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Thread: New here, and unsure what to do...?

  1. #1
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    Default New here, and unsure what to do...?

    Hello everyone, I'm new here - and I'm sorry, maybe this question is more just seeking support as I am a bit anxious right now, but you may also have useful information for me?

    My 13 y/o shih tzu was diagnosed with Cushing's last summer, and so far it has been well controlled with Vetoryl. She hasn't really developed too many of the common symptoms yet, though there is some fur loss and she has had some recurring skin infections. She is on a course of antibiotics right now for her second skin infection, finishing that up. Her eyes have been pretty bad since I adopted her years ago - cataract, scarring from uveitis - one eye she hadn't seen out of much for years, the other has a cloudy cataract. Well, the sclera often looked a little pinkish, and I asked her vet about them and had the pressures checked - he said it was within normal limits, but it ever became very red, then it was a concern.

    This past week, I did notice one eye seemed more red, though it seemed to come and go - other symptoms that seemed to come and go were some squinting of that eye and a little watering. I thought it might clear up if it were pink eye or allergy. This is the eye she already doesn't see much out of, if at all. I planned to take her to my regular vet Monday if it hadn't cleared up. Then today, I noticed that that eye's cornea seems cloudy - and I wanted to take her to a vet ASAP (I'm always fearful of glaucoma), but all the vets were closed for today and Sunday. I looked into emergency vets, but all of the ones I can find, near and far in my area, have a significant number of terrible reviews!! I don't want them misdiagnosing or starting her on something she doesn't need, especially something that might interfere with her medication or her Cushing's. Yet I am also worried about letting this go another day before she can be seen by my usual vet on Monday. Do you think I am better off waiting for my vet on Monday - would that be okay? He is very experienced with Cushing's and we have years of good experiences with him. Or should I take the risk and go to one of these emergency vets that I don't feel very confident about and might just get us started on a wrong path?

    Thank you for any advice - I'm guessing there are others here who also understand what it's like to feel worried about their pups and unsure what to do.

  2. #2
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    Default Re: New here, and unsure what to do...?

    Hello and welcome to you and your sweet girl. Gosh, I wish I knew more about eye conditions, but I'm afraid I would be in over my head in that regard. As a result, I really can't tell you which approach is best. However, bear in mind that even if you do opt to have an ER vet examine her today, you don't have to approve any diagnostics or meds with which you take issue. So the peace of mind of at least having somebody evaluating her today may make you both more comfortable even if you do choose to return to your regular vet tomorrow. I always get pretty panicky about eye issues, myself, in both humans and animals.

    Obviously the eye problem takes first priority. But once that gets straightened out, we'd love to hear more about your girl's Cushing's journey, generally. Please do keep us updated regardless of which way you decide to go with the vet visit.

    Marianne

  3. #3
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    Default Re: New here, and unsure what to do...?

    Hello. Welcome to the forum. I too don't know much about eye conditions. However I wonder if there could be an infection? Also how are her teeth as teeth infections can also cause eye issues.
    I'd take her in first thing in the morning unless you think she is getting worse and I'd ask for a referral to a doggie ophamologist who specializes in dog eye issues. That is what I ended up doing with my dog when she started to lose her sight due to high blood pressure causing retinal bleeds.

    Do let us know how she is doing and what the vets say.

    Welcome to the forum
    Sharlene and the late great diva - Molly muffin (always missed and never forgotten)

  4. #4
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    Default Re: New here, and unsure what to do...?

    Hello again! Thank you for the replies. Yes, I was unsure what to do because I figured it could be due to a few different things - with the Cushing's also, I just wanted to be sure she got the best care....I can be a teensy paranoid since I have experienced and heard of other people experiencing bad/misleading care for their pet.

    I just wanted to update you all on my own experience in case it helps anyone else! I finally found afterhour/ER services at a hospital that had very good reviews and took her in on Sunday afternoon - it was indeed glaucoma, in both eyes, though the worse eye was the one that was red and cloudy. By this point, it even looked a little like it was bulging, though it is hard to say because that eye already had poor vision, turned outward, cataract and scarring inside, and shih tzus have huge eyes. She had the eye like that from the time I adopted her years ago. Anyway, the pressure was quite high, and they started her on drops, I am also seeing an ophthalmologist today.

