Viva Sunday #9: Improved Treatment and Diagnosis of Cushing's Disease

The treatment and diagnosis of Cushing's disease is under constant improvement and research. During the years Viva had Cushing's, a lot already changed, and more changes are ahead. If there is one thing Viva and me learned, it is that this is not not a disease you can manage by sticking a pill, but you have to be constantly on your toes, and take the clinical signs you notice very serious.

Cushing's is caused by a tumor in the pituitary or the adrenal gland, causing an over production of ACTH hormones which in turn triggers an overproduction of cortisol. A life threatening condition affecting inner organs like kidneys and liver. Some of the most common signs are hair-loss, a pot-belly, lethargic behavior, incontinence, and being overly interested in food and water. Cushing's is many times mistaken with normal aging signs of dogs, making it a silent killer.

This is what we learned along the way:

Diagnosis
Back in 2011, Viva was diagnosed with Cushing's based on a urine test and a ACTH stimulation test. During her life, she continued to have ACTH tests quarterly to measure her cortisol levels for possible adjustment of her medicin dosage. Although the test is reliable to measure levels for treatment adjustments, it proved unreliable for the diagnosis itself, when the results are negative. Negative test results should always be followed up by at least an LDDS test, and even better, by an ultrasound, to indicate the type of Cushing's which is significant for what treatment options are available.

Large dogs
The recommended dosage of Trilostane (Vetoryl), the medication for Cushing's disease, was set too high for larger dogs. Something Viva found out the hard way. But thankfully our vet read the signs correct and adjusted her doses far below the recommended dosage for a dog of her size. Later, in 2012, research was done that confirmed that at least dogs weighing more than 30 kg. need a significant lower dosage of Trilostane, maybe even dogs weighing more than 15 kg.

Once or twice a day administering of medication
The last has not been said on this subject. Basically Trilostane works up to 8-10 hours, and that might require a twice-a-day administration, instead of an only once daily which is standard. Research is still being done, and some vets are already recommending twice daily administration of Vetoryl. At least some research here and here has shown, there is hardly risk in trying. We never got that far with Viva, it was something I was discussing with our vet, as I could see she consistently was showing more lethargic signs during the end of the day.

***

A dog with Cushing's requires continuous research, together with your vet, and to be vigorous about measuring the clinical signs of your dog. We always kept a Cushing's diary, and it was a great help in supporting Viva in her battle against Cushing's. Whatever research was available at the time, or not, the diary was always right.

Kenzo's Hopes

We went out the back for Kenzo's first 15-minute walk of the day. I already had him leashed with his "Halti", to prevent him from dashing through the garden, and thereby risk a new injury to his tendon. Especially in the morning it is difficult. Both Kenzo and Viva always launched themselves as rockets through the door, straight towards the bird-house, in an attempt to surprise attack a squirrel that might be in it. They found out if their attempts paid off, once they reached the bird house. But usually it was empty.

Kenzo never caught one, but Viva caught two squirrels this way.

The squirrel family in the back garden have already gotten used to the new situation, and when I get out with Kenzo, they won't move until we literally are only feet away. They are getting more and more bold, and we have a visitor nearly every other day. They will come to regret that later on when Kenzo is fit again, I thought when we passed the bird-house. 

Suddenly a squirrel jumped from the bird-house, and Kenzo launched himself towards the speeding creature. Instinctively I loosened my grip on the leash attached to Kenzo's "Halti". That's how dogs get hurt. But Kenzo made an abrupt stop, and watched back at me. I was still standing, looking horribly worried what he would choose to do next, and still faced the backyard's gate.

He took one last look at the squirrel, and quickly returned to me, in hopeful anticipation to get through the gate, and start his walk. "That's how much you miss your walks, huh. You would even give up a good squirrel hunt for your walk, big guy?". I talk to him a lot more these days.

