Olivia'sMom
06-25-2017, 12:56 PM
Hi All – I am very grateful to have found this group, as your posts have helped me to feel not so alone in this Cushing’s journey with my girl. I hope this post isn’t too long - as I could really use some experience, strength and hope here.
A little background – Olivia is an 11-year-old pug who came to us as a rescue (after bouncing around between several foster homes), just before her 1st birthday. She joined my almost 2-year-old (at the time) pug, Mr. BIG, and completed our family. They were inseparable until we lost Mr. BIG almost three years ago. It was hard on Olivia, but in some respects, I think she also really enjoyed being an “only pug” and did well. However, about a year later (two years ago) she started having separation anxiety if we left her alone in the evening. I work from home, and always have, so she is used to constant company. She also started having episodes of colitis and we found that she had some pretty advanced arthritis in her rear hips and knees. She went on Royal Canin Gastrointestinal food, and started on a Dasuquin supplement.
Olivia also has Recurring Vestibular disease, diagnosed almost 2 years ago. We ruled out inner ear infections, as well as any inner ear defects or tumors with a CT Scan. However, the scan was unable to confirm or clear any possible brain tumors. We decided not to do an MRI, as results would not change the course of treatment – and a brain tumor was considered a high possibility due to the recurring nature of the episodes. Olivia has very intense vestibular episodes with severe nystagmus and a complete inability to walk, stand or sit unassisted. The episodes last anywhere from an hour to two hours, and range in intensity. She has sometimes gone only a day between episodes, but more often goes a month, sometimes three or more months in between. As traumatic as they were at onset, we have learned to manage quite well. And, the symptoms completely resolve between episodes, meaning – no lingering effects. We give her Meclizine at onset, and sometimes for a few days after to help with any motion sickness she may be experiencing.
A year ago, we moved, and this was very hard on her. It was a big change, and we also had to change vets. Fortunately, we found a vet we really love in our new town. Her nighttime anxiety spread into the day time as well, and she became increasingly needy – not able to take her eyes off me and working herself into a total panic if left alone. We finally got into a good routine in the new house, and she settled in. I could leave her during the day for grocery shopping, etc. and while she would stand vigil near the door (we made a comfy bed for her there) waiting for my return she was mostly relaxed, and patiently waiting (we installed cameras so I could see her at all times). We tried Composure supplements from the vet, which really didn’t have any effect – but, time and routine seemed to be helping – for a while. I also noticed she was drinking more water than usual – but, it wasn’t excessive or concerning. Our Mr. BIG had diabetes, and I knew what excessive drinking looked like, and this wasn’t it – just a slight increase – that I’m surprised I even noticed. She has always had regular vet appointments, and had recently had full senior panel blood work, which was all within normal ranges.
Around September last year she started moaning and groaning a bit more than usual when getting up or laying down. Our vet did X-rays and found a collapsed disc in her spine, and commented that her arthritis in her hips and thighs was advancing. We did a course of Prednisone and started with laser treatments and Adaquan injections (admin by our vet). We did the Adaquan injections multiples times the first week, and reduced down to every other week. We tried to reduce to once a month, but Olivia seemed more comfortable at the two-week mark, so that’s where we continued. We do a laser treatment at the same time as each Adaquan injection. We were also given Rimadyl to give as needed – on days where Olivia seemed a little more stiff or sore. This seemed to happen only on rainy days or bath day.
During this time, Olivia’s anxiety was increasing – but, we adjusted. And, she started having some intense colitis episodes. She was prescribed antibiotics and a short-term pectalin supplement. We eliminated all treats and stopped putting chicken, carrots and green beans on her Rx GI food (which we had been doing for some time). We also added a probiotic: Entero Flora Pro to her food. One thing that was interesting to me was that during this time Olivia was eating her bland Rx GI food without any enticement – and she’s always been a VERY picky eater… to the point that I would sing to her, hand feed her, and add the chicken, carrots, green beans – even cheese or peanut butter just to get her to eat. But, now, her food was totally plain and she was gobbling it all down. She was also wanting to eat earlier and earlier in the day. Which I attributed to a “senior thing”. I didn’t even mention it to the vet – I just thought her tummy upset (and lack of treats) left her hungry, and this was a good thing. I was honestly just relieved she was eating without any issues. We finally seemed to have her colitis under control and everything was going along smoothly with our new routine of laser, Adaquan and occasional Rimadyl. On our continual vet visits, we noticed that she wasn’t dropping any weight – even without the treats and extras on her food. So, we ran a detailed thyroid panel – and everything came back normal. Okay, good. We chalked up the lack of weight loss to her age – I mean, I can relate.
