Pockets - 12.5 yr old Maltese (Update: Pockets has passed away)

[da_lizard]

I forgot one other thing is she is having times where she shakes like she is cold or in pain....any thoughts on this?
Thanks again.
I have to go to work, but hopefully I will have a chance to check replies tonight.
Elizabeth and Pockets

[Harley PoMMom]

Some info about Exocrine Pancreatic Insufficiency:

The acinar cells in the pancreas manufacture digestive enzymes that empty into the duodenum in response to the stimulation of a meal. Without them, food cannot be adequately digested and nutrients therefore cannot be adequately absorbed. For reasons that are unknown, the acinar cells may atrophy and stop producing enzymes. This condition is called pancreatic acinar cell atrophy (PAA), and is one of the major causes of pancreatic insufficiency.

For Exocrine Pancreatic Insufficiency most dogs respond well to having the missing enzymes added to their meals.

http://pets.webmd.com/dogs/dog-pancr...eatment?page=2

If Pockets was indeed showing any signs of pancreatitis, either in lab work or in symptoms, I would ask her vet to run a cPLI or cPL test to confirm the pancreatitis. These tests are specific to the pancreas lipase enzyme only.

http://www.idexx.co.uk/animalhealth/laboratory/speccpl/

http://www.cvm.tamu.edu/gilab/

My boy Harley has pancreatitis, didn't know this until his first ultrasound his first cPLI came back at 528 (0-200). We have gotten his cPLI levels down to 303 with diet changes and other things. Pancreatitis can be life-threatening, I know it scared the crap out of me.

Best of luck to you and Pockets.

Love and hugs,
Lori

[da_lizard]

Hey, after thinking and reading more, I am wondering if her shaking may be pain from pancreatitis. She ate the dried duck treats and that was all before I left fo work. She is getting around and making it to the kitchen to do her business but in between not much.
I am going to have her Dad bring her to the vet. in the morning when I get off work, which I hope will be on time and be there when they open. I am going to get them to further workup the pancreatitis and see if it is worse and ask for the cPL test. Problem is I am on call all day tomorrow (Neonatal ICU transport and ECMO nurse) and we have a baby on ECMO which means I have to be able to be back at work in 30 minutes if there is a transport or if anything happens to baby.
I guess if I can't pick her up if they keep her for the day, they can keep her overnight-she would be stressed to the max though!!

You would think being a baby nurse for 18 years I would be used to my patient not being able to tell me what is wrong, but this sux!! Everyone keeps telling me it is because it is My baby though so it is different.

Any other thoughts on what I can do prior to taking her to my Mom.

(We leave for Hw on Sat. AM so I need to be back Fri. night to pack etc as all I have had time/energy for is Pockets and work. I wanted to take her on Thursday evening so I could spend the night and get her settled in a little and leave around noon on Friday.)

Sorry to be so needy and stressed, I just need to try to get as much done tomorrow as possible... This dang trip (and work) is messing everything up!!!

Thak you,
Elizabeth and Pockets (oh and Dad too)

[labblab]

Hi Elizabeth,

I'm so glad that Lori has given you the additional info about the pancreatic testing. And I doubt that you would be able to work this in prior to your trip, but the other testing that I would recommend at this point is an abdominal ultrasound (but that should be performed on a high resolution machine, which may require a trip to a specialty clinic or UGA). As I said earlier, your description of Pockets' symptoms now sound much more consistent with Cushing's. But an ultrasound could provide additional confirmation as to the existence and type of Cushing's, as well as supplying helpful info about the state of Pockets' internal organs.

Unfortunately, it does really come down to a judgement call as far as continuing with the trilo while you're gone. Although, hopefully, the pancreatic testing will help shed more light on that issue. As you already know, Cushing's does predispose pups to pancreatitis. So if Pockets does not have acute pancreatic issues right now and is, in fact, a Cushpup -- then treatment for the Cushing's is a "plus" in terms of warding off future episodes of pancreatic problems...