    I wish I had taken her in right away instead of waiting to see if it would clear up (pink eye or irritation). We had other things going on, then the holiday, and it seemed to vary in redness and she didn't seem in much discomfort - but had I googled as I normally do, then I would have seen I should have taken her right away, even if it were a false alarm. I have recently had to take her in frequently for various things, and I wasn't sure if I was being a hypchondriac so I hesitated - but if your dog has this bloodshot eye, take them in right away, don't wait for it to get better or worse is my humble advice! If it is the weekend and vets are closed, please still take them to an emergency clinic as it is an emergency - every hour counts. By the time it is red it may already be advanced, certainly it was advanced by the time it was starting to get cloudy as it was when I took her, but the earlier the better as vision can be lost very quickly.

    The topical drops they gave does not interfere with the Vetoryl, is what they told me. Also, they said if the Cushing's is well controlled, then the glaucoma wasn't caused by elevated cortisol. I am curious to see if the ophthalmologist will have anything else to say, but my guess is just drops. Poor doggy - because she was already deaf and had poor vision in both eyes - barely any vision in that worse eye, but now I don't know if she has any in that eye. The other eye has a cataract in it. My focus now is to really hope her other eye will stay as it is with glaucoma drops, I don't want her to be blind and deaf together. I am just glad that at least the Cushing's is well managed for now and her eye pressures are down. She is a trooper for her age and lots of different age-related issues.
    Last edited by Jade; 11-28-2016 at 12:38 PM.

  5. #5
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    Default Re: New here, and unsure what to do...?

    What did the ophamalogist say? I'm a big fan of using an ophamologist for dog eye problems. It really helped my dog and I saw them at the recommendation of our internal med specialist.

    Hopefully the eye drops will help out. How is she doing now?

    yes shihtzus have those huge eyes and it can be hard to tell if they already have eye issues exactly what is going on with them. They sure are beautiful though.
    Sharlene and the late great diva - Molly muffin (always missed and never forgotten)

  6. #6
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    Default Please help! Seeking advice from experienced dog parents/owners!

    Hello everyone,

    It has been nearly 3 years since I last posted. My very senior dog has Cushings disease, along with a host of other serious health issues: glaucoma, heart disease, arthritis, possible slipped disc/spinal degeneration issues, unstable/painful joints. She has been hard of hearing her whole life as long as I have had her (I adopted her), and she has been completely deaf for a few years. She lost all vision in one eye from glaucoma 2 years ago, and she now has an ulcer and inflammation in the other eye that is leaving her essentially blind in that eye as well. I always thought being blind and deaf, along with all of her painful joints, would be poor quality of life for her. Her doctor says it's too early to see if the dog can adjust, but I think she's very old, does not appear to be adjusting - is miserable. The doctor is still trying to heal her eye, but it is taking much longer than expected for any progress to occur, and it is unsure whether any further progress will occur, and if so, what - she may still be blind or near blind in that eye if even this issue can be resolved. It has already been over a month that the poor dog is miserable - discomfort, anxiety, pain, blind, deaf, going to the vet every week. It is also severely wiping out my bank account and my paid leave and raising eyebrows at the office because I take off so frequently to try to care for my dog. Her appointments are costing $250 to $400 per week, plus additional medicines right now with this eye problem. Her other issues were being adequately addressed through medications - heart and lungs look great, bloodwork looks great, joint/nerve pain somewhat managed, though still definitely there. Her present anxiety through this latest ordeal was being managed with anxiety medication, but now she is refusing to eat any food or medications (no matter how I try to hide/administer them). So all is okay with meds - but now she won't take meds. And she has a LOT of meds. LOTS. It's not a matter of just forcing in 1 or two pills. She is fine with taking them when she has an appetite. The problem is zero appetite.

    Up until the past few months, she did great on Vetoryl. Then she started having episodic diarrhea and vomiting, and her vet would recommend that I just skip one dose, and that would resolve it. But this time, I am taking her off for at least a few days. I have read that side effects of too much Vetoryl can be anorexia, increased drinking, increased muscle weakness....I just need the dog to eat. Even using the appetite stimulant is not working with her. I am hoping that stopping the Vetoryl will increase her appetite again so that she can take her meds - because without those meds, her pain and misery are too great (nevermind all the heart condition stuff, I'm looking at immediate quality of life issues).

