Can someone tell me

[Alaska]

Well here it is the middle of the night and I'm just sitting here thinking good thoughts towards RD and his mom. Hope tonight is a lot more restful for both of you than last night.

 

I second the speculation that the wheezing, and maybe the diarrhea too, could have been related to the IV fluids. I overhydrated a dog with an IV once (by misunderstanding the doctors orders), and yeah, the excess fluid does have to go someplace.

 

Here's my helpful suggestion for the elbow: take close-up photos at least once or twice a day. That way you can show the vet how it progressed, and how it responded to your treatment. Also, when I'm not sure whether the dog really needs to be dragged off to the hospital, I'll drop by and show them a photo and let them decide. Could save a little wear and tear on the patient (and sometimes, in my experience, on the wallet as well).

 

Sweet dreams...

[Mudpups]

Well, its early evening over here in Australia, but I keep checking back to see if RD has made any progress. Best wishes to all of you that you get some rest and have a peaceful night.

 

Michelle

[shanni and kingsley]

keeping my fingers and toes crossed for RD

[kelpiegirl]

Well jeez, you just can't catch a break sometimes. I would ( as you said) go to the vet today, and get it looked at. I know by how bad Nikke's infection became, just how bad things can get FAST, and the smell thing- definitely infected, and the abx he is on, may not be effective against this particular bacteria.

[painted_ponies]

Just checking for updates. I'm glad to read RD is rallying. I've been praying for him. And his mum.

[Kyrasmom]

Just wanted to check in and add my good thoughts and crossed fingers and paws for a continual mend. Your blog entry made me cry and brought me back to when I was caring for Kyra, loving her so much, and all I could do was hope that she would respond to her meds.

 

best of luck to you both!

Maria

[MrSnappy]

Well, we are going in to the vet in a half hour to get those abscesses looked at. I opened up the big black one on his elbow and drained a boatload of pus out of it (sorry to be so graphic). I have been putting hot compresses on it periodically. Poor guy must feel like crap as even with his cone of shame on he keeps trying to lick them.

 

In other pancreatic related news, he is still holding his own. Still drinking, eating sometimes and had a perfectly normal poop this morning. A vet friend recommended strongly that I consider a plasma transfusion, so I am going to try and find the money for that and look into it as an option. My bank account is pretty well tapped out.

 

There's your update! Thanks again for all your help and well wishes etc.

 

RDM

[sweet_ceana]

We're still thinking of you both. Hang in there RD! All the girls in the office are adding their wishes to his recovery as well.

[Laurae]

That sounds encouraging! And I hope you'll give out PayPal info for people to donate to on behalf of RD's vet expenses if they wish to, considering all that you have done for needy border collies over the years...

[nancy in AZ]

And I hope you'll give out PayPal info for people to donate to on behalf of RD's vet expenses if they wish to, considering all that you have done for needy border collies over the years...

 

Yes-please do!!

[OffTopic]

Just adding my well wishes.

Hope RD continues to beat the odds and that you continue to hold strong for him.

[MrSnappy]

You know, I don't know how much more of this I can really take. We just got back from the vet, where we confirmed RD did indeed have a giant disgusting pressure sore on his elbow. Vet cleaned it out and I am to make sure he doesn't lie on it at all. He also pointed out that RD is in the first stages of Cushings, and warned that even if he does recover from the pancreatic attack, there's a) the Cushings and the intense scarring of his organs from the amount of pancreatic fluid that leaked into his abdominal cavity. He is still bloated and all.

 

What you do? I mean, I can't stay home forever with him to make sure he doesn't lie on his elbow, to feed him every two hours etc. - I work on contract, and I don't get paid when I don't go to work. And so he recovers from pancreatitis to die from Cushings? I just don't know what I'm doing anymore. He's bright and alert and eating, so I certainly can't kill him. But I don't know if I'm doing any favours keeping him alive either. This just really sucks.

 

RDM

[ShoresDog]

Oh man, that does sound hard. How can you keep him from lying on his elbow without pretty constant supervision? I wish I could come over and dog-sit for you. Whatever happens, you have lots of people pulling for you and RD. Sending you <<<hugs>>>.

