tinch of Ricotta and she loved it.

So she's now eating veggies.

Can someone tell me where the best place to get the slippery elm?

I ordered probiotics for her too.

She has what I think is vaginal hyperplasia or prolapse and I'm wondering if it's related to the the mucus in her urine?

She is such a smartie because I had to take pictures of her little cha cha and for about an hour afterwards, everytime I got near her little behind she'd keep turning so she was facing me. So cute.

All in all, after a very scary week and a half I would say Sammi is doing well. I'm also super happy about those electrolytes and that the Potassium is no longer high and it's completely within normal limits.

The vet seems to think that she's going to go back into Cushings but we'll see after her next stim test on Nov. 16.

[sammisam]

Forgot to add...

white cell count was done and was within normal limits (actually right in the middle of the range)

[Squirt's Mom]

Here is some info on SEB that I posted on another thread yesterday. Be sure the get the powder and not capsules. Much easier to measure powder than empty and measure capsule contents, usually wasting some from the caps. ;) You can see the bottle in the upper LH corner and compare pricing here -

https://www.google.com/shopping/prod...HdTGD6wQ2SsIEw

Here is a link to dosing info as well a bit of info on the herb itself. The link is from a cat site but the dosing info is valid for dogs too.

http://www.littlebigcat.com/health/slippery-elm/

And some general info on SEB:

https://vcahospitals.com/know-your-pet/slippery-elm

https://www.whole-dog-journal.com/is...es/5455-1.html

[sammisam]

Thank you so much for the slippery elm info.

I just don't know what to do sometimes. Of course I will always take Sammi to the vet but you have to check and recheck every little thing. I started doing that years ago when the vet prescribed 1.0 mg of something for my cat and it was supposed to be .1 and they apologized but thank God I caught it before giving it to her.

Sammi has been taking Marbafloxacin for 3 days now. Today I noticed excessive drooling that felt slimy and thats never happened to her. Also seems not her same self that she's been the past few good days (little nauseas, licking lips a little, slightly lethargic, didnt want to go for walk with Taylor, drooling).

I double checked the Marbafloxacin dose on her bottle and then did a little research (I can't believe i forgot to check that bottle 2 days ago).

Recommended dosage is 1.25 mg/lb to start and with the "fluoroquinolones" is should be started at lower dosages.

It says it can safely go up to 2.5 mg/lb but EVEN at the highest dose thats still too much for an 8 lb Sammi! One of the side effects was excessive salivation! Her dose should be 10mg to 20 MAX! She was prescribed 25 mg 1x/day.

I'm going to trust my instincts and I'm kind of mad at myself for not listening to them sometimes, because every time I trust my instincts, taking into account what the vet recommends, I'm usually correct.

I wanted to have her Vetoryl lowered almost 2 months ago and it turns out my instincts were correct.

So I'm sure how Sammi is feeling today is due to TOO MUCH Marbafloxacin.

We haven't even confirmed a UTI and with both tests (within 12 days of each other) coming back negative for UTI (haven't received yesterdays results yet but the 2nd test was done the day before the 3rd - free catch and diff vet because we didn't know if she would be able to see her internist) I kind of doubt she will have one so she shouldn't be taking antibiotics anyway.

I can't blame the vet for that because we were sure she had one (or vaginitis?). He had all of the results from the other vet and the results from their test 11 days prior but he gave her the marbafloxacin.

I don't even know what's good and not good for her sometimes.

She just had a little snack and is walking around a little bit now and the drooling seems to have stopped, so hopefully she's feeling a little better now.

[molly muffin]

Instincts go a long way. No one knows our fur babies as well as we do after all.
Yes it does seem it is the medication that was causing the salivation.

She is smart. No camera taking pics she doesn’t want take. Hahahha.

[sammisam]

The vet seems to think that Sammi will return back to Cushings in a short period.

Sammi started panting (which she never does, with the exception of when her Cushing's wasn't being controlled enough because the Vetoryl dose was too low) The panting stopped but she seems to be breathing faster than usual).

Here is my question...

If her Cortisol level is rising... I'm thinking it could be, because of the change in her electrolytes (potassium returned to normal instead of being high), her panting for about 20 min, her voracious appetite lately, and fast respiratory rate (not sure if that's a Cushing's symptom), then wouldn't we be making it worse by giving her the daily Prednisone?

How are we supposed to know if she is now producing cortisol and she isn't scheduled for the next stim test until Nov. 16th? Vet wanted to wait until 28 days had passed since the DOCP injection.

Let's say she was tested and her levels of cortisol were VERY high... couldn't it be assumed that it's not just the Prednisone doing that?

Would it be of any benefit to lower her Prednisone dosage for tomorrow and see if those symptoms go away?

I'd hate to be giving her Prednisone when she may already be starting to produce it again. That's the same as giving her Vetoryl when her levels are extremely low.

Any help would be so appreciative.

[molly muffin]

I would call the vet, tell him what Sammi is doing, and ask about a schedule of reduction of the prednisone. You can always increase it back if need be, but you could certainly work out a schedule for reduction too. Maybe reduction in amount or in frequency either one, might work for her.

[Squirt's Mom]

You mention "her voracious appetite lately" - is she really eating "voraciously" or has she simply started eating on her again and wants food when offered? A cush appetite is 24/7 and pitiful to behold because they KNOW without doubt they are starving. My Squirt would look at me as if it were my fault she was so hungry and it made me feel about 1/10" tall. :(

You say, "Let's say she was tested and her levels of cortisol were VERY high... couldn't it be assumed that it's not just the Prednisone doing that?" The answer is Yes, it can cause the exact same signs we see in a pup who's cortisol is elevated. Both are steroids. ;)

You asked, "Would it be of any benefit to lower her Prednisone dosage for tomorrow and see if those symptoms go away?" In your shoes I would probably try that but I am NOT a good example. :-D The correct thing to do is to call your vet, discuss what you are seeing in Sammie (the changes you think can be attributed to the pred), and see how the vet feels about starting to taper off. So call her vet. ;)

[sammisam]

This is what I wrote the vet and his response is below what I wrote.

Sammi is still having panting a lot at night and breathing really fast (4th night in a row) when she's sleeping or trying to sleep. It's really scaring me watching her. When she had panting episodes in the past, it was usually because her Vetoryl dose was too low at night or it was when she only had the once a day dose in the morning. When we gave her the pm dose of Vetoryl or increased the pm dose, the panting stopped literally the next night. So I'm wondering IF its because she is producing Cortisol on her own AND she's taking the Prednisone. I'm just guessing. But if that's the case I would think she'd be breathing fast or panting during the day or shortly after her we give her the Prednisone.

So, again, I'm thinking should we try stopping the Prednisone for one day or is that not safe to do? Or, should we lessen the Prednisone for the next few days and wean her off of her .3 dose instead of stopping it immediately Her test is Nov 16 and I can't stand to see her suffer every night. We're going to have to start lowering it as it gets closer to the Nov 16 date anyway.

Here's the email below...

************************************************** ************************************************** ********
Joseph Bisignano (Joseph.Bisignano@vca.com)
To:you Details Slideshow

Yes you can stop the Marbofloxacin now. I’m not sure why the panting is only at night but we can reevaluate her medications when I see her and determine if she still needs the Prednisone.

Sent from my iPhone
__________________________________________________ __________________________________________________ ________________________
On Nov 1, 2017, at 9:18 PM, "traceylacey11@aol.com" <traceylacey11@aol.com> wrote:

She seems to be doing well.

Putting weight back on (almost up a pound!). Eating. Pooping normal. Haven't spotted any mucus in a few days. Eyes cleared up. Her dandruff completely went away on it's own (weird or maybe the marbofloxin fixed it?)

Should we stop the Marbofloxin being that there's no UTI?

The only thing she's doing that's abnormal is the past 3 nights she starts panting and can't get comfortable (lays down, gets up and moves, lays down, gets up again, and so on) and she's breathing really fast (only at night).

In the past, the only time the nightly panting happened was when she was taking too low a dose of Vetoryl, or when she only took the Vetoryl in the morning. The minute the Vetoryl was increased or given twice/day vs. once/day, the panting stopped.

Could it be that her cortisol is rising on her own and it's higher at night (she get's her Prednisone in the morning)?

I'm just wondering why the panting happens only later in the evening (and the not being able to get comfortable). She'll eventually get to sleep and a couple of those nights we gave her about 12.5mg of Trazadone.

I guess we'll know more when she takes the next stim test in two weeks.

Other than the panting I'd say she's doing the best she's been in a long time!

Tracey

[molly muffin]

In dogs with high cortisol often they need a split does, morning and evening to keep cortisol levels stationary throughout the day. It may be that the same thing is happening with Sammi on the pred, she is experiencing an increase in the evenings, especially if her glands are producing on their own right now.

Just a thought. How is the eating going now?

[sammisam]

That's an interesting thought because Sammi used to take the Vetoryl twice per day.

Sammi is still eating great but the panting and rapid breathing happen almost every night. I like the idea of splitting the Prednisone and giving it twice a day but I'm assuming the rapid breathing and panting are from Sammi's cortisol being too high, so if we give her the half dose of Prednisone at night I would think the breathing and panting would get worse. I'm not really certain if the rapid breathing and panting even means her cortisol is high. Could it be from her cortisol being too low? If that were the case then splitting the Prednisone may work.

I just remember when she did the panting thing at night, back when she was on Vetoryl, as soon as we started giving the Vetoryl twice/day, the panting stopped almost immediately.

So maybe Sammi has started producing cortisol again. She has an appointment next week for her ACTH test.

My gut is telling me to give her half of the Prednisone tomorrow morning, and see how she does tomorrow night. We have to start weaning her down anyway because of the ACTH test next week.

[molly muffin]

Gosh I looked back at what I wrote and though, huh, what was I thinking there again. It made sense in my head at the time, but not so much now. Yes, she probably does need to start cutting back on the pred and see how she does, you should talk to your vet about a schedule for that and how much to cut as don't want to lose any eating progress.

[sammisam]

Sammi goes in on the 16th for her ACTH test since having the DOCP injection last month and taking her daily prednisone. We weaned her down but the vet said to stop it entirely starting tomorrow and then her test will be on Thursday. I know Prednisone is not supposed to be stopped suddenly so the 4 days of not taking it scares me. She went from 1 pill taken for 3 weeks and then 1/2 a pill taken for a week and now starting tomorrow, no pill at all.

Does that sound about right?

It's a good thing I contacted the vet because I think he forgot to tell us that we should've been weaning down so I'm glad that's what I had started to do. I just thought the Prednisone was stopped only for 24-48 hours before the ACTH test, and not 4 days. I'm hoping it'll be ok for Sammi.

The day we went to half of her dose she didn't have any rapid breathing and panting at night but then it started up again the past 3 nights.

Any thoughts?

[labblab]

Can you tell us what dose of prednisone is in each tablet, and also remind us how much Sammi weighs? That will help us judge the appropriateness of the weaning.

Also, as a reminder, if she seems to be struggling during this time off the prednisone, the vet could prescribe some dexamethasone instead. Dex does not interfere with ACTH testing in the same way that prednisone does.

Marianne

[molly muffin]

I would do exactly what Marianne suggested if Sammie seems to be having any issues off the prednisone and that is get the vet to give her a Dex shot.

[sammisam]

They're 1 mg tablets, so she's been on .5mg for the past week. I didn't even have time to taper down because the vet didn't tell me. I did it on my own starting last week, so she's had .5mg for the past week, but according to the vet we're just supposed to stop today. I would've liked to go to a quarter tab (.25) for a few days but now I can't.

When it was prescribed, Sammi was just under 8 lb. She is now just under 9 lb. (YAY Sammi... gaining some weight back)

[sammisam]

So we finally got Sammi's results back...

Her last DOCP 10/13/17
Her last dose of Prednisone was on 11/12/17

She had the stim test on 11/16/17

Pre 4.1

Post 5.4

So her body is definitely producing cortisol again.

She also put some much needed weight back on. Last month she was under 8 lbs. and her weight on Thurs 11/16/17 was just over 9 lbs.!!!

So the vet said nothing about putting her back on a lower dose of Trilostane and she doesn't have to get any more steroid injections or take Prednisone. Is it possible that Sammi's cortisol levels may remain "normal" and she won't have to take Trilostane, or do we just have to wait and see and monitor her along with doing the stim test again?

She's really doing well with the exception of the panting and rapid breathing at night and more toward the evenings. The vet said he didn't know what the nightly panting and rapid breathing was from but did mention, possibly high blood pressure or pulmonary hypertension and we'd have to see the cardiologist to determine that.

He said if she doesn't seem to be in distress we can just monitor her for now.

What are your thoughts on her most recent pre and post test?

[Harley PoMMom]

Those numbers do indicate that she is producing cortisol on her own which is great! Whether the Trilostane will need to restarted will be a wait and see approach. On the forum we've seen some dogs that have had their cortisol drop too low while being treated with Trilostane/Vetoryl and then go on a "Vetoryl/Trilostane hiatus" for a period of time.

[sammisam]

Here is our Sammi update...

She had her 2nd ACTH test since the Addisonian crisis and we're just waiting for the results (any second now!)

She had gotten extremely weak in the back legs and is doing the panting thing much more. She also just doesn't seem right. We are REALLY hoping her results come back and show that her cortisol is way high again otherwise I don't know what could be going on.

Just now got an email saying Sammi's numbers were normal!!!!!!!!!! That doesn't make sense. I asked what the numbers were so I could compare them to a month ago.

when we did the last stim test her numbers were

pre 4.1
post 5.4

I'll find out the numbers of yesterdays test.

MY QUESTION... would anyone suggest starting Vetoryl is Sammi is showing outward signs but her numbers are in that range.

Her numbers when she had the stim test (prior to taking her off of Vetoryl) were

pre 0.6

post 0.9

[sammisam]

ok, here are yesterdays results

pre 6.1 (high)
post 8.2

How do read these and how is it that Sammi is showing the signs of Cushings again?

I know the pre test says HIGH but isn't it the relationship between the two?

So her cortisol has gone up significantly but I don't want to do something that will hurt her by giving her the Vetoryl. BTW we would only start her on 5mg per day. Waiting for the vet to call but i'm starting to feel like she doesn't know what she's doing (new vet at the VCA).

[sammisam]

I just don't understand this.

Spoke with the vet, she explained that in order for her to recommend the Vetoryl again Sammi's #s would have to be in the teens or greater than 20 on the post test. I don't understand how Sammi is having all of these symptoms and the test is coming with numbers that are not yet at the point where she can start Vetoryl again.

[sammisam]

So, while we were waiting for the vet we emailed Dr. Bruyette with all of the tests and he said to start Sammi on the Vetoryl again. That is our (husband and I) instincts and we would only start her on 5mg. how is it that the ACTH results are interpreted so differently?

But once again I come back to the question that brought me here... Don't you want to compare test results in comparison to YOUR animals test results (and signs and symptoms)?

Any input is appreciated!

