NeylasMom

I came home to a different dog! To the point that he was acting like a crazy dog, totally carelessly running and trotting around. I did what I could to keep him calm and not have multiple heart attacks since I know he's not quite ready for total mania yet. Unfortunately the toe is raw again. Still, Zoledronate is starting to work. Me, myself and I are going to celebrate since I seem to be the only one posting in here.

Any Cecil or Crouton updates today?

I don't know Zuri's Zoledronate dose, but they give it in fluids over 15 minutes like Cecil's. With the previous bisphosphonate, Pamidronate, you needed to do a much longer period of fluids before, during and after the treatment to mitigate the potential for damage to the kidneys. I remember Neyla's treatment taking close to several hours. My vet and I discussed in pretty good detail whether to extend the time for the fluids, especially in light of the extra precaution needed for his kidneys, but in the end one vet felt that the IV fluids tend to just move right through them so he felt the subQ fluids were a better choice as they get absorbed over time. My vet (who was out when we did the second treatment when we added the fluids) felt that since we didn't see an immediate jump in values after that treatment we should just stick with what was working. I felt like this treatment took a little bit longer yesterday so maybe they did do a bit more fluids than last time, but she didn't mention anything. I do think that may have "manhandled" him a bit to get him settled for the treatment. I can't be sure, but I know what he's like with people trying to physically manipulate him into a lying position and I now think that panting when they brought him out may be because he got stressed and/or was in pain as a result. We didn't have this issue the last time and the first time he was still pretty sedated from his CT scan. I did ask last time about staying with him and they said I couldn't, but I am going to press them on it before the next treatment. It's really frustrating that the go to in veterinary care is just to force the dog when, especially in our case my dogs are quite cooperative. For example, when they came in to do the blood draw he was already settled on his bed. They immediately started climbing onto him to do a stronghold on his neck so they could draw from his jugular. I put a stop to that immediately and told them he would be happy to lie there eating treats with no restraint while they did the blood draw from his leg, which is exactly what he did. Meanwhile, the tech holding his leg was still holding it tightly, causing him to try to pull it away because that's the leg he's more sensitive about and tends to jerk away in his massage therapy if the stretch is too intense. Because it was so quick, I didn't bother to tell her if she just let the leg go he wouldn't even do that. Anyway, he seemed significantly more painful after his treatment than right before as I took him out to potty just before and he trotted along happily finding a place to poop and pee, whereas when we got outside after his treatment he started trotting to get to the car and suddenly yelped and look back at me as if he thought I had hurt him. And last night at 6:30 he woke me up with a single loud high pitched bark. I think he had awoken and went to reposition and hurt himself. We really haven't had the crying out in pain issue, with one or two exceptions very early on when he was still recovering from his CT so that was disappointing. And even though shortly after he got up without issue and resettled on the orthopedic bed in his crate for the rest of the morning I didn't really sleep after that. ANYWAY, hopefully the Zoledronate kicks in asap. If it goes like last time, that should be tomorrow, but when he had all of those issues after his CT it was a full week until we saw the Zoledronate's effect. I am afraid we're going to trend toward that timeline rather than the 2 day one, but am just holding out hope I'm wrong. In the meantime, one really positive update - his toe is doing really well! No swelling or signs of infection anymore and the sore is DRY! I am keeping it bandaged and socked for a while longer because I know if I don't it will rub right open again, but he doesn't mind the bandage so this is at least a huge relief. And I think we can stop the twice a day Epsom salt soaks as well.

Yes and no. Dr Couto has in both cases confidently confirmed the dx for Neyla and Zuri, but he also saw bony changes in Zuri's right leg that he thought were cancer, which led me down this whole path or other cancers that could appear as bony lesions in multiple places (which is really rare). Partially for that reason I proceeded with the CT scan for Zuri and it showed no issue with the right shoulder (but very clearly showed the cancer in the left). My question for you is, if it is cancer what options would you consider because of the vet issues. If you wouldn't pursue them because they require vets visits - things like radiation, Zoledronate, even amp - then there may be no point. You just treat for pain with oral meds as needed and live life to the fullest. If you need to know or would consider those treatments, do the x-rays or better yet get a CT and ask the vet for an anxiety med to administer in advance that will work with any sedatives they might need. Some vets use Xanax or Valium as a pre med so those might be safe options. Really hoping your vet is right in this case. Oh, other option before you proceed, have your vet have a radiologist review the images.