[Samantha J]

Oh no it just gets worse for you both.

Poor RD and poor you.

 

Have you got anyone who can sit with him or maybe a few people maybe take turns to sit with him whilst you are at work. At least for a few days until you see how he does.

 

I don't know much about Cushings but i think it can be treatable. So if he does get over the other things then hopefully that can be treated and he could feel well again still.

 

I feel for you, never met you or your dogs but on here you get to know certain dogs through photo's, blogs etc and so it does make you feel bad knowing they are so poorly.

 

The fact that he is eating, drinking etc has got to be a good sign i hope.

 

It does definately suck!!

[MrSnappy]

He has Cushings because he is on long term prednisone. The Cushings most like precipitated / caused the pancreatic attack, the margarine being a red herring. He is on prednisone because he can't walk - LITERALLY - without it. I can't take him off the prednisone, I can't keep him on the prednisone. And I can't kill him ... because I just can't.

 

RDM

[kelpiegirl]

Look at each thing, one at a time. I am not sure how you can keep him off that elbow- can you get some HUGE padding on it? I mean, not letting him lay on that would mean someone watching him 24/7, and even the vet's office can't do that. If you make big enough padding, so that he decides to lay on the other side, that may work.

[stockdogranch]

I wish there were more I/we all could say and do for you and RD. Just know that you are in our thoughts and prayers. The only other thing I can offer is to listen to RD--he'll tell you what to do,

A

[OffTopic]

Look at each thing, one at a time.

That's really all it sounds like you can do at this point.

It sounds to me like you may have reached the quality of life point with RD.

So, one at a time....

I agree that you can't watch him 24/7 on the elbow thing and the pad idea sounds like a really good option. What would a padded splint on that leg do? One that keeps the leg straight out. Would that force him to lie on his side more?

 

You can't give him prednisone because of the Cushings, Cushings may have precipitated the pancreatic incident, he can't walk without prednisone.

Which of these is the worst for him in terms of quality of life?

If you continue to give him prednisone, is he likely to have another pancreatic attack, even if you change his diet to the dreaded low fat Hill's Science Diet crap food that somehow seems to help some dogs? Or to a homemade low fat diet?

 

If you continue to give him prednisone, the Cushings will get worse. How fast? The vet said early stages. How quickly does the disease advance?

If you stop giving him the prednisone, the Cushings will go away (right?). What happens if you take him off the prednisone long enough to reverse the Cushings and then put him back on it? Is that enough of a break to give the adrenal glands time to heal? Buy some time that way?

But....

If you stop giving him prednisone, he can't walk. Not a good life for any dog. And I know you said you've tried all the other drugs. And I'm assuming arthritis as the cause.

How about physical therapy combined with a different drug? I know they use water therapy for humans with arthritis, strengthens the muscles around the joints without putting as much weight on the joints while exercising.

Also, since arthritis is inflammation, how about one of those cooling pads for him to lie on? That actually helps my older dog quite a bit....I don't have a pad, but I will put an ice pack against his neck and spine when he gets a flair up. But with his, you can actually feel the heat radiating from the flair up site.

 

I really don't expect you to address all these, I'm just throwing them out there. I know if it were my dog, I'd be so frazzled I couldn't think straight. Maybe having some questions listed out like this can help you focus on each issue.

 

I hope for your sake and RD's sake that there is still some wiggle room between that rock and hard place.

[Soda-pop]

Can you put a tshirt on him with a tennis ball sewn in the side so he can't lay on that side? Or a "brace" on the arm with the sore with something that makes lying on it uncomfortable? That's what they suggest doing for snorers.

 

My heart goes out to you.

[urge to herd]

Sheena, my heart goes out to you and RD as well. I wish I had a magic wand, or even some good ideas for you. Anna's right, RD will let you know.

 

God bless, and know that we're all pulling for you and your wonderful boy.

 

Ruth n the BC3

[Jack & Co.]

Ruth expressed my sentiments way better than I could! (Thanks, Ruth!) Hugs to you, RDM, and RD.