[labblab]

Welcome back to you and Sammi. I’m sorry you are receiving such conflicting information, because it must make a worrisome situation so much more confusing. But yes, you are correct — you need to take into account the symptoms and test patterns that your own dog is exhibiting when you make treatment decisions. And since Sammi is again displaying symptoms and her cortisol seems to be steadily increasing now, restarting her Vetoryl would indeed seem to be the appropriate recommendation. I don’t know why your new vet is wanting to wait until her cortisol were to elevate so significantly. Here’s the printed guidance of Dechra, and it corresponds with Dr. Bruyette’s instruction. Note that it is the post-ACTH value that is bring referenced below, and is key in making treatment decisions.


If the ACTH stimulation test is < 1.45 μg/dL (< 40 nmol/L) and/or if electrolyte imbalances characteristic of hypoadrenocorticism (hyperkalemia and hyponatremia) are found, VETORYL Capsules should be temporarily discontinued until recurrence of clinical signs consistent with hyperadrenocorticism and ACTH stimulation test results return to normal (1.45-9.1 μg/dL or 40-250 nmol/L). VETORYL Capsules may then be re-introduced at a lower dose.

http://www.dechra-us.com/Admin/Public/Download.aspx?file=Files%2fFiles%2fProductDownload s%2fus%2fvetoryl-5mg-pack-insert.pdf

I do think you need to discuss Sammi’s situation further with your new vet. She needs to be aware if you indeed restart the Vetoryl. Now that you are armed with both Dr. Bruyette’s advice and also the link to Dechra’s official product insert, you can ask her if there is something specific to Sammi’s situation that is making her hesitate to restart treatment at this time.

Marianne

[sammisam]

Thank you so much!!!!

The new internist vet is just temporary because Sammi's internist is out for the holidays BUT, we've been concerned with some of the issues that have happened at our vet and Sammi's dosage should've been lowered months and months ago and her Adisonian crisis may not have happened. It's this situation that's happening now, but in reverse (ACTH numbers going down and down each time until they were extremely low.

We decided to look for a completely new office to go to even though the West Los Angeles VCA has helped Sammi in the past with other things. But it does seem like there are so many doctors that say different things and then one discovers something that the others had no idea about so she doesn't get diagnosed until months after the problem she's having (her mange, for example).

We asked Dr. Bruyette for a referral and if he knows a good vet. Well, I don't think we could've gotten a better response....

His wife, Dr. Maya Lottati is an internist and practices literally ONE MILE away from where we live!!!!

So, we will be taking Sammi there!

It's been so difficult to watch her struggle the past few weeks. Her back leg just slides right from under her, she's panting and because she's a Boston it sounds like she's in so much distress, she's peeing and sliding in it when we can't catch her, can't sleep or get comfortable, and it's just killing us to watch this.

She also is having that mucus discharge come out again and I've been reading about sex hormones and cortisol and sometimes the hormones can be high and a bunch of other stuff that is so hard to follow if you're not a vet, but I can't help but think this is related to Sammi's cushings.

Thank God she is still eating!

She's going to start on 5mg once per day and then she'll be having another ACTH test in 7-10 days per Dr. Bruyette.

Thank you so much for responding and I'm going to read that insert right now!

[labblab]

Omigosh, that is such great news about Dr. Bruyette’s wife!!!!!! What a huge relief to think she’ll be taking care of Sammi from now on — cuz I bet you’ll continue to get the benefit of Dr. B’s wisdom, too ;-))))))).

Please keep us updated, OK?
Marianne

[sammisam]

Yes! That's exactly what I was thinking too!

So, wouldn't you know... Sammi does not want to eat this morning. She's been eating fine, every day and eating all of her food, so her not wanting to eat this morning is worrying me.

Just to be sure... there's no way Sammi could be toward Addison's with those numbers, right? Also, her potassium and nova stat electrolyte panel has been perfect the past two times (nov 16 was the last one). I just want to be sure because she's been just wandering around lately, and now, this morning, doesnt want to eat.

She hasn't gone poo poo in two days now so maybe that's it but now it makes me think something else in addition to the Cushing's may be happening.

They were able to do another blood panel the day after we left the vet. Case and point, AGAIN... my recommendation was to get more blood at the time of Sammi's second draw for her ACTH test in case we needed to order more tests. We didn't end up seeing the vet until after her second draw (their mistake, not ours because that's how I had set it up - common sense), so I'm really glad I had them take extra vials because now they have it and we don't have to subject her to a two hour car ride and nerves.

Anyway, the impt thing is that the blood panel is getting done so we can see if anything else is going on.

My poor girl... the not eating is scaring me and I think she's been nauseas the past two days (licking her lips a lot).

Hoping to get in with Dr. Lotatti asap but will have to stay with the other vet until then.

[Squirt's Mom]

I may be completely offbase here but I would agree with your vet. Sammie has been off of the Trilo for at least a month now so I would think the testing would revert to the ranges for a dog being first tested - one who had never taken any treatment for Cushing's. Therefore you would want that post # to be at least 19 and preferably over 20 as the vet says. In your shoes I would not restart the Trilo at ANY dose until she saw the new IMS -which is wonderful that she is Dr. Bruyette's wife and so close! And I would want a thorough exam to rule out anything else that could be going on. Sammie is not presenting the usual cush signs so a question would remain in my mind if it is truly Cushing's, something unrelated, or a combination of things. Just me tho. ;-)

[sammisam]

I understand everything you're saying... that's why I'm so torn.

I did think the same thing and wondered if they should be doing that LDDT test (or something like that) or treat Sammi like this is a whole new diagnosis, but then I read the Dechra insert and it says, "if clinical symptoms reappear and ACTH results return to NORMAL", so that makes me think that the results are read differently and interpreted differently than if dog was being tested for the first time. Plus, Dr. Bruyette's advice.

And that is the 1,000,000 question... Are the ACTH tests interpreted differently depending on whether a dog has undergone Vetoryl treatment in the past, etc.

Just got off of the phone with Dechra and she was so helpful!

Yes, the results ARE read differently. Briefly she explained that ACTH is more monitoring and it's telling us that Sammi's adrenals are working again and based on Sammi's ACTH numbers since her crisis, Sammi's cortisol is increasing. This makes sense to me now that you don't have to wait for the ACTH numbers to go in the high teens and above 20 in order to restart Vetoryl (provided that clinical symptoms are present also)

So now that this is making more sense, our only issue is why is Sammi not eating. It's only been this morning but one of the Cushing's symptoms is ravenous appetite... which Sammi always has so I'm just going to try and calm down and let her sleep and hopefully she'll be hungry and eat because we won't give her any amount until she starts eating.

She did have a very very late dinner last night because we didn't want to wake her and she still hasn't poo poo'd so I'm praying she gets her Sammi appetite back!

Here are her usual symptoms... They've steadily increased along with the last 2 ACTH tests increasing.

increased drinking (ex-at least 4 times within 3 hours in the middle of the night)
increased peeing
usually has a ravenous appetite (exception is this morning)
weakened back legs
panting has increased significantly
more alopecia
the head bobbing and slowly sinking as if she was drunk
yeast infection is worse

I don't know if "confusion" is part of Cushing's but she's definitely more "addled".

Please Sammi eat this morning... please!

[sammisam]

Blood panel came back normal.

I'm going to take a look at it when I get home.

She said liver enzymes were slightly elevated but consistent with previous blood tests, but I'll look at the entire thing and see if there's anything else. I'm just letting Sammi sleep because she didn't get much sleep last night. Hopefully when she wakes up she'll want to eat!

[Squirt's Mom]

I'm glad you got to talk to Dechra and they were able to clear things up for you...and me! :D :o I hope you have great luck with the IMS!

[Harley PoMMom]

The one thing I would recommend is to have her urine cultured to make sure that an UTI isn't the reason for the increased drinking/urinating.

As for the nausea, Vetoryl is known to cause gastric upset so giving Pepci AC 20-30 minutes before her Vetoryl dose may help, I'd definitely let the vet know that she seems to be experiencing an upset tummy and ask if adding the Pepcid AC would be beneficial.

Lori

[labblab]

Had Sammi actually started back on the Vetoryl yet? If not, you may want to hold off until you have a chance to make sure her appetite has first rebounded.

Marianne

[sammisam]

Sammi hasn't started the vetoryl yet and we'll definitely make sure she's eating first. She's been on marbafloxacin for four days now so I'm wondering if that's why she won't eat, maybe she's nauseas. She's taking it for the orange-ish colored vaginal discharge. Her last dose was Wednesday though.

I'm going to take her urine in... We did get a sample but it was already too many hours old so I'll bring in a fresh one.

We tried to see if she'd even touch a little piece of churro, which she never turns down and she did eat a tiny bit but we're waiting for her to have a good amount of chicken.

[sammisam]

OMG... I just thought of something. Sammi had her blood drawn for the blood panel at the second draw of her acth test.

Couldn't that throw her blood panel results off being that she was injected with the acth drug (cortsyn) or whatever it's called?

[labblab]

Of course I’m not a vet, but I don’t think the ACTH stimulation agent should have affected the other blood values. So if they were mainly normal, that’s probably an accurate result. If anything, I’ll bet you may be on to something with the marbofloxacin. Antibiotics are notorious for sometimes causing nausea, and I just checked and loss of appetite/nausea is indeed listed as a possible side effect for marbofloxacin. So hopefully she’ll be feeling better now that she’s finished taking it! Do let us know.

[sammisam]

I'm going to enter in her blood test values but I think some of the readings, even they are "abnormal", are consistent with the blood panel of a dog with Cushing's.

She did eat a little bit of chicken last night and took her first "restart" 5mg Trilostane. She had another rough night with the panting and it's now getting to where she's doing the panting most of the day. She didn't want to eat breakfast which is so unlike her. She really looks like she's feeling lousy. She does the head bobbing thing, which she started doing when she was first diagnosed (diagnosed by my husband and not the vet, lol).

The new, or symptoms that have increased SINCE the Adisonian crisis have been...

much much more panting
wandering into corners
trembling when she inhales (sometimes)
NEW SINCE ADDISONIAN CRISIS -Very very weak back right leg (completely slides forward when she's standing)
NEW SINCE ADDISONIAN CRISIS - enlarged clitoris with mucus discharge at times (i did not know that was a symptom of Cushing's and it blows me away the vet didn't say anything when I pointed that out over a month ago (both the temporary vet and her internist)

She finally went poo poo and it was diarrhea - soft stool, both last night and this morning. And she did drink water this morning.

I'm going to try to figure out how to post her actual blood panel but if someone can walk me through it that would be great.

I'm so worried about my lil Sammi it's killing me. Here are the "abnormal" blood panel readings. I tried to compare them to her panel that was done PRIOR to the Addisonian Crisis and some of them do align with previous panels with the exception of Amylase. I can't really compare them to the panel that was done on 10-13-17 because those values are more consistent with her Addisonian Crisis.

12-21-17 Blood Panel

Results Range
ALT (SGOT) 150 IU/L 12-118 HIGH
Alk Phosphatase 256 IU/L 5-131 HIGH
GGT 48 IU/L 1-12 HIGH

BUN 39 mg/dL 6-31 HIGH
BUN/Creatinine Ratio 35 4-27 HIGH
Glucose 68 mg/dL 70-138 LOW
Sodium 156 mEq/L 139-154 HIGH
Potassium 5.4 mEq/L 3.6-5.5 (in range but close to being high)
NA/K Ratio 29 27-38 (normal but I know this ratio number was impt when they diagnosed the Addisonian crisis)
Cholesterol 350 mg/dL 92-324 HIGH
Amylase 193 IU/L 290-1125 LOW (i don't believe this value has ever been LOW for her)
HGB 21.1 g/dL 12.1-20.3 HIGH
HCT 65% 36-60 HIGH
Platelet Count 542 10^3/uL 170-400 HIGH
Platelet Estimate Increased
Neutrophils 11.440/uL 88% 2060-10600 HIGH

Cortisol (again, these numbers are looked at and interpreted differently depending on whether they've been diagnosed with Cushings already, on Trilostane, etc)
What the past two ACTH tests have shown is that Sammi's pre and post numbers have been climbing and climbing and that her adrenals are working again.

12/21/17
pre 6.1 1.0-5.0 ug/dL HIGH
post 8.2 8.0-17.0 ug/dL

When she first had the LDDT test on 3/25/16 these were her numbers...

The reason I included this is because I would think that if her very first reading was 6.7 (before anything was injected) back in March of 2016, when we first suspected cushing's, and her pre reading was 6.1 three days ago, I would assume she's Cushing-goid again????

3/25/16
Cortisol sample 1 0 hour 6.7 1.0-5.0 ug/dL HIGH
Cortisol sample 2 Dex 4 hour 5.6 0.0-1.4 ug/dL HIGH
Cortisol sample 3 Dex 8 hour 6.8 0.0-1.4 ug/dL HIGH

[sammisam]

I lined up all of the readings in columns to make it easier but it looks like it didn't post that way.

Let me try and figure out how to add these to her profile.

[sammisam]

ok... I see how you have to "upload" something just to save anyone from having to explain it again.

[Squirt's Mom]

The way the results are entered is just fine, looks good in fact, but please double check the ALT result posted - "ALT (SGOT) 44 IU/L 12-118 HIGH". As posted the ALT is not high so I am guessing a number got left off?

[sammisam]

Good catch!!

alt is 150 12-118 high

Is there something that they give in the same way that prednisone is given for addisons to jump start or make them feel better.

Is it safe to say that giving Sammi prednisone is NOT safe?

She really seems to be struggling with panting and breathing.

[sammisam]

Decided to take Sammi to the emergency because the panting and breathing just doesn't seem right. Coupled with the fact that even though she ate last night her appetite isn't her usual self. We didn't have an appt with Dr. Lotatti until Thursday so I had to bring her to the new vet as an emergency but the great thing is that Dr. Lotatti (Dr. Bruyette's wife) is here today so the emergency doctor is consulting with her. They mentioned something about possible causes and it could be in addition to the Cushing's and possibly a clot. There's nothing I can do right now but sit in my car and cry. My husband is there because they are doing an ultrasound, urine culture, and x-rays. She needed them anyway because they're a year old and I'm ok with that because it just gives them more information. I came over to Petco to get her little traction socks because now it seems like both back legs aren't functioning too well. Please say prayers that we can take her home tonight and that she's going to be ok.

[Harley PoMMom]

Oh, I am so sorry. And I am saying and sending prayers for you and Sammi. I'm here for you.

[Budsters Mom]

I am so very sorry. It does look like Sammi is in the best possible hands right now. You are not alone. We are here.

Kathy

[sammisam]

Sammi will be in the hospital overnight and possibly for the next 48 hours.

Thank God for the thoroughness of this new vet.

Sammi has pneumonia!!!!!!!!!!! They said it's actually the best outcome considering what it could've been. She's getting treated with the proper antibiotics, oxygen tank, nebulizer, and whatever else she needs.

The emergency vet was one of the most incredible vets we've met and she went over every little thing. We haven't met Dr. Lotatti yet, but will on Thursday.

Sammi also has four healed bone fractures that showed up in the xrays?????

Anyway, Adam went back to give her a kiss and she was already doing better than when we first brought her there.

I cannot believe that she has pneumonia!

I want to say I'm relieved but I'll say that when she comes home and is snuggled on the couch with us.

I wonder how long she's had this????

[sammisam]

And thank you everyone for your support it has really helped so much. Thank you thank you thank you!!!!!