He must know it only will take 15 minutes before we are back again. But he never stops hoping. Every time we leave for a walk, "Maybe this time you will take me for a good walk!". I hate to disappoint him. Four times a day. Every day. For the last three months. "Well, we can have some extra sniffs this time, Kenzo!", I say, while I repeat in my thoughts a hundred times, it is for his own good.

When we reach the point in our walk where Kenzo notices we are on a path that would return us to the house again, he brings on the charm. With excellent heel-work, glued to my side, face up, looking at me, "See dad, how much fun we are having?". He is cunning, and proves me wrong again, when I said, he wasn't a pleaser.

The closer we get to the house, the more slow we go. Kenzo's head goes down. He is alerted by branches that move in the wind. Grass is sniffed extensively, and he points in different directions in an attempt to suggest alternative routes. He is trying to avoid the unavoidable. The walk is already over.

Almost back, Kenzo gives up and we quickly make it to the driveway and through the gate. At the door, Kenzo takes one last look at the bird-house. Maybe next time. Maybe the next walk, will be a good walk again. "It will, big guy. It will".

Frustrations

Three months into Kenzo's physical therapy to recover from a tendon injury, the side effects on his mental health are starting to show. Being leashed since December, his frustrations are mounting rapidly.

Physically he is doing great. Recovery is slow, but we are making progress. We do our exercises and a lot of extra training and activities to tire him out. People that already went through this, warned me how difficult it could be, but I underestimated it. What he lacks from walks, being social around other dogs, and expending his energy, can't be compensated by upping in other area's like training and nose work. At least, in Kenzo's case.

The first signs came when he started to misbehave when spotting other dogs - which I avoid as he is not allowed to play. Then the other day we met one of his long time favorite girlfriends, a nice calm girl, called Frida. I shouldn't have gone up to let them meet. I expected them to turn around each other with tail wags, as they usually do. Instead, he harassed her on a very rude way.

Kenzo and Frida last December, before his surgery, best friends

Kenzo is no saint, and he can be a bully on occasion, but this was past all limits. An explosion of cropped up energy and frustration.

We will have some serious re-socializing to do. I discussed it with our trainer from the club, who knows Kenzo since puppy hood, and his vet team. There is not much more we can do at this time. We have to finish our physical therapy first, before we can repair the mental damage. The only thing we do try is some damage control. After I tire him out with nose work, we go for a walk - on a short distance - with another girlfriend of him.

So far, it doesn't help, and his frustrations are very visible during those walks.

I am sure he will return as the Kenzo we know, but all of this is going to take a lot longer than I could ever imagine. Still 3 months of physical therapy to go. After that, rebuilding his social skills for an unknown time to come.

But we are in good spirit. We will get stronger out of it when we reach the other end, whenever that might be.

About Hovawarts, inbreeding, and Crufts 2014

It started with a moment that made me feel proud. The Hovawart winner of Crufts 2014 wasn't inbred. The "mate select" from the Kennel Club showed an "inbreeding coefficient" of 0.0%.

It just took 5 minutes before a friend with access to the Swedish Kennel Club database could prove, this wasn't true at all. The winner was inbred. His coefficient was 5.1%.

Viva Sunday #8: The Dream

We had a dream. When we learned how much Viva loved the Danish West-coast and its open spaces, we laid down a plan to change our lives. A plan to sell the business and create more time, and move with the family to the West-coast.

It was a dream where Viva could dash through the dunes and heath fields of the West-coast together with Kenzo, free of the day-to-day fears she suffered from a life in the city. We even dreamed of spending our holidays traveling along the whole length of the Wadden Sea shores, from the north in Holland, through Germany, to the south in Denmark, with its amazing nature, wild-life and abundance of open spaces.

We thought we had time, but as you know, we ran out of it far too soon.

The master plan, Viva's plan, was set in motion long before she passed and is rolling still, up to this day. My business is sold. We are looking at places to live. It is bitter sweet. We measure homes up to Viva's standards. She would have loved that view... She would have loved to have those heath fields in her "backyard"...

