My girl pug (confirmed Cushings & confirmed calcinosis cutis) / Tobey has passed

Just re-read my whole thread the other night. Talk about a trip. It was nearly surreal, especially reading the posts where I was clearly feeling discouraged.

I keep waffling back and forth on the low cortisol. When I went back and looked at all her ACTH's the last year, it appears her baselines have always been rather low. Highest was 3.9, but most hover in the 2-3 range. I am watching her like a hawk for any signs of low cortisol, but she's doing absolutely fine. In fact, last night she chugged a good bit of water, and I figured her cortisol might have spiked a bit.

I'm going to keep on with the current dose, but recheck numbers mid-november.

All that said - I sure do feel like Tobey could be considered a 'success' case, especially with the CC. I cannot thank my vet enough for her part in this journey. I really think I need to get her a gift and a card on the one year anniversary. And, of course, without the guidance of everyone here, we would not have been able to make such steady and safe progress. So, THANK YOU!

It is kind of wild going back and reading your own thread isn't it. :) :)
I think Tobey is a success too. That she is a success WITH the cc, is just down right phenomenal aka awesome!

Good idea on getting your vet a card and a little something. She sure has worked well with you as a team and that's pretty cool in and of itself.

But, I will always say, that you have played the biggest part in Tobey's success.

hugs Renee, and a job well done if I do say so
Sharlene and molly muffin

Hi Renee.... long time no see!! It is weird rereading your thread thought it would probably take me a couple of days to go through Flynny's now.

Tobey sure is a success because he has the Mama CC extraordinaire!!! I full heartedly agree with Sharlene, big pat on the back for you!! x

Oh yes, reading back through Flynn's thread would take a while! I can't believe how long some of these threads are. :) Talkative bunch around here, lol.

CC is so difficult. Mostly because a lot of people, vets included, really do not have good advice for managing it. No one knows what it looks like, how to treat it for short and long term, etc.

Renee, You did and are doing a fantastic job with Tobey.
I know how hard CC is.
Tobey is a very lucky girl to have you as her mom.

Tobey has thrown up 6 times in the past hour and a half. :(

She hasn't had an ACTH since the one in October. Before this, she has not displayed any symptoms of low cortisol at all. She should have gotten it tested this week, just to check, but with the holidays, it didn't work out. I had planned to get her cortisol tested next week.

I'm a little confused about whether she is throwing up because of low cortisol, or just over indulgence from Thanksgiving.

:(

Is just with hold the next trilostane dose. And maybe give her some
Pepcid and see if her stomach settles.

Renee, exactly what did Tobey overindulge in eating? Unfortunately, vets often refer to the Friday after Thanksgiving as "National Canine Pancreatitis Day" because of the uptick in cases due to overconsumption of fatty foods or foods that are unfamiliar to a dog's GI tract. Vomiting so frequently in such a short time is somewhat worrisome. If she keeps it up I would worry about dehydration. Does she seem to be in any pain?

Marianne

I'm not sure if she's in pain or not. She's being very quiet.

She had some turkey (white meat), mashed potatoes, and a few bites of coconut cream pie. :( But, the day before, my husband gave her some pizza crust too.

I just tried giving her some rice and broth, and she ate a bit of that. She did drink a bit of water too.

I'll definitely be withholding her vetoryl for a while.

After that much vomiting, you may want to hold off on feeding any solid food, even just rice, until later tomorrow. I would be afraid that anything more right now may continue to overstimulate her GI tract. The coconut cream pie was probably pretty rich and fatty, so it may be the culprit. I'm guessing it's more likely the food than the trilo that is causing this upset, but I understand why you'd want to temporarily discontinue the drug. I hope little girl feels better tomorrow!

Marianne

Thanks Marianne for always checking in. The rice was mostly floating in broth. My real motivation was to see if she would even eat at all, because if she refused food, we would be headed to emergency vet right now. She ate about 1/4 cup of rice and has been holding it down for the last 15 minutes. She does look miserable though and will not come out of her kennel. :(

I feel better about withholding the vetoryl for now, even if that is not the cause. Her cortisol has been at the low end of the acceptable range, so I keep wondering if it's going to drop too low one of these days, even though I need her on this tight control for the CC.

I hope Toby is feeling better now. Its good that she ate something and I sure hope she kept it down. My noncush baby, Buttons has been eating grass all day long every time we go out. She's got the Thanksgiving tummy ache too. I forbid anyone to give Dixie anything but turkey so she's made it thru pretty good. We all have just been whipped today and slept a lot. I'd love to go back and read all of Toby's story. There are so many of the threads that are soooo long but I want to read them all. Especially for those that have been on the forum for a long time. I feel like I'm missing so much by not knowing about all the precious pups here.

Let us know how she is doing. I'll say a little prayer for your sweet girl.