[Budsters Mom]

So glad you went with your gut feeling and took Sammi in. Yes, pneumonia is treatable. It sounds like those ER vets are on the ball! Please keep us posted.

Kathy

[sammisam]

We went to see Sammi during visiting hours and Adam went in ( i couldn't bare to go and didn't want to keep that image of her in my head). I know that Adam being there and touching her and letting her know he's there would be enough.

When he came out he seemed more upset and now I'm second guessing how she's doing. He said it was just hard to see her laying there with tubes and machines hooked up to her and her eyes watery and filmed over because of the drops they put in to help with dryness and redness.

When we spoke to the vet this morning she said that Sammi is going through the normal progress of what you would expect and that Sammi would definitely be there tonight, tomorrow, and then we can see how she is progressing. She also said that when she took Sammi out of oxygen she was showing more effort to breathe and distress so they're keeping her in the oxygen tank. But the vet was also happy that she was sleeping at times and more relaxed. They're doing the nebulizer every 4 hours.

I thought Adam was hiding something from me but he said he just had expectations that she'd be doing much better. The vet tech also said something like "I think she had a rough night", but I also think that if he saw her the past 3 nights he would have been witnessing the same thing (that's why I initially brought her in because it just didn't seem like typical panting or even typical Boston Terrier panting).

We also brought her the chicken that she loves so hopefully she'll want to eat.

I bought 4 rugs to cover the hardwood floor because she was sliding due to her back legs being weak, and bought her some traction socks.

We're just so worried and praying she pulls through this. Sammi has pulled through every obstacle she's faced over the past few years and we call her the "wonderdog"

They told us she's one of their favorites there at the hospital, probably because she's the tiniest Boston and she's so sweet, so calm and so cute.

Please Sammi get better. We miss you!

[Harley PoMMom]

So glad you listened to your instincts and took her the ER, the adage "Only the pet parent knows their furbaby best" was definitely confirmed with your sweet girl. Keeping you, Adam, and Sammi in my thoughts and prayers. Come on Sammi, get better, we all are rootin for ya!

[sammisam]

Went in to see Sammi this time and tried to get her to eat a little. She didn't look good to me, she didn't respond to me, she was just laying there and seemed to still be breathing harder on her exhale. I don't even know what to think. I was hopeful after leaving last night and even though I'm always hopeful, I was very sad seeing her like this. i HAVE to believe pneumonia is the right diagnosis otherwise I'm just going to make myself sicker than I already feel.

I was looking over her blood tests and her neutrophil count was high from her test the other day. Her WBC was normal but it was the highest it's ever been.

Again, my theory that you should always compare blood tests to all the previous blood tests of that animal, even if the reading at the present time isn't "out of range".

It makes me hopeful that the WBC and high neutrophil count lend itself to infection. Her WBC has always been around 8 ish but the other day the reading was in the 13 number and I think HIGH is 15.5 and over. Her neutrophil count is def out of range and has never been in the HIGH range.

It was really hard seeing her not really respond to me but the vet did say that she is much better than when we first brought her in. The reason I keep doubting that is because at home, Sammi would pant and pant and then fall asleep for a little bit but still be responsive to me. This time she was just in the oxygen cage and just laying there.

I know that one day we're going to have to say goodbye, but I just thought she'd be responding faster. I did read though that it can take several days to see improvement. She's so little and I just want her to be ok. I'm so sad right now, I can't even function. I keep hearing her little footsteps climb down the pillows to go potty but then realize it's not her.

Part of me thinks... please let this diagnosis be correct and please let this be the right course of treatment. I can live with that. What I cant live with is if she's not getting treated for the right thing and I know that's just my mind thinking... could I have done anything else, did they miss something else that could've been treated, etc. but I go back to the neutrophil count high and WBC count higher than it's ever registered on her many previous blood tests.

I'm going to just pray and hope that she pulls through this.

We asked the vet if she thought Sammi was in pain and should we think about doing the right thing. She said "No, I would not make that call right now". She even said "why are you crying, I think Sammi is doing better" but again I go back to "better" is not what I'm seeing. I've seen Sammi sleep like she was tonight, at home, but still be responsive to me.

I've never seen her be unresponsive to me. So the vet is comparing when Sammi first came in and in distress to Sammi sleeping. I'm comparing Sammi in distress and then falling asleep but responding. i think everyone can understand what I mean.

I also know that there have been at least 5 times in the past year that we thought this was it for Sammi and the next day or three later, there she was, back to eating, back to engaging with us.

Taylor, our other little red boston is doing ok. He's such a good big (younger) brother. He's been so good about knowing that Sammi has needed extra attention the past few years. He loves to eat too and sometimes when Sammi takes a bathroom break in the middle of breakfast, lunch or dinner, he'll go finish her scraps. The other night when she wouldn't eat at first, and walked away, Taylor went to eat her food and I said "no no Taylor" and he literally did a moonwalk back to his dish. So funny!

He also makes us laugh when he makes a bed with his teeth and he literally drags one his smaller beds (they have at least 6 beds) into one of his larger beds, to make this extravagant sleeping area. So cute he his and so amazing both of them are.

Everyone always compliments us on how well behaved they both are. They're so mellow, they don't jump on people, not yappy, sometimes you don't even know they're here because they're so "chill". I love them both so much and just have to pray that Sammi is where she needs to be and if this is her time she's not in pain and will let us know.

I can't bare to think this but I'm going to try and stay hopeful.

I truly appreciate everyone's kind words and support and unbelievable knowledge. I'm always telling my husband that I think all of you are are smarter than some vets. You've helped us keep Sammi as healthy as she can be this past year. All of us thank you for that.

I hope everyone has a peaceful, safe, healthy, happy holiday. I did not even realize it was Xmas eve and tomorrow was Xmas.

Keep Sammi in your prayers as I know you guys always do.

Tracey

[labblab]

Dear Tracey,

You and Adam have all my prayers and healing thoughts for our sweet little Sammi. I am so sorry she is having such a rough time right now. But it truly seems to me as though she is right where she needs to be, and is receiving the best care that is humanly possible. What we’ll be hoping for right now is a Christmas miracle!

Sending tons of hugs of peace and comfort flying westward to you all, and I’ll surely be keeping Sammi in my heart.
Marianne

[sammisam]

We just got an update on Sammi (we're going to see her in the next hour).

Not worse, not better, static. They've tried to lower the oxygen to 40% but Sammi didn't respond too well, so they put it back up to 60% and her breathing improved (vs. the 40%).

There are different vets that rotate through but each one has been exceptional so far and the original ER doctor has been there every day since we brought Sammi in.

I don't think we'll be bringing her home today but that's ok because we will change the date of our xmas to the day we can bring Sammi home.

I did ask some questions just to make sure no stone is unturned and the vet said that the xrays are definitely consistent with what they see in pneumonia.

My little monkey, I miss her so much and I just don't want her to be scared and alone. We're praying that she starts responding to treatment and the vet just said it can take more time, especially when dogs have compromised immune systems.

I'm starting to get upset that maybe, just maybe, we should've started her Trilostane over a month ago when the number were increasing but it's like you're damned if you, damned if you don't.

They keep saying it's aspiration pneumonia but that can turn into bacterial due to a secondary infection. Of course I googled it and one of the (possible) causes could be syringe feeding. We syringe fed Sammi for one day only and that was on Oct 19th. I emailed the vet about the panting and breathing around Oct 28th so we're wondering if WE caused it.

We were always super careful but you wonder. It is also more possible with Bostons and the vet did say that she thinks that was too long ago to have aspiration pneumonia show up so much later. I guess it doesn't really matter because she has it regardless of the cause.

We're going to visit her now and I'm going to bring her fresh chicken soup that I pulverized because that's what got her started last time she wasn't eating.

I'll update you when we get back.

AND I CAN'T TELL YOU HOW MUCH IT HELPS TO HAVE YOU ALL HERE TO HELP US THROUGH. REALLY HELPS ME FEEL LIKE YOU ALL ARE FAMILY AND IT'S VERY COMFORTING TO US SO THANK YOU THANK YOU THANK YOU!

[DoxieMama]

Keeping you and little Sammi in my thoughts today.

[Squirt's Mom]

I am so glad you got Sammie in to the ER!!! Don't get discouraged just yet. Having had pneumonia myself several times I can tell you from a human perspective it can be very hard to get under control and that it is absolutely exhausting. My little Trinket had pneumonia as well as COPD and it took several months to get the pneumonia healed - several different antibiotics finally going to home injections that did the trick. She was so very tired for a long time even tho her lungs were clearing, the fluid leaving, and everything looking better. It just takes so much out of you when you don't get enough O2 for a while....and Trink had had for a while when we finally got the right diagnosis so just hang in there and keep the faith she will be home soon. You will all be in my thoughts and prayers!
Hugs,m
Leslie

[Joan2517]

Poor little Sammi! Poor you...I hope you see some improvement soon. It is awful when you have to leave them and just wonder what they are doing, what if it was something you did, what did we do wrong?? The thing is, we just don't know, and we very rarely get the answer we want.

It sounds like you did everything you could and that's all we can do...thinking of you and little Sammi.

[sammisam]

Just got back from the hospital and Sammi was standing up and looking like she wanted out of that oxygen cage.

I pureed the actual chicken breast in the soup and the broth, and she actually licked some off of my fingers and then wanted more so I put it in a little dish and she licked some more of it. I'd say it was the equivalent of about a couple of teaspoons to maybe a tablespoon!

She was definitely more alert when I got there. They said she also drank some water.

Her left eye looks really really bad. It looks like when she had that "melting ulcer" a couple of years ago. I'm scared to get my hopes up but at least she looks like she's heading in the right direction.

Her front paw where they have the IV hooked up was incredibly swollen. Scared me. They said they'll be changing that.

We're going back at the evening visiting hours and if she didn't eat my soup from them, I will try again and hopefully she'll continue to eat. Felt so bad leaving there when she clearly wanted to get out and Adam couldn't stop crying when we left, but we're both thankful she looks better then yesterday.

I'll keep everyone posted.

Tracey

[Budsters Mom]

Tonight's report certainly is encouraging. Hoping that she continues to improve, so she can come home.

Kathy

[Harley PoMMom]

It does sound like she is improving! Just try to remember that this will take a while for Sammi to be completely over the pneumonia, so even baby steps are positive signs. Keeping you all in my thoughts and prayers.

(((Hugs)))

[sammisam]

Don't even know what to do.

Sammi was completely unresponsive and just laying there. the nurse said she was circling the cage for hours and wouldn't stop. They also said when they take her out of the oxygen or try to lower it she makes more effort to breathe.

My problem is this...

I know she has pneumonia but ARE THEY NOT UNDERSTANDING THAT SOME OF THIS OR MOST OF THIS IS FROM HER BEING CUSHINGOID RIGHT NOW AND NEEDING TRILOSTANE!

Yes they know she has cushing's but her usual symptoms are anxiety (ESPECIALLY at the vet) so how do we know regarding the breathing, what is pneumonia and what is Cushings because they could keep her in the hospital for a year based on what they are thinking is pneumonia not getting better but its really Cushing's regarding her breathing and anxiety.

Adam and I are going to talk to the dr and see if there's a way for them to get her the trilostane. I feel like she's not going to improve without addressing the Cushings.

Adam also mentioned taking her home if we/they feel the pneumonia is under control (but again they may never feel that way if she doesn't get her Trilostane) and seeing how she does. If we brought her home and she didn't eat we would decide then. This is no life for her.

She didn't eat for me tonight but she was exhausted from circling and circling the tiny cage all day. We have accepted the fact that she may not recover but we cant let her stay in a little box with oxygen and be either stressed out or incoherent.

The only thing that does worry me is that if i think some of these breathing issues are just from the cushings then she would have a voracious appetite. And she hasn't.

I just feel like it's a catch 22... she wont improve unless the cushings gets treated and she gets her trilostane...

but she cant get her cushings treated until her pneumonia gets better. This is my dilemma.

[sammisam]

I know this may sound crazy but we're researching buying or renting an oxygen tank cage to have at home and if we had to pay a vet to come to the house once or twice a day or whatever is needed to monitor, check vitals, check gas levels, etc., we will.

Even if it cost the same money as her being in the hospital, it would be worth it to have her home.

It would just mean having her home and seeing if we could get the Trilostane in her. Has anyone had any experience with oxygen tanks/cages for pets?

From what i was gathering you need a prescription from a vet and I'd do whatever I had to, to get that.

We'd then see if she'd get better. I'm trying to think of everything I can to give her the best chance to get over this pneumonia AND GET THAT MUST NEEDED TRILOSTANE in her!

We'd have to unfortunately get the compounded version because we would need a liquid so that if she wasn't eating she could at least get it down. At this point it's better than no Trilostane at all. Being that her numbers are rapidly increasing over the past 6 weeks I think the danger of Adisonian crisis would take some time to develop if the dosage was too high. It took at least 8 months for her levels to decrease from too high of a Trilostane dose and throw her into Addisonian crisis, so I think we could monitor that.

The Cushing's symptoms are causing her incredible anxiety right now, especially at the vet. The only reason she's resting is because she is so worn out from pacing and circling in that tank. The reason she's "circling" is because the tent is so small she has no where to go.

Part of the reason they want to keep her there was because some of the behaviors the vet was noticing. When we explained that THIS IS TYPICAL SAMMI behavior when she was diagnosed with Cushing's and before we got her on the proper dosage of Trilostane, the vet said "oh, that makes me feel better". So I go back to the fact that they'll NEVER think she'll be ready to leave if they keep interpreting Sammi's behavior as "oh she's not improving" when it's just that the Cushing's is causing this! I'M SO FRUSTRATED AND SAD AND ANGRY RIGHT NOW!

I just want to give her a chance to get that Trilostane and treat the pneumonia. We're not trying to be selfish and just keep her alive to live in a tent at home forever, but just to see if being at home will help her improve.

Adam and I have already cried and cried and decided that if she didn't get better or wouldn't eat we make the decision we obviously dread. There is this husband and wife vet team that came to our house within 2 hours of calling, on a Friday night, to put our 18 year old cat to sleep right in our arms and in her little bed, and we are ready for that if that's what is going to happen.

We can't stop crying but we also feel peaceful knowing that we'd rather have Sammi at home, under the right conditions (oxygen tank, proper monitoring, vet coming here, antibiotics if she still needs them, etc. ) and if she doesn't improve then she will at least be home, here with us, and we can make that decision then.

On a side note, I don't want to make this about money because we're already up to 5,200 for the past 36 hours and another minimum of 4,500 if she has to be there another 2-3 days. I'd rather spend that money having her here with a similar set up and paying a vet to come here vs. being in the hospital.

I got a little upset tonight when they wanted me give them another deposit that minute (tonight) and all I brought with me was my license because I didn't want to carry my purse tonight. It wasn't them asking for more money that upset me, it was the fact that they wanted me to fax or email my license, credit card and sign something and email to them TONIGHT. That's the last thing I wanted to do... screw around with my broken copy machine just to get them what they asked for TONIGHT.

I got offended, because what do they think... I'm just going to skip out on the bill and not pay them after I gave them 4,200 the very first day. I think you all can understand how I felt extremely insulted that I couldn't just bring my credit card in the morning when we come and see Sammi tomorrow. They ended up saying that was ok, but it just set me off as I was already upset seeing Sammi unresponsive again and extremely lethargic from wearing herself down due to CUSHING's.