Was it Viva's gift to the family to guide us down this path? Or are we trying to live a life that is no more? I believe it was Viva's gift but I am aware I still can't see clearly. The family is split. And I am told it would be a real possibility I'll find myself waking up every day, not on the West-coast, but in a place that will only be a harsh reminder of the fact Viva is no longer with us.

It is difficult to see how much of the plan was for us all, and how much of it was for Viva. Our lives were so intertwined, it is impossible to dissect what part of the dream was for who.

I am told too, I need more time. More time to see clearly. More time to figure this out. But my relationship with time is tensed, because of Viva. Those three years we were given were over in a heartbeat. Isn't time measured while you wait, and seem to play no role when you move ahead, follow your instincts and your heart, bringing you to places where things happen you never expected.

Still, the doubts I have do show, I am slowly waking up from my dream, the dream I had for Viva. Waking up I hope, will give room to a new dream.

Viva Sunday #7: Incoming!

Kenzo was the only dog in Viva's life, she trusted enough, to engage in some rough play. He was her favorite wrestle partner and body-check victim. But he was hard to knock down. The absolute premium was when she occasionally managed to let him tumble, by using strategies to ensure Kenzo either didn't see it coming, or to add some downhill advantage:

Down slope + midships! the perfect body check

Bracing for the upcoming opportunity...

Other then those perfectly timed attacks, it was a whole lot of hard work, to bring her pal down to his knees, even if she tried to seek it higher up:

Puf, puf, it's a lot of work

Maybe try from higher up

She didn't liked when he played rough in return, it was most fun when Kenzo was on the receiving end. He gladly played the victim part though, and if he would get too aroused by all the action and was looking to return some cookies, Viva send him the "off-switch look". When that didn't help, the last resort always was to come running back to me and hide under my skirts:

Enough I say Kenzo! I am pressing your "off" switch now

Dad! Help!

A Renewed Friendship

This photo was taken 4 years ago. Viva hadn't joined the family yet, and Kenzo was still an adolescent.

On it are our youngest grand-daughter, Lucia, only 1 year old, and her mother.

It made me happy Lucia was growing up with "a dog". I hoped, it would become a just as important and large part of her life, as it was for me, growing up with the dogs of my own childhood.

It was not allowed to last, it seemed.

Her parents, witnessing several incidents with other dogs, although not involving Lucia, became mistrustful of dogs in general. Including Kenzo. The blooming friendship between him and Lucia, was abruptly canceled.

You might not expect this, but I thought their newly found distrust wasn't a bad thing at all. Even if it meant I had to keep Kenzo - and later Viva - physically separated from them and Lucia, I had to give them their own time to learn and get to know how to let kids and dogs safely interact.

They asked me for guarantees, which I never gave. But I offered help and repeated what I always felt was best. Never leave them alone together, supervise each interaction, and teach (y)our child how to interact with dogs.

Time passed in a status-quo, until Viva, with her outgoing nature as a cuddle bear and her calmness, was the first to de-ice them. She was a great help in teaching Lucia that a dog is not a toy, but a living creature with its own personality.

It made me sad that Kenzo, unlike Viva, was still looked upon with distrust, as they thought he was dangerous, with all his barking and guarding. They never understood, he was merely protecting them too, as he did for the rest of his family. I never shared my sadness with them before now, as I realized they needed to find their own way.

Lucia in the mean time became fascinated of Kenzo and Viva. Both became equally important to her, and one of the main reasons why she enjoyed her visits. Even when she could only see Kenzo from a distance behind a baby-gate, or gaze in awe at him during a walk.

Slowly, step-by-step, Lucia's parents learned to appreciate Kenzo more, by small "incidents" like the next. I remember how Kenzo once sneaked up behind Lucia, when the baby-gate was left open by mistake. She felt someone was sniffing the back of her head, and when she turned around, stood nose to nose with Kenzo. She put both hands in front of her eyes - an inventive response to what we told her never to stare a dog directly in the face - and said "Hi Kenzo!". Kenzo licked her face, and settled down right in front of her. I could see how everybody exhaled, and Kenzo just earned a new installment to his "trust"-fund.

