My boy Darwin died suddenly a month ago

[cat]

I was last on this forum in 2015 when Carlos died suddenly from Cushing's. Both Carlos and Darwin were Galgos (Spanish Greyhounds) rescues from Spain. Age is unknown as these dogs are simply saved by the rescue. My first Galgo was probably 10 plus years and I think on Lysodren. He saw an internist. He was closely monitored. At my regular vets for something minor, while waiting to leave, he walked to the door of the room and I opened the door to take him out. He started to collapse and I fell to the floor with him. He was dead. They did CPR but he was gone. We got Darwin, also a male Galgo, a number of months later. He joined our 2 Greyhound retired racers. From the moment he got out of his crate at LAX, he was my boy. We are retired and he was my 24/7 shadow. After the 2 Greyhounds passed away, he was an only. He was diagnosed about 18 months ago. I recognized the symptoms. He was on Vetoryl. He never had an MRI of the brain but it was pituitary. I did ACTH stim tests regularly. He took gabapentin for atopia he had when he came from Spain. He was about 85lbs. and somewhat stable on 30mg twice a day. However symptoms became worse (water consumption, hunger, heat intolerance) and I think his level was 4.6 on Vetroyl. The vet said that should control it. We went up to 30AM and 40PM. I was given conflicting advice over the phone and also called Dechra (drug co) to make all was being done correctly for the stim test re feeding. She noticed (I think) some liver inflammation on labs indicating not well controlled so that was when the dose was increased to 30 and 40, then 40 and 40 then back down to 30 and 40. Things were best controlled at 40am and pm. Like most dogs, he was not fond of the vets. I was going to take him back in for another ACTH stim. He had problems with a nail and cancer was a concern. He sailed through surgery about 7 weeks before his death and a toe was amputated. It was not cancer but a deeper infection. Oral antibiotics made him vomit and the vet said injections could not get adequate concentrations to that area. Every week on bandage change they applied different antibiotics. He had been in for a bandage change the morning he died. I gave him trazadone before the vets to calm his anxiety his last 2 visits.He wore his new chillvest and cooling collar from Ruffwear in the car. We came home and he jumped on the sofa. A little later I left for PT for a broken ankle. He was lying in his favorite leather chair with ottoman, his paws forward and his head was extended forward sleeping. When I came back from PT, do not think he was alone at all but who knows. He looked so peaceful I did not go over to home. A while later my husband went to wake him to eat and said "I can't wake him up." He was dead. I did CPR and all, no use. We rushed him to our 24/7 vets. He was dead. It is just like Carlos but I think he died in his sleep. When he was having to go in weekly for a bandage change with an hour in the car then the vets, I just did not want to take him for that long drop off (to me) for the ACTH stim so figured after he had his boot off would give him a couple of weeks and go in. He also had high BP (moderate and possible intermittent) but because of Carlos sudden death I asked if he could be on HBP meds and blood thinner. They did a TEG (I think) test and his blood was average so giving him plaquenil blood thinner was considered fine. I brushed his teeth daily and no bleeding. I almost did a necropsy but could not decide so did not. It would not bring him back anyway and even if found out would give me no peace. After he died, I read about the surgery they were doing at Univ of Washington removing pituitary tumors and wondered why nobody had mentioned it. Maybe he would not have been a good candidate. Maybe the risk would have been too high. Maybe I overdosed him and a stim test would have shown that. Maybe his tumor was growing and why didn't I ask for an MRI when symptoms flared. Even the internist I go to, who was recommended, it seems like Cushing's is just seen as one of those not so common things. I did everything I could not to have a repeat of Carlos sudden death and feel I must have missed something. Thank you for listening. He was our only dog for the last few years and got all the love. He deserved it.

[labblab]

Dear Cat,

I’m so very sorry for your sudden loss of Darwin. I surely understand why you have so many questions swirling. His death is painful enough, but the uncertainties must make it even harder to find any peace. I’m very glad that you’ve made your way back to us, though, although I know it wasn’t easy! And we’ll do our best to help you sort through your thoughts and your feelings in the days ahead.

