Master of the Place Command

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Update on Baby-Day 8

Appetite:
Baby appears to have a better appetite in the evening versus the morning. She does eat her food very slowly and she tends to leave a little in the bowl. This morning I had to wet it down for her and get her interested. She seems to prefer her treats to actual dog food and has no hesitation in eating them. Maybe she’s being temperamental?

Activity Level:
We walked around the block last night with no problem; she seems to have the best energy level in the early evening. In the morning she seems lethargic. She readily gets up to go outside and eliminate, but after eating she lies down and somewhat hesitates to rise when called. As I said, evenings are much better.

Other:
I have also noticed she has some weakness in her hindquarters. She’s having some minor issues when jumping up onto furniture. She also has some intermittent trembling. Drinking and elimination are normal, although she has been having 2 BMs in the evening.

Wondering...
Should we skip an evening dose and see if that improves her morning appetite?

All things considered, we’re happy with her progress. She seems so much more at ease now.


-- Post From My iPhone

Hmmmm...

This morning brought a significant change in Baby's appetite. She did not immediately eat her food when it was presented, it took a minute or so for her to get started and when she did it was slowly and she only ate half of it.

Last night LacubriousToo took her out in the yard and she wandered around actively. She's still playing with her toys when prompted.

Stools are normal.

Water input/output is reduced as well.

The ACTH stim is scheduled for May 3rd.

-- Post From My iPhone


***Vet's response***

"This could be potentially worrisome, meaning that the medicine does not usually have that dramatic of an effest that quickly, however it is posssible that Baby's Trilostane dose is too high. I would like you to monitor Baby for 24-36 hours. If her appetite and water intake do not improve or continue to decrease, then give us a call tomorrow and we will reschedule her stim for this Friday to make sure that her Trilostane dose is not too high."

The results are...

LDDS Test Results on Baby confirm that she has Cushing's. Most likely PDH, Pituitary Dependent Hyperandrenalcorticism. Meds are on order from Roadrunner Pharmacy and should be arriving tomorrow!

Dex Suppression (3 Samples)
Time 815
Time 1215
Time 415
Cortisol Sample 1 5.6 Range: 1.0-5.0 μg/dL HIGH
Cortisol Sample 2 Dex 4.3 Range: 0.0-1.4 μg/dL HIGH
Cortisol Sample 3 Dex 5.2 Range: 0.0-1.4 μg/dL HIGH
INTERPRETATION OF THE DEXAMETHASONE SUPPRESSION TESTS:
*
Low-dose dexamethasone suppression test:
Normal: Cortisol level less than 1.4 ug/dl 8hrs post-dex.
Hyperadrenocorticism: Cortisol level greater than 1.4 ug/dl 8hrs
post-dex.
...
If the 8hr post dex. cortisol level is greater than 1.4 ug/dl,
the following can be used to differentiate pituitary dependent
hyperadrenocorticism (PDH) from an adrenal tumor:
1. Cortisol level less than 1.4 ug/dl 4hrs post-dex is
consistent with PDH.
2. Cortisol level less than half the baseline level at either 4 or 8
hours post-dex is consistent with PDH.(Samples taken at 2 or 6hrs are interpreted the same way as a 4hr
sample)
...
If neither of these criteria is met, further testing is needed to
differentiate PDH from adrenal tumor Cushings.
...
NOTE: Approx. 5% of dogs with PDH have normal results.
False positives may occur with stress/nonadrenal illness.

Article on

Still waiting to hear back on Baby's LDDS Test!

In the meantime, I found this short article about spending trends for pet medical expenses.

Trilostane AKA: Vetoryl

The drug recommended by our Vet for the treatment of Baby's Hyperadrenocorticism is called Trilostane, AKA: Vetoryl.

I found a detailed article that discusses how the drug works, how to monitor its effectiveness, and possible adverse reactions.

