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Leo the Boston Terrier Medical Update: Pet Parent Warnings, Cushings, Medications and Second Opinions

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Leo the Boston Terrier Medical Update: Pet Parent Warnings, Cushings, Medications and Second Opinions

*AS NOTED IN PREVIOUS BLOG POSTS I AM NOT A VETERINARIAN OR DOCTOR OF ANY SORT.
**I AM A COLLEGE DEGREE HOLDING PET OWNER THAT BELIEVES ALL PET PARENTS NEED TO BE PROACTIVE, DO THEIR RESEARCH, FOLLOW THEIR INSTINCT AND ADVOCATE FOR THEIR PETS. IF IN SHARING OUR EXPERIENCES AND LEO’S STORY WE CAN HELP OTHER FAMILIES IT WILL MAKE US FEEL LIKE WE CONTRIBUTED TO THE WELLBEING OF THE PETS AND THEIR LOVING FAMILIES.
As most of you know Leo had an anterior luxation that caused acute glaucoma and had to have an eye removed in May of 2013. In October of 2013 we noticed some symptoms in Leo that lead us to believe he may have Cushing’s Disease. Symptoms at the time included: weight gain in belly, fur loss on lower back region, panting and a slight increase in water intact. We took Leo to the vet and expressed our concern stating that we thought he may have Cushings and requesting he be tested for it. At this point in time that vet told us that the symptoms Leo was experiencing were common signs of a thyroid issue. They tested his thyroid and told us it was low at which point he was put on Soloxine. A few months later we took him back in to the vet for bloodwork to see how his levels were and Leo was diagnosed with a non-specific liver and kidney issue as a couple of his liver enzymes were elevated and he had 3+ proteins in his urine. Leo was then put on Denamarin to assist with liver function. More time passed and bloodwork was done two more times by this vet, both times Leo still had elevated liver enzymes and protein in his urine. Finally, we were able to talk them into testing for Cushing’s Disease as Leo had an increase in Cushing’s symptoms. They ran the test and it came back negative for Cushing’s Disease. We then continued to monitor Leo’s liver and kidney function with no definitive answers as to what was going on, what was causing the issue or how to effectively treat the issues. At our final visit with this vet they diagnosed Leo with high blood pressure and attempted to put him on medication for that…at this moment I decided to follow my gut and seek a second opinion from a holistic vet in our area.
Upon meeting the holistic vet and having him examine Leo and go over all of his records he noted that Leo’s thyroid was fine and that he did not need to be on the thyroid medication Soloxine in the first place. When testing the thyroid there are three numbers that come back, many vets only focus on one of the numbers, but all three numbers need to be taken into consideration. Our new holistic vet explained that thyroid issues are often times over-diagnosed in dogs. At this point in time we decided to take Leo off of the Soloxine as he didn’t need to be on it in the first place and it was what was probably causing the increase in blood pressure for Leo. A month and a half after taking Leo off of the Soloxine we took him in to run blood tests and check his blood pressure. Leo’s blood pressure was perfect! Leo’s thyroid was perfect! A couple of Leo’s liver enzymes were elevated and Leo did still have protein in his urine. We put Leo on some Chinese herbs to help with liver function and decided to do more bloodwork the following month. The next set of bloodwork came back with Leo still having increased levels of liver enzymes and protein in his urine, Leo also had increased calcium levels. At this point with all of the bloodwork results all of the signs were pointing towards Leo either having lymphoma or Cushing’s.
As concerned pet parents we were not good with the idea of Leo having lymphoma, so we started researching Cushing’s again, at which point I made a few very interesting discoveries. The following is the exact (minus the blocked out names) email that I sent to our holistic vet sharing the information I found and seeing what his thoughts were:
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Dr. ___________________,
I apologize for the length of the following email, but also know that typically I am better at explaining things in writing than I am verbally…so it is a bit of a read, but I feel there are some good points. Goal is for Leo to be as healthy and happy for as long as possible. I know that there is a chance that Leo has lymphoma, but looking at all of his symptoms, etc. I feel that he probably has Cushing’s Disease.
The symptoms most commonly seen in dogs with beginning Cushing’s include:
Increased thirst and urination (which can lead to the symptom of incontinence): When monitoring Leo he does drink significantly more than our other two dogs. During daytime hours they drink nearly the same amount, but Leo is up at least three times every night drinking water. Leo also requests to go outside far more often than the other two dogs. We have been lucky thus far and not had any incontinence issues.
Increased panting: When first bringing up the concern of Leo possibly having Cushing’s with old vet I did inform them that Leo was panting much more than normal. Leo, at that time, could sit and just pant, even with no physical activity prior. Leo is currently not doing this anymore.
Weight gain in the abdominal area, in spite of a reduction in calories (pot belly): The main symptom noticed with Leo, other than hair loss, was that he was getting or had a Buddha belly that was mainly noticeable when he was sitting, but was also quite noticeable when he was standing (he appeared almost pregnant).
Thinning skin and change in the pigment of skin, from pink to grey or even black; bruising: Leo’s skin does appear to be thinning, especially in the belly and neck area. Leo’s skin pigmentation has also changed in his ears turning to the greyish black color.
Hair loss and dullness of hair: Leo has significant hair loss on his lower back. Leo has also lost much of the sheen of his coat.
Irritability or restlessness: We’ve not seen much irritability out of Leo as he is typically very good natured. We have noticed a lot of restlessness.
Increased hunger: No increase in hunger noted.
• Seems very tired and inactive: Leo does at times seem very tired, but still has a great amount of physical activity and enjoys playing. We associated his decrease in activity with an increase in age.
Gets skin infections: Leo is suffering from ear margin dermatosis that he has never had before, this is new to him.
Decreased Muscle and bone mass: Leo’s muscle tone is lacking compared to how it used to be, we just associated this with aging.
Much less common are symptoms of rear limb weakness and blood clots. Leo has shown signs of weakness in his rear legs. Old vet noted that he did not immediately move paw back when she curled it under and stated it was “nerve damage.” We have witnessed Leo having episodes of back leg shaking and this has been increasing. Noticed it for the first time about 6 or so months ago. There are times that Leo’s back legs or hind end will shake while he is standing, but this does also occur sometimes when he is in a seated position.