I also got upset when the nurse said well "The Trilostane is too dangerous now and if she went into Addisons we don't want that to happen again. Usually when they go into Addisonian Crisis they usually don't ever need Trilostane or Cushing's medicine again" TO THE NURSE - WRONG WRONG WRONG!!!!!!!!!! I explained that she's already had two ACTH tests and her numbers are going up up up up up up up UP UP UP!!!!!!! Plus, I told her Dr. Bruyette recommended starting the Trilostane again.

I realize she's not a vet and we already got the ok from Dr. Bruyette 3 nights ago and Adam and I already instinctually know she MUST get back on Trilostane.

I apologize if this is all over the place but I just want to do what's right for Sammi and even though she does have pneumonia and it must be treated, I just don't want Sammi there if they can't recognize that some of these symptoms and behavior are from her untreated Cushing's! I can't bare the thought that she had been pacing and circling for HOURS tonight. We're beside ourselves with grief, uncertainty and frustration right now.

We reached out and emailed Dr. Bruyette again and Dr. Wu, the ER vet and explained this.

If anyone has any suggestions or sees a better way to explain this, I'm begging for any input. I'm in so much pain right now because I just don't want Sammi to suffer and at the same time I want to do every thing I can to give her the best chance.

Thank you so much for your understanding and support. It's helping me more than you ever know because I KNOW all of you understand exactly what I'm feeling.

Tracey

[labblab]

Oh Tracey, I’m so sorry for all your worry and pain! I wish so much I could reach out and give you and Adam a genuine giant hug!

I really hope Dr. Bruyette has the chance to reply to you. Because this is the thing — I’m not sure that starting back on the trilostane right at the moment is what’s best for Sammi, either. It’s true that her cortisol level was starting to elevate again, but it was far from having returned to being super high. Everything else being equal, yes, it seemed reasonable to restart the trilostane. But everything is not equal, and she is very sick right now. In truth, she may even benefit from having the added “push” to her system that is being supplied by the cortisol. For instance, it may be even harder to ever get her to eat anything if you knock her cortisol level way back down again.

One thing that I hate to bring up again, but feel it’s important to do so, is our recurring discussion that her pituitary tumor may be growing and placing pressure on her brain. This could account for the pacing, the restlessness, and loss of appetite. And if so, restarting the trilostane will be unlikely to help ease those problems, and may make some other problems worse. As I say, I really hope that Dr. B is able to give you his opinion about all this, especially because he is an expert re: enlarging tumors. I surely understand why you want to bring Sammi back home again. But I hate to see you committing to all that’s involved with home treatment if your primary reason for doing so is to restart the trilostane. Whether she’s at home or in the hospital, that may not be a good idea right now.

I’ll be hoping so much to hear word of improvement today, so that maybe she can just come home all on her own. Hang in there, Sammi girl!!

Marianne

[Joan2517]

I thought it was protocol that we never give a sick dog the vetoryl...and Sammi is very sick.

It was a little heartless to ask for money right then, but that's what they do. The first night Lena was in the ER, they wanted $2000! I didn't have that, not in my checking, no credit cards! I told them I'd write them a check, but not to cash it. Then they hooked me right up with Care Credit. I guess it's just policy, not a nice one, but they must get screwed a lot.

I'm thinking of you and Sammi and hoping that there is some resolution soon. The stress is too much for all of you.

[Budsters Mom]

My heart go our to you! You and Adam are certainly in a very tough spot right now. None of us EVER want to see our babies suffer. I know you are insistent on wanting to restart the Trilostane. I most certainly back Marianne on this one. Trilostane is a very powerful medication, that comes with risks of it's own. Sammi is VERY, VERY, WEAK AND SICK right now. Higher cortisol levels could help give Sammi a push in the right direction. Trilostane generally shouldn't be given when a dog is unwell. It is dangerous to do so. Sammi needs time to recover from the pneumonia, if she can. Trilostane needs to be dosed with a full meal for proper absorption. Sammi needs to be eating first.

Having dealt with a probable pituitary macro tumor in my own little Buddy, circling for hours and restlesses come with the territory. I am not saying that Sammi's tumor is growing. If it is, there is little room for the tumor to expand in such a small skull. I hope you are able to get some updated feedback from Dr. B, regarding Sammi's current condition.

$$$$$ are most definitely an issue for many of us. YES!!!! It is about the money too! We don't want it to be, but it is. I have been there myself. Weighing the expense of continuing to treat, without a cure, or fix. The vets will continue on for as long as you are willing to fork the astronomical bill. With Buddy, he would not have wanted to continue on the way he was. That was ultimately the deciding factor, but realistically $$$$$ were a huge concern also. It didn't make financial sense to continue to pay thousands of dollars, just to keep Buddy with me a little longer. That would have been for me, not him.

I am so, so, sorry.


Hugs,
Kathy

[sammisam]

Thank you so much for all of your responses. This is what Dr Bruyette said and it's concurrent with everything everyone said and Adam and I agree with NOT starting the trilostane at this point.

Hi. I understand your point but in patients with a severe concurrent disease it’s better to have the cortisol levels run a little high than to have them run too low so for now I would not use trilostane. They can give her something for anxiety to see if that helps but I would not worry about the Cushings for now. Keep me posted.

We're going to see if an anxiety med will help. I understand everything now. The symptoms they're seeing is NOT the pneumonia not healing but probably an enlarging tumor and that would go back to they cant keep her there until those issues go away because they'll never go away. and she's miserable in there.

Our goal is to get her home see how she does and if there's no improvement with the other issues, eating, pacing, can't sit still, then we know it's the enlarging tumor and we can't let her suffer like this. I'm hoping she has enough pneumonia meds where we wouldn't be putting her in more danger.

I can't let her die or put her to sleep at the hospital. I think her at least being home will give us the chance to see if there's a miracle and she improves or we have to do what's best for. We are not of the mindset that we think we know best and we think she'll be cured at home, we just want her home so we can take her out of an environment that she's obviously agitated in, scared and doesn't want to be there. Adam is making calls right now just in case we think she's suffering and need the vet that does the peaceful at home euthanasia to get here quickly. we are still hoping for a miracle.

Everyone understood exactly what I was saying before and put it so clearly so I'm hoping you understand what I'm saying now.

I also wanted to ask if you think that a dex or steroid injection is something that could help make her comfortable or decrease inflammation or would it be too dangerous (i'll be asking the vet)?

I definitely and thoroughly understand about Cushing's symptoms vs. enlarging tumor and the benefits of not having trilostane if it's more from the enlarging tumor, I have one question though.

If the tumor is enlarging then how come Sammi would be breathing better inside the oxygen. I will also say that her eye is looking so bad (she had a melting ulcer a couple of years ago) and I don't know if that could be from increased pressure from an enlarging tumor or the oxygen air.

I'm incredibly grateful for everyone here and because of your responses it helped Adam and I take our "GET HER ON THE TRILOSTANE" completely off of the table.

ANY suggestions, confirmations, input would be so helpful. Thank god for all of you. I feel very blessed to have you.

Tracey

[sammisam]

Here is another email in addition to the last one from Dr. Bruyette.

Here's where I wish I had an oxygen set up just to be able to bring her home until we decide what's best for her. They make an oxygen concentrator but it wouldn't be here until tomorrow or the next day. Even if it's just to keep her comfortable until they can put her to sleep if that's what's going to happen. I don't know what they are considering "distress" as far as when they take her out of the oxygen. It may just be what we've been witnessing here at home the past few days.

Any thoughts?


On Tue, Dec 26, 2017 at 10:59 AM, David Bruyette <david@anivive.com> wrote:


Hi. I think that a single anti-inflammatory dose of steroids will not hurt the pneumonia. If you notice improvement in the appetite within 24 hours of the injection that would make a macroadenoma more likely. I think it’s a really hard decision to take her home if she cannot breathe normally out of oxygen. If there is no real difference in her breathing out of the oxygen than I agree you can continue to give her antibiotics‘s at home.

You can’t make a wrong decision here.

Dave

Sent from my iPhone

On Dec 26, 2017, at 10:34 AM, Adam Rocke <adam289427@gmail.com> wrote:

David,

We've appreciated your help so much because right now we need an expert such as yourself just to help us with our decision. We're also more than willing to compensate you for all the time you've taken with us and valuable advice.

We completely get it now about the Trilostane and that's actually not what she needs at this moment, especially if it's from the pituitary tumor enlarging.

There's no reason to leave her in the hospital if they're waiting for her breathing issues to get better, or for her to eat, because if it's from an enlarging tumor they won't. We know we're probably dealing with pneumonia AND an enlarging tumor.

Prior to taking her to the emergency her back legs were also significantly weaker over the past 5 days.

She also had a melting ulcer which was treated about three years ago and ever since she's been in the oxygen tank it looks horrible. I don't know if that's from being in the oxygen tank or that could be another clue that her tumor is enlarging.

If she's had enough meds for the pneumonia then I think we want to take her home and make arrangements for "in home euthanasia" or pray for a miracle that Sammi improves somewhat in her home environment (she did eat a little for me yesterday - a few licks of pureed chicken soup).

If she won't eat at home, if she's continually agitated at home, if she's still having breathing issues at home, then I think we can safely assume that this is due to the tumor enlarging, so keeping her in the hospital is just agitating her and making any remaining time for her miserable.

Will a dex shot or some type of steroid shot help with any inflammation and be beneficial in any way even if it's just for temporary comfort?

Does this sound like "enlarging tumor" symptoms, especially in that we've given time for the tumor/inflammation to shrink, being that she's had no Trilostane for 10 weeks - so NO Trilostane is actually more beneficial regarding enlarging tumor?

Do you think that her having pneumonia treatment for the past 4 days is enough to take her home and see if the other symptoms worsen, stay the same, or miraculously get better?

We can't let her stay in the hospital and even though she's not worsening, she's not improving.

Thank you so much!

Sincerely,

Adam and Tracey

[Squirt's Mom]

Like you, I would want her home if at all possible regardless of what tomorrow may bring. Talk to the vet about home injections of the antibiotics if needed if you think you or Adam could give her the shots. If, IF, this is a macro you will know soon I would think. These tumors can cause all sorts of problems when they start growing and pressing on areas of the brain causing it to send out incorrect signals or no signals at all....like hunger. I so wish I had some idea to offer but I think the two of you have covered the bases very well and have a good game plan if she can come home with O2 and antibiotic shots if that is feasible. I can and do offer my prayers and virtual hugs to you and Adam and gentle ear scritches for our sweet Sammie girl.

((((((((((((((((((((((((((((HUGS)))))))))))))))))) )))))))))))))
Leslie

[labblab]

Tracey, I’m so glad that Dr. Bruyette has been able to correspond with you. I know you’re in the midst of some really tough decisions, and he’s such a good resource for you.

While you’re awaiting more info, though, I thought I’d try to answer one of your questions. An enlarging pituitary tumor can cause several different types of problems, but I don’t think trouble with breathing is typically one of them. If Sammi is gasping for air or otherwise in respiratory distress, I think that is being caused by the pneumonia. And that’s why the oxygen cage has helped her — it’s making it easier for her to take in the oxygen she needs. So I don’t think you can judge the presence or the absence of a macrotumor on whether or not the oxygen is helping her.

When I speak about restlessness associated with a macrotumor, I’m talking more about things like pacing back and forth, or circling, or constantly standing up and not being able to settle down. Actual breathing problems, though, I think are more likely connected to the pneumonia. And so the decision as to whether or not she can comfortably be taken out of the cage will depend not on whether she has a macrotumor, but instead on how much her lungs have been healing from the pneumonia.

Marianne

[sammisam]

This is such torture.

Went to see Sammi and spoke with the doctor IN PERSON which is what we wanted.

What Adam and I witnessed today was typical Sammi after a few minutes of me being there. She ate from my fingers and then when I held the bowl up for her. She also ate from my fingers about 30 minutes later.

She did her usual fussing when I went to wipe the food from her nose and she'd be curious when someone walked by and followed with her head and eyes back and forth.

This is basically what the doctor said. They're trying to wean her off of the oxygen and they had her out today and did an xray. She said she had Sammi out of the tank for at least 10 minutes or more and she was fine. But then she noticed Sammi using more effort to breathe and put her back in but still lowered the o2 to see how Sammi was doing and she's getting weaned down from 60% to 50% back to 55% back down to 50% etc. but they're working on lowering it. I also made it clear not to confuse Sammi panting for a little bit with respiratory distress.

When I was there I purposely wasn't careful this time to keep the door closed on my arm because I was watching the o2 level go down and Sammi was doing just fine. I also opened the entire door and reached in, gave her a kiss and pet her and she was fine. The o2 went down to around 43%.

I really believe they are trying to wean her off and Sammi is making progress. They also said that she curls up in the bed they put in rests comfortably.

I would say today Sammi looked the best I've seen her since she got there. Even though her eyes were read and she was kind of standing in a weird position. They repositioned her and then she sat in her bed and that's when she started eating for me.

The vet also said that after 7 days they'd know if an animal can't come off of o2 and then we'd have to make a different decision. The vet really stressed that they think they'll be able to wean her off.

So our goal is to get her home asap and evaluate day to day, hour to hour, and at least she'll be home and we can make that decision with her here.

She was doing a little bit of her usual "drunken" head bobbing a little but she always did that prior to us diagnosing Cushings and when we needed meds adjusted.

We don't want to get false hope but I think we need to trust that they'll wean her down and now that I know that WE'LL know after 7 days (tomorrow is day 5) I can at least have a time frame. Otherwise you wonder whether they just think you're an ATM and you'll let them keep doing whatever. I did like that she didn't want to do a "lung wash" to test the bacteria (or something like that) and she didn't want to recommend some type of biopsy of the lung. She said that would kill her.

We're already over $8,500 in and I'm willing to give it another 2-3 days so they can wean her off and we can take her home UNLESS I think it's time and we get her home and have the "in home euthanasia" done. I'm praying thats not the case and being that it's not just the o2 but it's the iv antibiotics also, we just have to hope Sammi keeps improving.

The vet also explained something about a LAG in xrays. She said that the radiologist thought Sammi's xrays were worse, then she looked at the xrays from today compared to when Sammi came in and did agree they looked worse but then said she felt Sammi's clinical signs and behavior was better and improving.

She said it could be due to LAG time. The xrays don't always catch up to the symptoms so the xray taken today could match up to sammi's clinical signs 3 days ago. I'm going to have to read up on that. She also said she wants the same radiologist to read the xrays that were taken today but he wasn't there. Also mentioned that it was very difficult to read the xrays because of the anatomy of Sammi's chest.

She also said Sammi's bones look brittle especially the end of her spine. She talked about that could be due to that calcinosis cutis.

I tried to follow everything as best I could and it does look like she is doing ok on less oxygen, and they'll continue. She was VERY VERY happy Sammi ate and wanted to eat.

I don't want to take away her chance to improve if we're almost there, as I'd never forgive myself. If I had an o2 tank that i knew was safe and semi-comparable to what is at the vet, I would go get her right now. They're also still giving her iv antibiotics but Adam and I would def learn how to give injections if we had to.

