Introduction to Smiley, Cushing's (and Sammy, Diabetes)-update Sammy has passed

[Smileyspeople]

Let's see...Smiley is a ten year old n. male Chinese Crested powderpuff with Cushings. Sammy(aka Xami) is a twelve???year old n. female rescue with diabetes. Sam's diabetes is controlled (usually successfully) with 2 units insulin twice daily.

Smiley's diagnosis came as a surprise to us (about a month ago), especially since we felt that we were not given adequate info from our vet who did a rapid series of tests, and jumped (rather confusingly) to a compounded prescription of one of the standard Cushings meds. (I forget which one, but will look it up.) We received no guidelines or follow up calls...just the knowledge that my sister's golden retriever had died a painful death after three years of Cushings treatments much money (and two operations.)

Its not exactly that we went into denial...we just went into overload. (I'm giving you the abbrieviated version of this series of events...which involved finding expensive "problems" with all four of our dogs as the result of routine pre-dental procedures.)

Smiley is much loved...as are the rest of our pack. I have believed for sometime that he had a weak endocrine system. (Less by schooling than by observation.) He's had an ear hemotoma repaired by suturing, skin problems "cured" by clavamox. (He's now allergic to this pill.) And he also has an an ongoing luxating patella problem in his back legs...which became calcified until recently (and therefore allowed him fairly good mobility.) Now...of course, his legs really can't support him.

So...the little guy is still shining his bright little eyes out into the world. Still very much controlling the hearts and minds of all the canines in the household, and of course, the humans. But we are quite uncertain about beginning treatment, or what course to take. We are fairly sure (based upon his past) that he will not tolerate meds well, but do want to give him a quality life for whatever time he has left.

That's the story. I haven't yet contacted UCDavis as we are reluctant to start a medical treadmill...but that's kind of the direction we are going. We don't feel that our vets (where we were clients for over ten years) will honor our sensibilities. (I guess that's the way I would put it.) Example: the last conversation we had with them about Sammy (who has been on insulin for four years) was the "guess" that she might have a heart problem and require a pacemaker. This based upon a series of seizures...which (IMHO) seem to come about when she gets frightened. (She's blind and doesn't like noise.)

I ramble...but the Qs are: ethics of putting a sickly elderly dog with Cushings through a lot of treatment. Where to find vets we can work with. ANd so on...

Over to you.

[gpgscott]

Welcome,

It is very hard to watch them grow old.

The treatment itself for Cushing's should not be an imposition on an elder which is in reasonable control of their normal functions, it should bring relief in many areas and cause concern in others.

You should see improvement in body mass distribuation, better energy, improved skin and haircoat and an improved state of mind as they are not constantly thinking about either eating or eliminating.

The diagnostics can be exhausting, and we have seen members go through much un-necessary stress for the pup and cost for the parent.

So let me ask you for more information.

You have said you have a diagnosis and are treating, I presume with Vetoryl also known as Trilostane. Please confirm this and also let us know the names dates and results of the testing done. Please also let us know Smiley's wt. and the dosing of the current treatment.

I am sorry to hear about the bad experience with your sisters pup and can understand that it makes you pause. We will talk straight to you and tell you our personal experiences in the hope it will help you make the best descision for your little one.

Best to you all.

Scott

[Harley PoMMom]

Hi Smiley and Smiley's Mom,

Welcome to our cush-family, so sorry for the circumstances that have brought you here, but I am grateful that you have found this forum with these amazing and very knowledgeable people.

I also am so, so sorry to hear about your sister's golden retriever that passed, it is heart breaking to lose our furry best friends.

I am a newbie here myself, others will be along to give you their advice, these people have a vast knowledge of collective cushings experience under their belts, so you came to the right place for answers to your questions.

May I ask you what your name is, "Hey you" is so impersonal, and we are so friendly. :)

Hugs.
Lori

PS. I just looked at your pictures and you have an absolutely beautiful family.

[Smileyspeople]

Not a problem, although I will be happy to answer to "Hey, you" or any other name! I'm Dorothy (not from Oz, however.) Thanks for replying. I've read various posts and am getting up to speed. My sainted spouse (Peter) is very close to Smiley, and will understand the various test results better than I as he's been researching Cushings since we heard that Smiley had it.

Part of the overwhelming nature of the problem is that we also have Smiley's nephew...Emmett, who may be a candidate for Cushings also. We are close to our dogs (duuuh, aren't we all) so the total picture of 3 out of four critters with these illnesses is shocking. Also, Furby (the one "healthy" one) didn't get the prelim test when he had his checkup so...who knows. (They all have the same grandfather.)