Her achy days seemed to be increasing, so she was getting a Rimadyl more often and some where over the course of several months, we just started giving it to her every day with her morning meal. She was definitely more comfortable and had better mobility.
In April, we decided that since she was doing so well, we would schedule a dental. It had been almost three years since she’d had a dental, and her breath & teeth were showing the signs that we really should get that done. Also, I have had to have the vet trim her nails, because her quicks had stopped receding a few years prior. So, while she was in for the dental, we decided to do what they called a “show trim” where they would cut the nails down beyond the quicks and cauterize them. The hope was that this would “reset” her quicks. This was on 4/18 this year. She did perfect during the anesthesia and everything was great – she didn’t need any extractions, and she recovered perfectly, and everything was going along as before.
My husband and I noticed that she was getting hesitant to jump up on our couch (we have a super low pit group that she has always easily jumped up and down from) but decided it was just aging and arthritis and got her some steps to see if that would help. Also – for as long as she’s been with us, in the mornings, I would wake up, carry her from the bed and lay her on the couch – all while she was still mostly asleep. Then we would have to wake her up (she is a pug after all), take her for her walk. I had started noticing that on some mornings when I would wake up, she was already awake, sitting up in bed just waiting for me.
Then, on the evening of May 9th, she started limping a bit – her right front paw clearly bothering her. Thinking maybe she picked up a sandspur or bug bite while outside (we live in Florida), I checked over her paw completely and found nothing wrong. She screeched though when I would touch her pinky toe “equivalent” on that foot. There was no redness or swelling or anything obviously wrong though, and she was otherwise fine so we waited until the morning so we could see our regular vet. They did X-rays and found it was very swollen, but no breaks or fractures, no punctures or anything. We thought perhaps she twisted it or stepped on a rock or something outside. They prescribed Temaril-P (we were told NO Rimadyl while on it) and we were on our way. We were warned that she would most likely drink more water, and because of that need to pee more, but not to be alarmed, that was a normal side effect). That evening, she was panting a bit. I knew there was a small amount of steroid in the Temaril-P, and attributed it that, as she had some panting during the prednisone prescription last year. She was also drinking more, but not excessively. The next night however, her panting was pretty intense and she didn’t seem to be able to settle. I decided to take her to the ER vet, because I was just concerned and didn’t feel good about it. She ended up settling down before we got there, but I had them look her over anyway. Her heart and lungs were good and clear, and they felt she was in very good condition. They felt her foot, and she screamed when they extended her “pinky” toe, but was otherwise in excellent health. I had the doctor look at the Temaril-P pills – just to make sure they were the correct pills and the correct dose (even though I totally trusted my vet, you never know, right?) and they were correct and the ER vet said that is exactly what she would have prescribed. She said that some dogs are very sensitive to steroids and may pant during treatment, and that it was likely just a normal response for her. They said to just keep an eye on her and let them or our vet know if there were any additional concerns. I called our regular vet the next morning, and she was out of town – but spoke to her partner (who was brand new) and he said that we should continue with the Temaril-P and that panting is an acceptable side effect. So, we continued – she was drinking and peeing more, but not scary amounts - but lots of panting and discomfort, especially in the evenings. I also noticed that she stopped laying in her normal spots, which have always been either her bed or blanket (always somewhere soft and comfy) – and was instead laying on the tile or the chair mat next to my desk – hard, cool surfaces – but, we were managing okay, and her foot seemed to be healing. And, then came another bout of colitis. And, Olivia was definitely much more achy and stiff without the Rimadyl, and moaning/groaning a lot when getting up or laying down.
So, on that Tuesday, we were at the vet for our regular laser treatment and Adaquan injection, and so they could recheck her foot. Our regular vet was back, and examined Olivia’s foot and was surprised to hear about the reaction to the Temaril-P but felt that it did a really good job healing the inflammation. She had stopped limping, and wasn’t really even favoring it at all anymore. Our vet said we could stop the Temaril-P and resume the Rimadyl after 24 full hours off the Temaril-P. The colitis was pretty bad, there was a lot of bacteria, and tons of white blood cells in her stool, so they gave us an antibiotic and added a new probiotic to the mix: Synacore. Over the next couple days, Olivia was still panting often, drinking and peeing more, laying on the hard floors and just not seeming to be clearing herself of what I considered the Temaril-P side effects. She also started seeming more scared, fragile, confused somehow and generally unwell. I had put a detailed list together of all the things I had noticed over the last several months – that only now were starting to seem like symptoms, including the food, the confusion, the increased anxiety, being awake in the morning, etc. and emailed it over to our vet’s office on Thursday evening.
