Introducing Pepper

[zlypy]

I'm so grateful for the community the members and admins have created here. My life has been a whirlwind for the past few weeks and it would be great to share my story.

Pepper is a 9 year old shih-tzu/maltese. His story starts in March 2022, when he tore his ACL chasing a squirrel. Since I used to work as a vet tech, we elected to just rest him and let the ACL heal on its own. He was also his heaviest at this time (17lbs) so he started a strict diet. Even without exercise, he started losing 0.5 lbs a week, but also at this time his appetite went CRAZY, which we attributed to the lower calories and no more snacks and treats. End of March he eats 30 chocolate covered raisins my sister left out but with great vet support his kidneys didn't feel a thing. In May he starts waking up at 7am to pee (usually could sleep in until noon) but we assume he adopted my sister's school schedule. End of May he gets a dew claw infections that takes 3 weeks to heal. He's almost completely better on his ACL leg, but I start to notice his hind legs start bending a bunch when he walks and he started limping. He's had arthritis in the past so we were told not to really worry about it. Beginning of June he has two incidents of urinary incontinence overnight and we take him to the vet, and he's treated for a UTI. The vet also notices that his submandibular lymph nodes are very swollen and we perform a cytology that comes back negative. Two weeks later the urine is re-checked, the UTI is resolved, but he still occasionally urinates in his sleep. The vet recommended xrays and ultrasound but we decided to wait a week to see if it would resolve (because $$$$), and it did. Beginning of July his arthritis is still bad so I make an appointment at a holistic vet to try acupuncture and chiro. By the time the visit comes around 2 weeks later his hair is thinning, his belly has black dots, he has an abscess on the underside of his tongue, his belly is bloated, and he has noticeable muscle loss. The holistic vet immediately is suspicious of Cushings and performs a full blood panel, acupuncture, laser therapy, and gives us herbal medicine. The next week I follow up with my regular vet, who performs a LDDS test and ultrasound. Very high cortisol, mass on right adrenal gland. He goes on 15mg of Vetoryl, which we re-checked 3 days ago. His cortisol levels are under control but now his BG is super high (around 450) with sugar in his urine, so he started 2units Novalin-N yesterday. Past 3 weeks I've been taking him out around 3, 4am to pee, and now he's able to hold it until 7:30 again. We're rechecking BG on Saturday because on Monday I have a surgery consultation with a surgical oncologist. Crazy 3 weeks!!

I'm constantly back and forth between being sure he's going to die this month and being sure we'll get him to age 15. His activity levels have increased on Vetoryl (he did have 2 sluggish days), his appetite is back to normal (eating well but now refusing foods he normally would have before, like lettuce), he's peeing less, and today he even went up the stairs which he hasn't in months. So many symptoms were masked by other things; hind leg weakness = arthritis and ACL tear, big appetite = on a diet, bloated belly = used to be overweight and always had a big belly, peeing a lot = new wake up schedule, dew claw infection = couldn't keep his sock on and kept licking it, uti = he's had one last year.

We are definitely leaning surgery, but I'm afraid that Monday will give us news that he's a poor candidate, especially with this new diabetes thrown in (i suspect he's been pre-diabetic for a while and the Cushing's pushed him over). His ultrasound report said the tumor is 1cm and "resting" on the caudal vena cava, and the vet said she's unsure whether it's invaded it. I'm ready to do CT scans to see. I am so, so grateful that we got insurance right before everything started, but now I'm nervous that they'll kick us off (can they do that?). To top it all off, I have a trip scheduled for the 29 for a week and a half, which if that's when we need to do surgery so be it, Sweden can wait (crying).

My lingering questions that I hope to get advice on:
Can successful removal of the tumor reverse his diabetes?
If he has a successful surgery, will everything really go back to normal? His energy levels, his drinking, his hair loss?
When do you think his Cushing's really kicked off? I'm guessing it was around end of May when his hind legs started weakening. I'm worried that his body has had to deal with it for too long and he has irreversible damage.
Any recommended supplements? He's on a CBD chew, immunity boosting chew, fish oils, and various herbal medicines from the holistic vet.
Recommended diet? He's been on a home-cooked recipe for years now, and I just adjusted it to be 65% protein, 20% carbs, 15% fat. It's chicken breast, peas, carrots, zucchini, oats, safflower oil, and a vitamin blend specialized for this recipe. This week I introduced a nugget of raw venison in the mornings which he's been doing well on.

