Cushings and Pancreatitis - Little Missy has passed

[AnneB]

Hi All,

My names Anne and I'm new to the group and I'm looking for some information to help me make a decision.

I have an 11 year old Maltese who has been on prednisone, half tab every second day for approx 6 years. She has had white shaker syndrome. We now have been getting recurring bouts of pancreatitis, currently going through a bout right now.

Today she has been diagnosed with cushings due to the long term use of the prednisone and after having an ultrasound has a clot in her portal vein liver. Now being treated for this too.

Problem is treatment used to manage one problem causes more issues for the other problems and vice versa.

Have been told we can continue to treat both and see if anything changes in a couple of weeks or their best advice was to put her to sleep.

Has anyone been through this and thoughts please.

[labblab]

Hi Anne, and welcome to you and your little girl although I'm very sorry for the serious decisions you're facing. As you probably already know, Cushing's risks/symptoms that are caused by steroid use can be eliminated once a patient is weaned off the medication. So I guess the central question is whether or not your girl actually needs to remain on the prednisone at this time. I quickly scanned a couple of articles about white shaker syndrome, and it looks as though vets often attempt to discontinue steroid use after acute episodes of shaking have resolved. Has your girl ever had any breaks in the prednisone during these past six years? If so, how quickly did she relapse?

I guess that would be the option I'd want to try at this point -- weaning her off the prednisone in order to see whether she can comfortably tolerate shaker symptoms that might reoccur. If so, maybe you can just leave her off the prednisone for an extended period. Or one treatment alternative that I saw mentioned was the use of benzodiazepines (drugs such as Valium or Xanax). Drugs in this class would not induce Cushing's. While perhaps not totally resolving the shaker issues, that medication option might lessen their severity.

Please do let us know how things unfold, OK?
Marianne

[AnneB]

Hi Marianne,

Thank you for your reply, we did try weaning her off of the prednisone a few years ago but the vet wasn't happy with the eay she handled it, and have bever tried it since.

They have never suggested trying the other medications but I will put that to them today, thank you.

She is a pretty special case as she is unable to take certain med like pain medication as it sends her straight into a high.

Will let you know how we go, your suggestion is worth a try.

Thanks again.

Regards

Anne

[molly muffin]

Hello from me too. I would look for alternate to the pred if possible.
I will mention as you probably already know, that you have to decrease pred use very gradually, under the guidance of a vet. Especially having been on it for such a long time. Decrease in frequency and amount given, will be done at various stages.

I'd think anything is worth a try if the only other option is end of life. In the end quality of life is what is most important of course.

I'm so sorry your little girl is going through all of this and bouts of pancreatis at the same time. We see pancreatis often along with cushings, so I'm guessing it could all be intertwined together.

[Carole Alexander]

Hi Anne,
Welcome from me too. You are in a very tough spot with your pup and many of us have been there before and are now here with you. Please let us know where you go with the treatment. My best to you.

[AnneB]

Hi Sharlene and Carole,

Thank you for your input and support.

Ok spoke with vet today and going in to see her tomorrow, little Missy ate well yesterday, possibly giving me false hope, as today having trouble again.

I think as my little girl is a bit of fighter I am going to give her a little bit of time but I will also discuss this with the vet tomorrow.

I did mention the xanax/valium to her as Marianne suggested but she is of the opinion that this is given if the dog is suffering seizures etc, so not a path she is looking at going down. she did however mention maybe weaning Missy off Prednisone and putting her on a different medication. We will see, as Missy doesn't respond well to most medications. In saying this she also needs to start eating or the outlook is not looking good. Breaks my heart :(.

So I will check back in and let you know what happens after vet visit tomorrow.

Again, thank you for all your support and input, it is greatly appreciated.

Kind regards

Anne

[Squirt's Mom]

Hi and welcome to you and Missy,

There are some tricks you can try to stimulate her appetite. A dog's digestive process starts with the nose but as they get older their noses aren't quite as sensitive as they used to be so sometimes a nice stinky goodie on their food will help them get started. Something like water from tuna or salmon, a sprinkle of Parmesan or Blue cheese, even some home made chicken or beef broth can sometimes help (canned often has onions, garlic and other things not good for dogs). If there is a food you eat that Missy really likes try adding some of that to her food. My Squirt loved fried eggs and an egg running over her food would almost always get her to eat when nothing else would. When they don't want to eat, getting them to eat anything is what's important - a balanced diet can be reinstated after their appetite returns. ;) There is also a commercial food that I have had some luck using to get dogs to eat again. It's called FreshPet; here is a link to their products and a store locator if you are in the US ;) - https://freshpet.com/