We're feeling quite abandoned by our vets...but I think Peter will make an appointment, go in...and try to get them to spend the time to communicate info to us. This forum is a godsend...but you all know that.

[Smileyspeople]

Scott: Let me get the info from Peter and post it for you. I appreciate all the info, thanks for responding.

Here is the info from Peter. I'm hoping that he will get into this forum as I may not do the greatest job of passing on the info, but he will.

Smiley's weight: 21 lbs.

Trilostane dosage as prescribed by vet, (or perhaps as compounded by drugstore, we aren't sure) 18 mg capsule, by mouth, two times daily. (We didn't get any additional instructions, nor follow-up call.)

6/11/2009

Smiley had the following tests:

thyroid prof 2-SA370
Chem.5 (5-6 tests)
Radiograph abdome
Cortisol 2 Samples
Cortrosyn 0.w5/via

In consultation with several other clinic vets, the atteding vet phoned a prescription to the compounding pharmacy. The pharmacy then called us that they would deliver it the next day. We got the meds, but didn't give them to him.

Please note that we haven't yet started Smiley on this dosage ...our reluctance has been based on a lack of confidence, info, or knowledge. Peter now thinks the dosage *may* be way too high for Smiley's weight. Our reluctance to begin treatment, however, was (and is) based upon the fact that we haven't wanted to start a course of action without knowing more about causes, effects, etc.

His symptoms (described by Peter) are weight gain, bloated stomach w/fat unevenly distributed around neck &side. Panting. Skin rashes, small nodules over much of body. Hair isn't falling out as far as we can tell. He has a good appetite but not ravenous. Has a normal water intake.

Smiley had an ultrasound (abdominal) on 6/17/2009. (We just found the invoice for it...$431.24...the vets office has a "traveling vet" who comes in with the equipment on a cart about once a week.) So this would be in addition to the radiograph mentioned above.

[BestBuddy]

Hi Dorothy (not from Oz) I'm Jenny (and I am from Oz)
I just wanted to welcome you and your clan. You are really doing it tough with more than one dog and I do know that diabetes even when regulated is a bit of work.
Jenny

[Harley PoMMom]

Hi Dorothy and Peter,

If you suspect that Emmett has cushings there is a very non-invasive test that you can do at home and take to your vet it's called the urine cortisol:creatinine ratio (UC:CR).
Ideally 3 morning pooled urine samples are collected by the owners at home and refrigerated and then taken to the vets office. Dogs with elevated cortisol have increased excretion of cortisol in their urine. This excretion can be compared to creatinine excretion, which should be fairly constant in dogs with normal renal function. False-positive elevation of the UC:CR (i.e. elevation not related to Cushing's disease) can occur in dogs with gastrointestinal, renal, lower urinary tract, liver, neurologic, or immune-mediated diseases or congestive heart failure. Although the UC:CR is more frequently elevated than it is normal, when it is normal, you know that your dog does not have Cushing's disease and that you need to look for another possible cause for the dog'sclinical signs.


We're feeling quite abandoned by our vets Oh Dorothy, we do know how you feel there. When Harley was first dx'd by his former vet by JUST a LDDS test, I wanted more tests run, mainly the full adrenal panel and an ultrasound, Harley's former vet felt that I was "second guessing" his dx and sent Harley and me on our way...I was with this vet for 20 years. He did, however, give us a referral to an IMS, so I am grateful for that and you know what...his dx of Harley's type of cushings was wrong...Harley has Atypical Cushings. Alot of us have seen, still see an IMS for our cushpups, especially if there is multiple problems going on within the pup.

When you post the test results, please post the units the lab uses and the reference ranges too.

Will be looking for your updates! And routine pre-dental procedures, Good job. :D:D:D:D

Hugs.
Lori

[Smileyspeople]

I do love Oz folks...have Crested friends in NZ...funniest sense of humor! Thanks for the response, now that I know you're around, I *know* that this is a 24/7 forum!

[Smileyspeople]

Our vets took fecal samples at the time of the dogs annual checkups.
Both Smiley and Emmett did not have Cushings ruled out by the results. (Furby was non-cooperative in producting the necessary sample so...who knows)

We were told not to worry, that the tests really didn't indicate Cushings. Emmett is totally asymptomatic and has always been incredibly healthy (He's an 8 y/o this October.) Emmett is intact as he had been a showdog . (He loved it, we didn't) Now...the vet has suggested that he be spayed as it might "mask" Cushings. (He's not breeding and is very much an indoor dog, always supervised. So we haven't seen any reason to "alter his attitude" until this recent spate of veterinary activity took place.

And yes, they have all always had annual (or twice yearly) dentals. Generally have done well for a breed with a history of teeth problems.