    I know this is the part where one might ask, well why don't you take her to the vet? My answer is this - I have taken to the vet so many, many times, with increasing frequency over the past few years. I don't have the money left for all of the appointments or tests they may recommend. Some months I have spent up to $1000 on veterinary bills/medicines. I can't sustain all of the vet appointments she needs as she develops new issues. She's got 3 doctors as it is (1 regular vet, 2 specialists). All of this was doing great for a couple of years, but I am wondering how I can tell when it is time to stop, because she's not doing great anymore. I am annoyed with her doctor right now for dragging out the eye treatment. Well, that's unfair. But the eye makes extremely slow progress (much slower than hoped/expected), and we aren't sure if it will ever actually heal...but I feel immensely guilty keeping the dog like this, deaf, blind, anxious, and in pain, while playing this extended wait and see game which will currently be going for at least 6 weeks. I wouldn't be surprised if it would be more, at this rate, but I can't know. I felt this hopeless when waiting for her eye surgery, then after that eye was taken care of, she was fine again.

    But this time, will she be fine? What about all of this arthritic pain? And what about the next medical issue, whatever it might be? It's so unpredictable, but it's a roller coaster now. No idea if/when there will be smooth coasting for a while, nor how long it will last. No idea if the next issue will be so painful that she needs to be put down....but I never wanted to put her down when she had already reached a state of extreme suffering, that seems too late for a peaceful end. I wanted her to have a peaceful end.

    Most of all, I think I have been expecting to receive permission from my dog about when to end her life. So many people have told me their dog gave them a sign, looked at them a certain way. But what if my dog never does that? And should we even expect that - aren't we, as the humans, supposed to bear the burden of such a decision for our little ones? I would love to receive a sign, but I am wondering if I never will. Before she went anorexic, she would still chow down on her food. She still likes being petted. She still seems feisty, just miserable. Her spirit is as strong as ever, but her medical issues are like a prison. She can't enjoy walks. She hasn't enjoyed toys in quite a while now. Food was her big thing, but that was really it. And being petted. Her gait was really wobbly/messed up from arthritis and neurological issues. The things she used to love most were walking and playing with toys, those things have been gone for a good long while.

    Should I wait until the next eye appointment next week, maybe being off of Vetoryl will increase her appetite and help her take her medicines, maybe the increase in cortisol will help her arthitic pain? At this point, I may just stop treating Cushings, at least for the time being. I simply cannot afford to go take her in, get her tested, re-dosed any time soon. Maybe later I can have her put on an alternative to see if it will help. But right now, she seems to need more cortisol. And she is nearing the end of her life (she is about 18). I am just sick of focusing on the day to day, trying to put out fires, when I can't see what the long term picture looks like. I think the long term perspective would really help me decide whether I should be putting day to day fires out, or putting my dog down to stop having her suffer through these day to day fires.

    So my main question is - is this as good a time as any to put the poor girl down, to end her suffering? Or if the eye problem has not resolved by next week - how long do I keep her like this? I feel like I am doing this for the sake of the doctor right now, like I am being strung along - YES, normally I would be all up for this, but when she has this many issues and is suffering in the present moment, and I know how much she has suffered over the past few years as well (coming in and out of things), is it time to say enough is enough, this is the last bout of suffering for her to go through? Then also the practical side of not being able to sustain it myself - the bills, the time off I need to take for all of her appointments, I am always on the verge of no leave and no money. And now, for the past month, no sleep - the dog is always waking us up in the middle of the night to be taken down to potty or to be placed in front of her water bowl or food bowl (when she was eating), and she's got that dang cone on that keeps her from being comfortable as well......and the lack of pain medication keeps her very uncomfortable now.

    Around and around it goes. Please, experienced dog owners, help me make sense of this - help me know how I am supposed to decide when it is time to euthanize my dog. I want her to go peacefully, without being in a state of acute suffering beforehand. Is now as good at time as any? If I wait, will she have suffered longer than she needed to? If I wait, will she maybe get better, but then later on have an even worse episode, a worse way to die? If I wait, and she gets "better", will her quality life still be so poor that it's not worth it? It's so hard to tell because her spirit is strong. I expected a dog's spirit would fade away. I'm wondering if my dog might bark at me for it, her spirit is so strong. She always wanted more than she could handle - even with walks. The Cushings and the heart disease made her strain so much, but she would still want to go on and on, I'd have to put an end to her walks and carry her up when I could tell she was getting exhausted.