There is a product called NutriCal that supplies all the vitamins and minerals a dog needs and can help keep them going when they aren't eating. I used this for several Parvo dogs and it kept them alive until they could swallow foods again (Parvo makes their throats raw). You can get it from Amazon and several other online stores, and some foot stores (is that a term?! :D ) used to carry it. Be sure it's NutriCal - there are some products that claim to be the same but have a whole lot of sugars in them. ;)

Let us know what the vet says tomorrow and I really hope an alternative to the pred can be found that is effective and that Missy can handle.

Hugs,
Leslie

[molly muffin]

Let us know what the vet says.

[AnneB]

Hi All,

Thank you for the info on the food, will definitely be trying this.

Here is what we discussed at the vets summarised in an email, sorry its rather long, but I thought I would post all of it just in case anyone else is looking for more info. :)

Missy: Hi Anne, Thought would try to summarise/better explain Missy's problem. Main issue is large blood clot in her portal vein. This is compromising blood flow through her liver and we suspect also pancreas. 1. The liver function is poor at present - in effect she has a portosystemic shunt which means blood flow that would normally go via her intestine through liver for processing and then into the body is going directly from her intestine to her body. This means after she eats she feels pretty rotten. Strategies to deal with this are: Antibiotics to reduce ammonia forming gut bacteria Lactulose to move faeces through intestine more quickly Anti oxidants such as SAMe (Mood Manager or dog specific version - Denosyl) Diets that are lower in protein/have high quality easily metabolisable protein to reduce toxins in blood stream. The main downside to the commercial liver diets are they tend to be high in fat. 2. Pancreatitis - possibly couple causes - decreased blood flow to the pancreas related to the clot but can also be associated with Cushings. Strategies are low fat/easily digestible diets like she is on. Long term I think the Hills w/d would be a bit better as it has a lower protein level and higher fibre level which would also be compatible with requirements for her liver disease. Also trying to improve blood flow - Plavix hopefully will prevent or reduce risk of further thromboemboli forming. Dogs are pretty amazing at forming alternative circulatory routes and Missy seems to be trying to do this a little already. Otherwise anti nausea, pain relief, hydration as required 3. Cushings Disease - we are worried this may have led to the blood clot forming. This condn is caused by the overproduction of cortisone by the adrenal glands - usually secondary to a pituitary tumour. We have a suspicion but are not entirely sure this is going on. We can test her but generally would have her off cortisone for at least a few days (preferably a few weeks). We could get an equivocal result because cortisone can intefere with results. When we treat Cushings we are treating symptoms ie increased drinking, increased eating, increase panting, weakness/pot belly. Treatment is not curative but can improve quality of life. The main concern I have though is that Missy needs cortisone for her immune system disease. Having said that there are alternative immune suppressants. One option we do have is to taper her cortisone dose at present so reduce to every 2 days then every 3 days and just see what happens - maybe she doesn't need it anymore! She is a pretty complicated girl but know she is a fighter and that you have got her through some pretty bad times in the past. I suppose my gut feeling is I would be concentrating on trying to make her feel better in terms of her liver disease ie antibiotics, lactulose, diet, SAMe at this stage, also trying to prevent further clots with the Plavix. I am not sure pursuing treating the Cushings is the right thing to do for her but I think is a very grey area and certainly referral for a second opinion is definitely an option. Know you have had bad experience in past but would rec Chris Small (who did her ultrasound), he is working at North Coast Veterinary Specialists. Anyway will catch up with you tomorrow regardless, Cara.

Ok so basically I don't think they are 100% sure that it's cushings but are assuming it is I guess based on systems etc.

So we are going to concentrate at this stage on getting her to eat, and then I think we can slowly deal with everything else and wean her off the prednisone. Fingers crossed we have decided to check her again in 2 weeks so hopefully she will have improved by then.

Thank you everyone for your suggestions and info regarding all of this I have found this all very helpful and your support is wonderful.

Will post again shortly to let you know how she is going.

Thank you.

Kind regards

Anne (& Missy)

[DoxieMama]

Hi Anne, thank you for sharing the email from your vet. It sounds like you've all got a good handle on possible approaches to take care of Missy, including the suggestions you've already received here.

Please do keep us updated. We will remain by your side as you navigate the road ahead.

