La Quinceañera; Miss Phoebe turns 15 years old

I am feeling a bit disoriented today.  It's hard to believe that it's May 10, 2013 and Phoebe is sitting on my lap as I drink my morning coffee and read the news.  You see, today is a day that I was told would most assuredly never come.  My little girl, Phoebe, turns 15 years old. It seems that since the day I met her there has always been a challenge to her health and survival and, yet, she always prevails.

I met her on May 7th, 1999 when I went to the Manhattan CACC (New York City's kill shelter).  I was looking for a companion for my dog Blackie.  The only dogs available that day were too big for him and for my small studio apartment, so I was leaving with the intent on coming back another day.  That's when the cops rushed in with a small tan and white chihuahua who appeared to be dead, wrapped in a blanket.  I waited around and watched them from a distance working on her.  She stared at me and our eyes met and I knew I needed to rescue her.  I enquired as to her status and they told me it was unlikey that she would survive her ordeal; Her owners moved out of their apartment, chained her to a radiator and left her without food or water for days.  When the landlord went in to inspect the apartment to make sure his tenants moved out, he found what he thought was a dead dog- Miss Phoebe.  He called the cops and they found her alive and rushed her to the CACC. I told them I was still interested and if she survived, to please call me.  I got the call from the CACC when I was up in Albany visiting my grandmother and mother for Mother's Day weekend that she survived and that I had 24 hours to come and get her.  So I went back to New York, headed to the CACC and rescued her.

Phoebe's next challenge that she survived was a near-death bout with IMHA when she was just 2 years old. I was told that 50% of the dogs who have this died before 3 years out and greater than 85% were gone by 5 years out.  So when we made it past her 7th birthday, my attitude was that we were living on borrowed time.

When Phoebe was diagnosed with Cushing's disease in February 2007, Michael and I were devastated.  We knew this was a possibility, as she had been on steroids for over a year (which increases the risk of Cushing's later in life) but it never occurred to us that Phoebe might live into her old age.  We were "over-prepared" for the idea that she would most likely not live a normal lifespan for a small dog.  In new territory, dealing with later-in-life health issues, we became immediately determined to get her whatever the latest, cutting-edge treatments were to restore her health.  We put her on a new (at the time) drug, Trilostane and hoped it would work.  Thrilled when it did, our vet was always cautious to tell us that the mean survival time on this drug was just 2 years.  That was over 6 years ago.  Again, she survived.

It has not been easy in the past year and a half.  Phoebe is definitely showing signs of her age.  Her bout with Idiopathic Vestibular Dysfunction last year wore her down.  Like her brothers Blackie and Chandler when they became very old, Phoebe also has difficulty hearing us.  The dog who used bark when she heard cars pulling up to the driveway from up in her bedroom can now easily sleep through my arrival at home and all the jumping and noisy fanfare her two younger brothers create for that nightly event.  Phoebe also tore her ACL last year and we opted against surgical intervention (for a number of reasons).  She's adapted well to her limp though she is sometimes frustrated by having only one good, strong, reliable rear leg.  Still, she runs around and chases her brothers, explores the yard and she often makes a mad dash away to the far end of the Zen Garden when I tell her it's time to come in from the walk.  She's still got spunk.

For me, Phoebe personifies survival against all odds in a way that no other person in my life has.  She has taught me to see the "odds" and the "statistics" as mere numbers that suggest patterns but that say nothing about the exceptional individuals who defy them.  She has inspired me to be exceptional, as she is.  Most of all, Phoebe's tenacious, fierce, loyal and intensely loving personality has rubbed off on me and I can now see that I have become much like her in the third of my life- these past 14 years- that we have been together.  So on her "Quinceañera", I say to my sweet survivor girl, Happy Anniversary my love.  You have changed my life for the better and I will always be grateful to you for that.  As is the case for adopted/rescued companion animals, your anniversary is also your "birthday".  So, happy 15th birthday my darling.  I look forward to enjoying today with you and every day to come for as many years as we have left together.