Also, side note: the holistic vet put him on turmeric and it is GOLDEN. His hind legs look way better, and since his ACL tear he used to pop his left shoulder out constantly to compensate for the injury and because of arthritis in his shoulder. About a week on the turmeric and his shoulder is nice and straight all the time. Definitely recommend if anyone's dogs are having arthritis issues.

I really didn't mean for this to be crazy long and yet.

[labblab]

Hello and welcome to you and Pepper! I’m afraid it will be tomorrow before I’m able to return and write a more comprehensive reply. But I wanted to let you know that your membership is now approved, and you don’t have to worry about completing any further email confirmation :-). We’re very glad you’ve joined us, and I surely look forward to talking with you further about your sweet boy.

So stay tuned, and once again, welcome to our family.
Marianne

[zlypy]

Thank you so much! I know I wrote a ton so no rush

[Joan2517]

Welcome from me, too! A ton of information is good! If you could type in the results from the LDDS and also any HIGHs and LOWs on the blood work that was done, that would be great. It sounds like poor Pepper has been through the wringer. I've had two dogs with Cushing's and this forum has helped me tremendously. My Lena was 14 by the time she was diagnosed and died a few months later, but my big, boy Gable was diagnosed when he was around 7 and made it to 13, which I know he wouldn't have if I had not learned from the wonderful people on this forum.

It sounds like you have a good vet who will work with you. I didn't have that with Lee, but I did with Gable...and that's what you need.

[zlypy]

Hi, thank you for you responses. Pepper passed last night. He was active and happy all day, until he very suddenly collapsed. I wasn't home, but my mom said it took a matter of minutes. She performed CPR for 40 minutes. He had been improving the past few days and had more energy. The vet wasn't in today so I wasn't able to speak to her, but I'm assuming it was a blood clot somewhere. While I was upset about him having maybe just a few months left, I feel so cheated now of that time.

[labblab]

Oh no! What a horrible shock! Since Pepper’s collapse was so acute, it seems as though it could indeed have been a clot. Or perhaps an internal bleed? I don’t know whether adrenal tumors can rupture and cause emergent crises, but maybe the tumor was involved in some way with the collapse. For instance, there is a particular type of adrenal tumor — Pheochromocytoma — that can cause a host of life-threatening problems due to the type of hormones it secretes, including heart attack or cerebral hemorrhage. Whether spontaneous rupture of the tumor itself is also possible, I do not know.

But no matter what the cause, I know your heart is broken. You have been trying so hard to save Pepper’s health, and now this. Life can just be so cruel. I realize there are no words we can say to ease your pain. But please know how sorry I truly am. Also know that even though you have just found us, we’ll continue to remain here by your side should you wish to talk with us more in the days ahead. Everything is undoubtedly a huge jumble right now. But we’ll always be here as you sort things out. Thank you so much for taking the time to let us know what has happened, even in the midst of your own shock and pain.

Again, I’m so deeply sorry. Huge hugs to you. And fare thee well, sweet little Pepper. Fare thee well, little boy. Even though your earthly time with us was short, we’ll always honor you here as one of our own.

https://www.k9cushings.com/forum/sho...288#post211288

Always in loving memory,
Marianne

[Joan2517]

I'm so sorry for your loss of Pepper. Losing our beloved pets is so hard, whether it's sudden, or longer. I still talk to my Lee and now Gable...in my head, in written words, and lots of times out loud. It makes me feel good and somehow it feels like they are still with me. It helps...