We are still trying to work out the appointment for the LDDS, Low Dose Dexamethasone Test for next week. It's a busy work week and fitting in a full day at the vet is challenging but I really feel that the sooner we get Baby oon the treatment the better she will feel.

Today she's a bit lethargic again and her belly appears bloated. It seems like these symptoms wax and wane every few days and I'm not sure why. I also wonder if she is having any pain. I understand that cortisol is a steroid and as such should mitigate any inflammatory response, but does that mean the dog is not in any discomfort? Also in my research, the added cortisol can affect the GI tract and so giving NSAIDS to an untreated cushingoid dog can cause GI bleeding.

Do they have doggy narcotics? Those are probably metabolized by the liver which is not a good option either.

I guess she's just going to have feel better from having a good meal and maybe a full body massage...doggy spa style!

Mutt Census...

Just read this interesting article on a national mutt census.

If you go to the referenced Mutt Census site, you can click on your state and view detailed information, including Most Popular Breed and Most Unique Breed.

Cushing's Anyone?

jl-0178_NI
Originally uploaded by dehmystic

Well, I just got the call from the Vet Specialist. Baby's test results were as follows:

ALP: 2800
Cholesterol: High
Platelets: High
Thyroid: Normal
Urine: Dilute
Blood Pressure: High
Liver Aspiration: VH - Vascular Hepatopathy (typical in cushings, NOT CANCER!)
Spleen: EMH - extramedullary hematopoiesis (not typically treated, NOT CANCER!)

So the Vet (as was I) is leaning towards Cushings. Next step is a Low Dose Dex test, probably next week sometime. It's an 8 hour test where they will do 3 blood draws after they administer Dexamethasone. They will be testing for cortisol suppression, if there is any, then no Cushiings, most likely there will be none and she'll be diagnosed Cushingoid. Their recommended treatment is with a drug called Trilostane. On going follow-up by ACTH testing every 3 months for monitoring dosage.

So, as always, we're keeping it real...real interesting!

Dog Obedience Class #2

sa-0458
Originally uploaded by dehmystic

As usual, I was in a rush to get home and get to my evening commitment! Doggy Obedience / Owner Training class!

I gave Ivy just a tidbit for dinner so she'd be hungry for treats in class. Then we loaded up our doggy bag, water, treats, etc. and headed to city hall.

As expected, it was a bit trying but the new pinch collar makes her so much more controllable. She was the noisy one in class, barking and whining. She did eventually calm down and since the class was small (only 4 dogs/handlers, plus the instructor and her 2 dogs) Ivy got on with the training pretty quickly.

We basically, worked on heeling, turns, and leash pressure work.

It went by fairly quickly and I think Ivy enjoyed the stimulation!

We played in the backyard when we got home...that dog LOVES to retrieve!

Introducing Ivy!

This is her younger picture from HALO:



Yes, it says Heidi which is what they named her but we wanted to change it. We kicked around Cissy, since she's Baby's new sis but that just didn't fit. Ivy sounds like Heidi so we're going to try that.

In Memory of Linus

One year ago on this day we said goodbye to our dear dog, Linus. The end of 13 years of memories of our "play dog", Linusaurus Rex. It's been really hard not having his little personality around anymore. I can't believe it's been a year. It still seems like just a few months ago.

How he came to be our dog...

It was a year or more after my childhood dog, Honey had passed away that Linus came to us. He was a stray that had "shown up" at my parents home in Gerald, Mo. Dad called and said he had a dog for us, so we drove out to take a look. He was about 5 or 6 months old, lanky, and a bit under the weather. He had a very expressive little face and we loved him immediately.

He rode on Darrin's lap all the way home, a bit lethargic but still cute.

We took him to the vet ASAP and got him all fixed up, wormed, shots, neutering, etc.

That "puppy stage" was so trying! He had a penchant for chewing plastic. CD cases, cheap shoes, one of every pair of my dress heels! Oh, and how dare the mailman bang on our mailbox every day! Yep, Linus busted out the front window glass one day prompting a stern letter from the USPS about controlling our dog. We promptly replaced the 50 year old windows.