[Mudpups]

Sheena I am so sorry to hear that. If you can sort out the not leaning on the pressure sores as the priority, this might give you a little time to recover mentally/emotionally/physically to be able to assess the whole situation a bit clearer. While none of us would see a dog suffer, it is not easy to make the best decisions (and ones that we can live with) when we are exhausted and stressed out of our brains.

 

I completely understand your "I just can't" statement.

 

Is the vet 100% certain that leaking pancreatic enzymes have damaged other organs? Has this been confirmed by blood tests that are not improving? Or was the fluid ascites? I know this may be totally unrelated to canine pancreatitis, but my husband has idiopathic pancreatitis, its nearly killed him on a number of occasions, and from my experience with this disease, human Doctors don't know a lot about it. Its a wait and see game, and alot of it is assumptions on what is going on inside. My hubby has had a CT scan that showed his pancreas was necrotizing (which is irreversible)...and yet further CT scans showed no necrotic tissue whatsorever. He has had heart, lung, kidney and liver involvement (confirmed by BTs/scans) on more than one occasion...all of which resolved without medical intervention and have not caused permanent damage.

 

I know human...elderly dog...big difference, I guess what I am trying to say is make your decision (one way or the other) based on your gut instinct and what RD is telling you, rather than the doom and gloom the may be saying. Of course quality of Life must be taken into consideration, but a decision made today is not necesarily the same decision you may need to make next week, next month or next year.

 

I hope that you and RD have the strength to get through this, whatever the outcome may be.

 

Michelle

[Mojo]

RDM:

Before I say anything else, did the vet just diagnose Cushing's based on clinical appearance and RD's history of long-term glucocorticoid therapy, or did he actually get a urinary free cortisol/creatinine to confirm the suspicion? Did they see anything that looked like an adrenal source of the Cushing's (i.e., a tumor) on his ultrasound? Okay, here's one whopper of a question: do they think that RD's facial issues from a few weeks back might be in any way related to the Cushing's...i.e., a PITUITARY tumor that caused all of this? Please know, I *really* don't mean to scare you, but facts are facts--the tumor is either there or it isn't, and if there really is an adrenal tumor, the vet SHOULD have seen evidence of something on the ultrasound. I can't quite remember all the facts offhand about RD's facial drooping, so I can't recall if they were typical of a pituitary lesion or not. The vet should have been able to put all of that together for you without having to get a brain MRI, or anything like that.

 

Now, regardless of whether the Cushing's is the result of the chronic steroid treatment or an adrenal or pituitary tumor, RD is not likely to "die of Cushing's," in all honesty. The disease itself is not that bad, but the high levels of cortisol in his system DO make him more immunocompromised (i.e., it could have had something to do with his infected pressure sores, too). Cushing's also makes patients more susceptible to other disorders like, as you noted, pancreatitis, among a host of other things (diabetes, heart problems, renal failure, etc.)...but you have to remember that ANY dog, really, is susceptible to major medical disorders as they age. For example, Godiva doesn't have Cushing's (although, incidentally, she has a benign, totally unrelated adrenal tumor) and has never been on steroids a day in her life, nor had any previous health problems, and yet, she somehow developed major pyelonephritis that turned into kidney failure AND pancreatitis AND colitis out of the blue--and we still have zero explanation as to why, other than that she is an old dog. Clearly, I haven't put her down for any of it, and trust me, there have been extremely bad days that turned into extremely bad weeks and months. More on that below.

 

Similarly, chronic quality of life issues related to Cushing's itself are not that terribly significant--I think the main symptoms in dogs are really just weight gain, lethargy, skin/coat issues, and excessive thirst/hunger/urination, which are really not good reasons to put a dog down, IMHO. In fact, a lot of times, in light of other conflicting medical issues (i.e., in RD's case), you may not even want to bother to TREAT the Cushing's disease itself--so that right there may be an option for you. Yet, if treatment is warranted in the hopes of improving those few Cushing's symptoms , as you noted, iatrogenic Cushing's caused by long-term steroid therapy is fully treatable by removing the source of the exogeneous cortisol, and even if the Cushing's turns out to be the result of an adrenal or pituitary tumor, there are effective meds to treat those, too, if RD is not a surgical candidate (and I would agree with that). So, you have more to fear from the pancreatitis than the Cushing's, IMO. The leaking pancreatic fluid is not unusual for pancreatitis, and while it could cause a general peritonitis of his abdominal cavity, with his steroid doses (i.e., immunosuppressive meds) on board, it is certainly quite possible that it won't affect him too much--you said he was bloated, but seemingly feeling fine, so that's all very good.

