Killian's vet visit :(

[Sudilar]

Today was Killian's check up day. He was a good boy and even let Dr. Ball look in his mouth (a little). However, he does not like to give up any blood for testing. :rolleyes: That's always a chore.

Now, the dear sweet loveable big (still 106 lbs.) boy has drug induced Cushing's Disease (by clinical symptoms) to go along with liver disease and immune system problems (pemphigus et al). He has no undercoat anymore, has a pot belly and has muscle weakness in his rear legs. The worse news is that we cannot take him off the pred that is causing the disease. We are between a "rock and a hard place". Pred is the drug that has the least side effects for his liver, so that is what we are stuck with to keep the autoimmune disease at bay. We will TRY to cut him back by 1/4 a dosage, but it may send his system into another all out attack on his immune system. What to do!!! I watch him like a hawk, so I will try to cut back, but at the sign of the disease getting worse, I will be forced to up the dosage. I will have to look into the prognosis for Cushings to see what is in store for him. Can it get any worse?
Yes, he also has conjunctivitis. The good news is that he can use some of Shiloh's eye med to help clear it up.

Other than that, with all those diseases, he is doing well considering. He is his happy friendly wonderful self. I was truly blessed to have been able to rescue him from death row 7 1/2 years ago. I do not regret one minute. Killi, hang in there, Boy.

Shiloh will go to the vet next week. I can't take all this stress in one vet visit! :eek:

[Corinna]

MIxed blessing glad but sorry on your news. As long as he has a good quilty of life its good news I guess. Keep up the fight Killi.

[tatsxxx11]

Oh Killian, Killian, Killian:( Sue, as you said, the good news is he's doing so well on all other counts. Wow, maintianging his weight! That's such great news! But oh dear, drug induced Cushings? :confused: Seems I've run into a lot of dog moms lately that have pups suffering with Cushing's. And on the radio the other day, a vet was talking about Cushings and the drugs that are used to treat it, but I can't remember the names. He did say though that most dogs lead full lives with the disease, but of course, they are not having to also deal with all that Killian has been dealt:( Did Dr. Ball mention just cutting back the Pred or cutting back and adding another med for the Cushings? Sue, your head must be spinning right now. And through it all, you and Killian both manage to hang in there and keep fighting the good fight. You are one amazing team, you and Killian. Please keep us updated Sue. We're sending you our love and support and of course, lots of slurpy licks and tail wags. Hang in there dear, brave Killian! Sandra, Cody and Star:)

[Cinder & Smoke]

Hi God ~

We're not sure Who'z in charge of passin out da *challengez* fur
us guyz livin down here onna Big Durt Ball...

But kuld You check on whut's bein handed out
fur Killian an hiz Mom?

He'z been given a LOT of *challengez* -
an he an Mom are handlin em purdy well...

Kuld You ask em to *ease off* a bit?
Mebee jest let poor Killian *enjoy* hiz Senior Years?

'Preciate any Help You can give to this matter, God.

THANKS, God!

/s/ the Prayer Pups

[Sudilar]

We are just going to try to cut back on the pred. That drug is used for his pemphigus (autoimmune disease). Right now he is at the dosage where if we cut back, it might make his pemphigus worse ( crusty, stuffed nose, outbreak of crust on ears, mouth, body, oozing sores, etc. ), but I am going to at least give it a try. The meds for Cushings might affect his liver disease. He is in such a delicate balance right now, we are afraid to do anything. His pemphigus is slightly acting up still (nose sores and crusty spots). Since his Cushings is drug induced and pred is the offending drug, we are sort of in a little trouble here. Any pred replacement will also affect his liver so we are stuck with it. Everything affects his liver!

The good news is that he still has quality of life, that's for sure!!!

[tatsxxx11]

You PM'd me, my inbox is full. I PM you to tell you I emptied mine, and your's is full. lol! Seems were two pretty popular ladies!:D

[Sudilar]

Hehehe, tag....you're it!! My box is emptied now! LOL

[Sudilar]

Thank you Cinder and Smoke!!

Sometimes I wonder what else can go wrong..........then it does!

Pretty soon I should know all about so many diseases that I could open my own vet practice!!

[chocolatepuppy]

Sudilar I've been between that rock and a hard place with my Mandy in making decisions about her health, it's no fun. I'm sure you're doing the best you can. And I'm sure Killian knows how hard you try. My thoughts and prayers will be with both of you.

