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Dr. Deb
Dr. Deb, Dog Veterinarian
Category: Dog
Satisfied Customers: 6054
Experience:  I have bred dogs and shown dogs for 20 years.
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my 16 year old ***** *****, has spent at least a week on and

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my 16 year old ***** *****, has spent at least a week on and of at the vet.
vomiting, yellow and white foam, they detected rise in liver enzyme alt 126, so placed on wringers drip, ursotan and milk thistle, she gets better, i bring her home do the diet accordingly. next day doesn't want to eat, vomits on rising, so i take her back to the vet, she has a slightly enlargened adrenal gland on the one kidney. while she is at the vet she improves, they are at a lose what to do, they are going to try different medication today and stop everything else.... she shakes on her front legs when she stands. she had similar symptoms last year but got better, no adrenal gland swelling though... vet has ruled out cushings. I am at my wits end, about 6 months ago her head was hanging slightly to the left, so raced her to the vet, said there was nothing in her ear, came home she was fine, what about vestibular disease? she looks depressed. have you experienced any of these symptoms in dogs before? i am now to scared to take her home and dont want to use her as an experiment. thanks
Submitted: 9 months ago.
Category: Dog
Expert:  Dr. Deb replied 9 months ago.
Hi, I'm Dr. Deb.
I recently came online and see that your question about Maxine hasn't been answered. I'm sorry that you've had to wait for a response but if you still need assistance, I'd like to help if I can.
I do have a few questions to ask first, if you don't mind:

1. How was an enlarged adrenal gland detected? X-rays or ultrasound?
2. How was Cushing's Disease ruled out?
3. Do you have the results of her blood tests that you can share with me?
4. Do you know what drugs are being given to her?


I see that you're currently offline. There may be a delay after I receive your answers since I have to type up a response to you and I may be offline at the time you respond. But I'll get back to you as soon as I can since I'm on the computer some part of every day.

Thanks for your patience. Deb

Customer: replied 9 months ago.

They did ultrasounds and xrays, I asked the vet, he feels it is not the issue.


I will get them when I visit tonight, they have taken her of all drugs and just concentrating on the tremors.


I saw her about 2 hours ago for a visit, she was happy to see my, but shaking, took her outside in the grassed courtyard , well she didnt stop running around a little staggery bum moving to the left a bit but, full of i would say ***** ***** energy. then i picked her up and she rested and relaxed in my arms. I meet the nurse who cares for her all day and night and they had given her some valium.. On speaking to the vet, this is not an easy case and i am so scared maxine will die from something simple, that has been overlooked. I have been googling which i think is sometimes not a good thing and some of her symptoms come up in many illnessess. I will be seeing the vet in 3 hours time to discuss maxine, what do you think about a mri.... should i ask the vet something specific? drugs given up to now.... wringers drip, ursotan, lopec mugs, pharm. milk thistle, anti nausea, stomach protection. the vet said he would have liked to do a scope, but with the age of maxine he can not guarantee that she would survive the


anesthetic. so i am lost what to do. thanks

Expert:  Dr. Deb replied 9 months ago.

Thanks for the additional information.

I agree that this sounds like a complicated case and I don't think something simple is being overlooked. I know you must be terribly worried about her but it sounds like your vet is handling the case well so far in terms of diagnostic testing (at least from what I can tell).

I agree that endoscopy would be helpful if her vomiting isn't well controlled but I do understand the risks of sedating her.

It would be helpful to know if a Low Dose Dexamethasone Suppression Test and/or a High Dose Dexamethasone Suppression Test was done to rule out Cushing's Disease. But is Cushing's Disease has been ruled out and she has an adrenal mass, then something else to consider would be a Pheochromocytoma which is an adrenal tumor. (LINK)
When you read the symptoms associated with this condition, tremors aren't specifically listed but they can be seen with this problem.