Cushing’s is an over production of cortisol which is the stress hormone. Leo didn’t start showing any symptoms until October of 2013. In May of 2013 was when Leo had his eye removed, which could have been a trigger as he had been in a lot of pain prior to surgery and losing half of your vision, plus your depth perception, along with running into things, etc. has to be very stressful on him. The increase in cortisol can affect immune function, “trigger a glucose release from the liver” (thus making the liver work harder and I would assume knock liver enzymes, etc. all out of balance). “Cushing’s dogs get referred after a misdiagnosed liver disease. The liver of an animal with hyperadrenocorticism gets overtaxed from trying to process the excess cortisol in circulation throughout the body. This causes an elevation in the liver enzyme alanine aminotransferase (ALT) and the inducible liver enzyme, alkaline phosphatase (ALP).”

There are two major types that affect dogs:
Pituitary dependent. This form is the most common, affecting about 80% to 90% of the animals who have Cushing’s. It happens when there’s a tumor in a pea-sized gland at the base of the brain, called the pituitary.
Adrenal dependent: This type comes from a tumor in one of the glands that sit on top of the kidneys, called adrenal glands. About 15% to 20% of diagnosed dogs will have this type.

When we first took Leo to old vet with concerns about him having Cushing’s they diagnosed him with a thyroid issue and put him on Soloxine. The following are cautions linked to Soloxine:
Cautions:
Soloxine should not be used if your pet has ever had thyrotoxicosis, or an uncontrolled adrenal gland problem. Tell your veterinarian if your pet has heart disease, anemia, diabetes, or problems with the pituitary or adrenal glands. If you give your pet insulin or diabetes medication by mouth, dose adjustments may need to be made.

Being that Cushing’s Disease in dogs has two primary types: Pituitary dependent and Adrenal dependent and that the above states that Soloxine should not be used in cases where the animal has issues with pituitary or adrenal glands I question if Leo being on Soloxine when the Cushing’s test was done could have affected the test results.

Depending on your opinion I would really like to re-test Leo for Cushing’s Disease, or start to treat him for Cushing’s Disease to see if it would help him.

Sincerely,
Roxanne ______________
SOURCES:
http://pets.webmd.com/dogs/cushings-syndrome-dogs
http://healthypets.mercola.com/sites/healthypets/archive/2010/09/21/cushings-disease-caused-by-pet-stress.aspx
http://www.1800petmeds.com/Soloxine-prod10138.html
http://healthypets.mercola.com/sites/healthypets/archive/2010/09/21/cushings-disease-caused-by-pet-stress.aspx

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Our holistic vet received this email on Monday November 2 and by Friday the 6th we had Leo in testing him for Cushing’s a second time. As you remember from above the old vet tested him and it came back negative. This time Leo was not on unnecessary medication (Soloxine) that would skew the results. On Monday November 9th we received the call that confirmed that Leo DOES have Cushing’s Disease.
Leo has now started Vetoryl, one of the only FDA approved medications to help with Cushing’s…not a cure, but a help. Leo has only taken two doses so far.
Now our adventures in diagnosed Cushing’s Disease begins….we will be sharing Leo’s story along the way.