Just had to leave her at pet emergency. :( She continued vomiting, is very dehydrated, and now I think it is more likely she's in addisonian crisis.

So here is my dilemma - It's saturday, meaning that if I run a stim test, I won't know results until Monday. Of course, I can't wait until Monday to decide if she needs prednisone or not. I just asked them to run a baseline cortisol check instead of the acth.

Thoughts? They are also running full blood panel, checking electrolytes and starting her on fluids right away.

Renee I am sorry to read this. Won't the er give her the rescue dose without the acth test? Our ims gave Zoe the rescue dose at er without knowing. If it were me I would be giving the rescue dose.

Addy, they are pushing for the ACTH, but I told them I would decide on the rescue dose based on her baseline cortisol; that I did not want to wait on a stim test. They should be calling with those results any time. I at least wanted a baseline before giving the pred.

Is it possible she is having pancreatitis?

Just spoke with the vet.

Results are strange.

The baseline cortisol is above 10, so more than the machine can read. Red blood cells, platelets, and lipase are high. I don't have figures, because this is not my regular vet and she didn't seem to want to give me specific numbers over the phone. BUN is low. Of course, ALT and AlkPhos in the normal high range, as expected in cush pups. Electrolytes do not support low cortisol.

So, no rescue dose of pred, given her high cortisol. They are keeping her on fluids for the next 12+ hours and we are treating this as pancreatitis.

I'll be going by later this afternoon, and I will get copies of all her results.

Oh no! I was so hoping she would be feeling better today. I'm sending prayers your way.

:( Let us know how she's doing, Renee.

Awwww Renee so sorry to hear Tobey is under the weather, poor wee girl. Hopefully the fluids will perk her back up, maybe get the to do a spec Cpl if they do more bloods to confirm the pancreatitis. I will be looking to read good news about her later on xxx

So sorry to read that Toby is in the hospital -- I know it was hard to leave her there. Will be sending good vibes that fluids will make her feel better!

They should be able to do a snap test to diagnose pancreatitis, keep us in the loop ok?

Oh Renee, I'm so sorry to read this news. FWIW, I would guess that the high red cell and platelet counts are due to dehydration, and the high baseline cortisol can be due to the stress of this acute illness in conjunction with a lack of trilostane. So it seems as though the high lipase may be the most significant finding and that pancreatitis is indeed likely. Addy is exactly right, there is a snap test that can give you a quick "yes/no" answer (SNAP cPL test). But the tradeoff is that you don't get a specific number against which to gauge recuperative progress, as you do with the Spec cPL that takes longer to process. So each form of the test has pluses and minuses. It sounds as though Tobey is being treated as though she has pancreatitis, anyway, so the test results may not be urgently needed and you maybe can wait for the full numerical result.

I am so sorry she is having such a rough time!

Oh no. So sorry this has turned into an emergency room situation. Does sound like pancreatis. :(. Was hoping just an off day.

Hugs

Sorry I have been slow to check back in.

We are definitely treating it as pancreatitis, even without the snap or spec test. I'm not even sure if one or both of those tests was run. I stopped by earlier to talk with the doc and visit her, but they had a huge rush of emergencies and they sent me home. I went back a few hours ago, but could only visit. Saturday's are busy, because there are only two emergency vets in town.

I'll be checking back in around 8pm, and hopefully I will be able to talk with the doc then. When I did visit, Tobey still seems quite lethargic and disoriented. Seems the fluids are slow on helping her recover. I'm not sure what other treatment is done for pancreatitis?

I have since found that my husband gave her quite a few more than just one pizza crust. :mad: He feels bad about it now, since I have been warning this will happen. And, of course -- just wait until he gets the bill too. I hope lesson is learned for him, I'm just frustrated that Tobey is the one suffering.

If I remember correctly, pain pills sometimes metronidazole are given.

I hope she gets better through the night. Don't be too hard on hubby, he must feel badly, CUsh pups are prone to pancreatitis, doesn't take much.

Oh poor baby. Yes I am sure hubby feels bad. Poor tobey. We have had many Cush dogs go through this. As addy said doesn't take much. I worry about it constantly too as the low protein kidney foods always have higher fat content and it's so easy for it to just come on seemingly out of nowhere. Some recover more easily than others. Hopefully she will be more herself tomorrow.
Boiled chicken and mushy rice gore a bit though as they can't tolerate much more than that.

Hang in there Renee. We are all pulling for you and Tobey.

The cortisol is not my main concern at the moment... but, I am still a bit worried about the baseline being over 10. It has never been that high, even before treatment. I am wondering how far back this will set her progress.

Renee, baseline cortisols can fluctuate a great deal from hour-to-hour and day-to-day, even in normal dogs. That is the reason why baselines are of absolutely no value as diagnostic tests for Cushing's. Extreme physical or emotional stress is virtually a guarantee for a temporary related increase. Just as soon as Tobey is physically stabilized and resumes her trilostane, I'll bet her cortisol will even out once again. I know you are especially worried about her skin, but I'm really hoping this short-term episode won't have that much effect on things.

