Lucygoo - Pit. macroadenoma, endoscopic transsphenoidal surgery, trans-oral approach

Hi everyone...
Well, we're home. And she's sleeping...thank GOD! I'm exhausted already..I have to have a hold of her everytime she wants to get up. I hate to see her like this. :( Just talked to Dr. B....he said he's sure her vision will come back. He said he'd be very surprised if it didn't. I'm hoping he knows what he's talking about and not just trying to appease me. They think that's where a lot of the anxiety is coming from, poor girl. She still wants to walk, drink water all the time, and always wants to go (pull) to the left, but seems to have a little close vision out of her right eye. She's on a ridiculous amount of medication, and I just hope I get it all right.

Thanks for everything, guys, and I'm sure I'll be posting throughout the evening;)

Gina and Lucy

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Originally Posted by LuvMyMunchie

If I didn't have this forum and the caring members to hold my hand while I vented my way through the trials and tribulations with Munchie I would be totally bald now (instead of only partially bald!!) :eek:

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Hmmm? Sounds to me like you could have some abnormal intermediate adrenal steroid/hormone activity. You may want to ask your M.D. if s/he could request a full UTK panel for you. Just remember that estradiol can be a problem to control. :D:p:D:o

So great that she is home - and that she is sleeping. Sounds a bit like bringing a baby home from hospital for the first time!

With the drinking - have they mentioned the possibility of Diabetes Insipidus (DI) (completely different from the diabetes that this site is about) and is she on medication for it? I understand that it is a really common, and usually temporary result, of pituitary surgery.

When I've had animals or people on multiple and tricky med schedules I've made myself a table setting it all out that I can tick off as I give the med along with a section for any "comments" I may want to make. It can very useful to (a) keep you on track particularly if you are tired or stressed and (b) as a record if there is any reaction (good or bad) to any med.

Alison

Oh Gina,

That's great, Lucy's finally home. You are probably so scared right now, with all the meds., watching her like a hawk... but you'll do just fine...remember to get some sleep too, you know.

I'm hoping that you will be amazed at how well Lucy will recover at home in her familiar environment with her loving Mom to dote on her...oh, she will be so spoiled :D:D But, that's what our furbabies are here for, for us to love and to spoil.

I really don't believe Dr. B. would pacify you about her vision, if he says that he believes her vision will come back, then he truly believes that, and we must think positive, right? :)

Very much looking forward to your posts tonight, but like I said, do TRY to get so sleep dear Gina.

Hi Gina,
So happy that you got the Goo Girl home. I can imagine feeling like a basket case but your doing a wonderful job and taking good care of her. Keep positive and good thoughts. We are.

We are all pulling for you and the GooGirl.
John (Roxee's Dad)

How wonderful for both of you that she is home. Dorothy was right -- there is no place like home.

I second what Alison said about a chart to check off or write down when you give the meds. I find it is the only way to keep things straight -- particularly at first.

We will be waiting for updates.

Carol, McGill, Atty Cat & Winnie (always)

Hi Gina,

I am so glad you are both home and that you are together. :) I am also very encouraged by Dr. B's prognosis. I definitely don't think he is just trying to appease you.
You are doing a miraculous job of coping and caring for Lucy at this unbelievably stressful time. I second the opinion that Lucy will be more comfortable with you in the environment that she is used to at home.
Keep up the wonderful job you are doing and we will all keep the positive feelings and prayers going for the two of you!! You are an amazing dogmom and an inspiration to all of us!!!

with love and prayers...
Dorothy and Mikey

Hi guys....and thanks as always.
Here's what she's on now:
Clavamox 375 mg, bid (antibiotic) for 7 days
Baytril 136 mg once daily for 10- days...may discontinue after urine culture.
Cortisone acetate 25 mg, 1 tablet bid indefinitely
Thyroxine 0.4 mg 1 tablet bid indefinitely
DDVAP drops: 1 drop into conjunctival sac twice daily (This regulates water balance)...Dr. B said to watch her water consumption, and they can adjust accordinly

Acepromazine 25 mg for anxiety as needed
Artificial tears, 1/4 inch strip in each eye twice daily

She's also on Science Diet A/D...am going to try to transition her back to regular food in a few days....it also says to offer her food and water four times a day

Here are her diagnoses:
1) History of pituitary dependent hyperadrenocoriticism with decreased appeitite and weight loss.
2) History of pituitary macroadenoma/pituitary removal 5/13/09
3) Hypothyroid secondary to lack of TSH
4) Hypocortisolemia secondary to lack of ACTH
5) Blind - suspect caudal to the optic nerve due to mechanical injury vs. inflammation vs. vascular event
6) Fever - rule out inflammation vs. infections vs. hypothalamic dysfunction.