And thank you! They called me to check out as I was typing that. We're home. Zuri has a giant lump from the subQ fluids, seems bigger than last time so maybe they gave more given the creatinine. Unfortunately all the bs with the blood work took forever so I have to leave in 20 minutes to teach. He seems good though. Was unusually stressed when we left but settled quickly in the car and is waiting patiently in his crate for dinner right now so I know he'll just sleep while I'm gone. Well and maybe pee as he absorbs the fluids, but I can deal with that. Can't wait to be home later and just chill out with him. And a glass of wine. Or maybe liquor. Regardless, there will be alcohol.

Yeah, we have years of annual blood work. His creatinine was never higher than 1.6. He's on a kidney support supplement. I've heard very good things about Standard Process' supplement, but we went with VetriScience's renal support. The Standardized Process supplements are based on whole foods so there are things like cow kidney in it. It's pricey and since we feed raw I thought the Vetriscience product maybe made more sense. I started that when they first went up so maybe it has been helping, who knows. He also gets milk thistle and curcumin, both of which are supposed to have some positive effects on kidneys. We likely won't do a special kidney diet. If he gets to the point where he's actually sick because the values have gone up more it will be time to say goodbye. I don't believe in limiting protein in the early stages of disease, especially in this scenario.

Well a little bit of bad news. BUN is down a touch, which is not surprising as it was a really hot day last time and he had been panting a lot and his creatinine hadn't budged so I figured the slight elevation in BUN was dehydration, but today his creatinine is up. The highest it's been is 2.2 and today it's 2.4. Not high enough to prohibit treatment so he's getting it now, but still stinks. I had started to stupidly hope that 4 weeks of stable values meant maybe they weren't going to continue going up, that maybe something isolated like the sedation from his radiation had caused a bit of damage, but that would be it. I suspect it's the Deramaxx, but we can't really do anything about that. All I can do is hope it continues to creep as slowly as it has. Anyway, I hadn't anticipated doing bloodwork, but Zuri settled really well while we waited for results and we got in some quality snuggle time. They're doing his treatment Now and then we just hope for what we saw last time - quick improvement and no sudden kidney changes.

Yeah, I've used Simply Sleep, which is made by Tylenol. It's actually just Benadryl in those pills. It usually works for me for a night or two and then it starts to do weird things to me. A friend suggested Unisom, saying it wasn't an antihistamine, but turns out it's just a different one. Anyway, I have Simply Sleep here so I may use that as I likely won't have time to pick up the Unisom. I just wanted to take it for a night or two to get back on track though since we're going in for the treatment today and the toe continues to improve I am worrying less and likely to sleep better.

I'm so sorry for the scare with Cecil. It's "funny", we had a slip last night and I started to post, then stopped myself because I was afraid people would judge me. Zuri lost his footing coming up the stairs, which of course freaked him out. I keep the front half of his help 'em up harness on for walks so I can grab him just in case, and because having the leash clipped to it going down the steps seems to slow him down a bit, but without the back harness as well I couldn't get him steady so I had to resort to picking him up, which only caused more flailing, and carry him the last few steps. I thought he'd be in a lot of pain today, but he is actually pretty good - definitely a bit more sore, but nothing horrible. He went down and up the stairs for his last pee break last night and again for our morning walk today with only a little hesitation on the up because he was still nervous, but it freaked me the f out and was not fun for him either. I also did something to my back carrying him so I woke up in the pain in the middle of the night, but it feels better now that I've been up and moving around. Thankfully I had had my massage earlier yesterday so I think I was nice and loose when it happened. Anyway, hindsight is 20/20, but we definitely should have done the Zoledronate last week. He was doing good on slightly increased meds, no signs that he was in a lot more pain, but I think between that and the toe he's tired this week. In the future, we will do it at least every 5, if not every 4 weeks. So basically the treatment can't come soon enough! We leave at 1 and I am just hopeful that it kicks in as quickly as it did last time. They are going to do subQ fluids with it again to protect his kidneys so presumably those will give him a nice boost today regardless. Fluids always make animals feel good. I also want to be done with this toe injury. The swelling has mostly resolved, but the sore is still oozing, though it's much improved as well. But I am still doing epsom salt soaks twice a day and then there's the bandaging, applying ointment, stopping him if he tries to lick, etc. It's just a nuisance that I wish he didn't have to deal with though he's quite tolerant of all of the fussing. Anyway lesson learned on the Zoledronate. I've been feeling guilty the last few days for sure, but I know once the treatment kicks in and the toe is better I will have a completely different outlook. But these bumps in the road do really affect me. Any discomfort on his part is felt by me 100fold so much that I haven't been sleeping well, and thus deal with this stuff more poorly. I tried Melatonin last night in the hopes that I could just get a good night's sleep, but pain from my back woke me up repeatedly and I felt groggy this morning. So tonight I think I will just go Unisom. Glad Crouton continues to improve. Having them on the right med schedule really can make a huge difference. Hope it keeps up. And hope Cecil continues returning to normal as well. I'm sure he will. I've found when Zuri has an "incident" like that it's about 3 days until he's close to normal again. I've just decided that when those types of things happen, I will increase meds for 5 days no matter what to make sure he has ample time to recover without discomfort and then if he seems to be his usual self I will drop back down. Hopefully wtih a little more time and the repeat treatment of Zoledronate coming up he's good to go asap.