[Harley PoMMom]

Hi Dorothy,

I am a relatively new member here, but I do alot of reading about cushings, and I have never come across anything that said that you can test for cushings with fecal samples...urine samples, yes the UC:CR test. You might want to double check this. Fecal pertains to poop. :eek::D

Hugs.
Lori

[frijole]

Fecal samples?! Are you sure they were testing for cushings? My dog has had cushings for 3 yrs and that has how long I have read here and this would be a first. Kim

[Smileyspeople]

Well, I think so. But I'll go back and pull "old bills." Thats pretty much all the documentation we have in the absence of trying to get their full charts.

[Harley PoMMom]

Usually the test used to dx cushings is the LDDS. IMO, I would not start the Trilostane yet, Smiley just doesn't seem to be showing the symptoms and without the proper tests being done, I truly believe yous are doing the right thing holding off using the Trilostane until you find out exactly what is wrong with Smiley.

Usually cushpups have excessive drinking and peeing, accidents in the house, ravenous appetite, pot-belly appearance, weakness in the hind legs, some have hair loss, some become lethargic.

Usually cushpups liver enzyme values are elevated...ALP and ALT, also their cholesterol may be high.

Could you check for any of these tests (LDDS, UC:CR) or values (ALP, ALT) and see if they are elevated, the liver values I think are on the chem.5 test you had done.

Hugs.
Lori

[gpgscott]

Hi Dorothy,

If I was not certain of the diagnosis and the Dr. has not explained clearly to me about the treatment and objectives I also would not commence a treatment.

The test which was done was an ACTH or stim. You can tell that by the use of cortrosyn which is a synthetic agent that stimulates the adrenal glands. You need the results of that test there will be two numbers designated as pre and post. This test alone is not conclusive for Cushing's.

Many of us use an IMS (internal medicine specialist) to diagnose and design the treatment and then go back to our primary care Dr. to administer the treatment. I am placing a link the our resources forum where you can find information about diagnosis and also locate an IMS.

Scott

http://www.k9cushings.com/forum/forumdisplay.php?f=10

[Squirt's Mom]

Hi Dorothy and a belated welcome to you and yours! :)

I have been reading along but this is the first time I have posted to you. When my Squirt was first diagnosed in 3/08, that was the first time I had ever heard the word "Cushing's", and I thought I was gonna die on the spot! :eek: The look on my vets face was one of sympathy and compassion, so I knew that wasn't good and I just lost it. I cannot imagine having the prior experience you did with your sister's baby, then hearing that your own had Cushing's. :(:(

But I want to tell you something that has been proven over and over again here - each pup is different. They are each biologically, psychologically, and emotionally unique so no two dogs will react the same to treatment. There are medical parameters considered the "norm" but the fact is, each pup has it's own "norm". We have several pups here, in fact, who have apparently read the "rule book" and do everything they can to flaunt it! :p My point is, there are too many variables in each pup to make comparing one to the other for definitive expectations unrealistic. Smiley is Smiley, and no other is like him - but, of course, you already know that! ;):p So, don't fear treatment based on a negative outcome seen in another pup, even litter mates.


Smiley had the following tests:

thyroid prof 2-SA370
Chem.5 (5-6 tests)
Radiograph abdome
Cortisol 2 Samples
Cortrosyn 0.w5/via

Based on the above, Smiley has had his thyroid function checked, a blood chem work up, an abdominal ultrasound, and the ACTH (the last two items). The U/S and ACTH may well tell you if it is Cushing's or not, and which form, if PDH or ADH. If you can get copies of the actual results of the U/S and the ACTH, and post them here, we can help you determine what they say and offer more meaningful insight. Your vet should be glad to give you copies - you did pay for them, after all. ;) Not only will those results help here, it is a good idea to keep a file at home just in case you ever have to see a different vet, like on vacation. That way, you will have all Smiley's info in hand when you walk in the door.

I think you and your hubby are very wise to take a step back and try to figure out some things before starting treatment. Especially since you feel some unease with the way it came about and with your vet. Always trust your gut when it comes to your babies! No one knows them better! ;)

You have done a great job so far! Just take a deep breath and we will look at all the info together, then help you decide how you want to proceed. This is a unique family, too, as you will soon see. We already care a great deal about your Smiley simply because you introduced us. We care about you and Peter, too. We will offer our ideas, suggestions, experiences and hopes, and you take what you can use. No matter what you decide, we will be here and support you all the way. You don't have to take this journey alone. We do understand.

Hang in there!
Hugs,
Leslie and the girls

[gpgscott]

an abdominal ultrasound
Leslie and the girls

Dorothy just a quick note here to comment on Leslie's observations. It is not clear to me that this was an ultrasound and in fact it would be unusual as most general practice Drs. do not have U/S equipment. I take this to be an xray. You need to find out.