All my love,

Dad-E

Three Months Later, Miss Phoebe is doing GREAT!!!!!

It's been an interesting three months. Miss Phoebe is better. We eventually re-started her on Trilostane after her Stim Test showed that her Cushing's Disease was coming back, but we went to a very low dose; 2 mg in the AM and 2 mg in the PM. That's been great for the past few weeks. We rechecked her last week and Dr. Mlekoday said that her Stim level was still a bit too high, so next week we're going to alter the meds again and bring her dose up a tad bit. But, no vomiting and she's been eating well, every day. About the eating; Phoebe has decided that, after 13 years with me and 6 with Michael, only Michael knows how to feed her properly. I now am banished from the kitchen at meal time. That's right... it's not enough that she won't let anyone other than Michael feed her anymore, but she will not even tolerate my presence when Michael is feeding her! I'm not gonna lie, it's a bit heart-breaking while, at the same time, so sweet how much she loves her Daddy-Michael. Three weeks ago, Phoebe turned 14 years old. The dog who wasn't supposed to live past 5 is 14. What I've learned about Cushing's Disease is that it's variable-- there are relatively better and relatively worse times, so cherish the times that are good and remind yourself when things are bad, that this won't last. And what I've learned from Phoebe (among the many things she's taught me) is that you never know how much time you have, so enjoy the NOW. That's why you haven't heard from us on this blog for the past 3 months... ...we've been busy, staying present, and enjoying the "now".

A Tiny Bit of Good News to Share

Dr. Mlekoday called over the weekend and let us know that the repeat urinalysis on Friday was CLEAR of any casts!!! Hopefully, this was just a transient infection in the kidneys and the antibiotic is working.

We have an appointment at 12 noon today with Dr. Ferrari at NYC-Veterinary Specialists in Manhattan. She's a GI specialist. Hopefully, there's lots of more, useful info to follow.

We'll keep y'all posted...

The latest on Miss Phoebe

So it's been an interesting few weeks... Let's catch up on the good stuff, first.

Phoebe has pretty much entirely recovered from her "attack" of Idiopathic Vestibular Disease. Her balance is back. She runs, jumps up and down off the sofa, chases Charlie and does everything normally. There is just the very slightest residual head-tilt, but it's so slight, it doesn't bother her and we knew to expect that. She's made a great recovery.

We've been concerned over the past few weeks about Phoebe's appetite and her eating in general. Normally, Phoebe is ravenous. She eats almost anything you give her. She can be a bit finicky about her food from time to time-- wanting wet food, then wanting dry food, wanting baby food, etc...-- but she eats. Over the past few weeks, though, she's lost weight and her appetite has diminished. We were concerned that this might be related to her taking Trilostane for Cushing's Disease so last week she went back to Dr. Mlekoday for an ACTH stim test. The results came back that she was running a bit low on steroid-- meaning, over the past 5 years on Trilostane, even though we keep adjusting the dose down and down, it's been "over-correcting" her a bit. Dr. Mlekoday wanted us to take her off the meds, and we did.

The unexpected part of the visit were the findings that her BUN was elevated and there were Casts in her Urine. This is, typically, a tip off to some sort of kidney inflammation, infection or renal disease. To approach the infectious angle, we started her on Baytril. We were going to wait to re-check her urine for casts next Friday but we've been concerned about her demeanor. This is hard to explain; There's nothing specifically off or obviously wrong with Phoebe but she's not herself this past week. Initially I took it to be possibly irritation from the new (powerful) antibiotic and/or the withdrawing from Trilostane. Even our Dog-walker, Jill, said that Phoebe doesn't seem her normal self. Dr. Mlekoday didn't want to wait on this, so we brought her in this morning for another stim test, and a repeat urinalysis.