    Sorry for this being so rambly.....please, owners who have had to put their dogs down, multiple dogs even, share some wisdom with me.

    Thank you....for wading through this. I am really distressed and confused. My first time owning a dog.
    Last edited by Jade; 10-14-2019 at 10:43 AM. Reason: Correction

  7. #7
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    Default Re: New here, and unsure what to do...?

    Sorry, this is a very delayed reply! I haven't been back to this forum until today. Well, that eye was already blind from the glaucoma by the time I got her to the doctor. I can't remember if it was just managed with drops for a while, but the pressure was so high and painful that the eye needed to be removed or destroyed. My dog was/is not a candidate for surgery due to serious heart issues, so the eye doctor injected her eye with a chemical to essentially "kill" the eye - that doesn't work in all cases, but fortunately for my dog, it worked. After this, she was much more comfortable. Her depth perception was off. She had trouble with steps initially, but then became very good at jumping up and down a curb, though I didn't have her going up and down stairs. She couldn't chase her ball anymore, though, her favorite game. She could sort of catch it in an altered game, and she still liked playing tug of war and trying to catch the sock we'd rile her up with :-) The doctor sill had her on a few pressure drops on that dead eye, just in case, and ointments and testing/monitoring to make sure it didn't get too dry. Also monitoring for that other eye, since glaucoma often also develops in the other eye eventually. She did good for a couple of years - until just recently, she developed a very bad ulcer in her good eye, and now is blind and deaf, plus in pain from lots of arthritis. I am currently trying to decide what to do about her overall situation.

  8. #8
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    Default Re: New here, and unsure what to do...?

    Hi Jade, and welcome back to the forum. I’m so sorry, though, for the rough time you and your sweet girl are going through! You’ll see that I’ve gone ahead and merged your new thread into your original thread — this way, all of your history and our earlier suggestions will be consolidated in one spot.

    You certainly are grappling with some very serious decisions. First of all, though, I totally endorse you stopping the Vetoryl for the time being and, at this point, perhaps forever. If you can’t entice your girl to eat, then no other medical treatment will matter very much. With everything else that she’s confronting right now, I do believe that Cushing’s may be one of the least of her worries.

    Given her age and her struggles, I also understand why you are considering euthanasia. It is one of the hardest decisions we’ll ever be called upon to make in our own lives, with so much doubt and indecision. However, my own belief is that it’s a decision that we must weigh based on our observations, experiences, and love for our animals. I, too, have heard so many people say that your dog will somehow signal you when it’s time. I did not have that experience with my two angels. It was a decision that my husband and I felt that we had to make on their behalf, based on what we were seeing with our own eyes. I do want to warn you that the question of whether it is “too soon or too late” is the one that haunts us all. If you are like most of the rest of us, no matter what you decide you may still always second-guess yourself. Without the benefit of seeing the future, there are always lingering doubts that things might have played out differently, if only you could have known. But all you can offer is your best decision on any given day, based on what you see and know at that time. And most importantly, based on your love for your devoted companion and your desire to ease their suffering.

    From what you are describing, I do not think there is any one of us here who would judge you harshly should you decide that your girl is suffering from too much ongoing discomfort to continue to prolong her life. And in my own mind, prolonging life through treatments and medications is just as much an intervention as is ending life through euthanasia. In the wild, your girl probably would have left this world long ago. It is only through your loving care that she has survived to reach this point. But now the most loving act may be to release her spirit from her failing body. Still, I certainly understand why you are so torn as to the best path forward.

    Since you’ve asked us for our thoughts, my own suggestion would be to go ahead and see if there’s any improvement during the next week, both in terms of her eye, and also with her appetite now that you’ve discontinued the Vetoryl. If the answer is yes, then there may still be cause for hope. If the answer is no, then quality of life issues may well become paramount. In the meantime, please continue to mull things over with us, and certainly do update us as to any changes in the coming days.

    Once again, welcome back to your family here.
    Marianne

  9. #9
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    Default Re: New here, and unsure what to do...?