Overnight Thursday, she woke in the middle of the night/early Friday morning and I took her out to potty. When I brought her back inside, she seemed very wobbly and unstable. The look in her eyes made me think she was about to have a vestibular episode. So, I hunkered down beside her, prepared to help her get through it. She didn’t end up having one, and laid down to sleep. I kept a close eye on her, just not feeling right about her. As morning came, I got her up to go potty again, and she was very wobbly and unstable, she was trying to be “normal” but didn’t seem able to really control her back legs. She fell over twice – her back legs just seeming to come right out from beneath her. I was sure something neurological was happening. I scooped her up and went straight to our vet and got there just as they were opening. I left her for them to observe and they kept her most of the day. She remained stable, but when I met with our vet that afternoon, she said she was very concerned with how unwell Olivia seemed to be and how she went downhill so fast. They did a full blood panel and put a rush on the results, hoping to have them the next day so we could get an idea of what may be happening. My husband and I loaded her in the car to take her home. When we got home, we took her out of her car seat and set her down so she could go potty, and I noticed that the nail on her “pinky” – the site of the mysterious injury – was completely lifted up and bloody. Somehow this happened on the way home, even though she was sitting stable in her car seat – because it wasn’t that way when we put her in the car. She didn’t yelp or cry or anything either. So, we put her right back in the car and headed straight back to the vet. It was late in the evening and our regular vet had just left, but her partner was still there, and they took her back. Her nail popped off completely while in the back, and they cleaned it, wrapped it and gave her something for the pain, and an antibiotic Rx and we headed home.
The next morning (Saturday), the blood work results were back, and there were no signs of organ failure or anything super alarming, but our vet felt that there were indicators on the results that suggested we test for Cushing’s disease – so we scheduled a drop off first thing Monday for an ACTH Stim test and a bandage change on her nail/paw. On Saturday evening, after coming in from a walk, I noticed that one of Olivia’s back toe nails was a bit lifted from the quick, and had oozed some blood, but was not bleeding. It didn’t seem to be bothering her at all, and the nail seemed stable. I decided not to take her to the ER vet, as that would seem to be unnecessary stress. She was already on antibiotics and it wasn’t bleeding. Then, on Sunday – Olivia had a pretty major vestibular episode. We gave her meclizine, and held her and comforted her until it passed, which it did – after about 2 hours.
On Monday, she went in for her ACTH Stim test. They also cleaned and treated her back toe and said we were right to leave it, and we will just watch it for now. Her bandage was changed on her front paw. We had an appointment on Wednesday for another bandage change, and the results had come in from the ACTH Stim test.
5/22/17
PRE: 13.5 ug/dL
POST: 34.8 ug/dL
Clearly, Cushing’s. We would start Vetoryl the following morning. Starting dose 30mg.
We also had a long discussion about what was going on with her toes. Two potentials: one – that because of the Cushing’s disease, she didn’t heal properly from the nail trim/cauterizing done three weeks prior. Or two: Symmetrical Lupoid Onychodystrophy*(SLO) which is a Lupus-like disease that attacks the nail bed. There is no real test for this other than amputation and biopsy – which of course – isn’t an option. So, we just treat the infection/injury and go from there. Neither nail was getting any worse at this point, but neither was getting any better either. We also started Senilife, a supplement which sometimes helps with senility. We also decided to move the laser and Adaquan injections to once per week. We got topical drops for her back toe, and scheduled her next bandage change on her front toe.
Over the first two weeks on Vetoryl (about a week or so in), we saw a reduction in panting and drinking/urinating was completely back to normal and although still hungry, Olivia started wanting her food “enticements” again. Her achy-ness and discomfort was worse at night, so she started getting her Rimadyl 2x a day. So, she was definitely seeing some mild improvements, but still wasn’t comfortable or feeling very well – she still felt fragile and "off" to me – she didn’t seem comfortable or relaxed. Her back toe remained about the same, no better but no worse, and her front toe finally healed enough to remove the bandage. No nail, no quick left – but, she didn’t seem to mind or notice.
We did her second ACTH Stim test on 6/6. And, the two days following were the best she had in a long time. She laid in her usual comfy beds, lounged around – had big, long, lazy yawns and stretches. Things I hadn’t even realized she wasn’t doing – for who knows how long? The vet didn’t put a rush on the results, so it took several days. In that time, Olivia had one evening where she panted quite a bit – but, then it went away again - BUT she was back to laying on the hard surfaces, seeming to be generally uncomfortable. When the results came back in, the vet said that the results weren’t what she expected to see, but, that she didn’t want to change her dose until she spoke to a specialist/endocrinologist to review Olivia’s case. I didn’t even ask for the numbers at this time, as I was comfortable waiting for the specialist’s opinion.