[dragondawg]

with the Pemphigus, but have you tried other immuno-suppressants in the past?

One of the preferred treatments is with Azathioprine, although that one can be hard on the liver. Cytoxin and Leukeran are also drugs that are used routinely.

A possible thing try that you should discuss with your Vet is to start tappering the Prednisone while starting on Leukeran at a low dose. As you continue to decrease the Prednisone, increase the Leukeran. Over a period of weeks if not months you might be able to reduce the Prednisone down to a very low level, while depending on Leukeran to keep the Pemphigus under control. The main side affect of the Leukeran will be myelosuppression or bone marrow suppression. Don't believe it will cause the liver any problems, but of course you would have to monitor for it. Else it's the rock and the hard place.

[captain]

Oh Sue ............... I saw your thread heading, and the tears started ...........

BUT, lets hope that the "medication dance" works for you ....... come on Killi, you are one big, brave, strong boy ...... we know you will cope.

Sue, HUGS to you and Shiloh ........

[Sudilar]

Thank you everyone for all your support. It means so much to me!

Killian is still acting happy and eating, so I am grateful for that. We can see that his body is wearing down, but quality of life is still there.

Dragondawg, thanks for the suggestions. Is Leukeran a chemo drug? You think that it might do some good for the pemphigus vulgaris? He is susceptible to infection very quickly, so it may be counterindicated in his case being that a side effect of Leukeran can be the inability to fight off infection. He has a variety of autoimmune problems and liver disease. He has had (rare in dogs) ulcerative granulating and fibrosing eosiniphilic gingivitis, pemphigus vulgaris, lip fold pyoderma, a small liver, multiple acquired shunts and microvascular dysplasia causing high blood pressure in the liver. At the moment, the pemphigus is not completely gone but is present slightly. The minute we raise the pred dose by a little, Killi has stomach reactions and blood in the stool. If we lower the dose, pemphigus takes over. The other drug choices have even more side effects that would cause more harm to his liver. So we are very slightly reducing the pred to see what happens next.
He is on prednisone (20mg every other day), milk thistle, salmon oil, vitamin E, Sam-e, lactulose and a pace dose of amoxicillin, plus a home cooked diet.

[ChrisH]

Oh, Sue ... lost for words here. Killi has all this stuff going on but he is so lucky to have you help him through. Hugs and much love to you and the dear, sweet boy, and Shiloh too.

You are all ever in my prayers.

Chris

[Logan]

Sue, I read this yesterday and hardly knew what to say. I hate for you and Killian to be struck another blow to deal with. Somehow, I know you will deal with it, though. Please give that sweet boy a hug from me and don't forget Shiloh too. Hope she's doing ok. Please keep us posted and we will certainly be keeping Killian and you in our prayers.

Love,
Logan and the gang

[Rachel]

Oh, Sue, I am so sorry to hear that there is yet another challenge for Killian and you. I don't know of anyone who could have cared for all his problems with any more of a concerted effort. It seems you have one determined veterinarian as well. In the process, you have become quite an expert, and honestly, I think you have worked a miracle in managing to keep Killian alive and functioning and enjoying life despite having almost everything in the book having been thrown at him. Keep up the good fight.

[Pam]

Sue I was almost afraid to read this. As always you and Killian have my utmost admiration for the way you are both dealing with all of his medical issues. The most wonderful words in your post were "his quality of life is good." For that I am grateful and I know it is because of your good nursing and never-ending love for your boy. (((Hugs))) to you both.

[robinh]

Every time I see Killian's name in a post I hold my breath. You both have been through so much, but you just keep plugging away. When I feel down about all the problems I have with Max and his allergies, I think of the two of you. Your faith, joy and love for Killian is inspiring for not just me, but for many.

Give he and Shiloh a big hug for me. And one for you too.

[Sudilar]

Again, I want to thank everyone for your wonderful thoughts, prayers and encouragement. It means so much to me. Hugs to you all.

When I brought Killian into the vet yesterday, the techs and front desk told me that Killian was their favorite GSD. They told me that they remember the first time I brought him in. He was so skinny and rashy, but what a great personality he had! His vet told me that he was such a lucky boy to have us as his family. As long as he has quality of life (and he does), we will fight the good fight.

All of this seems to stem from autoimmune breakdown with liver disease as a big complication.

Thank you all so very very much. This is the best bb!!!!!!!

