Skippy has passed; 12 y/o Yorkie with likely pituitary tumor (Trilostane)

I hope he is better today. I hope that he can beat this. You have both been through so much and I know that you are both sooo tired. It is just so overwhelming sometimes.

Whatever happens, you know we are right here with you and if we could be there at the hospital for each visit and decision, we would be.

HUGS

Hello and thanks so much for your supportive comments. I so appreciate your kindness. Here is the update: They cultured his urine and began Amoxicillin on Saturday. No response. They have him on three times normal dose of maintenance fluids and have managed to get his Creatinine down to 1.7. His BUN is steadily rising, e.g., it was 90 on Saturday and today it is 139. Purdue says that their nephrologist is Dr. Adams who says there is nothing more they can do. They can’t send him home because of the high fluid requirements; antibiotics don’t work and his BUN is rising. I brought him home for a couple of hours today; he is weak and is the walking wounded but he ate greedily. (He won’t eat much there.) They will do another ultrasound tomorrow to look for clots or anything they missed but are essentially waiting for me to pull the trigger and put him down.
I sent an email to local vet to ask whether it would be worth trying to put in a port, keep him on the IV and bring him home? Keep him on the antibiotics and see if they would work to cure the infection? I know this is a pretty out there idea, but if the antibiotics need more time to work and he needs to be out of the hospital, it seems feasible – maybe.

Plan B is I will take him out of Purdue Wednesday, if he lives that long, and have him put down at the local vet because that is her first availability. Life sucks!

It sure does suck, Carole...the poor little guy has been through so much.

Poor little guy. I wish I had the right words for you, Carole. I wish I had ideas or even better, answers.

Hugs.

I have nothing to offer but empathy and ((((((((((((((((((((((HUGS)))))))))))))))))))))))) )....and a belly rub for precious Skippy.

Awww Carole, I’m so very sorry the options seem so grim. At this point, if you’d prefer to have him home with you, I’d endorse trying to make that happen, either with or without the IV. If his system can’t be cleared adequately with the fluids, I’d expect that he’d become increasingly lethargic as his kidneys shut down. But he’d be at home, probably peaceful, and you’d be with him. It is such a hard decision to make, though, and no matter what you decide, we are here with you.

Sending my thoughts of strength and comfort to both you and your brave little boy.
Marianne

Just spoke with the IMS again and they are going to aspirate one of his kidneys, if the kidneys have changed in any way, to look for renal lymphoma this afternoon. I didn't ask about bringing him home with an IV port. They likely think I'm insane already. The IMS did say that with enough fluids over months that his kidneys could heal but he's still not sure what I would be looking at. They cannot figure out why he has gone into acute kidney failure so suddenly. They don't think the infection and antibiotic not working are the problem. They pumped up the fluids yesterday after I brought him back; he fought them about going back into the cage. I am going to take him out again this afternoon after the ultrasound. It only occurred to me while talking with IMS that I should offer to donate his body if they could learn from what's happening to Skippy. Marianne, thanks for the idea about bringing him home to die. I will explore that further. BTW, the Dandie Dinmont terrier with whom Skippy lives, is highly suspicious of Cushing's; she's my friends beloved dog. She hasn't been tested yet but I'm going to secure a copy of her CBC from a few weeks ago. When it rains...

I am so hoping that a “fixable” explanation can be found, and I will keep checking back for news. If the options are exhausted, though, and you want to bring him home, you may want to explore the possibility of a vet who performs home euthanasia. In that way, you will be equipped to speedily ease his release at any time if he appears too uncomfortable.

If there can be such a thing as a “good death,” though, life ending through kidney failure is often described in that way. Of course, none of us can know what someone else experiences at the end, but here’s what has been written about humans who consciously decide not to prolong their own lives through dialysis.

Quote:

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Patients who choose to stop or not start dialysis are not required to eat or take in fluids. In most cases, a patient is allowed to eat or drink if they want to, but forcing fluids or nutrition is not recommended.

Medicines can be given for pain, anxiety, agitation or congestion. However, other medicines are often stopped when a person decides to quit dialysis treatments, since treating the chronic medical conditions is no longer a priority.

As the body’s systems shut down, a person slips into unconsciousness and the heart stops beating.