At the time, water and urination was still back to normal – panting (other than the one evening) was gone – she was spending some time on her soft bed, and sometimes on the carpet – but still spending half the time on the tile or other hard surface. She still wanted enticements to eat, but was back to wanting food earlier in the day again. I still felt she was generally uncomfortable and unhappy, but stable (including no colitis episodes). Hind leg weakness has been better some days, worse the others. Confusion seems to be better, but heightened neediness has stayed the same.
It took a bit to get the consult from the specialist. At this time, I asked for the numbers:
6/6/17
PRE: 15.2 ug/dL
POST: 33.9 ug/dL
So, still extremely high, and the Pre number even went UP.
Also, liver enzymes increased – I don’t know how much, other than before, they were within the normal range.
ALP: 211 (normal 5-160)
ALT: 162 (normal 18-121)
The specialist was concerned that the pituitary tumor may be a functioning MACRO and the suggestion was to double the dose of Vetoryl to 30mg in the morning and 30mg in the evening. The doses to be 12 hours apart, no less than 11 and no more than 13. This would be a big challenge, as she eats no more than 9 hours apart, and is adamant about her feeding time.
The hope was to see some improvement within a week and then retest at 2 weeks to check the numbers. If there was no improvement, the specialist suggested an abdominal ultrasound.
We started the double dose on Saturday June 17th. We are giving her some whole food treats at her normal dinner time, and are able to push dinner and second dose out to 11 hours, but she does a lot of whining in between snack and dinner and is very unhappy about this. With no change her food anxiety, our vet scheduled our ultrasound for this past Friday. An internal medicine vet came in, performed the ultrasound and found no adrenal gland tumors (I guess they were wondering if she could have both pituitary AND adrenal tumors). They did find a lesion on her spleen, that they would normally suggest a needle aspiration/biopsy for - but didn’t recommend that now, as Olivia wouldn’t be a candidate for any surgery or treatment. The internal medicine vet suggests continuing on the double dose and doing the retest to see where the numbers are.
Our regular vet is out of town now until July 5th. We are scheduled for the third ACTH Stim test that day. We are still dealing with infection under her back toe (she’s had two antibiotic shots in the last month) but the nail remains stable. There is a tiny new nail starting to grow on her front paw. Her hind leg weakness is still significant some days, but seems somewhat better on others. We don’t know if this is Cushing’s or Arthritis, or most likely - both. And, this week – her tail has mostly been down, or at half-mast – which, a pug owner knows, this is a big indicator of something being very wrong. She’s still wagging her tail though… it’s just at half-mast. It breaks my heart.
It is my understanding that we are likely looking at a Macro pituitary tumor. We met with our vet’s partner who explained that the only way to know for sure is an MRI – but, again – treatment wouldn’t change with the knowledge, and the expense and stress of the test is unnecessary. I asked what the game plan will be if we still have high numbers on the next ACTH Stim test. He said we could consider increasing her dose again, but that could be risky, as the likelihood of a crash increases significantly and that we’re really running out of options. We had a long discussion about quality of life and paying extra attention to her and how she’s feeling, and listening for her to tell me when she’s had enough.
When we lost Mr. BIG, I put him through a month of hell trying to make him better… and he was miserable and I swore I would never do that again. I decided then that I would rather cheat Olivia out of a few good days or weeks than make her suffer through a terrible end. I want her to go peacefully and as comfortably as possible. I know right now she is not happy or comfortable – but, she’s stable and she still wags her tail and she can still eat and drink and go potty. I just can’t see letting her go yet. But, I’m worried that if I don’t make a decision soon, that she’ll be stuck with only bad days left and I don’t want that for her.
And - I’m so tired, so emotionally, physically and mentally drained. I just want to go back to before we took that damn Temaril-P. It feels like that shot this whole thing into overdrive – and while she was likely Cushing’s before then, things just spiraled from there and I’m afraid we can’t ever go back. My plan is to wait until we can do the repeat ACTH Stim test on July 5th – and see where her numbers are (including liver) – unless something else happens before then.
I’m just really hoping that some of you can share your thoughts with me. Should I really have any hope that her numbers might come down? That she might have some quality time left? Or is this the time I should really be focused on letting her go so that we don’t run right into that terrible wall where it is all bad? Any thoughts, experiences and input is very welcome and truly appreciated.