Scott

[acushdogsmom]

"Radiograph abdome" = abdominal x-ray (which is not an ultrasound)

"Cortisol 2 Samples" = is most likely in reference to an ACTH stimulation test, which tells you if the dog has low, normal or high cortisol production.

High cortisol production is consistent with a Cushing's diagnosis, but other conditions can cause elevations in cortisol production, so in my opinion, an ACTH stimulation test alone is not enough to confirm Cushing's.


Smiley's diagnosis came as a surprise to us (about a month ago), especially since we felt that we were not given adequate info from our vet who did a rapid series of tests, and jumped (rather confusingly) to a compounded prescription of one of the standard Cushings meds. (I forget which one, but will look it up.) We received no guidelines or follow up calls...

I haven't yet contacted UCDavis as we are reluctant to start a medical treadmillIf you are saying that your Vet says your dog has Cushing's (based, it seems on the results of one ACTH stimulation test) gave you an Rx for trilostane to treat Cushing's and did not book any followup appointments or give you any further instructions regarding the use and need for monitoring (with ACTH stim testing) of the medication ...

please please please do contact UC Davis or a private Specialty Clinic in your area and get your dog seen by an Internal Medicine Specialist, to properly confirm the diagnosis and to properly treat and monitor your dog for te long-term if it really is Cushing's that you are dealing with. I think you may already know that's what you need to do.

I'd also like to let you know that when it is Cushing's, and if it's properly treated and monitored by a Vet who knows how to do it correctly, most dogs will live out a long and happy life on the correct dose of Lysodren or Trilostane. Mine did wonderfully well on Lysodren for more than six years. And we have many others here whose dogs are doing well on trilostane.

When the diagnosis is incorrect, or if the meds are not correctly dosed and monitored, the outcome is not always very good one, however.

[Squirt's Mom]

Scott and Cushy - thanks for catching that! It is indeed an X-ray, not ultrasound. :o

[Smileyspeople]

Thank you all so much for your insights, expertise, and interest. We (Peter & I) always feel more informed after reading your posts.

I'm going to be gone for a week, but (hopefully) Peter will post to the list in my absence as he's staying with the dogs. He's going to get the actual test materials from our vets so we can most this information to you. If he doesn't get to posting, I'll get to the info when I get back.

Its our plan to make an appointment at UC Davis for Smiley before beginning any treatment. Thanks to all of you for steering us in this direction. We are grateful to you for giving us a starting point to understand the process.

Back soon...Dorothy

[Harley PoMMom]

Please get Peter to post! :D

We do not bite! :eek::D

[Smileyspeople]

Thanks. I've printed all materials for Peter ...he knows Smileyspeople and the password so he'll probably post. I don't think he's afraid of biting! (Nobody with four dogs really fears anything but being "woofed" at in the middle of the night.)

Dog A:"Take me outside or I'll pee RIGHT now."
Dog B:"If she gets to go, I get to go."
Dog C:"Already at the door, I am..."
Dog D: "Might be a good chance for me to sneak into the bedroom, they'll think it was Smiley who peed on the bedpost...what fun!"

[Harley PoMMom]

Oh Dorothy,



Dog A:"Take me outside or I'll pee RIGHT now."
Dog B:"If she gets to go, I get to go."
Dog C:"Already at the door, I am..."
Dog D: "Might be a good chance for me to sneak into the bedroom, they'll think it was Smiley who peed on the bedpost...what fun!"

That was hilarious. :D:D:D:D

Love and hugs.
Lori

[Smileyspeople]

Peter has been busy in my absence. He's made an appointment for Smiley at UC Davis for next Tuesday. He's also gotten a copy of Smiley's charts from our vets. (We will bring this with us when we make the journey.)

I'm setting out tomorrow at dawn to head back tothe Bay Area. Should be there by nightfall which will give me a chance to clean the car, clean the dog, and (maybe, just maybe) clean the house *before* we head for Davis.

Will post any/all info about that visit after we return. Fortunately, both of us, and the doglet, will be able to keep the appointment. I've heard a rumble that the rest of the dogs want to go also, but what's so difficult about the direct command, "NO WAY!!!"

Talk with you soon.

[Harley PoMMom]

Hi Dorothy,

You might want to take a tape recorder or notepad along with you bc if you are like me...I never remember everything they tell me/or the answers to the questions I asked. Also ask for copies of all tests done...please...mainly for youself.

Good luck!!!

Love and hugs.
Lori

[Smileyspeople]

Good thought. I scribble notes *really* fast and can usually get most of the comments verbatim. Peter can't read my handwriting :rolleyes: but I can write a legible version that evening. As he is going, he'll hear answers as well, so we do have four ears listening. (Six ears if you count the dog...and Smiles is a good listener!)