    Hi Jade,

    Sorry your sweet girl is having such a tough time. I think stopping the Vetoryl is a good idea. At her age the constant vet visits and pokes and prods are a bit much. I am sure she would appreciate not have to face that any more at all. Letting the cortisol rise can also help with her arthritis and may help with the appetite. If it does not help with the appetite, then I would say there is the sign you are looking for. My little Chi that passed in Dec, who was not a cush pup, had one thing left that brought her joy - food. When the day came that she turned her nose up at food I knew that was the sign she was ready to move on. My Squirt also stopped eating and drinking - I would syringe food or water into her mouth and they would just roll back out. She had had enough. She was a cush pup, 16+ at the time, and I had stopped her treatment the year before. Whatever you decide we will be here with you. Know that whatever you decide is the right decision - no decision made from a place of love is wrong.

    Hugs,
    Leslie
    "May you know that absence is full of tender presence and that nothing is ever lost or forgotten." John O'Donahue, "Eternal Echoes"

    Death is not a changing of worlds as most imagine, as much as the walls of this world infinitely expanding.

  10. #10
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    Default Re: New here, and unsure what to do...?

    Quote Originally Posted by labblab View Post
    Hi Jade, and welcome back to the forum. Iím so sorry, though, for the rough time you and your sweet girl are going through! Youíll see that Iíve gone ahead and merged your new thread into your original thread ó this way, all of your history and our earlier suggestions will be consolidated in one spot.

    You certainly are grappling with some very serious decisions. First of all, though, I totally endorse you stopping the Vetoryl for the time being and, at this point, perhaps forever. If you canít entice your girl to eat, then no other medical treatment will matter very much. With everything else that sheís confronting right now, I do believe that Cushingís may be one of the least of her worries.

    Given her age and her struggles, I also understand why you are considering euthanasia. It is one of the hardest decisions weíll ever be called upon to make in our own lives, with so much doubt and indecision. However, my own belief is that itís a decision that we must weigh based on our observations, experiences, and love for our animals. I, too, have heard so many people say that your dog will somehow signal you when itís time. I did not have that experience with my two angels. It was a decision that my husband and I felt that we had to make on their behalf, based on what we were seeing with our own eyes. I do want to warn you that the question of whether it is ďtoo soon or too lateĒ is the one that haunts us all. If you are like most of the rest of us, no matter what you decide you may still always second-guess yourself. Without the benefit of seeing the future, there are always lingering doubts that things might have played out differently, if only you could have known. But all you can offer is your best decision on any given day, based on what you see and know at that time. And most importantly, based on your love for your devoted companion and your desire to ease their suffering.

    From what you are describing, I do not think there is any one of us here who would judge you harshly should you decide that your girl is suffering from too much ongoing discomfort to continue to prolong her life. And in my own mind, prolonging life through treatments and medications is just as much an intervention as is ending life through euthanasia. In the wild, your girl probably would have left this world long ago. It is only through your loving care that she has survived to reach this point. But now the most loving act may be to release her spirit from her failing body. Still, I certainly understand why you are so torn as to the best path forward.

    Since youíve asked us for our thoughts, my own suggestion would be to go ahead and see if thereís any improvement during the next week, both in terms of her eye, and also with her appetite now that youíve discontinued the Vetoryl. If the answer is yes, then there may still be cause for hope. If the answer is no, then quality of life issues may well become paramount. In the meantime, please continue to mull things over with us, and certainly do update us as to any changes in the coming days.

    Once again, welcome back to your family here.
    Marianne
    Dear Marianne,

    Thank you so much for your time and advice! It really helps with perspective how you've pointed out that prolonging life/fighting death with medical treatments at this point is just as much an intervention as euthanasia to end life would be. I am also beginning to think that it is hard to know the "right" time - maybe the two options are too early or too late - very rarely can we know if it's just right. When viewed that way, I would rather be too early. Your words are such a comfort and a help! I have spent all day searching for answers and ways to re-strategize her medical treatments and weighing that against euthanasia. But your words are helping me come to peace with the idea of euthanasia. I am realizing she may not experience the relief of pain, since she will die - but rather, the point is, she will experience relief from the other option - the experience of more and more suffering. It's that future that she is escaping, if I don't delay too much. And there's not much joy in her life - maybe not at all. All I see is love. She has love for us. She does not have joy in life. That is what is keeping her going, perhaps - and keeps me hanging on. I will give more of an update in the response I give to Squirt's Mom.

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