We're waiting on the results of the stim test and we'll have those tomorrow. If it's high, we put her back on the Trilostane. If it's low, we can take a bit of a drug holiday. However, her BUN level was abnormally elevated today, again. Though Phoebe is only a bit over half way through the course of Bayril, this means that the cause is less likely to be infection. They did an abdominal ultrasound. Her kidneys and the adrenal glands (which sit on top of the kidneys and are important factors in some kinds of Cushing's Disease) were normal. However, they found an abnormal signal which looks like an early, forming mucocele in her gallbladder. Additionally, there is a region of small intestine which looks to be thickened and inflamed. Historically, mucoceles were considered to be surgical emergencies as they often will cause rupture of the gallbladder with peritonitis. However, given advances in abdominal ultrasonography, they now are finding these "pre-mucoceles" so much faster than ever before that they often treat them effectively with antibiotics.

However, there are lots of "what is that?" questions on her ultrasound. Nothing that looks like a frank tumor, but things that jump out as looking different than on other ultrasounds she's had. Given this, her weight loss and our consensus that she's "not herself", we've been referred for a Gastroenterology consult at NYC Veterinary Specialists-- the folks who took great care fo Chandler (Phoebe's brother) before he passed away. We called and got the first available appointment- this coming Monday, at 12 noon.

So, for now, we wait the weekend, celebrate Michael's birthday and the fact that our Phoebe girl is around to share another one of our lives' milestones. We are confident that, no matter what ultimately comes out of all of this as the final diagnosis, Phoebe will be well. She beats all of the odds, statistics, changes, predictions, etc... her entire life. Why should this be any different? It won't be...

SUNDAY UPDATE: Again, Miss Phoebe Gets Well

I knew I named this blog properly! If there's one thing our Miss Phoebe does consistently throughout her life, it's survive, get well and thrive. It's been a busy 4 days but I wanted to update everyone who reads the blog.



That's a photo of Phoebe, begging for more food, just an hour ago. Clearly, feeling herself, again!

Phoebe came home last Wednesday night and she was super unstable. Essentially, dogs with Idiopathic Vestibular Disease (IVD) have to completely re-learn their senses of balance and proprioception without the use of their inner ear. This takes quite a bit of time. Dr. Mlekoday told us to expect this to really show improvement in 72 hours with a more complete resolution over the next 2 to 3 weeks, and that's exactly what's happening.

As I said, on the night we brought Phoebe home (the night this happened) she was very unstable. Sitting propped up on her front two legs was really challenging for her. If she ever tried to shake or twist herself to scratch or lick herself, over she would fall. But the next morning, her balance had already really improved. Michael stayed home with her that day and he even noted by midday how much better she was doing. By the time I came home from work, she was walking around and appeared to be much more steady. However, that evening (day 2) she became very tired and as she tired, her balance gave way to more falling. She was still having crazy nystagmus.

But with day 3 and 4, she tired less and less and her nystagmus calmed down. Her appetite has been very strong throughout this whole episode. Last night she actually tried to chase Charlie around the living room and this morning, she jumped up onto the couch! Getting down is still pretty dangerous for her, so we're helping her with stairs and up/down jumping. Still, knowing her, she'll be back to normal jumps/landings and stairs in the next week. She's just amazing.

I'm posting a link to a short video in 3 parts: Phoebe's Recovery from IVD The first part is her the night she came home from the hospital. She had just finished eating her dinner and was trying to shake and lick herself. In the middle part of the video, you can see her on day 2; the nystagmus was still very active. But the last part, on day 4, was taken today, just a few hours ago. She can pee and poop without assistance for balance. She can run around the yard and do what she wants. It's been a hard 4 1/2 days for her-- for us all-- but she's surviving and getting better each minute.

Again, to everyone who has asked after her, emailed, called, text-messaged, it's been an amazing display of support and we appreciate each and every one of you!

xo

Mid-day Update

Phoebe seems to be stable, according to Dr. M.

She had some breakfast, but needed help eating. She's still super wobbly, but she's not panting anymore and she' not trying to stand up. Her labs were 100% normal. So was her X-ray.

It's too soon to tell but, for now, Dr. M is leaning towards believing that this is Idiopathic Vestibular Disease, and NOT a brain tumor or a stroke. This is the best news we could have hoped for!