Will start a new thread to post the info. And (yes, again thanks) will ask for copies of tests done.

[Harley PoMMom]

Just post all your info here in this thread, that way it's all in one place.

Love and hugs.
Lori

[rhodesian46]

Did I read that the trilostane dosage was 2x a day? Usually the dosage is 1 x a day( Trilostane) May be switched to 2 x a day if the clinical signs are still there such as excessive urination or thirst.

I read this info that you posted and cringe. Not because of you but because your vet probably doesn't have the experience with a Cush pup. I cannot tell you how important a knowledgeable vet is. Reading that he handed you Trilostane with no proper instructions is horrible. And didn't advise you on what symptoms to look for if your boy has diarrhea,vomiting,walking away from his food (not eating),depression, weakness etc. If you any of these symptoms then you need to stop the trilo and give pred. An ACTH stim test would need to be done immediately.Pred should of been given to you just in case this happens and your dog suffers from a adverse reaction to the Trilostane. The reason why this could happen is that the trilo is supposed to suppress the adrenal glands. If the trilo suppresses the glands too much then there will be a steroid deficit in the dogs body and this will make the above symptoms occur.

So having this knowledge on what to watch for is really important. Whenever in doubt always always call your Dr and always have an emergency number( 24 hour ER)readily available. Your dogs records need to be available to you in a crisis like this because the outcome will not be good if you kept in the dark on what to look for and what to do

I hope that you find an Internal Medicine Specialist to handle this. I believe their is a link her to find an Internal Med Dr Could one of the moderators post the link?

[Harley PoMMom]

Marianne, the trilostane was never started, and Dorothy and Peter have an appt. for Smiley at UC Davis for next Tuesday. :)

I agree tho, that vets just hand owners this med. and send them on their way...:eek::eek::mad::mad:

Love and hugs.
Lori

[rhodesian46]

Sorry my bad!!!!

[Smileyspeople]

Thanks for the info though, Rhody! We appreciate all the support. Will be at UC Davis tomorrow morning.

I want to mention that our original vets are pretty familiar with Cushings and have treated quite a few dogs. They are a pretty busy practice and seemed to think (or so we think) that we could educate ourselves rapidly by researching on the net. This, combined with the fact that three of our four dogs were being discussed in rapid succession made for a very confusing situation. And...somehow (even though we can do without a lot of handholding) it seemed incredibly *distant* to send out the trilostane prescription, have the pharmacy deliver it to us, and not give us a call back. (Like: How's Smiley doing? )

Anyway we're off to Davis tomorrow and hoping for the best. Will post results...and thank you all for your support.

And, btw...there seem to be two different protocols on the number of doses each day. So...I suspect our vets used the British protocol rather than the Davis protocol.

We're learning the lingo, slowly but surely...Dorothy

[Smileyspeople]

SMILEY at UC Davis...so far, a success story!

Let's see...where to begin?

We took Smiley to UCD and he stayed overnight. He came home the next evening, but we just finished speaking with the supervising vet, Dr. Amy Tenwolde this evening. (Friday)

Quick post that everything you hear about Davis is true...is awesome. His student intern was Sarah, she spend over half an hour examining him, took her info (and his prior records) back to Dr. Tenwolde and then they both came to speak with us. They spent about two hours on that first appointment.

Written report from Davis summarized:

Weight: 9.2KG

1) Admitted for further evaluation of is diagnosis of Cushings. (Hyperadrenocorticism)
2) Initial diagnosis (from prior vet) was based on an ACTH stim test and an ultrasound. (Client reported patient does not eat or drink excessively at home and it concerned about starting patient on Trilostane.)
3)On physical exami, Smiley was bright and alert. He did have a "pendulous" abdomen and enlarged liver. He has trouble moving his legs on the right side. He has a heart mumer on the left side of his heart. He is also overweight.
4) Basic bloodwork performed (by Davis) indicated Smiley's organ function is normal. Minor elevations in some of his liver enzymes, which are seen with Cushings , but his liver functions are fine. HIs complete blood cell count (CBC) was also normal. HIs urinalysis showed no evidence of infection but he does have some protein in his urine. Abdominal ultrasound perfromed, confirmed that his adrenals are both mildly enlarged. Low Dose Dexamethasone Suppression test perfomed (by Davis) to help confirm whether he has Cushings. (Will call with results of test.)We duscuss at that time whether he would benefit from treatment.
5) X-rays of Smiley's chest taken which showed that his heart was mildly enlarged. Location of murmer indicates likely cause of murmer is degeneration of the mitral valve. (Common in older small breed dogs.) Disease will be monitored by taking chest x-rays every 6-12 months. (Option regular vet or VMTH Cardiology service.)
6) Because of Smileys' trouble using his legs on his right side, he was evaluated by Neurology Service. Signs indicate a problem in his neck. Most likely cause: intervertebral disk or possibly tumor. Less likely to be a problem in his brain. MRI (under general anesthesia) best way to give idea of what is going on. (We decided to hold off on this for the present.)