 



If the shaking/tremors are originating in her brain, then I think an MRI would be very useful but vomiting is not usually seen if a problem of this sort is suspected.

Also ask your vet about testing her for hypertension. This condition is almost always secondary to other underlying problems such as Cushing's, kidney issues, Diabetes but can also be seen with Pheochromocytomas as well,

Deb


Expert:  Dr. Deb replied 9 months ago.
Unfortuantely, I have a doctor's appointment and will have to log off from my computer for a little while.
But I'd be more than happy to discuss this situation with you further when I return or if you have additional questions.

I know this is a difficult situation for both you and Maxine and that you want to do everything you can to help her.

Deb
Customer: replied 9 months ago.

Morning Deb,


Well I had a chat to the vet last night and he says, with the symptoms at are presented and discussing it with the team, he suspects Pheochromocytomas and is treating her accordingly, alpha antagonists, bentoz... (valium) to bring down the shakes and a stomach protector for her stomach, she is eating well, looks good, she ran around when i visited, when i cradled her in my arms she was very relaxed but shaky. The vet says that he hasnt been able up to now to do the blood pressure due to the shaking, which he suspects could be part of senility.


he says we could do a host of tests, but they may show something or not.


the shakes are a concern, but she has always been a anxious dog, feisty, would be the better term. I believe i should take her home, give her the medication and give her lots of love and watch her. when reading the article that you sent and reading a few others, sometimes this condition has no symptoms at all, and some of the symptoms are identical to many other diseases. this condition seems to effect the organs around it, maybe that is why her ALT is slightly raised and urine ph not perfect, and it is quite interesting that on reading when they say how a IV makes them feel better. I must take her home even though honestly i am scared, scared she will die in my care. I just need to read what the contra indications are for the alpa antogonists. i asked the vet about the Cushings, he says for sure he knows it is not cushings, as he has had many patients with this illness. so at least we can rule out one. Thanks

Expert:  Dr. Deb replied 9 months ago.

Thanks for the update; I appreciate it. And, I'm glad that she appears to be feeling a little better.

I agree that this is a tough diagnosis to make but if Cushing's has been ruled out, then there really is not likely to be another explanation for an adrenal mass, especially given her symptoms.
Since Pheochromocytomas are fairly rare, I've only seen two in my entire career. Both dogs were intermittently symptomatic and neither one had surgery. Both did reasonably well for quite a few months before they were euthanized.

I assume your vet prescribed Phenoxy­benzamine (LINK) or possibly Prazosin.
I've used the former for other conditions and most dogs tolerate it very well.
I don't have any experience with the latter but adverse reactions might include potentially hypotension, central nervous system effects such as lethargy or dizziness or gastrointestinal effects (vomiting, diarrhea, constipation, anorexia).

While I understand your fear that she will die at home (and this is always a possibility, unfortuantely), I think making a final decision about her would be premature. See how she does and what her quality of life is like.



Good luck. I hope you'll continue to keep me posted. Even after you rate (if you do, of course), we can continue to communicate at no additional charge to you. I can also send you a follow up email in a week or so to which you can respond when you have the time to do so.

Best regards, Deb

Customer: replied 9 months ago.

Hi Deb,


 


I am lost, apparently she is quite lively and hopefully being on the medication for two days is okay, not sure how long it takes to settle in. But i know what ever i do and what ever happens i will blame myself. I am not sure what to expect should things go wrong, or what to look out for. the vet says I must take her home and "give her the benefit of the doubt"


I must believe that the vets have given her the time and thought and caring and at least trust their diagnosis. many thanks for chatting, will keep you in the loop.

Expert:  Dr. Deb replied 9 months ago.

I honestly don't know why you should blame yourself in this situation. You didn't cause her medical issues and it sounds to me like you've done everything you can for her.

I hope you won't take offense at what I'm about to say: But you know how empathic dogs can be. If you're constantly stressed and worried about Maxine, she's going to pick up on it and possibly react to it...which is not going to be good for either one of you.