Thank you so much for taking the time to read our story,
Olivia's Mom: Jenny
A little background – Olivia is an 11-year-old pug who came to us as a rescue (after bouncing around between several foster homes), just before her 1st birthday. She joined my almost 2-year-old (at the time) pug, Mr. BIG, and completed our family. They were inseparable until we lost Mr. BIG almost three years ago. It was hard on Olivia, but in some respects, I think she also really enjoyed being an “only pug” and did well. However, about a year later (two years ago) she started having separation anxiety if we left her alone in the evening. I work from home, and always have, so she is used to constant company. She also started having episodes of colitis and we found that she had some pretty advanced arthritis in her rear hips and knees. She went on Royal Canin Gastrointestinal food, and started on a Dasuquin supplement.
Olivia also has Recurring Vestibular disease, diagnosed almost 2 years ago. We ruled out inner ear infections, as well as any inner ear defects or tumors with a CT Scan. However, the scan was unable to confirm or clear any possible brain tumors. We decided not to do an MRI, as results would not change the course of treatment – and a brain tumor was considered a high possibility due to the recurring nature of the episodes. Olivia has very intense vestibular episodes with severe nystagmus and a complete inability to walk, stand or sit unassisted. The episodes last anywhere from an hour to two hours, and range in intensity. She has sometimes gone only a day between episodes, but more often goes a month, sometimes three or more months in between. As traumatic as they were at onset, we have learned to manage quite well. And, the symptoms completely resolve between episodes, meaning – no lingering effects. We give her Meclizine at onset, and sometimes for a few days after to help with any motion sickness she may be experiencing.
A year ago, we moved, and this was very hard on her. It was a big change, and we also had to change vets. Fortunately, we found a vet we really love in our new town. Her nighttime anxiety spread into the day time as well, and she became increasingly needy – not able to take her eyes off me and working herself into a total panic if left alone. We finally got into a good routine in the new house, and she settled in. I could leave her during the day for grocery shopping, etc. and while she would stand vigil near the door (we made a comfy bed for her there) waiting for my return she was mostly relaxed, and patiently waiting (we installed cameras so I could see her at all times). We tried Composure supplements from the vet, which really didn’t have any effect – but, time and routine seemed to be helping – for a while. I also noticed she was drinking more water than usual – but, it wasn’t excessive or concerning. Our Mr. BIG had diabetes, and I knew what excessive drinking looked like, and this wasn’t it – just a slight increase – that I’m surprised I even noticed. She has always had regular vet appointments, and had recently had full senior panel blood work, which was all within normal ranges.
Around September last year she started moaning and groaning a bit more than usual when getting up or laying down. Our vet did X-rays and found a collapsed disc in her spine, and commented that her arthritis in her hips and thighs was advancing. We did a course of Prednisone and started with laser treatments and Adaquan injections (admin by our vet). We did the Adaquan injections multiples times the first week, and reduced down to every other week. We tried to reduce to once a month, but Olivia seemed more comfortable at the two-week mark, so that’s where we continued. We do a laser treatment at the same time as each Adaquan injection. We were also given Rimadyl to give as needed – on days where Olivia seemed a little more stiff or sore. This seemed to happen only on rainy days or bath day.
During this time, Olivia’s anxiety was increasing – but, we adjusted. And, she started having some intense colitis episodes. She was prescribed antibiotics and a short-term pectalin supplement. We eliminated all treats and stopped putting chicken, carrots and green beans on her Rx GI food (which we had been doing for some time). We also added a probiotic: Entero Flora Pro to her food. One thing that was interesting to me was that during this time Olivia was eating her bland Rx GI food without any enticement – and she’s always been a VERY picky eater… to the point that I would sing to her, hand feed her, and add the chicken, carrots, green beans – even cheese or peanut butter just to get her to eat. But, now, her food was totally plain and she was gobbling it all down. She was also wanting to eat earlier and earlier in the day. Which I attributed to a “senior thing”. I didn’t even mention it to the vet – I just thought her tummy upset (and lack of treats) left her hungry, and this was a good thing. I was honestly just relieved she was eating without any issues. We finally seemed to have her colitis under control and everything was going along smoothly with our new routine of laser, Adaquan and occasional Rimadyl. On our continual vet visits, we noticed that she wasn’t dropping any weight – even without the treats and extras on her food. So, we ran a detailed thyroid panel – and everything came back normal. Okay, good. We chalked up the lack of weight loss to her age – I mean, I can relate.