7) If Smileys signs in his right front and right hind legs become rapidly progressive over the next few weeks, diagnostic test would be recommended.

8) Smiley did well in the hospital overnight. Recommend the following at home:

9) Water Intake Test. (How many cups of water drunk in 24 hours.) ( We noted it appears to be between 1 cup and 1/2 cups a day.)
10) Monitoring: for increasing difficulty wlaking, stumbling falling or inability to rise. Indications would be progressional of spinal chord disease...call our Emergency Service if he is unable to move limbs or to get up at all.


----------
So, this evening we spoke with the vet about the LDDS test. She believes it may show the beginning of Cushings, but that we should wait before beginning treatment. Rest him, work on getting his weight down (with appropriate kibble, carrots as "treats." It may be several months before we need to treat...the main thing to worry about now his his neck. (Note: the legs seem to be improving each day since Tuesday.)
------------------
Thats my summary, errors are mine, not from the report. The carefully worded Davis conclusion was that our vets weren't wrong...they just moved faster that UCD would have.

Over to you...and thank you all...you were right! UCD rocks! And the fees were significantly less that private vets, too. (We ain't rich...so it does matter...)

[Harley PoMMom]

Hi Dorothy,

I'm happy that you had an informative and pleasant visit at UC Davis concerning Smiley.

Altho I am no expert at cushings, they are, so in my opinion, you have heard from the experts.

So sorry Smiley has all these medical ailments going on at the same time, but I'm sure at UC Davis, the Dr's know what should be tended to first. As cushings is a slow progressing disease, it's taking a back seat to the other medical issues Smiley has.

Please keep us updated on Smiley.

Love and hugs.
Lori

[Smileyspeople]

We will. The exciting news for us is that the endocrinologist at Davis feels its far too soon to begin trilostane as Smiley has just entered the (basically asymptomatic) early stage. And when they to start drug therapy is will be with a much smaller dosage than the one we were given.

So...we feel we were right to stall on treatment until more tests were performed. And it also does seem that Smiley's "neck" situation (slight paralysis on one side) is improving daily.

We're hooked on Davis. I'm going to make an appointment with UCD to have Emmett (Smiley's nephew) evaluated as our vets felt he was headed for Cushings. Forewarned is forearmed...and Davis has a dietary specialist so we are planning to work with them to take Smiley's weight down.

Can't thank all of you enough...we were truly paralyzed with fear about the sudden diagnosis. We can now prepare for the future and deal with Smiley's Cushings systematically and (hopefully) effectively.

This list is the cat's pajamas!

[Roxee's Dad]

Hi Dorothy,


6) Because of Smileys' trouble using his legs on his right side, he was evaluated by Neurology Service. Signs indicate a problem in his neck. Most likely cause: intervertebral disk or possibly tumor.

Not sure if you use a collar or a harness with Smiley but you may want to consider using a harness, especially if Smiley has a tendancy to pull on the leash. I've read that many neck and spinal injuries have been caused by using collars. Can't find the post now but I think it was originally posted by Alison (apologise if I am wrong) but if Smiley does have a neck problem a harness would be a good way to keep it from getting any worse.

Found the info - http://www.dolittler.com/2009/05/12/Collar-safety-in-dog-training-and-in-real-life-A-veterinarian’s-take.html

[Squirt's Mom]

Hi Dorothy,

So glad you had a productive visit at UCDavis and that you have a plan for Smiley. :)

I have only one word of caution...Trilo is known to elevate other hormones involved in Cushing's while it lowers the cortisol. If a pup already has some or all of these other five hormones elevated, the Trilo will only make them rise. These hormones will cause the same damage as the cortisol. These hormones I am talking about are Estradiol, Androstenedione, 17-Hydroxyprogesterone, Progesterone and Aldosterone which are tested for only at the Uni of TN in Knoxville. You don't have to go there, just send the sample there. So I highly recommend that you have the UTK full adrenal panel done BEFORE starting the Trilo.

Keep up the good work!
Hugs,
Leslie and the girls

[Smileyspeople]

Sammy died today after four years as a diabetic. During her last couple of weeks, she began to shed hair and develop that classic "pot-bellied form." We suspected the onset of Cushings.