My fear was that if we decided to take her home just to have her put to sleep I didn't want her to suffer until the vet got there. Being that I saw sammi today and being that they had her out for a while and she wasn't in distress I'm not so worried about that. She was never cyanotic, even when we took her there on Saturday it was just heavy panting and it didn't really stop. But it has stopped now.

She also didn't want to give her a steroid shot right now because she's seeing improvement and doesn't want to do anything to delay healing.

Sammi now has the "penthouse" o2 cage because one area is completely empty for her to go potty and the other side is her little bed and blanket. She IS drinking and she is peeing.

This is such a roller coaster and I'm praying this is improvement (which it looks like to me, and the vet). The vet even asked what we thought because we know Sammi better than her. This is her first time with Sammi (she is an internist also) but based on everything she read from all the reports and what she observed, she thinks "clinically" Sammi is improving (as do we).

I'm sorry if there are any typos/grammar errors, I'm mentally exhausted.

I'm just shaking and praying for ANY sign to lead us one way or another. Today, I thought, I don't think it's her time. At least not today.

[Budsters Mom]

Buddy would get very restless and have difficulty settling, particularly at night. He would pant excessively during these spells. He never had any actual breathing issues. I think Sammi's need for oxygen is probably caused by pneumonia. When the lungs are inflamed, it is difficult to breathe in enough air. I have had walking pneumonia a few times. I had to make a conscious effort to breathe in deeply. This zaps your energy and takes quite a while to recover from.

[sammisam]

Just got back a little bit ago.

When we got there they said she's just been standing up but when we left we put her in the bed and hopefully she'll just lay down and get some rest.

Sammi ate a few licks from the vet tech right before we got there and then ate equal to, or a little more from me (I'm estimating about 2 tablespoons maybe more) It's the pureed chicken soup thats all carrots, parsnips, chunks of chicken, broth and a little bit of dill. I pureed it into a paste. She seems to love it and that's what got her eating again when she was in her Addisonian crisis.

Her O2 has been lowered from 60% to 50% and while i was there she was tolerating 45%. If she stays on this schedule and is doing ok, I'm praying they can get it down lower, soon.

The O2 in the air is 20% so I think the goal would be 20% but one of the vets said 30%. So we're praying they can keep weaning her down so we can just get her home. i'd hate to pull her out now and undo all of the progress.

Poor little Sammi's paws are swollen and her eyes are so red. We know that if we can get her home that if we need to make that hard decision we know we did everything we could for her. I just can't live with myself always wondering if we just gave it 2-3 more days we might've had a better outcome. She seemed the same from lunch to dinner and she definitely licked and licked up that chicken soup (it wasn't just licking to remove what I accidentally got on her lips). She definitely wanted it.

The way our living room is set up now is we have pillows and beds covering the entire floor in front of the 9' L shaped couch. When (when, when, when, not if...) she comes home we're going to take the mattress and (boxspring if we have to) and put it in place of the pillows so that it's a more flatter surface instead of having to be a little range rover (as Adam calls her) and sort of climb up and down. This way it's easier for her to sleep on that and get down with less effort.

We're going to gauge how she does and if there's no quality of life we know what to do but at least she'll be home with us and with Taylor. It's her being home that's going to ease our soul. We're not going to be selfish and just keep her here for us. She was behaving like "Sammi at the vet", so we'll see when we can get her home.

I can make my own schedule with work and Adam is home all day. There's not one minute she'll be left alone and that's how it's always been and that's how we love it. She's such a trooper and I just want to get her out of there! She'll let us know the next step.

So we're praying that she does well as they decrease the oxygen. So far so good. She's still drinking and peeing and I can tell she just wants to get out of there. If we have to give her injections for the pneumonia then we'll learn how. I'm also wondering if a humidifier will help her. We just want to make her environment the most conducive for her to get through the pneumonia.

We know Sammi's usual quality of life. She's never really been an active dog since her Cushings diagnosis but she's content sleeping, coming into the kitchen when she knows we're cooking and coming up on the couch and resting her head on Adams shoulder or arm or legs, and occasionally wanting to walk in the hall or come outside with Taylor. She also has the best spot on the couch and always goes into that corner.

Ugh... one minute at a time. We just want to get her home!

[Harley PoMMom]

She's eating a bit and tolerating less oxygen, sounds like things are moving in a positive direction! Saying and sending prayers for continued improvement...go Sammi! And hugs for her Mom and Dad.

[Squirt's Mom]

Sounds like she is making progress, slow perhaps but progress nonetheless! I pray this trend continues and she can come of the O2 then home with her family soon!
Hugs
Leslie

[sammisam]

Sammi ate double of what she ate yesterday and even ate from the vet tech, again.

She is now down to 30% oxygen (weaning her slowly from the full strength 60%) and gets up out of her bed and goes pee pee in one corner of the double O2 cage and then gets back in bed. Her eye is looking better too. They also said she's resting much better and not circling or "addled" like in the previous days.

Again, I don't wan't to get my hopes up but it's definitely progress. I believe they're hoping to have her on room air tomorrow. They have to keep changing where the IV is and they had to put it on her back right leg which still looks completely weak because it's sliding.

She is such a tough cookie and we're praying to get her home soon and praying she'll start improving even more.

They want her to have a cardio ultrasound just to be sure they're not missing ANYTHING. Plus she's never had one before. I'm just debating on when we should do that and I guess that'll depend on how she is at home (God willing she gets here). The vet seemed very positive that Sammi will be coming home very soon possibly even tomorrow or Friday.

The only reason I would consider the cardio ultrasound is just because if there's something else going on and the treatment could be as simple as one little pill daily. It's also a non invasive procedure.

I'm on edge every day and told everyone please do not call me because I jump every time the phone rings thinking it's the vet. They told us from the beginning "no news is good news" with the exception of 1-2 updates per day, but they usually update us when we're there.

I am really happy she is eating more and more each day, I'm just so scared to get my hopes up. Her appointment with Dr. Lottati (Dr. Bruyette's wife) is tomorrow and I'm sure we'll just be speaking with her while Sammi is still in her little "penthouse", but I'm interested to see what she thinks about Sammi's progress and our game plan going forward.

I think we're going to end up renting an oxygen concentrator with a face mask just to have here in case of emergency or if Sammi has a rough patch (my gosh, Adam and i might even need it too!). This is all contingent on her coming home and we're going to make sure her quality of life is good for her. We would never ever let her suffer just because we don't want to let her go. Adam and I are both on the same page with that, thank God.

The prayers seem to be working and Adam is doing better too. He's been inconsolable at times. I'm trying to hang in there but I've had a Rx for Xanax that's been sitting in my medicine cabinet for years, and I've had to use it (it's probably expired but I barely take a quarter of a quarter of a quarter and I think it has helped).

We feel your support, love and prayers and they've been helping all of us get through. Adam is on a cleaning binge (whatever it took, lol) and we're thoroughly vacuuming, cleaning, sanitizing and steam cleaning the house (especially the couch and pillows) where Sammi likes to be, just to make sure we get rid of any germs that might make her relapse.

Been a rough, rough holiday and hopefully Sammi will be bringing in the new year with us.

Thank God for all of you and I sincerely mean that. Not only your knowledge, experience, but what you've been through, and what your little fur babies have been through, have been something that has enabled us to get every extra day with Sammi we can.

Sammi is sending kisses too!

[Budsters Mom]

Yes, this does sound encouraging. I will be waiting for tomorrow's appointment/strategy on moving forward. Baby steps. Hope Sammi is able to return home to her family.

Kathy

[DoxieMama]

How is Sammi doing??

And how are you????

[sammisam]

I have been wanting to get on here all day and I just don't know where to start.

I'm going to try to eat some dinner and then I want to update all of you.

We're really disappointed and don't even know what to think with this new VCA office.

For now, Sammi is home, we took her home 12 hours early because she was out of the supportive oxygen when we got there to see her and we don't know how much time she has left or if she's going to get better again. We shouldn't have to feel bad or get attitude because we wanted to take our dog home. It's not like they recommended six days of treatment and we said we can only do one.

She was there for over six full days $9,000 and it shouldn't matter anyway. It's just really disappointing and what's worse is that not one call today to see how Sammi is doing!

I'll just say that she's had bouts of panting and bouts of rapid breathing and also quiet time. She pooped the minute she got home, she's peeing, she's waiting in the kitchen to eat and she's eating like crazy, and she's had no stimulant since they gave it to her yesterday (we didn't realize they had even given her one but she's eating without it now). Her back leg was weak but she's managing and seems to be walking around just fine.

She is just standing around a lot today which worries me.

I will update on the rest after dinner.

[sammisam]

I’ve been just choked up all day. I’m relieved that Sammi is sleeping right now, but we actually gave her some Trazadone, as recommended.

I’ve now honed in on the details of the breathing problem/problems.

This is what Sammi is doing and this is what Sammi has been doing, dating as far back as March. The recent episode (the past two weeks or so) of much more panting than usual, couldn’t get comfortable, rapid shallow breathing, etc. has been due to the pneumonia and probably merged with those same symptoms she already had. That’s what is not helping the situation.

So there’s...

1) Panting, on and off started once in a while back in March and when we increased her Trilostane and added 5mg at night, the panting stopped immed. Then the panting really started up again and it happened during the day where it used to only be at night. This happened when she was off of Trilostane and has increasingly gotten worse from around November 14th to present.

2)Rapid shallow breathing while resting and sleeping. This happened back in March/
April. It was shortly after Sammi had an ACTH test and then 2 days later we were in the emergency room where Sammi received a steroid injecton to help with her breathing. It did help but I noticed the rapid breathing while sleeping even though she had a sedative shortly before. I don’t think I noticed this type of breathing again until this past November where it started again.

Around mid Nov. to now, the rapid shallow breathing has gotten increasingly worse (with the worst of it this past 2 weeks (pneumonia?)

It’s still going on now, several times per day. It starts, then stops for a while, then it’ll start up again and this is usually while she’s resting or sleeping although it does still happen when she’s awake.

3) This last kind of breathing seems to be more regular breathing although it’s much more forceful on the exhale, although not as rapid.

I know that the breathing is a symptom of many other underlying conditions and the breathing issues have def gotten worse since being off of Trilostane (maybe related maybe not)

I only know about a few so if anyone has any ideas, i’m all ears

PTE (clots)
heart problems
macroadenoma
Cushings

Vet and I agreed that we just have to wait and see how Sammi responds at home and being that we took her home last night I'm really disappointed there's been no follow up as far as a call to see how Sammi is doing after she got home. It's actually insulting.

Dr. Lottati had already left for the evening but at least two different people (one of the emergency vets that had worked with Sammi and one of the techs) tried to do the "hard sell" "guilt trip" and let us know that it's a different dep't and they weren't ready to discharge her, blah blah blah. I, unfortunately wasn't there because I ran home to get Sammi's pet tube for the car and quickly finish the house while Adam waited there for them to discharge her.

Of course no discharge procedures were even started until the final measley $400 was paid (after paying $1,000's of dollars on time every 2 days).

I just feel extremely insulted that it appears they really don't care about Sammi or they're offended that we decided to take her home last night when we saw she was off of oxygen.

I also had to sign something saying "I'm refusing treatment" and refusing the new estimate for Sammi leaving Thursday night instead of Friday morning.

Maybe I'm over reacting and making this something it's not but I feel that Sammi is just left out in the cold once the credit card charges stop. I'll give them the benefit of the doubt and see if someone calls tomorrow, but my instincts are pretty good.

I also feel that a medical professional, doctor, vet, dentist, etc. should NEVER be the one to bring up money. It's just unprofessional. That should be left for the business manager.

You spend a really informative 15-20 min with the doctor going over all the medical stuff and then the last thing the vets say (which blew my mind) "oh, there's another estimate you need to sign with the new charges before you leave"... It just negates everything they just said, even though that wasn't the intention, it comes across that way.

There's no reason they needed to say that! I paid everything, every time they presented it, in FULL! They could've left it for the front desk, who ALSO makes sure to bring it up. I'm just feeling very protective over Sammi right now don't want to burn any bridges because her care is what is most important right now.

They also wouldn't write a RX for supportive O2 in case we needed it (which I can understand both sides - sort of). I explained that we wouldn't be using it in lieu of treatment. we wanted it in case, God forbid Sammi had an episode and we had to wait for the in home euth. vets to arrive. I didn't want her to suffer if that were the case. Thanks God it turned out that situation was no where even close to what happened, as she's been doing much better than we expected.

Ironically, an office we went to when we first moved here (the "smelly" vet office that's a little "guerrilla like vet care"), pulled through and wrote a RX for Sammi for NO CHARGE. They've done something similar for my cat who passed away 5 years ago, so she got to be home with me instead of passing away at their office. I thought that was unbelievable and caring of them.

Anyway, I'm sorry for ranting, and maybe I'm just super sensitive right now. I'm going to try to post some pictures of what we set up for Sammi at the house. right now she's sleeping very calm... actually I just looked over and she's breathing a little fast at the moment, but still sound asleep (and I REFUSE to believe that Sammi being in the hospital an extra 12 hours, not even in the O2 cage, would've made one bit of difference in how she's doing now).

I'm going to try to get some sleep before I combust!

[Joan2517]

I think you were right to bring her home with you. I'm sure she is so happy to be there. Unfortunately, vet care, as well as medical care, has become about money. You're right about it being the front desk's responsibility. When the doctor or PA brings it up it's insulting. My vet has a practice and it's all about the money to him. I always ask for one of the others because I know they won't charge me for every little thing just because they know I'm desperate. I learned this all with Lena. There were many ways he could have saved me money and I know it now from being on this forum.

She's your baby, you know her best, and if you want her home, then they should respect that whether they agree with you or not.

[sammisam]

Here's Sammi's update.

Yesterday was her best day so far and it seems as though she has many more hours of "normal" breathing, and less, of the what I call "breathing issues"

*Significantly decreased panting episodes
*Less episodes of the rapid shallow breathing.
*The "exhale" portion of her breathing seems to have improved
*Back legs still weak - but she also gets around when there's food involved (meaning she'll hang around the kitchen and walk back and forth from where her food dish is and then back in the kitchen). She will walk over to her food.
*Eating/Drinking and appetite is healthy

What I'm noticing is that since she's been home (and she did this in the hospital), she will not make a conscious effort to lie down. She'll sit, and stay there and slowly creep down as if she's falling asleep, catch herself, raise back up, slowly creep down again until she's finally just laying down, and then she'll go to sleep.

Sometimes she'll adjust the position of her front or back paws, but she does NOT make a conscious effort to just lay down from the sitting position herself. Once she's down she'll usually just go to sleep. She's actually sleeping AND snoring ;-) right now. The "not consciously deciding to lay down" is a new behaviour.

Another "newish" behavior (ESPECIALLY since she's out of the hospital) is that she "just stands there" for an extended period of time. Sometimes she just needs a little nudge in the right direction but I'll describe it as "semi confused" because sometimes she'll continue to walk toward her water, or the couch, or wherever, but if there's food involved and she's waiting to eat, she'll move as quickly as she can (healthy appetite)

We're monitoring her very closely to see if she'll get up on her own, go into the potty on her own, come out of the potty on her own, go get water on her own, etc. It's very confusing for us because sometimes we think she's going to have to be carried everywhere (which is no life for her), but then she'll get up and slowly make her way to wherever she needs to go. I'm going to start noting it in percentage of time, so we can really determine what is happening, what symptoms are still getting over her pneumonia symptoms, etc. Really difficult when so many symptoms cross and overlap.