Her achy days seemed to be increasing, so she was getting a Rimadyl more often and some where over the course of several months, we just started giving it to her every day with her morning meal. She was definitely more comfortable and had better mobility.
In April, we decided that since she was doing so well, we would schedule a dental. It had been almost three years since she’d had a dental, and her breath & teeth were showing the signs that we really should get that done. Also, I have had to have the vet trim her nails, because her quicks had stopped receding a few years prior. So, while she was in for the dental, we decided to do what they called a “show trim” where they would cut the nails down beyond the quicks and cauterize them. The hope was that this would “reset” her quicks. This was on 4/18 this year. She did perfect during the anesthesia and everything was great – she didn’t need any extractions, and she recovered perfectly, and everything was going along as before.
My husband and I noticed that she was getting hesitant to jump up on our couch (we have a super low pit group that she has always easily jumped up and down from) but decided it was just aging and arthritis and got her some steps to see if that would help. Also – for as long as she’s been with us, in the mornings, I would wake up, carry her from the bed and lay her on the couch – all while she was still mostly asleep. Then we would have to wake her up (she is a pug after all), take her for her walk. I had started noticing that on some mornings when I would wake up, she was already awake, sitting up in bed just waiting for me.
Then, on the evening of May 9th, she started limping a bit – her right front paw clearly bothering her. Thinking maybe she picked up a sandspur or bug bite while outside (we live in Florida), I checked over her paw completely and found nothing wrong. She screeched though when I would touch her pinky toe “equivalent” on that foot. There was no redness or swelling or anything obviously wrong though, and she was otherwise fine so we waited until the morning so we could see our regular vet. They did X-rays and found it was very swollen, but no breaks or fractures, no punctures or anything. We thought perhaps she twisted it or stepped on a rock or something outside. They prescribed Temaril-P (we were told NO Rimadyl while on it) and we were on our way. We were warned that she would most likely drink more water, and because of that need to pee more, but not to be alarmed, that was a normal side effect). That evening, she was panting a bit. I knew there was a small amount of steroid in the Temaril-P, and attributed it that, as she had some panting during the prednisone prescription last year. She was also drinking more, but not excessively. The next night however, her panting was pretty intense and she didn’t seem to be able to settle. I decided to take her to the ER vet, because I was just concerned and didn’t feel good about it. She ended up settling down before we got there, but I had them look her over anyway. Her heart and lungs were good and clear, and they felt she was in very good condition. They felt her foot, and she screamed when they extended her “pinky” toe, but was otherwise in excellent health. I had the doctor look at the Temaril-P pills – just to make sure they were the correct pills and the correct dose (even though I totally trusted my vet, you never know, right?) and they were correct and the ER vet said that is exactly what she would have prescribed. She said that some dogs are very sensitive to steroids and may pant during treatment, and that it was likely just a normal response for her. They said to just keep an eye on her and let them or our vet know if there were any additional concerns. I called our regular vet the next morning, and she was out of town – but spoke to her partner (who was brand new) and he said that we should continue with the Temaril-P and that panting is an acceptable side effect. So, we continued – she was drinking and peeing more, but not scary amounts - but lots of panting and discomfort, especially in the evenings. I also noticed that she stopped laying in her normal spots, which have always been either her bed or blanket (always somewhere soft and comfy) – and was instead laying on the tile or the chair mat next to my desk – hard, cool surfaces – but, we were managing okay, and her foot seemed to be healing. And, then came another bout of colitis. And, Olivia was definitely much more achy and stiff without the Rimadyl, and moaning/groaning a lot when getting up or laying down.
So, on that Tuesday, we were at the vet for our regular laser treatment and Adaquan injection, and so they could recheck her foot. Our regular vet was back, and examined Olivia’s foot and was surprised to hear about the reaction to the Temaril-P but felt that it did a really good job healing the inflammation. She had stopped limping, and wasn’t really even favoring it at all anymore. Our vet said we could stop the Temaril-P and resume the Rimadyl after 24 full hours off the Temaril-P. The colitis was pretty bad, there was a lot of bacteria, and tons of white blood cells in her stool, so they gave us an antibiotic and added a new probiotic to the mix: Synacore. Over the next couple days, Olivia was still panting often, drinking and peeing more, laying on the hard floors and just not seeming to be clearing herself of what I considered the Temaril-P side effects. She also started seeming more scared, fragile, confused somehow and generally unwell. I had put a detailed list together of all the things I had noticed over the last several months – that only now were starting to seem like symptoms, including the food, the confusion, the increased anxiety, being awake in the morning, etc. and emailed it over to our vet’s office on Thursday evening.