Also, before you are too hard on hubby, unless the pizza crust had a lot of cheese left on it, I wouldn't think it was the primary problem since it is mainly just carbs in the form of flour with a little oil added. I'd be thinking the coconut cream pie or even the mashed potatoes would have been more fat-laden (I know our own Turkey Day taters were especially delicious because they were loaded with butter, heavy cream, and soft herbed cheese :eek:). Perhaps hubby was the culprit with those items, too. But I think that's where a lot of people get into trouble giving their dogs holiday treats from the table -- the treats seem innocuous, but the holiday ingredients are especially rich or flavorful with the addition of special fats or dangerous items like onions or onion powder. I don't think anybody at our table had a clue as to how rich the mashed potatoes were -- all they knew was that they tasted especially yummy :o.

Marianne

Checking in again first thing this morning and hoping for an update on Tobey. Continuing to send warm thoughts and healing hugs across the miles.

Marianne

Checking in this morning too.
Hope Tobey is better today

Hugs

Me, too. Hoping she is much better today.

Hey everyone, thanks for checking in.

I brought her home yesterday. She was very quiet, slept a lot, and still seemed very weak. Would not eat at all, but did drink water and pee.

I was thinking I would have to take her back, but then she ate a bit of turkey around 8, and drank a bit more water. Funny, she would not eat, but when I put the turkey in front of her and invited my other pug to come over, she hurried up and ate it before he could!! LOL.

She ate a bit more this morning, some rice and boiled ground turkey, so I decided to let her stay home, rather than taking her back to the hospital. I was going to take her back, if she would not eat.

She has not had her vetoryl since Friday morning. I'm still not comfortable giving it to her, since she is barely eating. If I can get her to eat a full meal, then I will start dosing her again, although I am considering easing into it by doing a half dose for a week. I don't want her to have a huge drop, when I am guessing her cortisol may be pretty high by now.

She's definitely put the scare in all of us this weekend.

Glad to hear she's home and stayed so far. I hope her appetite picks up more as the day goes on. Of course, you could keep making her think someone else will eat her share! :D

I'm so glad Tobey is home and eating at least a little bit. Such a relief that she is out of the hospital!!! Good job, Renee!

Good to hear that Tobey is home and eating at least a little bit.

hugs

Any ideas for bland food I can make the girl? She is still rejecting her rice / boiled ground turkey. She ate less than 1/4 cup of it this morning, but I can tell she is just not interested at all in it. This has been my go-to bland diet whenever one of the pugs is sick.

I'm thinking she is being turned off by the rice, because she ate some friday night when she was sick and then threw it all up. :( I guess just like people, she doesn't want to stomach something that just made her sick a few days before.

She did eat a slice of lunch meat when I went home at lunch to check, so she could get a pain pill. And, I had some canned wellness she ate at lunch too... but, I hesitate to do canned food. Could be too rich. I didn't let her eat very much at all.

Hi -- a few suggestions - one is Royal Canin Gastro-Intestinal Low Fat canned food. My vet prescribes this for post-surgery pups as it is a very palatable, easily digestible food. Abbie absolutely adores it -- it is what I use to wrap all of her pills and also add a spoonful to her dry food.

Another thought is canned tuna fish (in water). I personally hate the smell of it but my Maggie loved it when she was reluctant to eat. You could also try cooked, lean ground beef.

If you are worried about Tobey not getting enough nutrients, you could get some Nutrical. It is a high calorie, nutritional supplement. It is a paste and I gave it to Maggie on a tongue depressor -- she would just scrape it off with her teeth. The color is a bit off-putting (looks like poop ...) but at least our pups don't mind that!

Good luck!

I think that Judy just covered my ideas. Tina uses ground lean beef for her Jasper when he is off, I use chicken with molly as that is her thing, she also loves rice and thinks it some kind of treat she is getting, but I can see where Tobey would be off that if she threw it up. Did you try cooking the rice maybe in some turkey broth to get it some flavor, that might entice her.
The nutrical is a good idea, for a nutritional supplement if she not into eating. Whether she'll take it or not with an upset stomach is hard to say.

hugs

Hey Renee, you might want to take a look at this article by Mary Strauss. It was really helpful to me when my Peg had her episode of acute pancreatitis.

http://dogaware.com/articles/wdjpancreatitis.html

As you'll see, Mary recommends low fat, moderate protein, and high carbs when a dog is first recovering from an acute attack. She suggests that potato -- either white or sweet -- are reasonable substitutes for white rice. You'll find a link in this article to another one that focuses on low-fat dietary guidelines and menu suggestions. Hope this may help!

Marianne