**PET PARENTS:  PLEASE FOLLOW YOUR GUT.  FOLLOW YOUR INSTINCT.  GET A SECOND OPINION OR EVEN A THIRD IF NEEDED.  DON’T BLINDLY TRUST A DIAGNOSIS IF YOU FEEL LIKE IT COULD BE SOMETHING DIFFERENT.  DO YOUR RESEARCH.  ASK QUESTIONS.  ADVOCATE FOR YOUR PETS–YOU ARE THEIR VOICE!!!

Leo the Boston Terrier with his sister Kuki and brother Doc.

Leo the Boston Terrier with his sister Kuki and brother Doc.

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Aging Independently & Doctors Know Best?

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  Dorothy was born the day after President Calvin Coolidge declared the Statue of Liberty a national monument.  Dorothy has lived through Lindbergh’s nonstop flight across the Atlantic, the stock market crashing, the development of plastic, WWII, Pearl Harbor, the A-bomb, tv becoming the next big thing,  Alaska and Hawaii becoming states, the Cuban Missile Crisis, Kennedy’s assassination, the British Invasion, hippies, a man on the moon, the endangered species act, introduction of the world-wide web, 9-11, and all of the moments in history in-between. 

     Dorothy was married.  She gave birth to 5 children, but was only able to raise 4 of them due to one passing away while being born.  In her 40’s Dorothy decided to stand-up for herself and divorced her husband who she believed was stepping out on her (a story in itself), this left her to raise her youngest child independently, he was 12 years old at the time.  Dorothy raised her children, worked full-time, maintained a home, was an active member of the community and a very independent woman.  Dorothy lived through the untimely death of her oldest son.

     After all of Dorothy’s children were raised and moved out on their own she became an empty nester.  Dorothy never remarried or even considered remarrying.  Dorothy spent almost four decades living independently after her children moved away.  Her youngest child always lived close and was able to help with tasks that she was no longer able to do on her own like putting the dock in and taking it out, mowing the lawn, shoveling the snow, fixing the roof and so on.  A few years back Dorothy slipped and ended up laying on the floor of her home for almost 13 hours before her son came to check-in on her.  She did not break anything, or even get hurt, but her son decided that for her safety she should live with him…this also helped him because their homes were almost 35 miles apart and fuel prices were on the rise.

     Dorothy lived with her son for a few months, she was doing well and slowly starting to adjust to her new living situation.  Not too long after that her son got married and the household became three (well, 4 with the dog).  Dorothy’s sons new wife had worked in health care for many years and having her help was very appreciated.  The home was large and everyone had their own space, so there was still a feeling of privacy and independence.  A year later Dorothy’s son got a job in a different state and Dorothy was offered the choice of finding a nice assisted living facility in the area or moving out-of-state too.  Dorothy had no interest in living in a facility and decided to move with the family.

     The new home in the new state was not handicap friendly.  Dorothy uses a walker and physically is unable to manuever stairs without assistance.  In the new home the three bedrooms were upstairs, so the family set up the livingroom as Dorothy’s bedroom.  Her bed, dresser, lift chair, television, everything in one convenient place…a living bedroom.  At first Dorothy seemed to be comfortable with the set-up, but soon her family found that she was spending very little time in her bed at night which was causing increased edema in her legs.  Dorothy’s mood slowly worsened and she overall seemed very unhappy.  Her family sat down and talked with her and Dorothy explained that she had been independent her entire life and that she wanted to have her own apartment and be independent again, she explained that lack of privacy from not having her own bedroom was really wearing on her. 

     After months of searching the perfect little affordable apartment was found.  The apartment was close to her son and daughter-in-law’s house so that they could stop in and “check” on her everyday (at least once a day).  Dorothy’s apartment was decorated with paintings that he father had done, antique family furniture, and other wonderful things from her past that made her happy.   Dorothy was happy to have her own bedroom and her family soon noticed that she was actually sleeping the whole night through in her bed, and even taking a nap now and then during the day in her bed.  The swelling in her legs decreased significantly, her mood increased significantly.  Dorothy enjoyed feeling like she was independent again.  After a lifetime of being fiercely independent, being able to have that feeling of independence back was exactly what Dorothy needed. 

     Everyday Dorothy’s family comes in and preps her breakfast and lunch for the next day, they make her a wonderful hot supper and spend quality time visiting with her.  They make sure her home is clean, laundry is done, assist her with bathing, do all of her grocery shopping, assist her with making sure bills are paid, and in assisting her with all of these things Dorothy has the belief that she is living independent.  Yes, she gets a lot of help, but loves having her privacy and alone time.