 

Now, about the steroids. If there IS a pituitary or adrenal tumor, there's likely no need to stop the steroids, or taper them, or do anything to them on behalf of the Cushing's, since they have nothing to do with the source of the problem, but could be adding to it. If there is no tumor, however, someone above mentioned the possibility of temporarily "stopping" the steroids to give the Cushing's a chance to remit, and THEN starting the steroids again. That's actually medically sound, as long as the initial steroid taper is done according to protocol. I think I stated this previously, but in humans, the taper of long-term steroids is done very gradually over months, not days or weeks, in order to prevent "Addison's" (rebound adrenal failure that is similar to primary hypoadrenalism--i.e., Addison's).

 

From everything you have said, though, I fully recognize that RD needs long-term steroids; I'm not quibbling with you there. I just don't know what dosing schedule he's on or if there is any room for even temporary adjustment. IF there is, I am just suggesting that, as another option, you and your vet could work out a taper to decrease the steroids to a point where it seems like the Cushing's is getting better (as the adrenal glands recover their old function), while balancing the arthritic pain symptoms that may appear as the doses are lowered, and then work up the steroid doses again (hoping that the newfound adrenal function is preserved)....but it MAY not be worth doing. Really. I'll say it again: Cushing's may sound scary to you, but RD likely doesn't even notice that he has Cushing's, and it will very likely NOT hurt him significantly to have it, as long as you keep a close eye on all of his other medical problems, and any new ones that may develop subsequent to the Cushing's...but in theory, that is all part of taking care of an old dog, in general, and has much less to do with taking care of an old dog with Cushing's.

 

Now, about YOUR quality of life: all I can do is show you what mine is. I am going to try my best not to get extremely sentimental here, but as I have also mentioned before, your case is particularly near and dear to my heart because it is so similar to what Godiva and I went through not all that long ago. Godiva is my best, oldest, and truest friend, and I've shared almost half my life with her. She is also my first dog. When she got sick, "devastated" did not really cover how I felt, and I had some pretty big decisions to make. I was extremely lucky that all this occurred when I was at a place where I could leave my old life, choose to take a new job, work out a plan with my new boss, and essentially take a 50% pay cut from what I should be receiving with my level of education/expertise in order to stay at home (telecommuting) with Godiva during the days, and only physically go into work a couple nights a week, at which point my kind and wonderful (albeit totally dog-inept) BF comes home and takes over the dog-sitting shift for the night.

 

I really can't remember the last time I went to a movie, or to a club, or did anything with friends that "normal" young people do, if it would involve leaving Godiva at home alone for more than a few hours. She simply can't be left alone for very long, what with all her dozen-odd medications that have to be given at various times of the day, and her four to six home-cooked feedings a day, plus her daily fluid injections, and going out to use the bathroom every 2-3 hours....if I neglect any part of it--even one, single missed pill--I usually will come home to a house splattered with vomit and urine and/or feces and one, very miserable dog. If I comply with all of the above, however, for the most part, Godiva is quite happy and energetic--even BOUNCY, and we are just four months shy of her FIFTEENTH birthday, now. Most people don't even realize that she has major organ system failure when they see her--she's got bright eyes, a healthy coat, and a spunky, imperious little attitude.