When Viva passed, they witnessed the unexpected impact it had on Lucia, now 5 years old, and realized what an important part in her young life, Kenzo and Viva already had become. I was grateful to see how they allowed Kenzo to step in, and support Lucia in her grief over Viva. Words were not spoken, but I knew this was the moment, Kenzo was granted the benefit of the doubt.

No need to tell you, it went very well, and a friendship was renewed in the blink of eye.

And so I leave you with this recent photo of Kenzo and Lucia playing.

It warms my heart, all our hearts, seeing those two finally together again. I say it with a huge sigh of relief too, that patience finally paid off and ensured all involved felt comfortable with the situation.

Lucia makes me proud when I see how she interacts with Kenzo. As we taught her, she waits for Kenzo to initiate contact and doesn't impose herself on him.

Most of all I am thrilled on Lucia's behalf, to experience the blessing of a dog's companionship while growing up, receiving unconditional love, learning empathy, responsibility, respect and understanding of animals.

Viva Sunday #6: Snowflake

I lay down with Kenzo in the snow, while children shout in excitement around us. The chilling air feels clean and fresh. The bright sunlight reflecting on the white landscape forces me to shut my eyes. And there she appears, being silly and romping around. The first snow was always our highlight of the year, and I squeeze my eyes even more to hold on to the image before it will fade, and I have to open my eyes again.

Life has returned to its regular routine almost three months after her passing. She visits me still, in waves. I don't know when she will come next. This time it just took a snowflake. Sometimes she comes during the day, and other times in a dream. I am thankful for each visit. Cherished as an unexpected opportunity to again feel that love that once was. Promise me, soon to visit again, Viva.

Viva Sunday #5: Problemsolving

Viva watched in horror how I threw a ball into the surf. While Kenzo was already breaking the waves to get it, and swam back with the trophy in his mouth, she looked surprised and a little despaired at her best friend. I realized she worried for him, and didn't like the idea he was in the mids of all that splashing evil. She protested loudly in an attempt to herd Kenzo back to the beach, and on arrival he received one of his regular Viva spankings.

Like a mother, punishing her kid for doing something stupid, while hugging him at the same time, glad nothing bad had happened.

The spanking never stopped Kenzo from charging the waves. Neither did his continued surfing efforts make Viva less reluctant of a roaring and foaming ocean. Her mind was made up, this was not a good idea. It would have been easier to try and convince the late Margaret Thatcher to spend a little more on welfare.

Although she got used to the fact Kenzo did return unharmed, and started harassing him instead to surrender the ball over to her as soon as he got it out of the water, she still never ventured further than the occasional wet paw. Thinking over what to do now, a genius idea suddenly struck me. In an attempt to challenge her, I threw in two balls. Kenzo would get one, but the other one would stay adrift. Kenzo couldn't care less about the second ball, just as I expected, "just throw this one I returned again, dad"!

Viva, with excellent accounting skills, naturally did notice the remaining one and so far the plan worked. But even with a floating ball in sight, she was still firm in her decision not to go in. I continued throwing two balls, in a solid belief I could be more pig-headed than Viva, and while we waited for the balls to return either by the tide, or by Kenzo getting the picture to retrieve the lost bounty, I suddenly realized ... I had just lost the final battle.

Noticing how the ball could return itself by the tide, solved the dilemma for Viva once and for all. From now on she would keep her eyes on the ball from a safe distance as it floated on the waves, and pick it up as soon as it washed ashore, if Kenzo didn't get it first - in which case she could still refer to Plan B, to steal it from Kenzo.

Problem solved.

Come to mama...

Got it, works every time!

Eek! Alright then, most of the time ... those waves are fast!

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Hovawart TV: Need For Speed

The scenery of the Swiss Alps might be distracting as they flash by.



If your dog had a bucket list, would this be on it?