He loved to chase a toy down the hallway, and walks were a favorite although we regret not taking him as much as we should have. Tennis balls were the only toy that survived his attentions. He loved the soft, stuffed, squeaky toys...but a little too much as it only took a few minutes of play for the stuffing to suddenly appear on the outside of the toy.





The Melanoma...

In 2008 I took him to the vet for an abscessed tooth. They put him under and did a good cleaning and ended up removing 3 teeth! Then in June of 2009 it appeared that he had another abscessed tooth. However, when they took a look it turned out to be a tumor. On June 30th it was removed and we had it sent off. The news was not good, Melanoma which in dogs is terminal, he had 2 to 6 months at best. We looked into several options and finally took him to The University of Missouri - Columbia. They did a full workup and approved him for a clinical trial of Interleukin. Wasting no time we brought him back the following week, they treated him with the trial meds and after 2 days sent him home. He promptly spiked a fever which resulted in a midnight run to our local vet for an IV, then an early morning ride back to Columbia. It was almost two weeks of the staff trying various treatments to get his platelets to normalize...they never did. I was amazed at the extent of the treatments but in the end Melanoma, or rather a complication called DIC due to Melanoma that had metatasticized was the final straw and we were forced into making the decision to let him go. It was one of the saddest times in my life.

Closure...

About 2 weeks after we said goodbye, we received the package from Columbia. It had his collar, paw imprint, and a card signed by all the caregivers, veterinarians, and vet techs. I opened the box in the kitchen by myself and cried my eyes out. Darrin came in from outside and I showed him what came and we cried together.



About a month or so after, we got a call regarding his Melanoma. They confirmed that it had metasticized to his lungs. There was really no way for him to survive. We did the best thing we could do, we gave him a chance, contributed to science through our participation in the trial, donated his tissue for the tissue bank, and allowed a necropsy...that's more than a lot of dogs get to contribute and we can feel good about that even while we miss him every day.

Rest in Peace, Linus.

Just for a laugh...

I wish I had the patience to train our dog to act!

Baby Mastering The Stairs

Bwah! Ha ha ha! Awesome dog!

Bailey and a Preview of WINTER! Brrrrrrrrrrr!

Phone Call From MUVTH

dogs0079_n
Originally uploaded by dehmystic

Today at lunch my cell phone rang and the caller ID said Mizzou Vet Hospital...my heart caught in my throat. Even though I know Linus is gone seeing that ID pop up just brought back the anxious feelings I'd get when they would call with an update.

I answered it and it was Dr. Selting. She wanted to go over the final report on Linus. Since we were at lunch with coworkers I opted to call her back. Of course then that's all I could think about so as soon as we got back I put in a return call, hoping to reach her.

Luckily I was able to reach her and find out why Linus did not make it.

First off she said he had a lot of abnormality in his tissues. Primarily the cause of his decline was something called D.I.C. or disseminated intravascular coagulation. Basically, it’s a clotting problem that leads to the formation of small clots throughout the body. These clots then pull any remaining clotting factors from the blood and cause bleeding problems. She mentioned that the blood sample pulled just before we euthanized would not clot. D.I.C. is secondary to other causes, meaning it occurs when other problems are present, like cancer.

Also discovered were some small metastases in his lungs. These were too small to be seen on an x-ray and it's not clear whether the IL-12 treatment would have affected these or not. In Dr. Selting's opinion, the presence of these shows he would have succumbed to cancer eventually.

Another odd finding was belly muscle damage. It was not consistent with trauma or bruising but may be associated with the D.I.C.

No brain metastasis was found. So the neurological problems he initially had were not related to any cancer there.

Tests showed the pneumonia was resolving, there was no trace of bacteria.

