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Sunday, May 27, 2012

The Chronic Cushings Diary

Viva Hovawart
It is just over one year ago Viva was diagnosed with Cushing's disease. And all that time she thrived on the prescribed daily medication - 120mg of Vetoryl, or Trilostane. Every quarter Viva was tested and the results were excellent. Such a test consist of an ACTH stimulation test and full blood-work. Viva's liver, battered by her Cushing's disease before we started treatment, was slowly but determinately recovering.

For a dog like Viva with several chronic diseases every vet visit can be turned into a puzzle. Has any of her known conditions worsened, like spondylosis, allergies or Cushing's? Or are we looking for something else this time? To be prepared we keep a diary of Viva's general state of health to note the changes as they come slow and first when compared over time you can really notice a difference. We write down things like:

  • Meals: how fast did she eat her meal?
  • Walks: after how long did she tire?
  • Play: did she play with Kenzo? And who initiated?
  • Cuddle: did she exchanged her infamous ear-nibbles with Kenzo?
  • Greets: did she wagged her tail so her back moved?
  • And more...
The list is specific to Viva. Like when she wags her tail a little less and the walks get shorter, we know we are up for an acupuncture session for the spondylosis in her back. So when the diary started to show a little less play and cuddles, we advanced her quarterly Cushing's test. And although Viva's cortisol levels related to her Cushing's were still perfect, the rest of her body and organs clearly were feeling unhappy as the blood work showed.

This meant we were looking at something new, or the Cushing's medicine - which is very aggressive and can be compared to chemotherapy - was giving side-effects. Based on what we knew from the diary and the lack of other symptoms we decided together with the vet to lower the doses of Viva's Cushing's medication. The most reasonably assumption was the doses was affecting her health adversely despite it kept her cortisol in place.

It took only a week for the diary to show us the first positive effects, and when we re-ran the Cushing's test at the end of that month, her cortisol level was still within the limits while her blood-work showed a lot of improvement on all area's. Would the diary not have shown any improvement, we of course would have been right back at the vet's again, discussing other options.

Having a dog with chronic diseases requires a chronic attitude. At first, it stressed me out having to watch everything she does through symptom-glasses. But now that I accepted what a chronic disease requires, it doesn't stress me out anymore. I became even more connected with Viva than before, and know she is living her life to the fullest despite the odds. That's just a terrific bonus, being able to give that to Viva.

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18 comments

  1. Well done and you are doing the right thing for Viva and we are glad she is better. Take Care and have a great Sunday.
    Best wishes Molly

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  2. Amazing how much a diary can help! All that you are doing to make Viva's life better is so impressive, you're going the extra-mile for her and I've no doubt she realizes and appreciates that. I can only imagine how special she is to you, even more so now!
    Yay, Viva! Wishing continued health and happiness for your special girl :)

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    1. Thanks Kim, seeing her thrive is the best reward. She is my special girl indeed :)

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  3. I certainly feel your pain -- and stress! -- because I do a similar type of routine with Frankie. But you're right; it becomes part of your everyday life so that you don't think about it any more. Still, you can pat yourself on the back for doing such a good job. Not everyone would, I guarantee that. I'm always appalled at how many people turn pets over to shelters when it becomes too difficult to care for them.

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    1. You are right, Viva was put in a shelter by her former owners, probably exactly for that reason.

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  4. Such a great thing you are doing, by offering her the proper treatment, love, patience and care. I myself have a chronic illness, and a dog with severe unknown allergies, so in a way i understand what you mean by chronic attitude. Keep doing what you're doin!

    With love and wags,
    Paige, Simba and Rocky

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    1. Glad it came across, it was meant positive. Wishing you all the best!

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  5. Hopped over to say hello. I totally understand what you're saying. My Indy has chronic liver disease. His protocol is part vet prescribed and part information I found through research. We're already 1.5 year past the time the vet said he would survive. Never give up!

    Hope you can stop by for a visit at Critter Alley

    Pat
    Critter Alley

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    1. Never give up, well said :) Thanks for bringing your blog to my attention!

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  6. Wow, that's great that your diary was able to give you the information you needed to make a positive change for Viva. And you're very fortunate to have a vet who recognizes that you are all part of the same team trying to give Viva the highest quality of life.

    When Christie had Cushings, we kept logs of her water drinking to help us manage doses. I feel very fortunate that she did not have other chronic conditions to contend with at the same time.

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    1. Absolutely, I have a lot of respect for how our vet handles it. She walks a fine balance. Her academic background pushes her to do all kinds of additional testing, like ultrasounds, etc. to be conclusive. But she realizes she can't do that every quarter with a dog as fragile as Viva, if it would probably only be a doses change we are looking at. A fine line ... and a lot of responsibility.

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  7. What a beautiful piece Kenzo. I also lived a chronic lifestyle with my dog, Aspen. I wish I had thought of the diary idea because I think it would have allowed me to notice the subtle differences in her behavior before they became worse.
    Kudos to you for caring for Viva in such a thoughtful way. She is such a lucky girl.

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    1. Thanks Mel. Good point, the diary also gives me a feeling of being in control, and I worry less if I would have missed something. Guilt control comes in handy in my case :)

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  8. Viva had definitely been a special gift for you ... and you for her. Learning to pay attention to the small details of her life requires you to be present in that moment. It sounds so simple, but a tough things for most humans to do!

    When Buster was having seizures, before we got his medication nailed down, we did the same thing with the diary, keeping track of when he seized, how long it lasted, how intense it was. It gave us a great basis for determining how the medication was working and figuring out the proper dose. He hasn't had a seizure in so long now, that seems like a lifetime ago.

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    1. Thanks for your kind words. She is a special gift to me indeed, like Buster is for you and Rod. They make us walk (drive in your case) roads we never would have imagined. My colleagues at work are rubbing their eyes when they hear I can muster the structure and discipline of maintaining a diary :)

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  9. That's a wonderful idea - it's always so hard to remember when something started and time seems to fly by - Viva is a lucky lady :)

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    1. Thanks! It started originally as a video diary. To be able to see if the work-out to build her muscles was paying off. Nothing better than comparing her agility with a video from last week, or last month.

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