Overnight Thursday, she woke in the middle of the night/early Friday morning and I took her out to potty. When I brought her back inside, she seemed very wobbly and unstable. The look in her eyes made me think she was about to have a vestibular episode. So, I hunkered down beside her, prepared to help her get through it. She didn’t end up having one, and laid down to sleep. I kept a close eye on her, just not feeling right about her. As morning came, I got her up to go potty again, and she was very wobbly and unstable, she was trying to be “normal” but didn’t seem able to really control her back legs. She fell over twice – her back legs just seeming to come right out from beneath her. I was sure something neurological was happening. I scooped her up and went straight to our vet and got there just as they were opening. I left her for them to observe and they kept her most of the day. She remained stable, but when I met with our vet that afternoon, she said she was very concerned with how unwell Olivia seemed to be and how she went downhill so fast. They did a full blood panel and put a rush on the results, hoping to have them the next day so we could get an idea of what may be happening. My husband and I loaded her in the car to take her home. When we got home, we took her out of her car seat and set her down so she could go potty, and I noticed that the nail on her “pinky” – the site of the mysterious injury – was completely lifted up and bloody. Somehow this happened on the way home, even though she was sitting stable in her car seat – because it wasn’t that way when we put her in the car. She didn’t yelp or cry or anything either. So, we put her right back in the car and headed straight back to the vet. It was late in the evening and our regular vet had just left, but her partner was still there, and they took her back. Her nail popped off completely while in the back, and they cleaned it, wrapped it and gave her something for the pain, and an antibiotic Rx and we headed home.
The next morning (Saturday), the blood work results were back, and there were no signs of organ failure or anything super alarming, but our vet felt that there were indicators on the results that suggested we test for Cushing’s disease – so we scheduled a drop off first thing Monday for an ACTH Stim test and a bandage change on her nail/paw. On Saturday evening, after coming in from a walk, I noticed that one of Olivia’s back toe nails was a bit lifted from the quick, and had oozed some blood, but was not bleeding. It didn’t seem to be bothering her at all, and the nail seemed stable. I decided not to take her to the ER vet, as that would seem to be unnecessary stress. She was already on antibiotics and it wasn’t bleeding. Then, on Sunday – Olivia had a pretty major vestibular episode. We gave her meclizine, and held her and comforted her until it passed, which it did – after about 2 hours.
On Monday, she went in for her ACTH Stim test. They also cleaned and treated her back toe and said we were right to leave it, and we will just watch it for now. Her bandage was changed on her front paw. We had an appointment on Wednesday for another bandage change, and the results had come in from the ACTH Stim test.
5/22/17
PRE: 13.5 ug/dL
POST: 34.8 ug/dL
Clearly, Cushing’s. We would start Vetoryl the following morning. Starting dose 30mg.
We also had a long discussion about what was going on with her toes. Two potentials: one – that because of the Cushing’s disease, she didn’t heal properly from the nail trim/cauterizing done three weeks prior. Or two: Symmetrical Lupoid Onychodystrophy*(SLO) which is a Lupus-like disease that attacks the nail bed. There is no real test for this other than amputation and biopsy – which of course – isn’t an option. So, we just treat the infection/injury and go from there. Neither nail was getting any worse at this point, but neither was getting any better either. We also started Senilife, a supplement which sometimes helps with senility. We also decided to move the laser and Adaquan injections to once per week. We got topical drops for her back toe, and scheduled her next bandage change on her front toe.
Over the first two weeks on Vetoryl (about a week or so in), we saw a reduction in panting and drinking/urinating was completely back to normal and although still hungry, Olivia started wanting her food “enticements” again. Her achy-ness and discomfort was worse at night, so she started getting her Rimadyl 2x a day. So, she was definitely seeing some mild improvements, but still wasn’t comfortable or feeling very well – she still felt fragile and "off" to me – she didn’t seem comfortable or relaxed. Her back toe remained about the same, no better but no worse, and her front toe finally healed enough to remove the bandage. No nail, no quick left – but, she didn’t seem to mind or notice.
We did her second ACTH Stim test on 6/6. And, the two days following were the best she had in a long time. She laid in her usual comfy beds, lounged around – had big, long, lazy yawns and stretches. Things I hadn’t even realized she wasn’t doing – for who knows how long? The vet didn’t put a rush on the results, so it took several days. In that time, Olivia had one evening where she panted quite a bit – but, then it went away again - BUT she was back to laying on the hard surfaces, seeming to be generally uncomfortable. When the results came back in, the vet said that the results weren’t what she expected to see, but, that she didn’t want to change her dose until she spoke to a specialist/endocrinologist to review Olivia’s case. I didn’t even ask for the numbers at this time, as I was comfortable waiting for the specialist’s opinion.