I’m afraid I will be heading off soon to have some dental work done (YUCK!), so I likely will be out of commission for the rest of the day and it will probably be tomorrow before I can write more. But I definitely want to welcome your return to our family, although I’m so sorry it’s under such sad circumstances.

I’ll be back again to talk soon,
Marianne

[labblab]

Dear Cat,

Here I am, finally back again — I’m sorry it took me so long! First of all, I want you to know how kind I think you were to adopt both Carlos and Darwin. They were both such lucky boys to end up in your loving forever home, and the care you’ve taken of all your furkids has been exceptional. Once again, I’m also so sorry that you lost both your boys so suddenly. As I wrote earlier, I think the shock of a sudden loss prompts so many unsettling questions. As it turns out, one of our other members has just lost her boy, Pepper, very suddenly as well. I’ve just now added a reply on her thread that I could have added just as easily here. It deals with the fact that it’s probably impossible not to be burdened with questions and doubts, no matter how we lose our precious dogs. It’s because we love them so much, and would do anything within our power to keep them with us. But heartbreakingly, that’s not a power within our grasp.

I will tell you honestly that I don’t think there’s anything you should have done differently with Darwin. It’s interesting to me that you even took the extra step of putting him on blood thinners, because that’s a question that Pepper’s mom was asking us about. It’s not something that I have much knowledge about, so you might want to stop by her thread if there’s any info that you’d wish to share with her about that. Here it is:

https://www.k9cushings.com/forum/sho...oducing-Pepper

As far as surgical intervention with pituitary tumors, the results were historically variable and we’ve not had any members in recent years who have given it a try. So I’m embarrassed to say that I honestly don’t know what the current status and outcome of those types of procedures have turned out to be. However, they still are not commonly performed except at a few specialty centers and as a result, for better or worse, they are not a treatment option that is frequently offered to patients.

All in all, I think you gave Darwin his best possible chance to live as healthy a life as was possible for him. And his peaceful passing was probably a great gift to him, even though it has broken your own heart. I surely wish I had more specific answers to offer to you about exactly what might have gone wrong for him at the end. But it surely was not for your lack of trying to help him. Or for a lack of love. That is abundantly clear.

Even after having done such a poor job of answering your questions, I still encourage you to go ahead and ask about anything else that comes to mind. Or just to return to tell us more about all your dogs and your lives together.

I remain very glad that you’ve returned to us, and that you’ve allowed us to join you in honoring your sweet boys.
Marianne

[cat]

Thank you for your support. Have had a very rough month.
i dreamed he was alive the other night. I venture to guess that a lot of us dream of our pets after they are gone. I am posting some cut and paste links on the pituitary tumor removal surgery. I also read that the surgery is first choice of treatment for pituitary Cushing's in Europe. I recall the Netherlands being mentioned. The cost is prohibitive for most unless you have really good pet insurance. Some policies now let you elect unlimited benefits. Still a pretty high, I believe 8-20% mortality during surgery and recovery. Hopefully cost and mortality will improve over time. I think both my boys with Cushing's died of a blood clot. Sudden death in peace was a blessing for them but not to be able to say good-bye is such a nightmare. I was with my Carlos when he dropped to the floor at the vets and I grabbed him and lay down on the floor as he went down. I saw in his eyes he was gone and there was nothing they could do with all their CPR. I remember when my husband found Darwin dead we hoped with CPR and mouth to mouth our ER could do something. I sat across from him on the couch and Darwin was probably already dead. Galgos like Greyhounds can slow their breathing so much when sleeping that I have put my hands on any one of them to make sure they were OK. After Darwin died, I would stare at the leather chair and ottoman and think, "Oh Dar, why didn't you tell me you were leaving. I'd have lain down with you and maybe we could have gone together." I did not really want to go but did not want to be separated from his from him. For me, and I think a lot of us on this board, the love of an animal is an all consuming passion we hope against hope will never end. When anything is elective, I always ask myself and the vet about the consequences of my decision. I try and tell myself nobody ever makes all the right decisions. We can lack knowledge, understanding, have incorrect information, have less than top notch vets, and, of course, our own emotions run very high with our animals. I try hard to forgive myself. I hold others to a pretty high standard too. Losing 9 dogs over the past 40 plus years has taught me a lot about what I do and don't know. But I always think I should have known or done more.