She will most likely have good and bad days. It might be helpful to chart them on a calender if the signs are intermittent. Then when bad outweighs good, a final decision may need to be made.
Or if it's clear that her quality of life is poor, even on the medication, then decisions may need to be made sooner rather than later.

But, I've give her a chance as well if this were my case or my dog. She may surprise you.

Please do keep me posted, though. I'd like to know how she does. Deb

Customer: replied 9 months ago.

Thank you, ***** ***** chat to the vet just now and ask him on the signs that i must watch for, i know he says she must rest for a few days..... hello this is a ***** *****, but i will make sure she does....


apparently the valium has calmed her shaking down, so they were able to do the blood pressure test, it was still above normal..


She is a strong dog, with the zest for life.

Expert:  Dr. Deb replied 9 months ago.
Jacks have very strong personalities and survival instincts/will to live which is always helpful in situations like this.

I'm not surprised that she might have hypertension but glad they were able to recheck her blood pressure.

Deb
Customer: replied 9 months ago.

hI deb.


Thought i would up date you.


Maxine, is doing okay I suppose, she is on valium and pratsiol, kind of zonks her out which is a concern and she doesnt eat as well as i would like, just lies and sleeps, take her outside she walks around and lays in the sun., only seeing the vet again next tuesday. in the morning she jumps out if bed and runs down the passage then looks for food, then i give her the tablet and the tiredness starts again. I am worried, spoken to the nurse that knows her well, she says I must just watch her , which i what i do all the time...

Expert:  Dr. Deb replied 9 months ago.
I'm glad you've sent me an update about Jacks; I was wondering how she was doing.

I'm assuming you mean she's on Prazosin? Sedation/lethargy can certainly be a side effect of this drug. What dose is she on? There's a range, so you may be able to reduce it.
I'm also not certain why she's continuing to take Valium which can also cause sedation. I assume it was for the tremors but perhaps this drug could be reduced or discontinued.

If she's zonked all the time, that hardly seems like a good quality of life; perhaps we can find a balance of her drugs that don't make her behave this way.

Deb

Customer: replied 9 months ago.

Hi Deb,


 


She is on 0.5 table twice a day of a 1mg Tablet of Prazosin/pratsiol... I have spoken to the nurse she says its normal until one gets use to eat, but how long is that, plus i am giving here locec mups which is for her tummy, she shakes quite alot and that jaw shudder.


 


when she eats she picks up the kibbles/blockies bites them in half and spits them out , then eats them again, maybe i am watching her too closely.


 


and a 0.25 tablet of 5mg valium. I have a follow up appointment next week tuesday, so hoping time will fly.


 

Expert:  Dr. Deb replied 9 months ago.

That's an appropriate dose of Prazosin but as I said, I don't use this drug for my hypertensive cases so I don't have experience with it.
If her side effects continue after one week on the drug, then I'd consider changing to Phenoxy­benzamine.

And her dose of Valium isn't too high either.

 



I don't think you're necessarily watching her too closely but you may be more bothered by certain things that she's doing than you need to be:) Deb

Customer: replied 9 months ago.

Hi Deb,


 


I forgot to tell you she weighs 5.2 kg, small ***** *****, would the doses still be okay? taking her next tuesday morning,she is 16 years, so i must be reasonable...the jaw shuddering worries me and the leg shakes.so you would say on this dosage she wouldnt collapse. how long does it take normally for the body to adjust to this drug?


maybe i should take one of her valium tablets?

Expert:  Dr. Deb replied 9 months ago.
Yes, perhaps you should take one of her valium pills:)

The dose of Prazosin is 1-4 mg per day regardless of weight of the dog so her dosage is ok.
Since I don't use this drug, I really can't be very helpful in telling you how long it takes for the body to adjust. I would think if she's still lethargic on it after one week, then she's not likely to improve. Then, I'd assume that this is not a drug that her body tolerates very well and I would consider other options.