 

And yet, when she's sick, she's REALLY, really sick--in spite of all that I do, I still can't prevent ALL the bad days, and we both have to battle through them as a matter of course. In fact, in late December, she somehow got an episode of (what I thought was) idiopathic vestibular syndrome (her vet thought it was a stroke) that left her essentially comatose for a full seven days. Once again, my vet wanted to put her down, and yet again (and for good, this time) I told him where he could put his advice. Godiva did not move, or eat, of her own free will for seven, full days, and obviously, she was vomiting multiple times a day every single one of those days. We really thought it might be the end, this time. Yet, despite the vomiting and the mostly closed eyes, she really didn't look like she was in pain--she just wasn't moving, and when I tried to prop her up, she would fall over unsteadily! So, I waited, and waited, and patiently waited some more, just giving fluid injections and syringing baby food down her throat and carrying her outdoors to pee at intervals. Then, on the seventh day--PRESTO. Very similarly to what you described RD did, which brought tears to my eyes when I read it--she popped her head up from her mound of blankets and diaper pads on the sofa, looked at me with eyes wide open, and simply decided that she was sick of being sick--she let out one weak little bark to let me know that she was *finally* hungry. She's been fine ever since, happy like her usual clam, and totally back to her stubborn-mule self. Seriously--there's nothing like having a dog to make one exquisitely humble about what they *think* they know about life.

 

In summary, her good times are REALLY good, and her bad times are REALLY bad. Yet, in spite of all the bad times, she has never once ever made me think that SHE wanted to give up. At least, not yet. So, I do whatever it takes to keep those good times coming, and battle out the bad times with her as they come, which is why it's very hard to make plans, or even appointments, with Godiva in the house. I think everyone I know now considers me to be extremely flaky, because it's always, "I'm so sorry...it turns out I can't make it. Godiva's just vomited...AGAIN." Or, "Godiva is having a uremic crisis...AGAIN." And now I've got a new one that has PSEUDO-SEIZURES, so what shambles was left of my social life have now completely disintegrated into nothing...but it was the choice I made for myself. I recognize that it is not likely a choice that many other people would make, or one that most even have the freedom to make, but it was, and is, what makes ME happy, so in theory, MY quality of life has not suffered much at all. Getting to see Godiva bounce across the floor in a burst of rare energy to chase a toy, even for five brief, beautiful seconds, is worth far more to me than everything I have given up on her behalf. I personally feel I owe it to her more than ever--she has, after all, devoted her entire life to being my best little girl, so giving her my time now is the least I can do to repay her for all the wonderful years we have had together.

 

I think I'd just like to emphasize again: bad times happen, and old dogs feel bad a lot, particularly when they've got chronic issues, and so you need to evaluate each individual episode quite honestly and as objectively as possible, which is often hard. In my personal opinion, if there is any hope of recovery, particularly if there is any hope of MAINTAINING the dog relatively pain-free and ambulatory (i.e., nothing like metastatic cancer, or something similar for which there is no treatment and the dog is expected to get progressively worse day by day), despite expected ups and downs, as long as YOU have the strength to go through it, I see no reason why you should not continue letting RD be as he is.

 

I really hope that helps in some small way.

[Alaska]

1. One day at a time.

 

2. If what you want to do is stay home with RD, I urge you to do that and not worry about the cost. I will be eternally grateful to the person who gave me this wise advice when my last dog was slowly declining. Conversely, I will eternally regret an earlier decision not to do that with an earlier faithful companion.

 

3. It won't last forever; nothing does. Odds are that what you're going through won't last all that long at all in the grand scheme of things, regardless of the outcome.

 

4. I don't know how you feel about giving out Paypal info for people to donate to you personally, but I do know how to donate to TDBCR. I have just donated a day of my take-home pay in honor of you and RD. I hope that will help you put off worrying about your job for another day, at least. For others who may want to do the same, there is a "Make a Donation" button near the top of the TDBCR Available Dogs page here.

 

Finally, your situation keeps making me think about a book I read recently: Merle's Door, by Ted Kerasote. If I knew how to reach RDF, or someone in Vancouver, I'd ask them to buy you a copy to read while you hang out with RD. I liked the book a lot, and in your present situation I think you might too.

[Allie Oop]

RDM, I read each update on Red Dog with a pain in my heart. The worry and wait take a big toll on you, both emotionally and physically, so try to take care of yourself. Having gone through a medical ordeal with my beloved 14 yr. old dog a couple of years ago, I know a bit of what you're feeling. I have to say, you will know when the time has come and that you need to say goodbye. Hang in there and know that there are a lot of other people who are wishing you, Red Dog and the rest of TWAAW, well.

 

Regards,