https://news.wsu.edu/news/2021/07/26...s-disease-wsu/

https://www.aaha.org/publications/ne...united-states/

https://vetmed.tamu.edu/news/press-r...gland-surgery/

[labblab]

Thanks so much for these recent links. We can definitely use them to update our resource library. As it turns out, Dr. Owen was originally located in Los Angeles, and it was there that she performed her first pituitary surgery in 2011 on one of our very own members, Lucy. It was a successful surgery, and we were such excited cheerleaders for our “Lucy-Goo!”

http://dogaware.com/articles/newscushingssurgery.html

Subsequent to Lucy, Dr. Owen relocated to Washington and also a couple other centers started offering the surgical procedure here in the U.S. Among our membership, however, we were more likely to see different radiation techniques employed to shrink enlarging pituitary tumors as opposed to surgical removal at an earlier stage. At first, radiation involved multiple conventional treatments spaced over time, all requiring general anesthesia. With the development of more targeted laser intervention, far fewer treatments have been required. With all these treatments, surgical or radiation, results have been variable, as you already know. Every patient brings their own individual risks to the table. But for those dogs who have benefited from successful intervention, it has been a gift. In years past, we had a much larger membership here and therefore we had more personal opportunity to keep abreast of treatment advances. However, now we largely rely on articles and printed research, so I’m grateful for your updates.

I also want you to know that your questions and doubts about your own decisions definitely resonate with me. My first dog was my Cushpup, Barkis. He’s who originally brought me to this family back in 2004 and his photo remains my avatar. Although we never performed the imaging to confirm it, he started displaying neurological symptoms consistent with an enlarging pituitary macrotumor. At that time, the only treatment offered was a number of conventional radiation sessions. We decided against that, and ended up having to release him when his symptoms became too severe. There are many aspects of my handling of his illness that still trouble me to this day if I allow myself to dwell on them. I feel certain that I made mistakes, and I will always carry guilt for that. But fortunately, the passage of all these years has finally softened the pain and now I remember our wonderful times together far more often than those dark final days. But as you say, each of us who loves our companions so dearly will forever wish that we could have had more time together, no matter how long we are given.

If it would please you, it would be our privilege to add both Carlos and Darwin to our memorial threads of honor. We can also add a photo link for each of them if you’d want that. If you visit our “In Loving Memory” subforum, you’ll see where our memorial threads are maintained. If you’d like for us to add your boys, just tell me the date of their passing. And we can talk further about photos, if you’d like that, too.

https://www.k9cushings.com/forum/for...-Loving-Memory

No matter what you decide, thanks again for returning with this additional information. And I continue to send you my best wishes.

Marianne

[djpassman]

Hi Marianne,
I'm new to this forum. My dog, Maia, has been diagnosed with Cushings. I'm trying to locate centers that perform the transsphenoidal hypophysectomy. I know Dr. Owen at WSU performs it, but I'm having trouble finding other locations. I'm trying to contact Texas A&M as a possibility. Someone mentioned a VCA in Boston, but I googled those and there are quite a few. I checked your Resources page and couldn't find anything. Do you know of other centers that perform this surgery? I would really appreciate it if you could let me know.
Thank you so much!
Deborah Passman

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Administrative Note: Deborah and Maia now have a thread of their own, so any information or suggestions can be posted directly to them here:

https://www.k9cushings.com/forum/sho...hypophysectomy