Well I'm not a vet so take my advice with a grain of salt. As far as I know it does not contain an anti-bacterial, which is why I mentioned using it if the wounds are not infected. If they are already infected I might use something else. Any chance it's just the spraying that's freaking him out? Could you try applying it with a sterile gauze pad?

What spray did she give you? Can you just apply antibiotic ointment? I read recently that Neosporin can be problematic for some dogs but in most cases it's fine, or there are others. If there's no infection present, you could also try EMT gel or spray. It supposedly creates a barrier to prevent infection and has a bitter component to deter licking. I have personally tasted it (not on purpose) and it's very bitter. Also supposed to promote collagen/healing. It's not particularly expensive though you may have to order it online. I'm using it for the sore on Zuri's toe and it dries it out nicely.

That's GREAT news!! Hope the upward trend continues.

Before you end this thread, I just want to say that I think Crouton is very lucky to have you. Hope your vet visit produces some good news.

Ah, good thought! That is where the worst of the irritation and scabbing was so that would make sense. Thank you! I will still have the vet take a look, but I feel much better now. Donna. And I can't believe you still have that blanket.

Zuri has his Zoledronate treatment tomorrow so I'm going to ask if I can have his oncologist take a quick look at the photo. I ALWAYS have new questions for her. Here I was thinking I would finally just be a normal client and drop Z off for the treatment without insisting on talking to her. Instead I'm going to show her vagina photos.

If you'd like I can upload some more photos so there's a different one for every month. Let me know what angle you'd like for the cover photo. Or this one could work for the cover: Still provocative, but leaves something for the imagination until you look inside.

So for those that have been following along, things are looking much much better (if you missed it and want to get caught up, here's the link http://forum.greytalk.com/index.php/topic/318200-irritated-raw-vagina-update-post-vet-visit-41/page-1) The Apoquel seems to really be helping and I have been cleaning twice daily with Chlor-hex and then applying the silver cream in addition to wiping with baby wipes immediately after she urinates on walks. The collar arrived, but I haven't actually gotten it out of the box because things are so improved. Having said all of that, now that things are cleaned up and I can see better, plus I'm feeling what's going on down there, I am concerned she may have a tumor and that's the source of all of this. The area of skin around her vulva closest to her anus seems larger and possibly harder than it should be and it is gray in color, which I have since read can be a characteristic of a specific type of vaginal tumor. I really have no idea what "normal" looks like so I could be completely making this up. Anyway, if anyone has any experience, I would love for you to take a look. I will of course be getting her back to my vet for a follow-up, but probably not until next week. Photo below. WARNING for anyone who doesn't want to see it, graphic doggie photo below ... The area I'm talking about, closest to her anus is to the left in the photo. If you click, you should be able to enlarge and see what I'm talking about better:

Great news! for a positive update tomorrow.

Do you already have blood work results? Kidney values were normal?

Thanks Roux! Zuri is more his bouncy self today. I did up his Gabapentin a few days ago and I think for the first day or so it was making him feel a bit weird, but today is the first day the swelling in his toes is noticeably better so I'm wondering if that wasn't bothering him more than it seemed. Will be doing the Zoledronate regardless on Tuesday and am really hoping we're well on our way to this stupid toe being healed.

Good luck and please do keep us posted. I would be weighing the risk of fracture as well based on your limited description of the x-ray. Hope you can find a good option that gives you a lot more time together.