At the time, water and urination was still back to normal – panting (other than the one evening) was gone – she was spending some time on her soft bed, and sometimes on the carpet – but still spending half the time on the tile or other hard surface. She still wanted enticements to eat, but was back to wanting food earlier in the day again. I still felt she was generally uncomfortable and unhappy, but stable (including no colitis episodes). Hind leg weakness has been better some days, worse the others. Confusion seems to be better, but heightened neediness has stayed the same.
It took a bit to get the consult from the specialist. At this time, I asked for the numbers:
6/6/17
PRE: 15.2 ug/dL
POST: 33.9 ug/dL
So, still extremely high, and the Pre number even went UP.
Also, liver enzymes increased – I don’t know how much, other than before, they were within the normal range.
ALP: 211 (normal 5-160)
ALT: 162 (normal 18-121)
The specialist was concerned that the pituitary tumor may be a functioning MACRO and the suggestion was to double the dose of Vetoryl to 30mg in the morning and 30mg in the evening. The doses to be 12 hours apart, no less than 11 and no more than 13. This would be a big challenge, as she eats no more than 9 hours apart, and is adamant about her feeding time.
The hope was to see some improvement within a week and then retest at 2 weeks to check the numbers. If there was no improvement, the specialist suggested an abdominal ultrasound.
We started the double dose on Saturday June 17th. We are giving her some whole food treats at her normal dinner time, and are able to push dinner and second dose out to 11 hours, but she does a lot of whining in between snack and dinner and is very unhappy about this. With no change her food anxiety, our vet scheduled our ultrasound for this past Friday. An internal medicine vet came in, performed the ultrasound and found no adrenal gland tumors (I guess they were wondering if she could have both pituitary AND adrenal tumors). They did find a lesion on her spleen, that they would normally suggest a needle aspiration/biopsy for - but didn’t recommend that now, as Olivia wouldn’t be a candidate for any surgery or treatment. The internal medicine vet suggests continuing on the double dose and doing the retest to see where the numbers are.
Our regular vet is out of town now until July 5th. We are scheduled for the third ACTH Stim test that day. We are still dealing with infection under her back toe (she’s had two antibiotic shots in the last month) but the nail remains stable. There is a tiny new nail starting to grow on her front paw. Her hind leg weakness is still significant some days, but seems somewhat better on others. We don’t know if this is Cushing’s or Arthritis, or most likely - both. And, this week – her tail has mostly been down, or at half-mast – which, a pug owner knows, this is a big indicator of something being very wrong. She’s still wagging her tail though… it’s just at half-mast. It breaks my heart.
It is my understanding that we are likely looking at a Macro pituitary tumor. We met with our vet’s partner who explained that the only way to know for sure is an MRI – but, again – treatment wouldn’t change with the knowledge, and the expense and stress of the test is unnecessary. I asked what the game plan will be if we still have high numbers on the next ACTH Stim test. He said we could consider increasing her dose again, but that could be risky, as the likelihood of a crash increases significantly and that we’re really running out of options. We had a long discussion about quality of life and paying extra attention to her and how she’s feeling, and listening for her to tell me when she’s had enough.
When we lost Mr. BIG, I put him through a month of hell trying to make him better… and he was miserable and I swore I would never do that again. I decided then that I would rather cheat Olivia out of a few good days or weeks than make her suffer through a terrible end. I want her to go peacefully and as comfortably as possible. I know right now she is not happy or comfortable – but, she’s stable and she still wags her tail and she can still eat and drink and go potty. I just can’t see letting her go yet. But, I’m worried that if I don’t make a decision soon, that she’ll be stuck with only bad days left and I don’t want that for her.
And - I’m so tired, so emotionally, physically and mentally drained. I just want to go back to before we took that damn Temaril-P. It feels like that shot this whole thing into overdrive – and while she was likely Cushing’s before then, things just spiraled from there and I’m afraid we can’t ever go back. My plan is to wait until we can do the repeat ACTH Stim test on July 5th – and see where her numbers are (including liver) – unless something else happens before then.
I’m just really hoping that some of you can share your thoughts with me. Should I really have any hope that her numbers might come down? That she might have some quality time left? Or is this the time I should really be focused on letting her go so that we don’t run right into that terrible wall where it is all bad? Any thoughts, experiences and input is very welcome and truly appreciated.
Thank you so much for taking the time to read our story,
Olivia's Mom: Jenny