Her dose of Valium isn't high for a dog her size.

I'm sure your vet told you that the best treatment options for a dog with a Pheochromocytoma is surgery. However, I wouldn't be putting my 16 year old dog through a surgical procedure so she may not be managed very well with drugs alone, unfortunately.

Perhaps ask your vet about a muscle relaxer such as Methocarbamol although I honestly don't know if it would help.

Deb
Customer: replied 9 months ago.

its been really nice chatting to you, i would have loved to have been a vet, but I would have probably killed a few owners. so i chose engineering, safer for everyone, well hopefully. I am an animal lover,and believe the innocent should be protected.


Will keep you posted after the visit.


many thanks, ***** ***** *****

Expert:  Dr. Deb replied 9 months ago.
I've enjoyed chatting with you as well but I feel so bad about this situation that you and Jacks are facing.

The most challenging job about being a vet is the people, of course. If we only had to deal with the animals, it might be easier, sometimes:)

I'll look forward to updates and I have a follow up email scheduled for the 8th.
Deb
Customer: replied 9 months ago.

thank you, ***** ***** agree...


Will keep you posted, have a good evening.


Debbie

Expert:  Dr. Deb replied 9 months ago.
Debbie, Well, it's morning where I live (New England) so I'll have a good day but you have a good evening as well:) Deb
Customer: replied 9 months ago.

Oh apologies, well you have a good day. :) Debbie

Expert:  Dr. Deb replied 9 months ago.
I will, thanks:)
Customer: replied 9 months ago.

Hi Deb,


 


taking maxine to vet tomorrow, she is doing very well, eating and more lively, spoke to vet i halved the dosage of pratsiol. the shaking has calmed down and now is in her front leg , like normal.


she still stands and stares a bit, but bounds down the passage way. will keep you updated... go well

Expert:  Dr. Deb replied 9 months ago.
Debbie:
That's really good news about Maxine; thank's so much for letting me know:)

I'll look forward to continued updates about her. Deb
Customer: replied 9 months ago.

Hi Deb,


 


Saw the vet today, he was very pleasantly surprised to see how well maxine is. no shaking so he could do the blood pressure test accurately, slightly above normal, but he says its fine, must just watch her. must continue with the Pratsiol and see him in a months time so he can do another scan and check the adrenal gland.... i am happy my little girl is happier., very stressful when your animals are sick, i couldnt thing, or concentrate.... many thanks for chatting.

Expert:  Dr. Deb replied 9 months ago.
Debbie:
So glad to hear that her blood pressue isn't sky high and that she's so much better than she was. She appears fairly stable for now.
I truly know how stressful it is when how pets are ill and we feel helpless to help them. But she sounds like a tough girl which most JRT's are:)

Please continue to send me updates, if you can. Regards, Deb

Customer: replied 9 months ago.

me too...Will keep you posted. thanks Deb

Expert:  Dr. Deb replied 9 months ago.
Laughing
Dr. Deb, Dog Veterinarian
Category: Dog
Satisfied Customers: 6054
Experience: I have bred dogs and shown dogs for 20 years.
Dr. Deb and 4 other Dog Specialists are ready to help you
Customer: replied 8 months ago.

Hi Deb,


 


Just updating you, maxine is doing well, she had gastro, apparently its going around, animals and humans.


I cant seem to keep up with her appetite, always hungry, will chat to the vet when I seem him in Nov, as they want to do another scan.


She has lots of energy so I might have to up the dose of pratsiol, but will let the vet make that call. hope you are well.?


 

Expert:  Dr. Deb replied 8 months ago.
I'm doing well, thanks for asking; I hope you're doing well, too:) Enjoying the gloriously wonderful fall weather here in New England.

That's really good news about Maxine although I'm sorry she had gastritis.

Having a good appetite is much better than the opposite, that's for sure!