Perhaps your vet could consult with an oncologist while working with you on this? My experience having gone through this with 2 dogs and being very active on this list while many others have is that many "regular" vets are often far too conservative with pain meds. Although I understand what you're saying about how fast the progression has been so it's worth seeing what your vet has to say first. But the important thing is that her pain is managed, the risk of long term side effects shouldn't even be on the radar. Also, what did her x-rays look like? How much cortical involvement? Is there visible swelling of her leg? That's a pretty critical factor imo. If there's a lot of moth eaten area or other evidence that the cancer is progressed and she's at serious risk of fracture or you're less likely to get her pain under control that's a very different scenario than the tumor appearing to be in earlier stages and you just need to find the right palliative options. I caught it early with both Neyla and Zuri. With Neyla we saw no progression on x-rays and very little pain (not much medication needed) for 5 months, but when it for bad it got bad. We bought ourselves some time with one Pamdrinate treatment (the older version of Zoledronate) but it affected her kidneys so we couldn't repeat it. After that, it for exponentially worse to the point that we couldn't get ajead of it, even maxing her out on her nsaid and adding in Tylenol with codeine. Zuri on the other hand was tougher because his weak hind end from his LS is a complicating factor, plus the manipulation from the CT scan and him being stumbly after the sedation made him sore for about a week, but once we got past that and for the Zoledronate on board (and massages for his tight muscles from conpensating) he's been good. But neither had a lot of cortical involvement or much damage period. Anyway, every dog is different. Just sharing my experiences, but knowing what the x-rays looked like would be helpful. Did your vet have a radiologist review them? The alternative is to send everything to Dr. Couto and have him take a look.

Yikes. I have to say I don't get your vets med recommendations at all. Contrary to popular belief Tylenol is safe for dogs, but it's really more of a last resort med imo. For starters, Gabapentin has a very short half life so dosing it just in the AM makes no sense and would explain why she was so painful overnight. I would be dosing that every 6 or 8 hours. Tramadol also every 8 hours. Doses for a dog her size are quite high. Zuri is 70 lbs and can have up to 150 mg Tramadol every 8 hrs and 900 mg Gabapentin every 8 hrs. The latter would be insane as he probably wouldn't be able to walk, but he currently takes between 100-125 mg Tramadol and 300-400 mg Gabapentin every 8 hrs and does fine (plus his nsaid and a muscle relaxer for his LS). If I were you, I would first find an oncologist who can better help you with pain management. Barring that, I would get her off the Dramamine and Acepromazine ASAP (any vet who prescribes a sedative for a dog who is struggling with pain is out in my book!) and get her on more regular doses of the appropriate meds - 100 mg Tramadol 3x/day and maybe start with 200 mg Gabapentin 3x/day and see what you get. If that isn't sufficient You might switch to 200 every 6 hrs or 300 every 8 hrs. You don't want to increase the Gabapentin drastically at once as it can cause dizziness, unsteadiness, etc but the important thing is getting her pain managed and getting her feeling better. I may be biased since Zoledronate has worked so well for us, but I think it's worth trying to get her on a proper med schedule and give it a chance to work. If she were on a normal routine of meds and you were close to maxed out then I would probably feel very differently but it sounds to me like there's a good chance she just got totally screwed up from drugs she really shouldn't have been on. Then again bone cancer is very painful so it's a lot to weigh. I hope you are able to sort out a decision that's best for you. Dealing with osteo is indeed a rollercoaster with many highs and lows. All I can say is that I believe very strongly in not prolonging life when a terminal disease involved if I don't have a dog who is not in pain or not enjoying life, but I have also learned that there is a learning curve to figure out what is going to work for your dog and it can take a little time to figure out what works best. With Zuri we ended up having a few bad days here and there before we finally settling in a good place and I feel it was worth it, but he was never in severe pain either and has always acted like himself, eaten, etc throughout. So sorry you're going through this.

So glad Cecil is doing well. Zuri is not as great as I would like, but doing okay. On Wednesday he seemed a tiny bit more gimpy so I called the oncologist to schedule his Zoledronate. They're not in on Fridays so I scheduled it for this coming Tuesday since I wasn't sure yet whether he was just having an off day or what. Its clear now that it was the Zoledronate wearing off. So in the future we'll just plan to do it every 5 weeks (Tuesday will be 6 weeks). In the meantime, I found a massage therapist who will come to our house and she did great work on him Tuesday and we went to our regular place today so between that and a slight increase to his meds he's feeling pretty good. Now if we could just get this freaking toe wound to heal! Wasn't healing as quickly as I wanted so scheduled a vet visit and when we woke up that day his foot was really inflamed and swollen. So he's on ABs and we're cold lasering more regularly and it's looking a bit better. Anyway, I'm looking forward to that being healed and him being back to his super bouncy self after his treatment Tuesday.

Zoledronate has been a lifesaver for us. Amputation wasn't an option, palliative radiation doesn't seem to have worked for him, but the Zoledronate gives him amazing pain relief. He's scheduled for his 3rd treatment next week. Last time I saw improvement within 2 days. The previous treatment it took about a week, but he had had a CT and had a hard time handling the stairs because he was so doped up from the anesthesia so I think he was very sore from all of that for that week. Hope you see good relief soon. And very sorry for the diagnosis. Please feel free to join us in the osteo thread.