I am happy to report that her last day was somewhat uneventful, she panted a lot, would not eat *and* coughed up mucus when drinking water. I got her out to pee along with the rest of the dogs at about 2:00. She (and they) then laid down on our bed for an afternoon nap. Shortly afterward, she seized slightly and ceased to wheeze. Smiley (her great friend) and I were both touching her. Then...she was gone. We took her to Pet Emergency but, of course she had long since passed over.

So...I think all-in-all that it was a good death for an old faithful dog. Smiley, on the other hand is pissed off...literally...as he usually pees right after her on the same spot and now can't find the "place" to go.

The good news (and there always is good news, isn't there?) Smiley has not yet shown sufficient signs of Cushings to begin his pills through UCDavis.

And the big two, Emmett and Furby, are fine with Emmett about to be scheduled for an appointment at UCD.

Would love to grieve my girl, but I think she had the best of all possible lives and the best of all possible deaths.

See you next month with a Smiley update...unless there is new info on him before then.

Thanks just for "being there."

[BestBuddy]

I am so sorry Sammy has gone but glad that you had that last uneventful day together. It must have happened so quickly and I can only hope that Buddy went the same way. I am hoping her memories always bring a smile to you and the knowledge that she fought hard with a good back up crew.

Jenny

[Harley PoMMom]

Hi Dorothy,

I am so sorry to hear of the loss of your beloved Sammy but I'm glad you and her great friend, Smiley, were with her when she was passing, this had to bring Sammy enormous comfort.

So happy to hear that Smiley has not shown sufficient signs of Cushings to begin his pills through UCDavis. But how is his neck doing?


See you next month with a Smiley update...unless there is new info on him before then.
And by the way, all of your precious pups are part of our family whether they have cushings or not, so you need not wait a month for a update. :eek: BUT if Emmett does get dx'd with cushings (and I hope not) you should start a new thread for him, ok.

We will always be here for you, Dorothy...always.

Your in my thoughts and prayers.

Love and hugs.
Lori

[John II]

Hi Dorothy,

I am so sorry for your loss and my thoughts are with you.
But, as you said "it was a good death" and I hope you can find comfort in that - she was with the ones she loved until it was time to cross the bridge. I think that is all any of us can hope for.

A great big long distance hug,

[Squirt's Mom]

Hi Dorothy,

I am so sorry to hear of Sammy's passing. But I am glad you and all those she loved were with her at the end. Sammy was well attended which surely eased her passage across The Bridge. Many of our babies were there to greet her and show her around her wonderful new home where she is no longer ill, no longer has to face needles, can eat whatever she wants, and feels like a puppy once again.

Sammy's name has been added to our list, Remembering All Who Have Left Us, 2009, so she will never be forgotten by her family here. Also, a candle has been lit in her honor at:

http://www.gratefulness.org/candles/candles.cfm?l=eng&gi=K9C

Know we are here if the grief overtakes you to listen, to cry with you, to help honor and celebrate her life.

Our deepest sympathy,
Leslie, Squirt, Ruby, Goldie, and Crystal

[gpgscott]

Dorothy,

Thanks very much for posting about the passing of Sammy.

We all miss our little ones deeply, even when it is after a long life.

Mine will all get special hugs tonight in memory of your Sammy.

Scott

[Smileyspeople]

Thanks for asking about Smiley's neck. It seems to be healing itself. Just as the right side limping came on fast, so is it leaving pretty fast. We've considered the possibility that the portable ultrasound at the vets "squashed" his little body...only because the limp seemed to arrive simultaneously and because he was crying all the way home in the car that day. (Not looking to blame any situation, so please don't think that we believe they did something "wrong."_

Your thoughts?

BTW, doesn't matter anyway but the limping does seem to be improving. Davis "retook" an ultrasound and there was no apparent problem resulting from that occasion.

High thoughts to all of you. Peter and I appreciate this list so much.

Sam was *my* dog, rescued from the streets of San Francisco so not having her around is very odd after eleven years. Not as impossibly difficult as I thought because I'm just grateful that she went so easily. First 24 hours are passed and it gets easier as time passes. (As you all know.)

Smiley is Peter's dog, so his hopes 'n fears continue to be tied up with the little guy. And the other two? They're kind of the family "watchdogs." Much loved by all, but equally shared among the pack though they do have "their" preferred humans. VBG.

[Roxee's Dad]

Dorothy,
I am so sorry for your loss of Sammy. We will be keeping you and yours in our thoughts and prayers.
Peace to you sweet Sammy.

[MiniSchnauzerMom]

Dorothy,

I am so sorry to read that your Sammy has passed.