I'm glad you're keeping me posted about her; she comes to mind every so often and I wonder how she's doing. You must be very pleased that she's so stable. Regards, Deb
Customer: replied 8 months ago.

Well here in South africa, Gauteng/Johannesburg we have received our first rains, everything looks so clean and bright, even the trees are greener, we have a tree here called a Jacaranda with purple flowers, they look fabulous, i love the rain....


I am very happy she is stable and watch her very carefully. Thanks for the chat , will keep you posted if you want? and will up date you on her visit to the vet in November.


 


regards


Debbie

Expert:  Dr. Deb replied 8 months ago.
That tree sounds gorgeous.

I'd love to receive updates about Maxine from time to time. And, November is just around the corner...which is so incredibly odd to even think about!

Deb
Customer: replied 8 months ago.

great will keep you updated.... scary how time flies, in retrospect life is short....


 


Go well

Expert:  Dr. Deb replied 8 months ago.
It's not only just scary about how time is flying by but terrifying!!!
Customer: replied 8 months ago.

hahahaahah., I agree...., so much to do , so little time to do it in.

Expert:  Dr. Deb replied 8 months ago.
No question about that; seems I'll never catch-up:) Maybe I should stop trying.
Customer: replied 8 months ago.

seems like that....never stop trying.. you do good work by helping and loving animals, they need as much love and support as they can get, yes I am an animal lover....:)

Expert:  Dr. Deb replied 8 months ago.
Laughing

I agree that the animals of the world need as much as we can do for them since we never, ever can do enough, that's for sure.

But the things that I don't have time to do don't involve them, thankfully. ...it's all that other "stuff" that makes up our daily lives that seems to pile up.
Customer: replied 8 months ago.

I agree, animal cruelty and abuse is on the increase, sometimes I wonder about the human race.... we cant live in harmony.


 


I understand what you mean, all is okay at work for me as well, its the personal things that seem to get waylaid. At the moment my income tax, deadline is close.....so I have to organize that, plus the many other things.

Expert:  Dr. Deb replied 8 months ago.

It's just never ending!
Customer: replied 7 months ago.

Hi Deb,


 


Hope you are well?


 


Just to let you know that maxine had her visit to the vet, he was so impressed with her that he said a scan was not necessary, my husband said that the vet actually looked shocked to see how well she is .... happily shocked. she eats like a horse, bounds around and barks at everything...


 


I am very happy.... she is a strong old girl... with lots of life.


 


Take Care

Expert:  Dr. Deb replied 7 months ago.
Debbie,
I am well, thanks for asking:)

Wow, that's pretty impressive about Maxine, isn't it!!!
I knew she was a survivor and was going to beat the odds; I'm glad she didn't make a liar out of me:)

I hope you all have a wonderful holiday. Deb
Customer: replied 29 days ago.

Hi Deb,


 


Hope you are well, just to update you.... Maxine is doing very well , gets younger every day.


Need to ask your advise... my friends dog which is a chow, male neutered and about 5 years has been diagnosed with a prostrate tumor, they did a biopsy and it is sarcoma... think I have right name there.. they say they cant operate because it looks to big, only problem at the moment is that he cant urinate , no blockage in the tube , they say its the tumor and are giving anti- inflammatories.. can you give any advise.


 


many thanks Debbie

Expert:  Dr. Deb replied 29 days ago.

Debbie:
I'm so glad to hear that Maxine is doing as well as she is; a truly impressive dog:)

Unfortunately, when a entirely new question is being asked (as in this case), then the site prefers that a new question be submitted. I'd be happy to try and address this issue with your friend's dog if you want to place "For Dr. Deb Only" at the beginning of the sentence.
I'm sorry but I hope you understand. Deb

Customer: replied 25 days ago.

Hi deb,


 


Not a problem I understand, will see what I can do... take care

Expert:  Dr. Deb replied 25 days ago.
Debbie:

Best of luck with your friend's dog. Regards, Deb

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