Most people who pass away from kidney failure have what family members and caregivers describe as a “good death.” A study reported that patients who discontinued dialysis described a good death as pain-free, peaceful and brief. The patients’ families echoed this sentiment, adding a good death included having loved ones present at the end.

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Once again, this may not be a path that you will need, or wish, to take. But I did want to speak about it in the event that you might want to consider it. You two have been such partners all along this journey, and my greatest hope is that you can peacefully share every moment that remains.

Thanks Marianne, this is helpful and I will consider it.

Oh Carole,

Sending huge loving hugs, wish I could do more for you and Skippy.

Hi everyone,
The second ultrasound of Skippy's kidneys revealed nothing; kidneys are normal, no blood clots, no renal lymphoma, no nothing except acute kidney failure of unknown etiology. Since I am stubborn and refuse to be a quitter, I ask Purdue about bringing Skippy home on an IV; I thought the IMS was going to choke but did say that he would have to seek approval from the hospital director. Okay, I see. Thinking more clearly about this idea, I can think of a dozen obstacles and a multitude of things that could go very wrong indeed as he would need to be on the fluids for weeks or months - if it were to work. He did say that Skippy is not a candidate for dialysis and based on what I've read, I truly would not put him through such an ordeal. Marianne, I did ask about bringing the boy hone to die; IMS believes it would be a very painful death accompanied by severe headache and other painful conditions. I ask about pain meds; he said nope, not from him. So, I'm picking him up at noon and will take him to local vet, who he hates as well, a few hours after. Purdue will perform a Necropsy and I've ask local vet about transporting his body, if not I will take his body back, but at least Skippy won't have to go back there alive. I saw him twice yesterday. The first for 10 minutes before the ultrasound, then last night they said I could only take him out for 10 minutes. He was ravenous and I fed him the fattest, crustiest KFC; then I took him back in but no one came for him - for one hour! We went back to the car where Skippy nearly ate the KFC box. When they finally came for him, they literally had to drag him from the front of the building all the way down the hallway until he was out of sight. It is heartbreaking.

I am trying very hard to regain perspective; there are millions and millions of tragedies daily involving violence, war, medical mistakes, accidents and such that lead to horrifying pain, suffering and inevitably, death. And, I know that Skippy is but one little mutt who has enjoyed the best of lives and the finest care a dog could hope for. In return, he has given back to me ten fold, asking for simply nothing in return. He taught me so much and made me wiser, more loving and more compassionate toward others who are experiencing their own anguish and pain. He has made me a kinder, gentler woman and it's been my privilege to spend a decade of my life with him. I am an old social worker who ran a domestic violence agency for thirty years so I've seen and experienced a lot of loss, pain and anguish personally and professionally. I've lost three dogs previously but nothing in the past prepared me for what Skippy and I have experienced this past year. I'm not a believer in afterlife, bridges and such but I know that the imprint that Skippy has had on one life, my life, is indelible and will be forever enduring. I will try to give back to this forum when I am again sane as all of you have been so wise, caring and giving of your time and knowledge. In the meantime, thank you and Godspeed Skippy.

Bless you, Carole. This is one of the hardest things we have to face. You and your precious boy have fought the "good fight" from day one, side by sided, united every step of the way. I have watched your journey with joy, sorrow, inspiration, and empathy. There is so little I can do for you now but be here if you need to talk. But do let me do this for you and for Skippy - let my belief in the next life give you a bit a comfort, my belief that you will walk with Skippy by your side and I will walk with Squirt by my side once again some day. The imprint you talk about is forever...that "tie that binds" never breaks. They remain with us always in one form or the other, their memories live on. I hope one day you hear Skippy's nails clicking down the hallway as I do Squirt's and you will know in your heart your baby boy is there.

You are a great mom and have done your best, and beyond, to give Skippy the very best life possible regardless of the situation. I know he is grateful and will leave this life on the wings of your love. Please know we are here for you - we DO understand.