So, based on all of this, we need some help in understanding Cushing's symptoms vs. Pituitary Macroadenoma symptoms, to help us make a better decision for Sammi, as there's a lot more experience here. I also need help to determine which symptoms, if any, fall on both sides. I do realize the overall category is called Cushing's so I'm just going to label the one side "Cushing's - increased cortisol" to make it much easier, and the other side Pituitary Macroadenoma. I will leave out the category and symptoms of "too high a dose of Vetoryl", because i think they overlap with a few of the Pituitary Macroadenoma symptoms, but we can leave that category out for now because Sammi has been off of Trilostane since around Oct. 15th (10 weeks ago).

Cushing's - increased cortisol
increased drinking/thirst
increased urination
voracious appetite
dry skin
panting
drowsiness
lethargy
behavioral changes
weak back legs?

Pituitary Macroadenoma

behavioral changes
weak back legs?

I in no way listed everything but where would these symptoms fall into...?

Confusion/Occasional confusional
Neurological or mental symptoms
In a trance when standing until she's pet or Taylor walks by

I also want to add that anyone, particularly someone that doesn't understand Cushing's/Macroadenoma/Trilostane -meds - to treat or not treat, might say, "well if you're having to do all of this or she's confused or whatever the "bad" symptom might be, you should have your answer right there" but I'm doing this to gather all the info I can to decide whether it's more beneficial or more harmful to reintroduce the (lower dose) Trilostane.

Both vets (ours and Dr. Lottati said that if the pneumonia symptoms seem better they see no problem in restarting at 5mg per day).

I just need to determine based on whether her symptoms are 1) Cushing's - high cortisol OR more toward 2) macroadenoma.

Funny, as I'm writing this she did make her way from the kitchen into the living room, where her entire "pet palace" is. Yoy ya yoy.... walked away again! Oh Sammi!

I hope I'm expressing myself clearly. Adam and I are no longer adamant about restarting the Trilostane immediately, because I do know that if it's more the macroadenoma symptoms then NOT taking Trilostane is better in that situation. but if it's more the Cushing's-high cortisol symptoms, then restarting Trilostane is better in that situation.

Or... could a dose of steroids help (dex or prednisone?)? It seems as though Adam and I are always emailing or suggesting something to the vet and then they say , yes, I think that would be a good idea. Should be the other way around but I can't change the world (or vets at this point).

Thank you again everyone for understanding and for your support and sorry if there are any spelling/grammatical errors...

[Budsters Mom]

These symptoms are often seen with macros. When you say, "Neurological symptoms", please be more specific. Buddy's front legs would buckle while running, without any warning. He would often do a faceplant on the concrete. There were many clues.


Kathy

I in no way listed everything but where would these symptoms fall into...?

Confusion/Occasional confusional
Neurological or mental symptoms
In a trance when standing until she's pet or Taylor walks by

[sammisam]

PLEASE, HELP...

Today was a better day as far as any neurological symptoms, which I can explain later, because Adam and I keep going back and forth on what is the best to do for Sammi.

We make a decision , cry, and then she is much better in the morning. She was getting up when she had to potty, wanting to eat, wanting to climb into her bed, etc. she's a little slow but her mind seems to be working better, at times. She was also fluffing her bed which she always used to do.

But more important we really need help right now. Sammi had a good day up until around 7:30 p.m.

Then, constant panting 90% of the time from 7:30 to 2:00 a.m. . Anytime she pants, or she has rapid breathing, she never turns blue, she never collapses, but Adam and I are so distressed watching her and we don't know if this is hurting her, or how can we put her to sleep for panting, when she'll stop for maybe a couple of minutes, she'll stop when she drinks, stop when she eats, and she stopped panting when we fed her at 2 a.m. (we fed her to get some trazadone in her because she just couldn't sleep because of the panting). She ate no problem.

WE ARE NOT TAKING HER TO ANY VCA HOSPITAL TO ASK THEM ANYTHING BECAUSE I DON'T TRUST THEM AND ALL THEY'LL SAY IS WE NEED TO STICK HER IN OXYGEN AND KEEP HER OVERNIGHT AND THAT'S NOT HAPPENING!

Are we witnessing something that is worse for us than her? As I said, when the panting starts, she's never turned blue, never collapsed and stops panting to eat and drink. the panting is on and off and tonight was the first time it went on this long.

I'm not saying that we would just keep her alive if someone says the panting is ok if she's not fainting or turning blue.

We were ready to call Dr. Amy in the morning ( the in home euthanasia vets) but then we fed her (she stopped panting while eating), and she's sleeping now with no panting. Probably because of the Trazadone.

I guess this is why we were so hung up on the Trilostane and thinking that MAYBE, just MAYBE the Trilostane would help and the panting is all because her cortisol is too high for her right now.

We are at a loss and don't know what to think or do.

[labblab]

Hey Tracey, my heart goes out to you guys because you are in such a tough situation right now. Since there’s no way to know for certain as to exactly what’s causing the panting, you’re stuck in the middle of a crazy guessing game :-(((((. Under the circumstances, as a last ditch effort if nothing else helps, I might indeed give the trilostane a try if I were you. However, if the trazadone truly was a help overnight, I might first just try keeping her on the trazadone for a couple of days. Or does it cause bad side effects that are a problem for you? If not, I’d say “why mess with success,” and see if the sedating effect of the trazadone can continue to keep a lid on her panting for at least a little while. If the trazadone creates problems for you, though, then I might indeed be tempted to give the trilostane a trial run. Anything you do now is really a gamble since we don’t know exactly what’s going on. So you would need to be prepared for the possibility that any particular intervention might make things worse instead of better. But if the status quo seems to be unbearable for Sammi, then those are two options — the trazadone or the trilostane — that you may want to try.

Surely hoping for the best for your baby girl!
Marianne

[sammisam]

Thank you so much. We literally cried ourselves to sleep last night and barely slept. I don't think the trazadone is a problem and what you said is exactly what Adam and I were thinking. We know she can't live like this where she's panting non stop and we also know that rapid breathing is also an increasing symptom. Plus, I really don't know if she's in distress or not and we never want to do that to her.

I needed to ask another question before I keep going on about what it could be and can we fix it.

When I looked up how do you know it's time, some links came back regarding in home euthanasia and the only humane way was to sedate, set up iv and then they slowly get the meds that put them to sleep.

When dr amy came here for my precious Lil Ronnie, they only did two shots. No IV. Even though that's "standard practice from the vet associations", it's not the most peaceful way, but most people don't know.

Of course I was upset about that and started thinking, did they not do the most humane for her.

Does anyone know anything about this, because I don't think I am in the state to research myself right now.



Does

[sammisam]

And the trazadone seems to be ok with her so far. She just woke up, no panting, no heavy breathing, but let's see what the day brings. She also had diarrhea this morning and actually got herself down from the couch, to the bed, to the"ramp" of pillows we made to get herself to the potty. And again, this is the problem. Its ok some of the time but then the breathing/panting start. If a dog doesn't collapse or turn blue, then I would think panting is ok but then when I witness her doing that (and the rapid shallow breathing), its heart wrenching.

we know what do and we know what to try so we'll see what happens.

[labblab]

I’m so glad to hear that Sammi seems more comfortable this morning. I’m hoping so much it continues!

As far as the euthanasia protocol, it has been done both ways with our two dogs, and I honestly did not sense a difference in the comfort level. Both times our same family vet carried out the procedure in the office. Our Barkis got the two shots, a sedating shot and then the final shot. Our Peg had an IV placed and the two medications were injected into the IV access. But we were with them both throughout, and they both seemed equally calm and peaceful. If this is a worry to you, though, I’ll bet Dr. Amy would be very willing to talk to you about the protocol she is currently using.

As always, huge hugs being sent across the miles to you all!

[sammisam]

Thank you so much Marianne,

i think the lack of sleep is catching up with me. I'm happy sammi is resting comfortably. Probably because of the trazadone last night at 2:30 a.m. but i'm i just can't get my hopes up because this is exactly the pattern...

I will ask dr. amy but i know for sure they don't do the iv. Actually Adam is going to do that, I'm too fragile at the moment.

Sammi ate, took her meds, and she's the most comfortable i've seen her.

I think I need to do something to make myself less scared of death. It's ALWAYS ALWAYS ALWAYS the same thing "i don't want them to feel scared and alone" and i do that when anyone I love passes away or is going to. That's what's hurting so bad right now.

[sammisam]

Can anyone tell me how to differentiate panting from rapid breathing.

As I'm reading I'm thinking that this whole time what we are calling panting, is actually all rapid breathing!

I just labeled it panting because sometimes her tongue will be out but it's not the typical pant i associate with panting.

Maybe sometimes we're witnessing "true panting" but it's mixed with rapid breathing.

I'm so confused. The one internist had recommended an echo when she was in the hospital and we were going to do it just to rule anything else out but the other internist said we can wait??????????????????????????

She's also never had any type of cardiologist exam.

[Budsters Mom]

Panting usually involves very short breaths, without filling the lungs, like we teach expectant mothers. Tongues hang out with dogs.

Rapid breathing, is more of a normal type breathing from the lungs. It is just faster and usually not as deep as regular breathing. You should be able to tell the difference by feeling Sammi's chest while she breathes. If her breathing is felt in her chest, it's probably rapid breathing. That's what I was told when trying to figure out Buddy's breathing vs panting.

[molly muffin]

Oh my goodness. What a month you and Adam and Sammi have had and continue to have.

I think that this has been a really overwhelming, scary situation for so long, that it might do good to try to step back and evaluate, basing on only current symptoms and not look for too much of the subtle nuances. Right down the broad over view and then add in the subtle issues.

I'm comparing it to when I had my molly and she was going through so much. I know facts and I know cushings, but what I could not do was look at the whole picture, because like all of us, we are terrified and searching for answers, so everything has the possibility to mean so many different things.

Where is sammi compared to before the addision crisis. Where is sammi compared to when you took her into emergency and pneumonia was determined?

Just like in humans, pneumonia is scary and can take a long time to recover from. Any exertion is going to cause two things, pain in the chest area and labored breathing. The pain will cause increased pain breathing also. This is just how pneumonia acts in a living being.

I would want her cortisol running a bit higher (not cushings levels of course, but higher for sure) while combating pneaumonia. It will help with the discomfort that she'll feel from the chest/lung/breathing issues caused by the pneaumonia. I would want follow up xrays to check the pneaumonia too, done by the VCA where she was staying so they can compare. You want to know if she is getting better or what is going on in the chest area.

Okay those are my initial thoughts.

[sammisam]

I do see what you're saying.

I think we're looking for the exact diagnosis so we can find the exact pill that will cure her. I know that's not reasonable. When I asked the vet the other day "do we know for sure that it's pneumonia"?, She said "no".

So far Sammi has been doing "ok". I say ok because she's very fragile, weak, just stands there at times, but the good things are that aside from the 6 hour breathing episode, the other night, they're been much fewer.

She's making her way (with a little "express ride" from us sometimes) to drink, to eat, potty (sometimes). She's also consciously lying down instead of falling asleep sitting up and then falling down. She started doing her little fluffing of the blanket again and just resting a lot. And she's climbing onto the pillows and mattress we have on the floor for her.

She certainly has some pet palace set up for her.

It's so tough, especially thinking could this be something else in addition to the Cushing's and we're missing it. But we're just going to take it day by day. Prior to the Adisonian crisis, I would say she's much weaker, more fragile. Prior to the pneumonia I would say she's more comfortable.

I do love that she's still eating and drinking and making her own choices. and I do love that she's sleeping with us, fluffing up her blankets, and laying down on her own.

I'm just in a daze, sick to my stomach, crying when I think about losing her, but I have to think that these past few days with her home have been the best gift. She's such a trooper.

[molly muffin]

Well of course you are in a daze. This is all very stressful.
Getting past the pneumonia will be key of course. I personally wouldn't as I mentioned before, try to lower cortisol during the treatment of pneaumonia. I think you want that to be left alone to help her feel better, or that would be my take on it at least.

How is she today? And when can you get a follow up xray at the VCA to see how her chest is doing.
(my hubby also has pneaumonia right now and it is really not good, poor little Sammi is much smaller fighting this)

[sammisam]

So far so good.

We're just going minute by minute.

The breathing episodes are definitely lessening and Sammi is making more conscious decisions on her own. I would say she's still not where she was prior to her Addisonian Crisis

Not all of the time but a good amount of the time she's still doing the "just standing there in a trance" and slowly sinks lower and lower if we just leave her. It's the same thing as when she's sitting and slowly starts to go down to the ground, but then we just guide her in a different direction or put her in her bed. She looks like a Tyrannosaurus rex dinosaur when she does that so we call her "TyrannoSammi rex" (along with her other 25 nicknames).

Every second she takes to get started eating is like a month to me but she's eaten every meal no problem! Haven't given her one appetite stimulant since we've been home (6.25 days but who's counting).

We give her the Trazadone at night, with dinner and the panting/rapid breathing starts to happen in the afternoon/evening (the past 2 days).

We're just so happy to have her home and it seems like each day is a little better. No diarrhea anymore (at least not tonight).

I've been so stressed and even though we're on 24 hour watch with her, it's gotten a little better but we still make sure to hold her up when she's drinking her water and on the Trazadone or falling asleep over the bowl. She spilled it on herself yesterday (poor thing was soaking wet) and I got mad at Adam for not watching! We invented a little stand so that can't happen again (the stand we have is too high so we can't use it).

We haven't really had to use the oxygen that much and I don't even know if it's working for her, because when she starts the rapid breathing, most of the time it'll just go away on its own, so we never know if it's the O2 working or not. I added the humidifier to it so her mouth doesn't dry out as she breathes in. We used it for about 5 min today and I'd say we really haven't used it everyday or all that much.

She's snoring, fast asleep right now and that makes me so happy.

One odd thing I've noticed, but I'd say it's for the better. I started noticing that the past few months Sammi didn't yawn. She would try to yawn but her mouth would barely open so she never got a full stretch. Over the past few days I've seen her be able to yawn just about normal.

One other odd thing she did that she's never done is that she licked the wee wee pad where she went pee pee. We have the washable ones and she turned around and sniffed it and then started licking it. I know sometimes that indicates a vitamin deficiency so if anyone knows anything about this I'd love to hear.

I definitely understand about keeping her cortisol higher but Adam and I have gone back and forth on the Trilostane and there have been many things where we are on complete opposite sides of the fence. I don't think Adam would ever forgive himself if he didn't try the low dose 5mg/day Trilostane on her. I can't win every disagreement and I've been 50/50 on whether we should've started back up again. Both of her internists said it's ok to restart.

We felt like we had nothing to lose because we feel like we're on borrowed time. We honestly thought that Sammi wouldn't be here with us since we got home from the hospital. This is her 4th day on it and interestingly enough the breathing episodes have lessened and her back leg seems stronger.

We have no way of knowing if it's partly due to the Trilostane, so we're just taking it day by day.