But as far as what to do while you're gone -- since Pockets didn't seem to be doing that well during her first days of dosing, it feels a bit like "dealing with the devil you know" as opposed to the "devil you don't know"... Even though Pockets was not doing well prior to the trilo, either, I'm still thinking that it may be best to leave things as easy as possible for your mom, without the risk of unexpected surprises? But for today, let's see what the pancreatic testing turns up.

And as for the tremoring, just to muddy the waters even further -- we've had several occasions through the years when members have reported unexplained tremoring or "shivering" episodes in their Cushpups. Mine was one of them. Shortly after beginning trilostane, he developed severe tremoring across his shoulders, especially during times of rest or sleep. We consulted a neurologist, but were not able to identify a cause prior to the time that they ceased, just as mysteriously as they had begun. Other members have reported similar episodes, with pups on Lysodren as well as trilo. And some before treatment has even begun. What I am talking about here is different from the quivering of legs or the hind end from muscle wasting. That type of quivering is very common for Cushpups prior to treatment. But you're right, shivering can also be a result of pain. So once again, the pancreatic testing may help shed some light on that as well.

Definitely keep us updated as to how things go today!
Marianne

[da_lizard]

Hey everyone. Thanks for all the info.

I took Pocket to the vet. this AM. She did not really eat anything except the duck treats Monday night and nothing Tues. No vomiting, but still diarrhea. She has been drinking water and peeing.

This morning at the vet, she was interactive and nervous as usual. Wagging tail when she thought vet was finished with her and looked pretty good. I asked the vet about a cPL and he did not really say anything, but then I hit him with a lot about the trip, waiting on trilo, diarrhea, etc.

He did a chemistry panel (and I forgot to bring the labwork with me so I will tell you what I remember.

Na:K ratio was 30

pancreatic enzymes had decreased (I think lipase was 3100ish before and was now 2600ish) I can post full values tomorrow if you want them

BUN and creatinine were improved

That was the main points I remember.

He did not run a cPL though

He gave me a sample bag of ID dry food to see if she will eat it - she would not eat it today for them but that does not suprize me!!
Also since it seemed to get better after a couple of packets of Fortiflora when she would eat it, he gave me some diarrhea gel to squirt in her mouth a couple of times a day.

He agreed it would not be a bad idea to hold the Trilo until we are back as he said "the devil you know is sometimes better than the devil you don't know." He said he likes Trilo because he has seen less reactions with it over the Lysodren, but has seen some GI problems with it initially (so it sounds as though he has used it).

Now though Pockets is having what he said was reverse sneezing and a lot of nasal congestion (she was not doing it there for him, but was before I came to work again tonight). This started on Tuesday.

I do feel better knowing her labwork is better and that the Trilo is going to be held until we get back!!

Thanks for all the information and good wishes!!!

Elizabeth and Pockets

[AlisonandMia]

Hi Elizabeth,

Just a quick question - those duck treats, where are they made? There can be problems with treats from China. Stuff from China has to be irradiated for import and this seems to cause some (as yet unidentified) chemical change in the food. The problem caused is a type of acquired Fanconi Syndrome.

Jerky treats actually manufactured in the US should be ok though.

Alison

[da_lizard]

I think they are probably from China will look in the AM. We had stopped giving them to her in April when the diarrhea started and we went to just straight chicken and rice and just started back Mon. night. Will try chicken and rice again.

She is just so finicky-loves somethng one day and not the next, it is hard to tell when she is not eating versus not having what she wants.

Is it OK to give Benadry to Cushing's dogs? I wondered if this might help the stuffiness and reverse sneezing. I have given it to her in the past for itching.

Thanks for the info!!

[AlisonandMia]

Here's a link to some info on the Chinese treats/Fanconi issue: http://www.k9cushings.com/forum/showthread.php?t=599

Alison

[littleone1]

Hi Elizabeth,

I have not posted to you before, but I have been following your thread.

Corky has allergies, and his IMS has approved of him taking Benadryl, or a generic for it. I would check with your vet or IMS first. Every furbaby is different.

I'm hoping everything will go well.

Terri

[da_lizard]

Thanks Alison, will definately stop with those!!!

Elizabeth