My deepest sympathies,
Leslie

Instructions To a Guardian Angel of Dogs
By ginger Patton

Hello. I’ve been expecting you for quite some time.
Here, come sit beside us for awhile
and let me tell you about this old friend of mine.
He might look tattered or maybe old
But I won’t say goodbye until you’ve been told.
He had the brightest eyes I had ever seen,
And wore a beautiful fur coat that would outshine a king.
He was never prissy but walked with an aire ……
And oh so polite, you could take him most anywhere.
He could run like the wind and could catch anything he chased
But he protected and sat with me when I had problems to face.
You could not find a friend nearly so dear.
Because no matter the trouble he always stayed near…
He has never asked for much from me;
Just to love and respect him and I think you’ll agree,
To give him a good meal plus a nice warm bed is not much to ask
When he has given me all his love and to him this was no task.
Now I understand you have a schedule to keep.
But I have a small favor before he nods off to sleep.
Please fold your wings around him and let him feel young while in no pain.
Dear Guardian Angel of Pets,
please keep him safe and happy until I see him again.

By Ginger Patton

Carole, I am here, too, and my heart and thoughts will remain with you throughout this day. You have done all that is humanly possible to heal Skippy’s body. What a journey, indeed. As heartbreaking as it is, today is the day that you will grant his spirit release from a body that just cannot be healed. The love and the memories last forever, though. And we’ll remain here, right by your side, in the days to come. We cannot replace Skippy’s place next to you, but we can celebrate his life and we can support you in your loss.

Fare thee well on your newest journey, little brave boy, and loving hugs of comfort bring sent to your mom.
Marianne

My heart is breaking with yours, dearest Carole. We are here for you and always will be.

Sending tons of loving hugs, ear scritches and belly rubs for your dear Skippy... and more hugs for you, Carole. Godspeed little one.

Just send me to the asylum. Purdue just called and Skippy's numbers are way down; his creatinine is 1.2 (normal) and his BUN is down to 70, still high as the top of normal is 30. But, they talked to me about bringing him HOME or keeping him there and try to taper the fluids. I will pick him up this afternoon for an hour and we will taper for a couple of days and see where we are. The IMS says that he thinks that there would be tremendous psychological benefit to Skippy to get him home, but cautions that it could all go south quickly. I no longer know what to think or if my mind is capable of thought. Thanks again, as usual.

And,no they don't have any explanation as to why this has happened. Regards, Carole

Skippy's amazing, just like his Mom.

I'm sure we'll all join you in that asylum.

Still sending those hugs, and positive thoughts.

Oh wow! I wonder if giving him sub-que fluids at home would help? This is amazing!!! I feel horrible about my earlier post now. :( I am sure hoping for the very best!!!

Double wow!! This is amazing news and I surely hope the trend continues! And no matter what new turns this rollercoaster ride may take, we’re with you and Skippy all the way...!

That's great news, Carole!

You'll have plenty of company. Many of us are regulars, or visit often.

So glad that you're able to bring him home.

Quote:

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Originally Posted by Carole Alexander

Just send me to the asylum.

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Leslie, I am the one who should be embarrassed; I write this lengthy dissertation describing my feelings, etc., about Skippy's final day in this life and then he's given a reprieve. But I think we both meant what we said as sincere and genuine. As did all of you who made such loving and kind comments - and I thank you on my and Skippy's behalf. I am incredibly drained and I'm sure my cortisol is at Cushing's levels. I went to pick up Skippy to bring him home for a little while and ran into a glitch. The administrative staff at the hospital have snapped to the fact that the IMS' have been letting me take Skippy out. He came home for an hour today under the frame that I was taking him for a long walk. (This is considered a discharge and there is a hefty add on fee for readmission.)Skippy looks better and seems better and was extremely glad to be home. He again ate voraciously, slept a little, followed me around and went outdoors. He is weak and remains the walking wounded but he was quite responsive for the two hours we spent together in and out of the hospital. (He did a quick run to try to escape out the hospital door when I had him unleased for a few moments and a student opened the door.) I am trying hard not to raise my hopes or expectations. Although his kidney numbers are looking very good at the moment, he may now be a "fluid dependent" dog at this point. I will know more tomorrow, but I am worried as we approach another week end without any clear direction. While I think they might have released him with Sub Q treatment today, I felt that making an effort to taper him was the safest. And, as many of you all know well, Skippy's prognosis remains very guarded. Add to that the Cushing's, the plethora of info out there about diet, nutrition, supplements, vitamins, refusal to eat, etc., and I am more than overwhelmed. I was very grateful for the time with him today and that he's still alive; he seemed equally grateful. Today will make it harder if the end remains near and the numbers were a fluke but I will treasure whatever time I have left with him. I will wait to post again until I know something definitely definite. In the meantime, you all are the very best. Carole

Just checked in on you and Skippy. No matter what happens going forward or when, I am very glad that he is home with you and enjoying being there.