I dread having to take her back to the vet but I guess she does need a follow up xray. What's weird though, about her other xrays, was that the second one they took looked worse than than the first one regarding the lungs. First xray was on 12/21 and second one was on 12/23. they explained that xrays can lag behind clinical signs.

Well every day with her HOME has been a blessing and we pray for more.

Thank you so much for being our support system!

Hope hubby gets better. He's welcome to recover here as we're all prepared with chicken soup, oxygen, mattress - blanket - pillows for easy access on and off the couch, antibiotics... you name it, we got it!

[labblab]

I’m so glad to hear how well Sammi is doing, under the circumstances. Just like you say, every day is a gift! I honestly don’t know what to make of her licking the pee pad, but I probably would try not to worry about it since she has stabilized to a good extent in other ways. And even though I’d normally agree that a repeat x-ray would be important, I think I’d personally hold off on returning her to the hospital right now as long as she is outwardly looking better or at least, no worse. I would think it would be really stressful on her to be taken back in, you always run the risk of exposing her to other sick dogs, and I guess most importantly — how would her treatment change even if the x-ray didn’t show improvement? You’re already armed with the oxygen and all the medication, and I’m guessing you wouldn’t opt to rehospitalize her again, no matter what. So I think I’d just keep her snug and cozy at home, at least for the time being.

If you get worried about her blood chemistries or blood counts, could Dr. Amy take a blood sample at home to submit for analysis? That’s one thought that occurs to me, that it might be a bit of a bridge between staying at home and taking her in. Going back to licking the pee pads, urine is somewhat salty, so maybe she might be craving salt. Does she try to lick yours or Adam’s skin? Skin can taste salty, too. That’s just one thought, but the licking of the pads may not really even mean anything at all. So again, I think I’d look at the whole big picture and it sounds as though Sammi is hanging tough right now. Good girl, Sammi!

Marianne

[sammisam]

Great advice Marianne!

It's such a hard decision to make, but I don't think we ever want to have her hospitalized again, unless we knew for sure that she'd be coming home and I don't know how you could ever guarantee that.

One of the internists had recommended that Sammi see the cardiologist for an EKG or something like that. It's a non invasive procedure. I want to look into if someone can come to the house, for obvious reasons.

It's odd because the rapid breathing/panting is now happening in the late afternoon/evening and I can't help but think if it's something with her heart, there may be a pill or something she can take to help her. It may just be due to the Cushing's and could even be the clots they talk about but small ones. I don't want to subject her to more tests and procedures but the internist noticed that she's never had any type of consult with a cardiologist (and I agree). You would think with all the times she's been to the vet something like that would've been done but we were always dealing with other issues.

She did her rapid breathing episode for about 45 min this evening, and then it stopped, started, stopped, started, etc., then it happened again and 5 minutes later she's fast asleep snoring away.

She's also at times just standing there and looks like she's going to fall asleep standing up.

We just want to know if she's suffering. If someone looked at her I wonder if they'd think she's dying or going to collapse because she's sitting and starting to fall asleep so her head is down, pressed against the couch or bed, panting/rapid breathing continues (not that noisy, just tongue out a little bit and mouth open) while she's sinking lower and lower and lower. Then she'll pick up her head, be just fine, or I'll pet her and she snaps out of it. Sometimes it lasts, sometimes not.

It's not the type of stance where their elbows are out and head is down, grasping for breath. It's her Tyrannosaurus rex mixed with the rapid breathing/panting.

She seemed a little drunk today but it was right after she woke up from a long sleep. What's so heartbreaking and scary is if she's lying on her side, or if she falls (which has happened a couple of times) she panics and starts kicking her arms and legs as if she's running. She did it this morning after her long peaceful sleep and she started whimpering (which she's never done) when she couldn't get up, so I gave her a little help and she was able to get herself back on her feet. It was on the mattress and blankets though.

When she was on the hardwood floor in one little section i have no idea if she'd be able to get herself up because I couldn't leave her there long enough to see.

That's why we just can't leave her alone right now. It's so scary and I know I've read some similar stories of this happening.

I was in the middle of writing this and had to stop to attend to Sammi for the past 3 hours (not that I mind). I don't even know if the oxygen is working because it's not a tent. We just put it up to her nose and mouth.

I really just don't know. Even though she's doing better she's still very weak, depending on the day, we carry her to go potty or carry her and set her by her food. I'm so sad because I don't know how she's feeling, if she's going to get to where she's not just standing there and sinking down. I cry when I can't keep myself busy and I haven't left the house in a week. I think we're going to have one of the vets who was recommended from her original internist (for in home euthan) (I can't even say it) come here to meet her and evaluate her. She's one of the vets that does the iv method. The plan would be to just meet the vet and then she could also evaluate Sammi.

I can't even hold myself together I'm so sad. I love that little monkey so much!

[Budsters Mom]

Excessive panting spells combined with head pressing, could be indications of pain. An expanding pituitary macro tumor, increasing pressure on the brain, can cause severe headaches. This is according to the neurologist team that oversaw Buddy's treatment. It was explained that there is very limited space for the tumor to grow. Continued tumor growth puts pressure on the brain. The larger the tumor grows, the more pressure/force and pain it creates. Dogs try to relieve the pain by head pressing and panting excessively.

A possible macro has been discussed before. I don't think it should be ruled out at this point. I hope I am wrong.

Kathy


head is down, pressed against the couch or bed, panting/rapid breathing continues (not that noisy, just tongue out a little bit and mouth open) while she's sinking lower and lower and lower.

[sammisam]

I've read about the head pressing and it wasn't that.

It was just that her head was next to the couch as she was sinking down. I almost wish it was the head pressing so that would help us make a decision.

We don''t know what to do. It seems like Sammi got worse overnight and the last day. rapid breathing then sleeping then rapid breathing then we get her back to sleep again and again. i keep thinking it's heart disease also. i just wish someone would tell me that even if it's heart disease it wont get better at this stage.

We're at a loss of what to do and which to do .....the 2 different methods of in home euthansia is killing me. we have the husband and wife team dr amy that we love and came here 5 yrs ago but then 2 of our vets said the most humane way is the iv method (which dr amy doesn't do).

they (dr amy)explained to adam why they dont but then its just like of course someone will say thats the best way (defend the exact method they use). i haven't heard from the other places that do this with iv method. i can't research anymore because it goes into detail and it's making me physically ill to read it.

sammi is sleeping comfortably right now and i'm petrified for her to wake up because if she's doing the rapid breathing then its getting worse.

[sammisam]

We're devastated.

Sammi is in heaven now and I can't even breathe, talk, stop crying.

I will write something later because it makes me believe in spirits, signs, afterlife as its the only thing we can hang on to right now.

We're in so much pain right now.

[labblab]

Oh Tracey, my heart is with you both! We are all here for you, no matter what, and no matter when you are able to write more. You and Adam are never alone, and neither was sweetheart Sammi. I have no doubt but that our other angels were crowded close by to greet her the moment she made her passage. But I know your hearts are broken. I send you all my hugs and hopes for comfort. You did everything that was humanly possible to help Sammi. I so wish I could do more to help you and Adam now.

Marianne

[molly muffin]

OH no!! I'm so sorry Tracey. I know you and Adam both have had your hearts broken. Just know that we are here for you whenever you want us to be.

sincerest condolences :( :(

[Squirt's Mom]

Dear Tracey and Adam,

My heart is shattered along with yours to hear of our sweet girl's passing. You all fought so hard for so long but sadly not all battles can be won as too many of us here have learned ourselves. I have no doubt that Sammie left this life on the wings of your love and will carry that with her til you all meet again...and you will meet again. Of that I have no doubts. I read something recently that says all love is of the Spirit and Spirit never dies. The only way I can face each day is believing those I love who have gone on ahead of me are together and that one day I will be reunited with them. Nothing else makes any sense to me nor resonates with my Soul as true. I believe in those signs you talk about - I hear my Squirt, Trinket, Brick and others walking on the vinyl floors, I see them out of the corner of my eyes, I smell them at night as if they were laying beside me, I see things in nature all the time that tell me they are near - like flowers blooming out of season where we used to walk or a bird landing on my shoulder to sing a short trill. Those things were sent to me to let me know they are still with me. Your Sammie will let you know in her own way that she remains with you, too. One of these nights you will feel a whisper of air on your ear - that will be her; one day you will feel something brush your leg when nothing is there - that will be her; one evening as the sun sets you will hear a soft song that no one else hears - that will be from Sammie. And then one day, when your jobs in this life are done, she will be there to greet you, flying into your arms once again to cover your face with kisses. Til that day on which we are reunited, we cry, sometimes every minute of every day and each tear is in honor of the love we shared, a love like no other.

Please know we are here with you any time you need a safe place to fall, to cry, to scream, to talk - we are here. And when you are ready, we will be here to celebrate the life you shared with your precious Sammie.

Fly free, sweet Sammie, fly free.

In deepest sympathy,
Leslie, Sophie, Fox, Bud, and all our angels



A Blessing For Absence
By - John O’Donohue

May you know that absence is full of tender presence

and that nothing is ever lost or forgotten.

May the absences in your life be full of eternal echo

May you sense around you the secret Elsewhere which holds

the presences that have left your life.

May you be generous in your embrace of loss.

May the sore of your grief turn into a well of seamless presence.

May your compassion reach out to the ones we never hear

from and may you have the courage to speak out for the

excluded ones.

May you become the gracious and passionate subject of your own life.

May you not disrespect your mystery through brittle words or false belonging.

May you be embraced by God in whom dawn and twilight

are one and may your longing inhabit its deepest dreams

within the shelter of the Great Belonging.
(Eternal Echoes 275)

[Joan2517]

Oh, Tracey...I am so, so sorry. I can't see to type, the tears are just falling. I hope she was with you as you wanted her to be.

[sammisam]

I feel you all with us and I'll explain more later as I do believe it was the macroadenoma. Adam is having a very difficult time as am I but we take turns to support each other.

I do want to talk about what happened so maybe it will help someone else and I'll do that when I can concentrate more. The only thing that's getting us through is this...

The beautiful thing that happened was that I was frantic about who to call because i was upset about which method of euthanasia would be the most peaceful for her. No one had called us back on time for the past two to three days and we decided to call our Dr. Amy who we used for Veronica our cat 5 yrs ago. In actuality Dr. Amy and her husband work with Dr. Michelle and Dr. Peter and thats who came to our house 5 yrs ago.

so it was dr. Michelle (i cant capitalize write now) who adam had spoken with the past few days.

when we called her this morning dr michelle was very sad and she said, "I'll be sending dr. samantha over". it took a minute but adam and i looked at each other and said DR SAMANTHA! our sammi is a girl and short for samantha (even though we never named her) it almost confirmed it was the right time and we made the right decision. how in the world would that be the doctors name and who would come out on the day we needed her. dr samantha's initials are S.S., well so is our Sammi. sometimes you can't just explain coincidences away.

dr. samantha was literally an angel, she was english, soft spoken, and our lil sammi was sleeping when dr samantha got here. it was just like sammi went to sleep so peacefully and even dr samantha said sammi made it so easy. we couldn't even believe what just happened. so we are so thankful that sammi just went into a deep sleep. she was in one of many many beds with us right ver her touching her with our faces and cheeks and telling her how much we love her.

i've always had a connection with 1111 (eleven eleven) for so many reasons and we didn't realize til later that this was the time adam carried sammi, wrapped in her favorite blanket down with dr samantha. we are choosing to have only HER ashes brought back to us. i know we're probably looking for any little thing but this is helping us get through as best as possible right now.

i cant thank everyone enough because YOU gave Sammi an extra 10 months of being with us. anything your babies went through helped us make better decisions with and for sammi.

thank you for being here for us and i will write later when i can gather my thoughts more.

we love you sammi and we miss you so much and we know you just left a sick body to come back to us again. and we know you'll be back and you're probably sitting on your favorite spot on the couch next to us right now.

[Budsters Mom]

Tracey and Adam,

There is nothing I could say that would help you feel any better right now, There are no magic words to help lessen your loss. Gather strength from each other. Sammi was and will always be cherished. She knows how much she is loved. I am truly sorry for your loss.

FLY FREE SWEET SAMMI, FLY FREE!! Our fur angels will watch out for you now.

[sammisam]

We are grieving so intensely right now. Adam is inconsolable most of the day. I told him to just cry as much as he wants. We both don't know what to do with ourselves. We have Taylor and thank God he's ok but it's so hard to make him dinner when he would always make for both of them. so hard to do everything.

This is just so hard. My chest is burning, Adam said he feels as if someone ripped a hole out of his heart. We're trying to help each other through as best as we can

[Budsters Mom]

Look. I didn't have any support at home when I had to let my heart dog fly. My best Buddy in the entire world. I had no one except my friends here on the forum. They stayed with me 24/7, taking shifts. Chatting among themselves, on my thread, to reassure me that I was not alone and I would get through. Even though I couldn't post for long periods, they knew that I was there and the forum was my lifeline to sanity. I was in shock for several days. I did not sleep, or eat, as far as I recall. Friends on the forum continued to encourage me to rest and eat a little something. It was an entire flock of mother hens intent on holding me together. I finally ventured out and went to return a bag of unopened dog food. It was a very expensive allergy formula and didn't make sense to keep it. I thought that I could handle that little task and was doing okay, until the sales clerk asked why I was returning the food. An innocent question. I broke out with hysterical crying trying to tell them that my dog had died, so I didn't need the food anymore. When I got home, I realized that I had left my purse somewhere. I was on Summer break from work, which was good because I was unable to accomplish even the smallest task.

You and Adam have each other to hold on to. You also have all of us, many of which have lost our precious babies and remain here to support others as a pay it forward. No one understands your pain as much as we do. You are in shock now, but you will get through. It takes time, but one day, it will hurt a little less and happy memories will surface. In the meantime, we are here.

With many soothing hugs,
Kathy

[Harley PoMMom]

Dear Tracey and Adam,

I am so sorry for the loss of your precious girl, Sammi, and you both are in my thoughts and prayers. Please know we are here for you both and always will be.

With Heartfelt Sympathy, Lori

[labblab]

Dear Tracey, like Kathy says, please come to your family here anytime day or night. And just like you’re already doing, just write straight from your heart. No matter what comes to heart, no matter what comes to mind. You are being such a good support to Adam. I totally agree with you — tell him to cry as many tears as he has in him. It is best to let them out. And I hope that we can be a comfort to you, as well. When I lost my Cushpup, Barkis, during those first hours and days, I grieved more intensely for him than I had for anything or anybody in my life. One of my few places of solace was here. Being able to write my true thoughts about my broken heart. I hope this will be your safe place, too.

Today will be your first morning arising without Sammi. Such a hard morning. Such a hard day. But we are here to listen and to hold you up.

I am so grateful to read about Sammi’s most peaceful passing. Your final loving gift to your precious little girl. A lifetime filled with love, from beginning to end. But now a new journey begins for you and Adam. Finding a way to continue on with your own lives. Thank goodness for little Taylor. I’m guessing he will be missing his sister, too. But he needs you now, and in a way, I believe that can be a blessing. Life does go on, even though it profoundly changes.

Sending my warmest thoughts today to your whole family, Tracey. And always in loving memory of your precious baby girl.