     Due to a different family member attempting to cause some trouble a few months back Dorothy has been being visited by a social worker monthly and has been forced to go have a physical.  Dorothy comes from the school-of-thought that if it isn’t broken don’t fix it, so getting her to go to a doctor’s appointment when she was not sick was like pulling teeth.  This last Monday Dorothy went to her unwanted doctors appointment.  The doctor was shocked that a senior woman of 87 years old was not on any prescribed medications, that all she takes is a daily multi-vitamin.  The doctor did a basic once over on Dorothy and encouraged her to get booster shots.  Dorothy agreed to the booster shots, but strongly refused to get the $300 shingles shot that medicare does not cover.  The doctor told her that she needed to get a pap-smear, mammogram and other tests and Dorothy immediately stood up for herself and told him “No, I don’t want those tests.”  The doctor spent less than ten minutes all together with Dorothy and during that time encouraged her to “move to an assisted living facility” at least four times, Dorothy was not pleased with his pushing and said “I am happy where I am.”

 

This gives you the back story and brings me to my points and questions.  I am the daughter-in-law who has worked in health care for over eleven years.  I’ve worked in group homes, nursing homes, hospice, in-home, etc. and the one thing that has rang true through all of my experience is that the majority of the people I have worked with have one long-term goal and that is to be INDEPENDENT.  Yes, in some situations there is no chance of the person living independently, but in other situations, like Dorothy’s, the person can have their own apartment and live mostly independent.  We believe that Dorothy currently has assisted living being that we help her with the majority of her daily tasks, but she feels independent because she has her “own” apartment and her family is coming over to “visit”…she would hate knowing that someone is getting paid to go in and spend time with her and help her.

As people age and become seniors they need to feel like they are still productive members of society and that they are needed.  When we take away their freedom of choice, their basic tasks that they are capable of doing and their independence, they will then feel useless and that is a feeling that none of us enjoy.  Look at the amount of seniors who get put in nursing homes and forgotten.  I’ve worked in a nursing home where you could see how depressed the residents were because their families had not called or visited in months, and when they finally would it would only be for about half an hour at a time…the residents would feel like they weren’t needed or wanted and that was why their family “stuck them in a home”.

If an individual is getting to a point health wise where they need the professional nursing care an assisted living facility or nursing home is probably a really good choice.  If an individual is getting to a point where they are a safety risk to themselves or to others an assisted living facility or nursing home will probably be the best bet again.  I personally do not believe that if an individual is in overall excellent health (for their age)\and is not a risk to themselves or others that they should be forced into a home.  It is almost like todays social service and medical system believes that once people reach a certain age that they should automatically be placed in state care of some sort, which I find ridiculous.  Why is it that the “system” trys to take seniors rights, choices, and freedom away?

Dorothy has been independent, strong-willed and a very private person her entire life.  She enjoys spending quiet time alone watching sports and doing puzzles.  She enjoys spending time with people when they come over to visit.  She enjoys feeling like a productive member of society.  She enjoys helping fold her own laundry.  She enjoys choosing when she want to go to bed or take a nap.  She enjoys choosing what she wants to eat for breakfast and eating when she is hungry, not when someone else tells her she is.  She enjoys going through her closet and picking out her own outfit for the day.  She enjoys being able to dress herself.  Now imagine if she was in a facility of some sort, where they schedule meal times, pick out and help you dress, and take those little freedoms and choices away?  Dorothy always says the same thing when the idea of a nursing home is brought up and that is “I will die before I go to a nursing home.”

Do you have senior loved ones that you’ve had to make the hard choice of finding an assisted living or nursing home for?  Did they get to help make the decision or was it made for them?

Do you have senior loved ones that you are caring for?

Have you thought about what you would want for yourself and your family when you become a senior and need assistance, both minimal and extensive?

Do you feel like todays seniors are getting their rights and freedom taken away and not having any say in it?

At what point do you think seniors should receive more assistance?

Is our medical system just out to make money?

Is our medical system recommending tests, shots, exams and so on that aren’t really needed?

Do you think that a doctor can know what is best for you or for your loved ones when he/she has only known you/them for less than 15 minutes?

How do you think our medical system should change to actually get to know you and your loved ones before they start making recommendations and choices for you/them?

What are some of the flaws you see in our medical system?

What are some of the flaws you see in our social services system?

Would you want your rights to be taken away once you become a senior?

Do you trust your doctor and their opinions?

When the time comes what living arrangements would you prefer?  Do you want to live in a nursing home or assisted living facility?  Do you want your family to care for you?

With the amount of abuse that you hear about on the news would you feel safe living in a facility or having a family member live in one?

Do you advocate for yourself?

Do you advocate for your loved ones?

Do you encourage your loved ones to advocate for themselves?

What changes can be made to our medical system to make it better?

How would you feel if your freedom, choices, independence was taken away?