With deepest sympathy,
Louise

[sunimist]

Dorothy,

I am so sorry to hear of Sammy's passing. I'm sure you can find a bit of consolation in her passing so easily, even though it doesn't help the heartache and pain of losing a precious soul. Only time can do that, as she resides in your heart forever.

My thoughts and prayers are with you and your family.

(((Hugs)))

Shelba and Suni

[Carol G]

I am so sorry for your loss of Sammy. My thoughts are with you and your family.

Carol

[Squirt's Mom]

Hi Dorothy,

Good to hear that Smiley's limping is getting better and that the repeat U/S showed no damage from the portable machine. I wonder if he maybe pulled a muscle at some point during the first U/S? Some pups are really afraid of those machines and kinda panic.

My thoughts and prayers remain with you and Peter during this tough time.

Hugs,
Leslie and the girls

[Smileyspeople]

Update on Smiley...

We took him to UCDavis yesterday to get a checkup and rabies/distemper vaccination. Of course, we need the rabies to renew his county license.

His checkup with Dr. Hahn went wonderfully and much to our surprise, the intern Sarah who had seen him when we first brought him in was on *this* rotation, so she was there, too.

Well, Smiley is doing well, indeed. He is now 17 pounds which is down three from his initial visit. (We are aiming for a weight of 12 to 13 pounds.) Sarah was most excited to see him and amazed at his ability to walk without limping, and his energy level. Dr. Hahn thought all was going quite well although (of course) the purpose of this visit was not to work with the Cushings.

So, we are pleased to report that UC Davis will be doing his (routine) dental cleaning in the next couple of weeks and that everyone is quite pleased with his progress.

Peter's secret for weight loss in a bitty CHinese Crested? Carrots and the occasional blueberry instead of Senior Teeny Greenies. He gets boiled chicken and is now eating about A THIRD of a cup of (senior) dry kibble a day.

BTW, Samantha's ashes arrived today in their beautiful little cedar box. They are on our mantel...and we *all* feel better to have the girl home, so to speak.

That's my monthly update...hope to have as much good news to tell next month. We know Smiley will be on Trilostane in the near future, but its exciting to report another month's passage before we need to begin treatment!

[MiniSchnauzerMom]

Dorothy,

Thanks for the update and happy that Smiley is doing so well....and even becoming svelte with that 3 lb. weight loss! What a fortunate boy that he's receiving his care and follow-ups at UC Davis. I take my Munchie to the UC Davis Veterinary Medical Center in San Diego (urology and cardiology) and I think they're fantastic.


We know Smiley will be on Trilostane in the near future, but its exciting to report another month's passage before we need to begin treatment!It's exciting to read your report that another month has gone by without the need of starting treatment and hope there are several more in Smiley's future!

I'm glad Sammy has returned home and is with her family again.

Louise

[sarahbera1]

Dorothy,
I am so sorry to hear of Sammy's passing. My thoughts go out to you in this time of sorrow.
Sarah, Darla & Rascal

[clydetheboosmom]

So very sorry for your loss. We are all with you. Glad that Smiley is doing better....

Lynne, Clyde & Bailey

[k9diabetes]

I am so sorry to hear of Sammy's passing. It sounds like she passed on very quickly and was spared any suffering. It is good I know to have her "back" with you.

Godspeed to your little girl,

Natalie

[Harley PoMMom]

Hi Dorothy,

Wow 3lbs!! I would think that would really help with Smiley's agility also. Kudos to Peter and you for his diet.


What a fortunate boy that he's receiving his care and follow-ups at UC Davis.I totally agree with Louise on this, You and Peter are such wonderful parents to Smiley and to all your furbabies.

I am also glad that Sammy is back home with her family.

Keep the updates coming. :D

Love and hugs.
Lori

[Wylie's Mom]

Hi Dorothy,

I haven't posted to your thread before, but I'm wanted to tell you that I'm sorry that Sammy had passed... it's good that it was quick and she had her family by her side.

I'm glad that Smiley is doing so well!

-Susy

[MiniSchnauzerMom]

Hi Dorothy,

I put a copy of your post from the Visitor Messages section here so everyone would be more likely to see your update....and a good update it is!!! :D Glad everyone is doing so well. Hope you have a good Christmas.

Louise
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Smileyspeople Yesterday 08:34 PM

An update; took Furby (age 11) to UCDavis for a well-dog checkup today...he passed but must return in two weeks as they want to recheck. FYI, we *love* UCDavis...they found no problem with Emmett (pre-Cushings) and approved Smiley for yet another month without Trilostan. So...the reason that you don't hear from us is that no dogs seem to be symptomatic. And Sam-the-diabetic (who is in our hearts this Christmas, of course) is in Dogbreath, watching over her pack. Thanks for being there.

Dorothy