Phoebe is being monitored constantly and they're checking for signs of deterioration because, usually with a tumor or a cerebrovascular incident (like a stroke) we see pretty rapid changes in the vitals and lab values. So far, none of that is present.

They're going to monitor her for the next few hours and, as of now, the plan is for us to take her home and confine her to a small space where she can be contained and safe from hurting herself. It's going to take some serious nursing to get her back on her feet, walking and such, but Dr. M thinks that a few days at home should be enough.

If we notice that she's not improving or if we feel that she's getting worse, then we'll bring her back into the city to see a Neurologist who can do an MRI.

But for now, this is the best news we could have ever hoped for.

Thank you ALL for your messages, texts, emails, comments on Facebook-- knowing that we have such a great support network rooting for us and for Phoebe makes all of the difference.

Phoebe is not well

When I went into the dog's bedroom this morning, I found Charlie up and pacing around. I thought it was simply that he had to pee really badly. I went to pick up Phoebe out of her bed as I always do (because she can't go down the stairs, so we carry her). As soon as I lifted her up, she lost her balance and wobbled over onto her left side. She couldn't straighten her head out. At first, as I was carrying her down the stairs, I thought that this was a vaso-vagal response; Like what happens to us older folks when we suddenly stand up, the blood pressure to our heads doesn't keep up and we get light-headed. I thought, "I moved too fast for her" but she'd normalize in a few seconds. But as we came downstairs and I put her on the floor in the kitchen she couldn't stand up. Try as I might to help her right herself, she kept falling over. Finally, beginning to panic (because this is looking like a stroke) Michael said, "take her off the slippery wooden floor and bring her outside." So we ran out the back door, put her on the grass, and while she peed, she could barely keep from falling over. Michael had to hold her up.

I was completely freaked out. This is neurologic.

We rushed the boys into the house, grabbed our packed bags and jumped into the car. We took the drive to Manhattan to her internist, Dr. Mlekoday, who manages her Cushing's Disease and 45 minutes later, we were in the office. They rushed her back, took her vitals and did a physical exam.

Dr. Mlekoday came in to talk to us. Here is the differential diagnosis as of 8:45 AM:

This might be Idiopathic Vestibular Disease; a fairly common condition in older dogs wherein, suddenly and for no apparent reason, they have an inner-ear phenomenon that causes them to suddenly loose balance, have nystagmus (eyes rocking left to right) and tracking of the head and neck to one side. Essentially, the world is spinning for them and they can't keep balance. If this is the case, they will monitor her today, give her fluids, keep checking her heart rate, pulse ox, and respiratory rate to see if there's a change. Ultimately, she should start to be able to stand, then eventually to walk (against a wall for support) and lastly, after a number of days the head-tilting will resolve and this whole episode will be a thing of the past which, interestingly, never seems to repeat itself.

However, given her advanced Cushing's disease, her history of inexplicable weight loss over the past year (and even more this morning) it's not looking good. Phoebe has had every test and we cannot figure out why she's losing weight. The fact that her Nystagmus is NOT left-to-right, but wobbly in a figure of eight pattern, points to something more severe. It could be infectious, though her blood tests have been normal. It could be the pituitary tumor (the Adenoma in her brain which causes the Cushing's) having grown to a size where it's now pushing on stuff, causing these symtoms. It also could a stroke.

I asked about doing an MRI. Right now, given her severe neurologic presentation, they think it's very dangerous to sedate her (which needs to be done for an MRI) and, frankly, we won't gain much information that would affect treatment from an MRI. I asked Dr. Mlekoday what she would do. She asked me, "Would you consider doing brain surgery on her?" I said I would not. She's too old, she's been through too much and that would be a cruel thing to put her through at the end of her life. She thought that was the medically sound and compassionate choice.

So, for now, we wait. They're doing X-rays, labs and physicals every 2 hrs, and watching her constantly.

More updates to follow...