Shana

[Squirt's Mom]

Hey Anne,

Thanks for sharing that wonderful email you got! Your vet sounds like a keeper as far as compassion and pursuing details goes....she also seems to know you which is crucial. To me this is the crux of the message -


She is a pretty complicated girl but know she is a fighter and that you have got her through some pretty bad times in the past. I suppose my gut feeling is I would be concentrating on trying to make her feel better in terms of her liver disease ie antibiotics, lactulose, diet, SAMe at this stage, also trying to prevent further clots with the Plavix. I am not sure pursuing treating the Cushings is the right thing to do for her but I think is a very grey area and certainly referral for a second opinion is definitely an option.

I'm with her vet all the way on this! Concentrate on everything else first...if she has true Cushing's it will more than likely make itself known. But I have a 'neaky feeling if all these other things can be brought under control and she can be weaned off the steroid you will see a different baby girl. ;)

Keep in touch and let us know how things are going! You and Missy are family now ya know. :)

Hugs,
Leslie

[molly muffin]

Thanks for posting the email from your vet. It is very informative and a good plan for treatment and progress forward.

I too think I'd wait to see if the cortisol isn't from the prednisone and her body trying to compensate for her feeling awful due to the liver issue caused by the clot.

Is there any possibility of dissolving the clot itself?

[AnneB]

Hi Everyone,

Sorry for not updating sooner.

Little Missy started to come good with the new treatment plans in place, it was like she had a second lease on life.

However 3 weeks ago we had to make the decision to have her put down (hate those words). She had developed, on top of everything else diabetes.

Our lovely vet Cara, advised this was best, as it would mean a lengthy stay at the Vets trying to stabilise her, which would be very tricky with Missy's history and no guarantees that it would be possible, with all her other issues.

Just thought you all might want to know as this maybe helpful for someone down the track.

Hope all your fur babies are doing well.

Warmest regards

Anne and Missy xx

[Harley PoMMom]

Oh Anne,

Thank you for coming back and letting us know about your dear girl, Missy, and I am so very sorry for your loss. Please know we are here for you and always will be, you are in my thoughts and prayers.

With Heartfelt Sympathy, Lori

[labblab]

Dear Anne,

I’m so very sorry to read this news, but thank you so much for returning to tell us. You and Missy battled valiantly, but sometimes the challenges just become overwhelming. Missy is now free from all pain and all struggle, and she left this world knowing she was loved dearly. We will always join you in honoring her here on our special memorial thread:

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

If you’ll tell me the date of her passing, I can add that to her memorial line. Also, should you ever care to add a photo link, just let me know about that as well and we can make that happen for you.

In the meantime, our family here sends you our sincere sympathy over the loss of your sweet little girl. Please feel free to return to us at any time should you wish to talk or to share special memories of your lives together.

Many hugs,
Marianne

[Squirt's Mom]

Dear Anne,

I am heartbroken to hear about Missy. You both fought so hard but when no more battles could be won, you gave her the greatest gift of all - freedom from pain and a failing body. There is no doubt she left this life on the wings of your love and she will hold that love close in her heart until the day comes when you are reunited.

Please know we are here to listen any time. We DO understand what you are going thru. so remember you have a safe, soft spot to land whenever you need or want one.
My deepest sympathy,
Leslie



"Your Pet In Heaven
by Ken D. Conover

To have loved and then said farewell, is better than to have never loved at all.
For all of the times that you have stooped and touched my head, fed me my favorite treat and returned the love that I so unconditionally gave to you.
For the care that you gave to me so unselfishly.
For all of these things I am grateful and thankful.

I ask that you not grieve for the loss, but rejoice in the fact that we lived, loved and touched each others lives. My life was fuller because you were there, not as a master/owner, but as my FRIEND.

Today I am as I was in my youth. The grass is always green, butterflies flit among the flowers and the Sun shines gently down upon all of God's creatures.
I can run, jump, play and do all of the things that I did in my youth. There is no sickness, no aching joints and no regrets and no aging.

We await the arrival of our lifelong companions and know that togetherness is forever.
You live in our hearts as we do in yours. Companions such as you are so rare and unique.
Don't hold the love that you have within yourself. Give it to another like me and then I will live forever. For love never really dies, and you are loved and missed as surely as we are.

Your Pet In Heaven"
{Missy}

[molly muffin]

oh no, I'm so sorry to see that your precious Missy has passed. :( my sincerest condolences