[Albea]

Oh, Sue, I'm so sorry Killian has yet one more problem! But your vet is right, the sweet boy couldn't have found a better, more caring mommy. For as long as his quality of life is good, that's all that counts.
I add my prayers to all the other ones for Killie's better health.
Hugs to you and the kids.

[wolf_Q]

Originally posted by Sudilar

When I brought Killian into the vet yesterday, the techs and front desk told me that Killian was their favorite GSD. They told me that they remember the first time I brought him in. He was so skinny and rashy, but what a great personality he had! His vet told me that he was such a lucky boy to have us as his family. As long as he has quality of life (and he does), we will fight the good fight.



Awwwwww how sweet!! He is definitely lucky to have you! I hope you will be able to figure out all of his medical problems. I'll keep you both in my thoughts.

[momoffuzzyfaces]

Originally posted by Cinder & Smoke
Hi God ~

We're not sure Who'z in charge of passin out da *challengez* fur
us guyz livin down here onna Big Durt Ball...

But kuld You check on whut's bein handed out
fur Killian an hiz Mom?

He'z been given a LOT of *challengez* -
an he an Mom are handlin em purdy well...

Kuld You ask em to *ease off* a bit?
Mebee jest let poor Killian *enjoy* hiz Senior Years?

'Preciate any Help You can give to this matter, God.

THANKS, God!

/s/ the Prayer Pups

Me and all my cats add a BIG AMEN!
to that!
Hang in there Killian and Sue!!!

[stacwase]

Poor Killian! I'll bet he's just being a trooper through it all, too. It's amazing how much they can go through and still be sweet and loving.

Afer reading your post, I'm doubly grateful for how well our visit went.

Kisses to Killian.

[dragondawg]

Sudilar

I recently ran into the subject of Pemphigus while corresponding with a puppy owner whose dog has a T-cell Lymphoma. I lost my 11 yr old puppy to Lymphoma last year so I keep in touch with the Lymphoma crowd. Anyway her dog apparently has as part of the cancer a wild T-cell line that attacks the skin which results in a condition known as Paraneoplastic pemphigus (PNP). It appears to now be under control with the use of Cytoxin.

You might try getting a reprint of a very recent article in the European Society of Veterinary Dermatology (2004 Vol 15, 90-98) titled Pemphigus: current therapy. It might be possible to get an address off the Internet somewhere. A couple of interesting snippets...

The author claims Pemphigus vulgaris (PV) is a very rare form of pemphigus accounting for less than 0.1% of the referral cases in a dermatology specialty practice... This form requires the most aggressive forms of combination therapy.

The big question with all the problems your dog has experienced is how agressive is "agressive"?

Per glucocorticoids such as Prednisone the author suggests if the Pemphigus can not be controlled by every other day or once per 72 hr maintenance then other immune suppression agents should be used.

As mentioned above the author gives Azathioprine (a transplant anti-rejection drug) as a preferred choice, but then goes on to listing possible liver damage as a side effect. He discusses the use of Mustard agents such as Leukeran (0.1-0.2 mg/kg every 24-48 hrs) . I have not been able to find any citations indicating liver damage as a possible effect of Leukeran. In fact it is used against cancer after it has spread to the liver. You need to ask questions about it. My puppy never received Leukeran, but instead Cytoxin another Mustard. I commonly gave both Metoclopromide, and Cimetidine as supportive drugs. Never had any GI problems with the Cytoxin. Leukeran would probably behave in the same manner.

BTW- I note you don't list a stomach acid blocker being used. If you are not using one, then get your puppy on Cimetidine or Rantidine as soon as possible to help heal the ulcerations the Prednisone is causing. I gave my 90 lb baby 200 mg Cimetidine 2X daily during Chemo and especially when on Prednisone. Check with your Vet for the dosage to give to your puppy.

An adjunct treatment the article lists is Tetracycline + Niacin. Only problem is that the Niacin might cause liver problems. Oops the Tetracycline can also cause liver shunting. So much for that therapy.

If you decide to discuss with your Vet the possibility of using Leukeran you will have to monitor the bone marrow function via blood tests. Given that the Prednisone has already suppressed the immune system, it's going to be a balancing act withdrawing from it, while switching to increasing doses of Leukeran. You'll definitely have to keep the puppy on the amoxicillin, and if you run into any infections before getting things stabilized have another antibiotic such as Baytril at the ready.

Hopefully you can get off the Prednisone while keeping the Pemphigus under control.

[KYS]

Dear Killian,

Always seding you good thoughts and lots of slurpey kisses.