If anyone has any experience/tips on meds or anything listed here, Lucy and I would much appreciate any feedback.

You guys are the best, and thanks for hanging in there with me:)

Gina and Lucy

Hi Gina,

I am so glad Lucy is home now! She will feel much better with you by her side. Rest when you can and try not to fret.

Hugs,
Leslie and the girls

Quote:

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DDVAP drops: 1 drop into conjunctival sac twice daily (This regulates water balance)...Dr. B said to watch her water consumption, and they can adjust accordinly

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This is for the DI (Diabetes Insipidus) - without the drops she would be needing to drink, and drink and drink and would be peeing to match - in fact I should have put that round the other way really - the urination is really what drives the thirst. A dog with DI needs free access to as much water as they need at all times as the only way they can avoid dehydration is to take in water - they are unable to concentrate their urine. The drops replace the hormone that "tells" the kidneys to conserve water and which she isn't able to produce for herself at the moment.

There is at least one member here who has experience with DI - Sharon (Ventilate) has two dogs with it but not as a result of surgery or anything.

I thought you might find this interesting as it sounds like it may be what Lucy is experiencing:

http://en.wikipedia.org/wiki/Blindsight

I guess they have a follow-up MRI planned at some stage?

Alison

Yes, Alison, she does have a follow-up MRI...they just don't want to traumatize her too much right now with more anesthesia and the whole nightmare. That will also tell us if she's had a stroke, I think...right? I'm bringing her back for a visit with Dr. B on Wednesday, if all goes well here at home, of course, and he'll know more then....meanwhile I'm calling him constantly as well....I told him he's going to have to take out a restraining order on me, too.

I'm getting kind of concerned with the potty thing. I told Dr. B she hasn't gone since we picked her up at 1....he said, "That's good." huh? I guess he's glad so she can concentrate her urine, but she's still drinking a lot of water. I guess she'll let me know somehow if she has to go. I'm also checking her temp 3 times a day.

Thanks for the advice, everyone....it really helps:)

Gina and Lucy

Maybe she got a bit dehydrated when in hospital because she wasn't as relaxed and didn't drink as much? I hope she stops worrying you on this front soon.

My dog (basically-healthy 20 month old at the time) had a three day hospital stay and he didn't drink well when there either (fortunately he was on a drip most of the time so it wasn't an issue) - but the first pee he had on getting home looked like coca-cola (:eek::eek::eek:) it was so dark and concentrated because of his inadequate water intake because of his not wanting to drink while away from home!

Alison

We went outside and she peed!:D
And the water consumption is decreasing. I think she was just really thirsty from the ride home and everything. She does want to circle though....and she keeps insisting on pulling and going to the left:confused: I also don't really see any awareness that she's even home...maybe I'm putting too much on her too soon, but I just hate to see her suffering so much:(

The saga continues.......

Gina and Lucy

Hi Gina,

I think everything sounds really good with Lucy. I am so happy she is home where she is comfortable and happy. She will heal much better with her Mom around and in her own home.

I don't believe Lucy even had a stroke, of course I don't know. I just think some very sensitive things got tweaked in her brain area and they will all adjust and heal with time. I've always thought Lucy will regain her eyesight and if Dr. B expects her to, she almost certainly will. Bottom line, that big old nasty tumor is out of there and now she just needs to heal. I'm sure her not seeing much is throwing her for a loop for now.

Every time I visited Shiloh after her adrenalectomy she drank copious amounts of water. Soon after I got her home she just drank like a normal dog. Have some patience, Lucy is some kind of a trooper! I just feel certain she is going to heal up well and she will get better every day.

Ken

Thanks Ken....
I can really appreciate that coming from you, and I'll just keep thinking of you and your remarkable Shi. It really is helping me get through this; you all are.

Hugs,
Gina and Lucy

Gina,
I'm glad Lucy has stopped drinking so much and has even peed. Every little improvement even if small is heading in the right direction. I know how much you want Lucy to get better but it is all going to take time.
Jenny

I gave Lucy an acepromazine around 9:30 p.m....It's not 1:10 a.m. she's now breathing heavy, hasn't moved in two hours, and shit right where she lay, and I can't seem to wake her up. She responds a little, but not much. I called the hospital, the vet on duty didn't seem too concerned...said if her breathing gets below 30 rpm to call or bring her in....I just e-mailed Dr. B....Does anyone have experience with this acepromazine crap?
Looks like I'm going to be up all night with her again....
Gina and Lucy