[zlypy]

Thank you so much guys. We've been spending a lot of time together as a family and healing, looking at pictures and sharing stories. Two days after, a big thunderstorm came through and a huge rainbow showed itself in the sky. It also got a little easier once we got his ashes and he was able to return home. He have a spot set up for him with flowers, pictures, and his favorite blanket. My sister was sitting near him yesterday on her computer when she noticed a pepper seed on her foot - he used to infiltrate our garden every day and gobble up all the bell peppers. We think it's his way of saying hello. I spoke with the veterinarian and she made it seem like because the tumor was so close to the caudal vena cava, it was a blot clot originating from there. I thought he had a chance since the mass was only 1cm, but 1cm in a 11 lb dog must still be large. I keep running through every possible scenario in my head, of how things could have gone differently these past few months, but in honesty I think this was the best possible way it could have ended. I am sure that he would have passed in or after surgery, and the guilt of that would have been unfathomable. Or he would have not done surgery and slowly grow weaker until euthanasia or maybe another clot. The universe was so cruel to him but we gave him such a loved life.
The one thing I can't get out of my head is this - I've read that cushpups frequently get blood thinners after surgery to prevent clots. Have you ever seen any beginning blood thinners prophylactically? I'm not sure if this would have even helped anyways.

[labblab]

It touches my heart to read about your rainbow and also the pepper seed! What sweet connections to your boy’s sweet spirit, and what gifts for your own hearts.

For sure, it seems that the proximity of the tumor to the caudal vena cava created the potential for multiple serious issues including that of a clot. So your vet’s speculation certainly seems like a strong possibility. In answer to your question about blood thinners, I’ve been following Cushpups on this and related forums for nearly 20 years now. And even though apparently Cushing’s can generate an increased vulnerability to clot formation in general, I can only recall a couple of occasions when dogs were given blood thinners unrelated to surgery recovery, and this was due to specific known risk factors that the dogs had evidenced in terms of pulmonary or cardiac function. So I don’t believe the practice is generally commonplace. But if anybody else has any info in that regard, I hope they’ll share it with us.

And in honesty, I’m very grateful on your behalf that you’re finding some peace in Pepper’s release. I have to agree with you that his longterm prognosis was very questionable given the location of that tumor. The way things played out, he was spared all the anxiety and any trauma. And he was safely at home when the moment of transition occurred. I don’t think there can be any good way to lose our beloved companions. And probably no matter how they leave, we wish it had been otherwise because the truth is just that we never want them to leave us at all.

We had to make that horrible decision for the final drive in to the vet with each our first two dogs in order to grant them peace when their bodies broke down. My beloved current Lab girl will be turning 14 in a couple of days, and her arthritis is so bad that every day now we just hold our breath that she’ll be able to keep walking until tomorrow. Otherwise, she’s totally herself and it haunts me that we’ll likely have to be making that last trip to the vet yet once again, just because of her poor old hips and legs. I try to imagine that if she just passed away peacefully in her sleep one night, I would find some peace in that myself. But having said that, I know that no matter how she leaves us, my heart will be breaking just the same afterwards and I’ll be wishing that things had been different and wondering what else I should have done. When we love them so much, I don’t think there’s ever an easy way to say goodbye. Never.

I apologize for hijacking your thread to talk so much about myself this morning! But what you’ve written about Pepper resonates with my own heart, too, and I thank you for that. Do take care, and please continue to return to us whenever you have more questions or more thoughts to share.

Best wishes,
Marianne

[zlypy]

Hi Marianne,

I've had this post open in a tab since August with the intention to write back. However, the grief was too strong for too long for that. It still floods over me in large waves, but less frequently. I wanted to say that I appreciate what you do for this community so much, and your replies helped me feel less alone in this loss. The hardest part these past few months have been trying to not take personally a very personal event. The universe or fate or God wasn't out to get Pepper or me, the world just happens to be chaotic and unpredictable and senseless things happen to the best people and animals. The most we can do is help each other along the way. I recently saw a quote that said "The grief is never ending but so is the love", and while it hurts to feel it, I'd rather have my love for him live on in this way rather than not at all. Again, thank you for being there for me and so many others on this forum.

Paulina