[Sudilar]

dragondawg,

I am so very sorry for your great loss.

Killian is a 10 year old GSD presenting with liver disease for three years now. His liver is not in good enough shape to add more drugs. The last test (and we will not test again) told us that his liver is getting progressively worse (we know that). :(

Pred is keeping the pv just at bay at an every other day dosage.

We don't use an acid blocker. At the dosage he takes, we have no evidence of ulceration. At higher doses, he gets bloody stools, but we don't go that high anymore.

At this point, we are not doing anything but cutting back (a very little) on the pred. If more symptoms of Cushings show up, we will have to rethink the protocol. The problem is the condition of his liver, that limits us on what to use.

Thanks for all the info. I will pass it on to his vet.

[Sudilar]

I just spoke to our rescue's president and told her that I would not be fostering Buddy. Killian needs more of my attention and with a foster here, I would be taking away from Killian. The bad thing is that Buddy would have fit right in at our house. He is perfect for Shiloh. But, things happen for a reason, so...Killian comes first.

[tatsxxx11]

Oh Sue:( I lost internet connection for most of the day; I'll write more tomorrow. {{{HUGS}}} and of course, ;love to Killi and Shiloh.

[Cincy'sMom]

Poor Killian!! You guys hav ebeen trough so much!! It is always so obvious how much you love him and I admire the life you have given him. He's sucha strong boy!!

[ramanth]

Thoughts and prayers and lots of hugs for you and Killian.

[Kfamr]

I've kept up with Killi through reading, but I rarely post.. It's so sad that you, Shiloh, and especially Killi have to go through all of this. He sounds like he is a happy boy though.. and as long as his life is of quality (and I bet it is!)


{{Hugs to all of you}}.. and kisses to Killi and Shiloh.
Many many many well wishes headed your way.

[shais_mom]

How is Killi doing? :(
Keeping you in my thoughts.

[Sudilar]

Thank you so very much for asking!!! Killi is ok. We cut down on his pred a very little and it was scary at first, but he seems to have adjusted. I don't think it is enough to help his Cushings, though, but we can't cut it down any more. :(

He is in good spirits! He still loves to eat (good result of the pred :)), steal Shiloh's toys, give her a good growl now and then and lets her take care of him! He is always ready to go for a walk, but it has to be short. The neighbors have been commenting on how low he is walking now (muscle weakness from Cushings). It is getting very noticeable. I haven't seen any indication of heart problems from Cushings yet.

He is still a happy guy, but slowing down quickly right before my eyes. I thank God for each and every day extra that he is with me. On a good note, he is still giving kisses to his special people.

Thanks again for asking! Hope all of you are well, too.

[anna_66]

I'm glad to hear that he's still eating good and still giving those special kisses:)
Give him a few from mehttp://img14.photobucket.com/albums/v43/anna66/blowingkisses.gif

[ramanth]

Thanks for the update! :D

[Logan]

Sue, I know it is hard to watch any kind of decline in him, but he sounds like he is still thriving, given all the medical issues facing him at this point. Thank you so much for the update. Please know that you and Killian are in our thoughts and prayers constantly, Shiloh, too!!! :)

Logan

[Sudilar]

Thank you very much. He is my walking miracle boy!

Shiloh is doing well. Her lump (checked at her vet visit) looks to be benign.....we'll have to just watch it......and her pannus is under control with her meds.

[ChrisH]

Thanks for the update, Sue.

I am so happy to hear Killi is in good spirits and eating well, big hugs and kisses to the sweet boy. Also happy to hear Shiloh is doing well, sending kisses and hugs for her also. :)

Killi, and you all, are ever in my prayers.

Hugs
Chris

[Rachel]

I think of the old Timex commercials when it comes to Killian...he just keeps on ticking, no matter what he has been through. I do believe it is his strong will to live for his mom, along with the most adept medical care he has received.

You the Dog, Killian!

[tatsxxx11]

You really are our miracle pup, aren't you Killi? Sue, I'm so glad to hear that Killian's doing so well, all things considered. It just seems that nothing's going to get that boy down! I know how hard it is to see them getting older. But it's nothing short of a miracle that he's managed to battle these serious conditions as he has. You're right, every day is a blessing to be treasured. Need I ask??? BIG hugs and kissses and slurpy licks to our bestest pals Killian and Shiloh from Aunt Sandra, Cutie Cody and Star***Shine! Keep up the good work Killian:)