I think it's the acepromazine...it says on the thing it will make her "quite sedate." Poor thing...now I'm up counting her respirations and checking temps. Next time she's only getting half of one of those suckers. Plus I think we went a little heavy this evening on the A/D food...diarrhea in her sleep:eek:
More to follow, I'm sure....
G and L

I'm not sure if it's the same thing but my kelpie Nelson used to get so stressed in a thunderstorm that the vet gave us some acp tablets to calm him. I was told I could give him whole tablet but it completely sedated him to the point of coma so I only ever gave him half when needed and even that made him quite spaced out.
Jenny

Jenny....thank you so much...You're a life saver. I'm pretty sure that's what it is....that's what the junior vet on duty thought it was, anyway, but he looks about 12 years old, too, so what does he know.
I'm so glad you answered....that makes me feel so much better:)
Hugs,
Gina and Lucy

The diarrhea could also be a side effect of the antibiotics.

I just Googled acepromazine and it looks like an adverse effect can be slow heart beat - they say less than 60 beats per minute - maybe you should take her pulse and contact them if it is too slow.

Hope that she is just a bit "bombed out" and is having a nice sleep - even if you aren't.

Alison

Thanks Alison...I'll do that. Her respirations have been about 58 to 60 per minute, and I would describe her breathing as panting with her mouth closed. I'll check her pulse now.

Thank God for you ladies in Australia:)

Hopefully her heart rate is nice and normal and you can relax and grab a few hours' sleep yourself.

I'm about to go and take my dog out for a walk (it 7.00pm here) but I'll be back in around an hour and I suspect Jenny will be checking in some time probably before then too.

Alison

I can't seem to get a good pulse on her, but her heartbeat seems rather rapid...her temp keeps going up too, but apparently that's normal for her lately...junior vet told me to call if it gets above 104.5. It's now 103ish. Fahrenheit, that is. He said the acepromazine should start wearing off in six to eight hours....so I should start to see something aroud 3ish, right? It's 2:30 now. I gave it to her around 9:15 - 9:30ish.
It's just her breathing is bothering me. Maybe it's because she's got a fever?

If it helps any my Nelson was so out of it for around 8 hours and he was at the time a young and healthy boy. I though I had killed him because he just couldn't move. I don't remember about his breathing or heart rate at the time but he really looked like he had been put under anesthetic.


I know you will sit any watch Lucy all night but if it is the acp don't expect any great changes for around 8 hours, as long as her breathing is regular and heart not too slow then it will probably be just a matter of waiting the drug out.

If you want to talk I'll be around for a few more hours yet (it's only 7.30pm here in Australia).

Jenny

Thanks, Jenny....
I think that's what it is...I'm just being overly paranoid. Maybe she needs a good long sleep....it's just they gave her one this morning, and she was up and walking around at 1 p.m. I think they gave it to her around 8:30 9ish this morning. Guess I'll have to wait until Dr. B calls me before I can relax a bit.

I really don't know how the acp works but maybe there was some residual from this morning and the second one really zonked Lucy out. I do know that it works much faster/stronger if given on an empty stomach, when did Lucy eat? As long as she is not in distress the sleep will actually do her the world of good and you will have another sleepless night!
I guess it's one of those things that you will have to wait out.
Jenny

Hi Jenny...you're right. It's just the rapid breathing that's worrisome. At one point I counted 80 respirations per minute...I hope she's not going into shock or something. I checked her gums, and they're pink...temp's running about 103.3.

She ate around 9 pm, because that's when I had to give her all her meds...so she definitely ate with the pill...I can't believe they said I could give her up to 3 a day:eek::eek: I also just read online that you should not give it to older animals..

Gina,
You really are doing great. I know you must be scared but as long as Lucy's vitals are ok then you are just going to have to wait it out. I also wanted to say that if I gave Nelson the acp at 6pm at night even at the 12 hour mark he was a bit mellow (dopey??) but once he ate it seemed to snap him out of it.
I am sorry you are going to have a long hard night but fingers crossed that all will be well in the morning. I'm sure the vets have taken into account Lucy's age and health but no way would I be giving 3 a day.:eek:

Jenny

PS Nelson has since passed away age 14 1/2 and until he lost some hearing around 12yo he was still getting the occasional acp (half only) with no problems at all. Just for the record he weighed around 25kg, how much does Lucy normally weigh.

Jenny...thanks for the support, and getting me through this horrific night:(
Lucy weighs about 50 lbs. now.