Tests on his spleen and bone marrow both showed that his body was trying to produce the necessary blood components. Dr. Selting thinks this is why we saw some improvement, then when the D.I.C. got too bad those organs could not compensate enough.

There is still no firm explanation for the excessive edema but it too could be part of the capillary leak and/or D.I.C.

All in all, while we were hoping for a cure or a reprieve, the truth is he showed many signs that the situation was not going to improve and the pathology information just proves that.

Euthanizing him was the best choice we could make at the time as there was no way to combat all the problems in his little body. At least we don't have to feel like we gave up on him. It's also better to know that his cancer had metasticized because we agonized over not just choosing surgery when truthfully that would not have helped in as much of a way as we would have expected it to given the spread.

Processing all of this has reopened the pain of our loss. I think that's normal, and I know that we'll get a point where we aren't as weepy when we think about it. There's no time limit on grief, is there?

In the mail today...

A wonderful and touching card with notes from the staff, his pawprint and his collar.

I should also mention that several of our friends and family sent us sympathy cards which we really appreciated.

Aftermath...

Just chillin at home and unpacking. Smothering Baby dog with love and treats. Thanks to all who sent their support and condolences. A wise woman recently summed it all up by saying "it sucks"...too true.

Everywhere we look is a memory...
Remember when Linus chased his toy down the hall? Or how he would roll on his back and squirm like a puppy? How he would follow us with his eyes? Or how excited he got at walk time?

I like to think that every "hole" created in our hearts simply heals into a stronger spot so that we may love that much more next time. Of course right now that sounds like mooshy hooey from a Hallmark card writer, but it works for me.

Heidi 1998 - 2009

My Mom's beloved dog Heidi had to be put to sleep today due to seizures and a stroke. She was a cute mini schnauzer that Mom had for nearly 11 years.


A Place Called Rainbow Ridge

Just this side of heaven is a place called Rainbow Bridge.
When an animal dies that has been especially close to
someone here, that pet goes to Rainbow Bridge. There are
meadows and hills for all of our special friends so they can
run and play together. There is plenty of food, water and
sunshine, and our friends are warm and comfortable.
All the animals who had been ill and old are restored to
health and vigor; those who were hurt or maimed are made
whole and strong again, just as we remember them in our
dreams of days and times gone by. The animals are happy and
content, except for one small thing; they each miss someone
very special to them, who had to be left behind. They all
run and play together, but the day comes when one suddenly
stops and looks into the distance. His bright eyes are
intent; His eager body quivers. Suddenly he begins to run
from the group, flying over the green grass, his legs
carrying him faster and faster.

You have been spotted, and when you and your special
friend finally meet, you cling together in joyous reunion,
never to be parted again. The happy kisses rain upon your
face; your hands again caress the beloved head, and you look
once more into the trusting eyes of your pet, so long gone
from your life but never absent from your heart
Then, you cross Rainbow Bridge together....

Author Unknown

Thursday - Day 11 *updated*

Lorie called this morning and said Linus finished the albumin and so far so good. It could take 24 hours for the edema to resolve. Dr. Selting had him up and out of his cage this morning, going outside and then walking him through the halls. Lorie said he was greeting all the other dogs and when they got back to ICU he went to each of the other cages as if to say "hey, what are you in for?". She said she only has one case today so she'll have a lot of free time to walk him around and massage his extremities to help get the fluid moving. We're planning to go up on Friday afternoon and stay the weekend.

**3pm call from Lorie**
Lorie called with the same story, good news and bad news...

Linus's HCT is up to 20,000 and his platelets are up to 100,000. He's walking and interested in other dogs around the hospital. His neurological symptoms have resolved! Unfortunately, the fluid has moved into his lungs so he now has pneumonia! He had some labored breathing so they tapped his lungs and pulled out the fluid to give him some relief. He's on nebulization every 4 hours and they've lowered his regular fluids via IV and added two antibiotics. They are running another kidney profile and may end up infusing him with another dose of albumin. When will this dog catch a break?!!?