Hugs

I have gritted my teeth since waking up at 5 am. Talked with IMS at noon; Skippy is having a pancreatitis flare up which has elevated BUN and Creatinine. Numbers are C -2.5 and BUN 93. But he thinks there may have been a testing mistake with Creatinine! They were going to run blood and presumably urine again at 1pm and have put him on lowest fat KD if he's eating it; they gave him an anti nausea injection as he was licking lip. IMS says he looks good and is active. I really would like to try to bring him home with Sub Q if they will agree. IMS is supposed to have called me two hours ago with PM test results. I am going to run over there and find Skippy's student to get a copy. IMS rattled off numbers this morning that all seemed high but it was too quick for my addled brain.

Oh no, Carole, I sorry to hear that his pancreas is acting up, it's such a fickle organ. Please keep us updated.

I took Skippy out for a half hour walk late afternoon. He was lively all things being relative. And, he walked gladly; anything to get out of the cage - remarkable since he has not wanted to walk for months. His values are back down - BUN is 63 and Creatinine is 1.4. They had not started the KD but will tonight. Who knows whether he will eat. They are starting to taper the fluids tonight by 15%. He still has soft stool approaching diarrhea. IMS said this afternoon that he thought there was a 50/50 chance he would recover. And who knows for how long. One day at a time...I have so many other questions but I'm so, so tired. Sweet dreams everyone.

Carole

Last night, Skippy tolerated the first taper at 15% reduction. He was receiving 175 (is it kg?) of fluid since he was admitted. They started a second 15% taper this morning and will do labs at 4pm. He is eating a little of the KD and the student thinks he's alert and looks good. They are treating the diarrhea. This morning's labs are BUN 64 and Creatinine 1.3. Maybe, just maybe the chief nephrologist who told the first IMS, "give it time" (and money), may be right.

I'm so glad to read that Skippy is improving and hopefully those kidney values will stabilize. Great job, Mom!

These ups and downs are so stressful, Carole. The poor little guy! I hope he gets to come home soon.

I saw Skippy this afternoon and took him for my 15 minutes. He had a massive diarrhea attack in the middle of Purdue's hallway as soon as the student handed him over. The student and her colleague did the cleaning; the student was lamenting this week that she had never seen the dog poop. I said, "here you go, pudding". Lengthy chat with the IMS this afternoon; I just wish I could remember half of what he said. Skippy's BP is down to 110 and he's not anemic, but the taper is raising sodium levels. He has consulted with Scott-Moncrieff multiple times and they are in agreement that his primary problem of the moment is NOT Cushing's. If he survives, Scott-Moncrieff thinks that we may see further reduction in his cortisol levels because of the radiation. This IMS is more concerned about the pancreatitis than his kidneys which are looking much better each day. I forgot to ask about proteinuria. They, of course, would like to keep him until he is completely stable in respect to his labs, off the fluids and not needing subQ. (I said let me create a GoFundSkippy page.) He's reluctant to offer a prognosis. He and Scott-Moncrieff are concerned that Skippy may develop diabetes (the boy's glucose is normal currently) and the explanation involved Cushing's, the pancreatitis and his kidney disease but I will have to ask him to explain again and I will record. He said there is no research that he's found supporting the notion that Vetoryl triggers kidney disease. Skippy is hating the hospital and will walk anywhere that is away from the place; I have to carry him the last half block in. He's on a low fat food that he's reluctantly eating and on diarrhea meds, the fluids, amlodipine and his weight is stable. I'm unsure if he is peeing as much as they are hydrating him. He's very hungry for real food. They did labs tonight but I haven't heard any numbers; this IMS is very thorough and seems to be trying hard to figure out Skippy's puzzling situation, especially now that he's moved on from his Tuesday pronouncement that, "you must give Skippy death with dignity now". I am more hardened to the reality of the situation now and if I don't have to file for bankruptcy over this, Skippy and I will plunder forward with clearer eyes. I hope everyone is good and hugging their pups. I am blessed.
Carole

The pancreas maintains the body’s blood sugar balance, as the primary hormones of the pancreas include insulin and glucagon, and both regulate blood glucose.And because of this important funtion from the pancreas, unfortunately, diabetes is the most common disorder associated with pancreatitis.