I was just trying to get my head around exactly how big Lucy is......about the same as Nelson was so I don't envy you having to pick her up or carry her around. Anything over about 10kg is definitley not what I'd call portable. All mine now are little and very easy to pick up.:D

Just had another thought, Lucy's body is sedated but her mind isn't so unless she's sleeping she will probably be able to hear you talking to her. I'm guessing she isn't far away from you but if you leave her alone maybe even some nice relaxing music would be calming.

Jenny

Hey Gina,
I just wanted to say that it's nearing 10pm here and if I want to be awake at work tomorrow I'd better try to catch a few zzzzz. I usually have to get up through the night for my elderly Phoebe's toilet trip so I will be back to check.
Keep posting and I'm sure others will be waking soon to join in.
Jenny

PS Give Lucy a nose rub and tell her she has friends all over the world looking out for her.

Hi Gina,

I found this link in our old ccnet library, hope it helps with the acepromazine:http://www.marvistavet.com/html/acepromazine.html

Gina - so glad Lucy is home. Looks like it was a tough night. You were in the best of hands with our Aussies Jen and Alison. Hope you managed to get some rest. Hang in there. I too feel Lucy will be just fine and continue to get a little better each day. You are an awesome mom. Don't forget to take care of yourself thru all of this. Big hugs, Kim

Gina...I am sorry you had such a tough night too. I'm glad you had some help to get you through....usually someone is on at some point. I wanted to let you know that they have given Bailey the acp, it knocked him for a loop for a longer time than anyone would expect. Each dog, like people, metabolizes things differently. Bailey is just very sensitive to most medications....except for the one med they gave him for me to give at home...that did nothing. I have to look at what that one was. But, anyway, the vet always looks at me shocked when I tell him that Bailey will be "out of it" more like 12 hours. My other bassett, pre-Scooter and Bailey (Heidi) was the same way. It just took much longer for tranquilizers and anything with a sedative effect to wear off. So, maybe not only the half tablet dosing may be worth trying, but also spacing things out a bit more? Something to check with your vet on anyway. For whatever reason, it just takes a bit longer to clear the system in some. Again, it can be an individual thing depending on metabolism.

I hope today is a much better day. I am confident, like the others, that you will continue to see improvement each day especially now that Lucy is home. And I would be that she does know she is home, the smells and sounds would let her know that....and having you by her side!

Lots of hugs, Beth, Bailey and always Scoobie

Thanks everyone....I'm still up and waiting for a call..she's still not responsive at all. It's 5:51 ...her temp's down a bit to about 102.6, and she seems to be breathing a little easier, but not much....and she coughed up a dime size spot of brownish blood...I'm thinking from the incision.....I'm definitely not giving her a whole pill of that anymore, but I'm still concerned about the breathing...it seems she's in pain even though she's sedated..is that possible:confused:

Thanks again everyone for getting me through this..

Gina and Lucy

Hi Gina,

Sorry you had such an axious night, but it sounds like it went OK.

Moria had hip surgery as a pup and about 6 years later developed a deep abscess. It took several days to properly diagnose and I was given acepromazine for sedation and pain relief and I can understand given Lucy's no doubt weaked condition from the surgery that it is putting her out of it. It is a commonly prescribed sedative but it probably is a good idea to ask of you can try a smaller dose.

Hoping she recovers her sight soon.

Best wishes. Scott

Hi Gina,

I just got up and was checking on you and Lucy.

The following is just my opinion, but it is my definite opinion. I believe alot of doctors prescribe more meds. than is neccessary. I know that after adrenalectomies, many surgeons have the dog on pain killers for many days and a myriad of other prescription medications. I'm so thankful, my surgeon doesn't believe in all that; Shi only took vitamin A, prednisone and a baby aspirin after I brought her home and she did great. Every time I go to the doctor, they try to prescribe something for me. A couple of months ago I told my vet that Shi occasionally has incontinence. He prescribed a normal dose of proin for a week. I gave her the first dose and it sent her for a loop. On my own I lowered the dose by 50% and she's done great. Now I give her a small amount once a week and she has NO incontinence. I'm not suggesting you not follow the doctor's orders on meds. and I don't know dink about these particular meds. But, I am completely committed to not ever giving Shiloh anything that might hurt her. I'm the one responsible for her well-being and I will question any doctor who prescribes anything for her and make my own decisions.

I hope Lucy is feeling better. I know you haven't had any sleep and that makes all of this much tougher on you. I hope you have an opportunity to discuss her meds and your other concerns with Dr. B soon.

Ken

Thanks everyone, but I still haven't heard anything, and now I'm waiting for the woman vet who discharged her to call me back after rounds. I honestly don't think Lucy's going to make it much longer. She's not responding at all, and lifts her head just slightly to pant. I can't take watching her suffer any more.