Marianne

[Squirt's Mom]

A peaceful, gentle passing....what a blessing for you all. Tho that doesn't mean much right now it will in the days and weeks to come. Sammie was with those she loves best, in her favorite place - home with you and Adam - and her body was able to release her Spirit to move on without struggle or anguish. Yes, truly a blessing and I am so grateful.

There are no rules, no time limits on grieving. Some are able to cry a little bit then carry on. Some take months or years for the tears to stop. Some never stop crying. And it's all ok. Whatever you and Adam need in order to express your grief is perfect. I walked around literally screaming for weeks after Squirt passed and for months after those screams would sneak up and out of me at the least little thing. Today, 3 1/2 years later, I still sob and find breathing hard at times. It hits me fresh all over again out of the blue or at times like this when one I have come to love has had to join my Sweet Bebe in the Rainbow Fields. But those times when she tells me she is still by my side make all those painful times easier to bear. You and Adam will one day know the same. But for now, grieve as long as you need in any way you need...and know we are with you always.

Hugs,
Leslie

[sammisam]

Everyone here has been such a blessing and I read every little thing everyone writes, sometimes two, three, four times ++++ over. This is helping, tremendously.

I thank you all SO SO SO much for understanding because all of your words, and all of your thoughts, prayers, support are helping us get through this tough time. It brings peace to my heart and at that moment relieves some of the grief.

That is the best gift and we are so grateful. SO GRATEFUL.

[molly muffin]

I remember when we lost our Molly muffin. My husband was absolutely devastated in a way I had never seen him before. I knew he would miss her, that he would grieve for her, but I didn't know that he would be as affected by her loss as I myself was. I still can't think about how much he hurt through saying good bye and the time afterwards without crying. We got through it together and with our friends here on the forum, they knew and loved us all so much. Our pain was their pain. Your pain is our pain because we know it personally, we understand it and we wish that somehow we could make it all better.

This precious little soul that was such a huge part of your life, will never truly leave you. She not only lives in your hearts but in every space in your world. It is painful, but is also a love to be celebrated.

Hugs

[sammisam]

Yes... I know everyone knows the pain and that's why this is helping us so much. I'm always the one writing on here and sharing it with Adam. He said "when I can pull myself together I want to write on the forum and tell everyone how thankful I am for them".

I'm afraid to go to sleep because I'm afraid to wake up realizing that this is not a dream. I know all of you understand the intense sorrow and grief we are feeling right now. I can’t even see most of the day my eyes are so swollen.

I wanted to share the story of how Sammi came into our lives and we would’ve never had her had it not happened the way it did. It makes me laugh because of some out crazy behavior back then but that's what brought us to Sammi.

I don’t know if this is the right place to even put this but I didn’t know where to post it. I hope it's ok.

Here’s how Sammi came into our lives back in 2006...

Our first Boston, Darla, passed away in 2005 and it was the most difficult most darkest time, as it is right now.

We didn’t know what to do with ourselves and at that time we didn’t put much credibility into psychics/people like that but we were so desperate we called an animal communicator (well known Teresa Wagner). We felt crazy doing this but the most amazing thing happened. She talked to us and described Darla to a tee! I mean even things that were personal and not a generalization of the Boston Terrier breed.

She also said that Darla wanted to come back even smaller in her next life. There were many more things she said that rung true but at the time Adam and I didn't know if we were just trying make those things come true because we were so devastated, desperate and wanted to believe.

So we said, let's go find another animal communicator that's local, and we can talk face to face with, and see if they say things similar, or see if it makes us believe Teresa is real or fake.

Long story short, the guy we went to was a complete quack. We were about 20 minutes into his “communicating”, and I was about 18 kicks to Adam's shin, under the table. I stopped him in the middle of his “act”, got so upset and told him he was fraud and shame on him for taking advantage of people at their most vulnerable time.

He said the most generalized things and it was nothing like when we spoke with Teresa Wagner. He also showed such fake emotion. I lost it, and Adam and I walked out of his house as he tried to refund our money, but I threw it back in his face. I was hysterical crying, we got in the car and then I got even more angry, got out of the car, banged on his door and said I changed my mind, give our money back and I cursed him out even further.

We drove away and about three houses down there were these young (maybe teenage) kids playing in front of the next house. We gave THEM the $300 the "fake communicator" just gave us back and told them to egg his house one day and we drove off laughing/crying at the same time.

I know it was immature but we were just out of our minds with grief. But it made us realize that maybe Teresa the animal communicator had something special. Adam wanted another dog right away but I didn’t. A couple of months later Adam found a litter of Boston's about 3 miles from where we lived and when I called them for information, one of the questions I asked was when they were born.

The guy yelled over to his wife as I was hanging on and said, "Hey hon, what date did Darla have the pups"? DARLA!!!!????? I about fainted because the puppies mom's name was the same as our lil Darla that just passed away. Then she answered him with Nov 27th. NOVEMBER 27!!!!!!!!

Our Darla was born on Nov 27th, only 8 years earlier!!! We rushed over there and Adam begged me to please agree to get one. I really was still mourning Darla, but we got the new pup. We named her Daphne, and she was NOTHING like Darla. Not that it mattered, but I just wasn't emotionally ready for another dog. I think we were trying to make Daphne be Darla’s spirit.

Adam and I fought over it and I still can't believe what we did... (we can't stand when people get pets and then just decide to give them away when they can't handle the responsibility). In this case it wasn't the responsibility for us at all, it was just that I was not emotionally ready and I think Adam finally admitted that he was not either.

We found her a wonderful home and even though we paid $1,200 for her, we gave Daphne to this wonderful couple and just asked that they please give her a wonderful life and the money they would’ve spent for her to please put that toward spoiling her. It was really a difficult time and we wondered if we just made the biggest mistake of our lives.

We even called them a week later and asked if we could have her back and we’d even pay them whatever they wanted.

They said they were so sorry, but no... no, they would never give her up as she was already a part of their family. That actually made us feel good that they really loved her, but we were so sad and confused.

Fast forward a couple of months later in February. I was now ready for a new pup and that's when we found Sammi, who was born about 7 weeks after Darla had passed away. We lived in Las Vegas at the time and Adam flew to Birmingham, Alabama on Valentines Day in 2006. Sammi was so tiny, I don’t even think she weighed 3 lbs. She slept on Adam’s neck and shoulder since day one and that was that.

It was always meant for us to have Sammi and everything had to happen the way it did for us to have her. She was EXACTLY Darla's mini me! We would've never had Sammi had we kept Daphne, because at that time we never even thought to have two pups and we truly believe that Sammi was Darla reincarnated. She did everything Darla used to do, she looked exactly like Darla (only smaller, and it dawned on us weeks later, what Teresa had said about being smaller). There were still so many other things Teresa had said and that was just one of them.

We never thought any pup could've been tinier, because Darla was tiny, full grown, but Sammi was even smaller. We believe all of that happened just so we would have Sammi as part of our family. I know it's crazy story but we really believe in our animals spirit coming back to us.

Sometimes coincidences are just not coincidences, and speaking of that, we found something else out about Dr. Samantha who was here yesterday to help Sammi get to heaven.

Besides the name is the same (Sammi short for Samantha)... Dr. Samantha

Besides that Dr. Samantha’s last name is Shone, and her initials are S.S, (our last name begins with an S and Sammi’s initials are the same, S.S.)

We just found out that Dr. Samantha is from Birmingham, UK and Sammi was from Birmingham, Alabama!

When I told Adam he just burst into tears. We truly believe that this was all meant to be and there’s no way Sammi’s spirit will not be in our lives forever. It’s still so difficult but the little things like all of this, help us with believing.

Thank you so much for reading this, it makes me feel better to write.

When I’m up to it I have another cute story that’s pretty funny. I don’t even know if “The National Enquirer” publication is still around but we have a wonderful story about a dog we rescued. Darla (Sammi’s predecessor) and "Rudy" (the one we rescued) were actually featured in “The National Enquirer as “angel dogs among us”. It's a very cute story that helps me smile during this tough time.

Thank you again for allowing me to get these emotions out and share our lil Sammi with all of you. The pain is unbearable at times and we are hurting so bad.

We love you so much my little SammiSam and you have family on this forum that are thinking about you too.

[Budsters Mom]

Yes, this was the perfect place to write your story. Right here on Sammi's thread. It's how it should be. I do believe things happen for a reason. They enter our lives when we need them the most. Thanks for sharing.

Give Taylor a tummy rub for me. I'm sure that he misses her too.

We would love to hear from Adam directly. That would be a treat for us all.

Kathy

[labblab]

Oh, what a sweet story! Kathy’s right — this is the perfect place to write, and please do add as many stories and memories as come to your mind. Reading about your lives with Sammi and your other babies helps us all as we work through our family’s sorrow over her loss.

We want you to know that on our “In Loving Memory” forum, we hold very dear a set of memorial threads dedicated to our angel babies. The threads are arranged by year, and Sweetie Sammi is our first angel for 2018. Within the next day or so, we’ll also be setting up a companion photo album to accompany this thread. When the album is in place, I’ll talk with you again to see whether you might want us to add a photo to the album. But for right now, here’s a link to Sammi’s memorial thread.

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

I soooooo understand that fear of going to sleep, knowing you’ll have to wake up and relive the shock all over again. That’s maybe the only good thing that comes out of the exhaustion of grieving — your body finally reaches a point where you just have to go to sleep, regardless. I know these first hours are so hard. Baby steps, that’s all you can do. One foot in front of the other, doing the things that must be done, even if it feels like sleep-walking. And keep on writing!!! The more stories, the better. We are so honored that you and Adam are allowing us to share in these precious memories of your precious pups.

Marianne

[sammisam]

I would definitely like to add a photo of Sammi. I took one of her 4 days ago because she looked so cute sitting on her little pillows and blankets in the pet palace we made for her.

Today was one of the hardest days. It just hit me the most, when I woke up this morning. I know it's going to be up and downs and going through the stages of grief. I have to get the picture out of my head from the other day and replace them with the past 12 years of memories. Adam said he can't see himself ever being happy again. He can't even make Taylor's food without crying because he would always make their food together.

He's been wanting to get a tattoo of all of our babies names and birthdays... Sammi, Veronica, Darla and I think this would help him. Taylor was looking all around the house today and he's been sleeping in all of Sammi's spots. This is so difficult and I'm so thankful to have everyone here.

Everyone and everyone's lil pups made it possible for Sammi to have the best 10 months. hearing all stories of what your babies went through and their symptoms and what the doctors said and what meds did what, enabled us to figure out what was going on with Sammi and what was best for her. In fact, after her Addisonian crisis it was because of you that she had the best month after she received the prednisone and DOCP injection. That was because of you. That was her best month!

Its not that the vets didn't know what they were doing (although that was true sometimes) it's that we were able to get Sammi what we needed immediately and we were able to go to the vet right around the corner just to get that dex injection as fast as possible. So we, and Sammi thank you for improving the quality of her life these past 10 months.

It helped us these past 3 days to not keep questioning what happened, because I think we already know. Wondering is sometimes the worst part and wondering if we did something different would the outcome have changed. We don't have any of that because all of you.

I'm afraid to go to sleep again so we keep the tv on.

Sammi was really a trooper. Everyone in our building was so upset to hear. She was really loved.

It's literally just one minute at a time here.

I'm going to try to finish with a cute story of Sammi.

She had so many nicknames... so many. One was "The Po Po", as in police. She would always follow right behind you anytime she heard someone in the kitchen so I would always say to Adam, "watch out, black and white coming up really fast behind you" so we joked that she was the police with her black and white color, following closely... and those times we would say "po po on your tail, get your license and registration out". I love that little girl so much and miss her intensely.

[spdd]

I have been reading your thread, and apologize for not writing sooner. My heart breaks for you and reading your story is difficult as it brings back so many memories. I lost "mah boy" over 3 years ago, but I do want to give you some hope. I didn't believe I would ever get over the loss, I was alone with no one but this forum to help me out but enough about me. I just want you to know that every heartache you are feeling and every tear you cry, I am right there with you along with so many others on here. Words don't explain just how we feel for you, but we know.... we really know what you are going through. Keesh's ashes are with me everywhere I go, and I can actually look at his urn, give him a kiss and NOT have a meltdown, even though sometimes I do. Coming back on this forum is and was difficult just because of the memories that came roaring to the forefront and the endless amount of tears, but with the support here, although we can't make it go away........ it definitely eases the pain we have when our very, very special babies leave. We may not fully appreciate it at the time, but it is true. So just know that our thoughts are definitely with you... the struggle is real, but someday, someway we get through it and although the pain rushes back at times, we can and will carry on. Our furbabies will forever be part of us and I hope someday you can smile when you recall the cute things they did, rather then break down. It will happen I promise you, just for some like myself it takes longer then others.

[DoxieMama]

Each time I have visited the forum lately, when there were updates to Sammi's thread, I read them first. Today, I hesitated, as I saw the change in the title. I am so so sorry for your loss. Please do keep us updated on how you and your family (including Taylor) are doing, and continue to share as much or as little as you need.

Run free, sweet Sammi.

Shana

[sammisam]

I SO appreciate all of your posts and thoughts and tears.

I know what you mean Shana... i have to blur my eyes and not look when it says Sammi is in heaven. When I would see that someone's baby had passed away in other posts I would get so upset but I know in some way it helps to know everyone's story and updates.

Judy... (mah boy - so cute) you can talk all you want about what you went through. When you wrote

"I have been reading your thread, and apologize for not writing sooner. My heart breaks for you and reading your story is difficult as it brings back so many memories. I lost "mah boy" over 3 years ago, but I do want to give you some hope. I didn't believe I would ever get over the loss, I was alone with no one but this forum to help me out but enough about me."

and then said "enough about me", my heart sank because I DO want to hear. It helps in my grieving process to know that anyone has had these same feelings and what those feelings were. Even if it's blowing up at the mean girl behind the register because she set you off, or being angry at the world, or crying on the side of the road. Whatever it is it just really helps to hear those stories so please... NOT enough about you, I would love to hear more because it makes me/Adam feel like we're not alone.

And that is for everyone.

Adam and I have been planning out our nights and trying to distract ourselves. We stay in and we set up hours and hours of tv programs just to stay distracted.

Yesterday morning I started doing the "what if". I started thinking what if she stayed in the oxygen longer, what if it were really a clot that had to dissipate, what if we got her on her Trilostane sooner, what if they checked her heart.... I started doubting she had pneumonia and had to stop myself and realize it was more than one thing and most likely a macroadenoma.

Taylor has been very subdued and you can tell he's sad. He finally played outside on one of his walks which made Adam feel good. I haven't left the house. As a matter of fact I just washed my hair and it took me 4 washes because I can't remember the last time I washed it.

I miss that little girl so much.

Adam is having a very rough time. He breaks down at the slightest mention of Sammi. when he takes Taylor out everyone asks where Sammi (Sammi the mayor) is and that's all it takes. Luckily, we have the sweetest people in our building and they start crying and then give Adam a hug.

I try to kiss her picture everyday instead of NOT looking at it. I sometimes can't look at it because I just break down but I don't want it to be that I can't even look so I try to kiss it everyday, several times a day.

This is such a difficult process and I'm so grateful for all of you.