Regarding proteinuria, many things can cause protein loss such as high blood pressure, UTI's, and even certain medications, so my thought is that with everything that is going on with Skippy the chances are likely that his urine does contain an abnoral amount of protein.

It is a really positive sign that he has an appetite. Some foods that are ok to be given to dogs with pancreatitis and kidney issues are chicken breasts (skinless, boneless), rice boiled to a mush consistency, eggs, and fish.

Love and hugs, Lori

Lori, this is very helpful; I am not sure that Skippy and I can "do" one more disease but I won't get in front of my skis. Back at you,
xo, Carole

The IMS is truly dumbstruck about Skippy. This morning after a 50% reduction in fluids, Skippy's BUN is 33 (Range is 15 -30) and Creatinine is .09 (Range is .05 - 1.9). He ate half a can of RC low fat for me this afternoon and I took him some pumpkin that IMS requested to offer for the diarrhea that he had yesterday. IMS said he's holding his breath and does not want to talk to me about what's going on as they continue the taper. Took Skippy out for a brief walk and he walked directly to my car and put his paws up; He looks and acts significantly brighter than he has in weeks and I had to carry him back in. Holding my breath.

That's a great update!! Keeping all various body parts crossed that he continues to improve.

What wonderful news!!! I so hope this trend continues!!

Wow that's great! Skippy's a little miracle man! Let's hope his good days outnumber his bad!

Great news! I'm so happy to see this. I'm going to be away for awhile, so I hope to see continued improvements when I get back. Go Team Skippy!!

Annie and Sharlene and Everyone,
Skippy came home last night after 14 days on fluids; he has acute and chronic pancreatitis, kidney disease of indeterminate stage, a urinary tract infection and of course, Cushing's. He is on low fat RC and will not eat it; last night and today, I mixed it with boiled chicken breast to get pancreatitis meds down but he's eaten a third of a can and a handful of chicken breast since yesterday. He's lost several pounds since this crisis and while Purdue won't say, it seems improbable that he can bounce back from this. IMS called tonight and will call again in the a.m. He thinks it's likely that Skippy is holding out for better grub and says we can go for a while without eating as long as I can get the meds down and he's drinking. He walked eight or ten blocks today, no diarrhea, no vomiting but sleeping mostly. Underlying cause of assault on pancreas is uncertain, likely idiopathic and Cushing's related.

One thing I learned from this IMS,who is specializing in kidney disease, that may be useful to others, is that Ursodiol has been used to treat pancreatitis in humans for a while. IMS says now they are treating dogs using this drug. Skippy is his first. Skippy is not on subQ as they didn't think it would help much; he will be retested tomorrow or Monday. His labs yesterday were BUN 77 and Creatinine 1.1. Thanks again for your support.

So glad that Skippy got to come home. There's nothing like your own turf, bed, everything.

You are one very strong lady Carol. I would not been able to hold everything together as long as you have. I have yet to figure out which one of you is stronger. You both must pull strength from each other. When it's time for Skippy to fly, know that you did everything you possibly could for him. He loves you for that.

Kathy

I am so glad to hear that he is home!! Getting them to eat can be a chore to do. Is the RC kibble or canned? If canned I wonder if warming in the microwave or baking in the oven would make it more desirable to eat. You could probably do this with the kibble too, maybe adding chicken broth to the kibble and letting it sit until the kibble has soaked up the broth.

I didn't know that Ursodiol was being used for pancreatitis, thanks for sharing that, and I hope it will help Skippy with his pancreatitis. You are doing such an exceptional job with Skippy. You both are in my thoughts and prayers.

Hugs, Lori