Kiska - 13y/o Samoyed mix - Update: Kiska has passed on

[kaliuma]

Just joined this forum today after Kiska received her formal diagnosis of Cushing's. She is a beautiful girl and I look forward to helping her feel better soon! Before I write more, I'll browse the site but wanted to introduce myself and my good girl. My plan is to treat her with Trilostane. I'm trying to figure out what all the costs are going to be.
Love,
Kaliuma

[BestBuddy]

Hi and welcome.

Don't make us wait too long for some more info.:)

We love details, we can already see Kiska is a 13yo samoyed mix but what about her weight and what she eats. Then of course we would like to hear about her symptoms and what lead to the testing, then of course we need to know what tests were done and results would make us deliriously happy.

As you can see we ask lots of questions and we are glad you found your way here.

Jenny

[bgdavis]

Hi and Welcome,

I lost my 13 yr. old Samoyed, Crissy, in March. She lived with Cushings' (atypical) and diabetes, discoid lupus, and hypothyroidism for 5 years. You can see her before and after pictures in our albums, under the 'community' tab above.

Tell us more about Kiska. How she was diagnosed and what treatment she is getting.

Bonnie and Angel Criss

_______________________
admin note:

You have to be a logged in Member to see them, but here's a direct link to Bonnie's album of photos of Crissy Ann, to make the before and after treatment (with Lysodren) pics of Crissy easier to find. :)

If you click on any of the photos in the album, you can see a larger version of that picture.

http://www.k9cushings.com/forum/album.php?albumid=116

[Squirt's Mom]

Hi Kaliuma and welcome to you and Kiska! :)

I am so glad you found us and really look forward to learning more about you and your baby soon.

As Jenny said, we LOVE details so the more you can tell us about Kiska and how she came to be diagnosed that would just tickle us pink! :) And actual results along with units of measurement and normal ranges would thrill us no end! Plus it helps us help you because we can see more of the whole picture.

Word of caution about Trilo. I believe Samoyeds are a Nordic breed? These breeds are more prone to a form of Cushing's called Atypical which involves intermediate/sex hormones not cortisol and Trilo always elevates one or more of these hormones. So it is best to check to see if Kiska has these hormones elevates already before starting Trilo. You can find out about these hormones and the testing in the links below:

Atypical Cushing’s*
(Estradiol, Androstenedione, 17-Hydroxyprogesterone, Progesterone and Aldosterone – an elevation in one, all, or any combination of these hormones, without elevated cortisol.)

http://veterinarynews.dvm360.com/dvm/article/articleDetail.jsp?id=485128&sk=&date=&pageID=1

Beware of false positives, negatives in canine hyperadrenocorticism testing
http://www.vetcontact.com/en/art.php?a=132&t

UT Panel
Explanation of hormones
http://www.vet.utk.edu/diagnostic/endocrinology/treatment.php

Cost sheet
http://www.vet.utk.edu/diagnostic/endocrinology/index.php

Dr O’s credentials
http://www.vet.utk.edu/faculty/oliver

Again, I am glad you found us and look forward to learning much more in the near future!

Hugs,
Leslie and the girls

[kaliuma]

Thank you all so much! I am overwhelmed and greatful for your interest in Kiska. I too, look forward to getting to you and your situations. My answers may come in fits and starts as life is hectic at the moment with Kiska's diagnosis, and lot of other family stuff going on.

Kiska is a 70 lb. Samoyed/Springer Spaniel mix. She was born sometime in 11/1996. I adopted her in the summer of 2002. Several years ago her tail started thinning. I had her thyroid checked a couple times, but it always came back normal, as did all her bloodwork. Over this past summer she developed some classic Cushing's symptoms: increase in drinking and urinating, ravenous appetite, pot belly, excercise intolerance, seeking cool places, panting, restlessness, plus bald patches on the backs of her legs.

My vet ran a blood panel which showed very low thyroid (<0.4) and very high alkaline phosphatase (1800). She put Kiska on a
thyroid supplement and told me to call in a week if she wasn't improving (which she didn't). I switched vets after a bad experience. More about that in my next post. Bottom line, I think my vet didn't know much about Cushing's and instead of referring me on, sort of stumbled around and eventually just stopped returning my calls. It was very shocking and upsetting.

My new vet did the LDDT which came back clearly positive and diagnosed Kiska with pituitary dependent Cushing's. He has a lot of experience with Lysodren but none with Trilostane. However he was previously a veterinary oncologist and has a great network of experts to refer to. I'm feeling good about our relationship. He recommended stopping the thyroid supplement for now since he suspects the Cushing's is causing the low thyroid, and her symtpoms are not improving with supplementation.

Kiska eats Iams large breed. I know it's not the best food, but I don't want to make any drastic changes in her diet right now - she is very sensitive to diet changes. Vet concurs.

There truly is so much more to tell, but this is a start. I signed up for this forum after reading a post that said "I cried for a week after my dog's diagnosis". Boy, did I ever relate to that! But now I'm ready to move on.

I do need to figure out a budget. What a terrible reality! But I have one child in college, another starting next year, and both my husband and I are being required to take unpaid furlough days at work. Any suggestions for saving money while delivering the best treatment for Kiska is appreciated! My vet is open to me ordering Rx from an on-line pharmacy. He also is helping me understand which tests are absolutely essential.

Thanks again!
Susan (my real name!)

[kaliuma]

Bonnie, so sorry for your loss. Aren't Samoyeds wonderful dogs? Crissy looks like a real character! I am bracing myself since I really don't know what will happen with Kiska short-term.

[kaliuma]

Thanks for the great info Leslie! I will ask my vet about these additional tests. Hey folks, if my posts are not in the right places, please bear with me. I'm just figuring out this forum.

[Squirt's Mom]

Hi Susan,

You are posting just perfectly! :D

Hugs,
Leslie and the girls

[kaliuma]

Hi Leslie,
Given that Kiska has all the traditional symptoms of Cushing's, the elevated ALKP and the postive LDDT, in your experience should I still consider atypical Cushings a possibility?
Thanks,
Susan

[Squirt's Mom]

Hi Susan,

In my opinion, yes. It is possible for Kiska to have both elevated cortisol and elevated intermediate/sex hormones and each of these are treated differently. Lyso will address all of the intermediate/sex hormones with the possible exception of estradiol. Estradiol can be produced in areas of the body other than the adrenals and since Lyso works only on the adrenals, it will not effect estradiol produced outside them. Plus she is a Nordic mix, which increases the possibility of these hormones being elevated.

Plus, I always feel better when all the bases have been covered before treatment with Lyso or especially Trilo begins. ;)

Hugs,
Leslie and the girls

[bgdavis]

Susan,

Crissy also had all the classic Cushings' symptoms, but it was a single sex hormone that did the most damage. Dr. Oliver put her on Lysodren from the start. It took us over 2 years to get the diagnosis.

I know you have lots to read already, but here is a link to the sister board of this one and directly to Criss' entire story.

http://www.k9diabetes.com/forum/showthread.php?t=83

Kiska does have that Sammie look although her color's a tad off!

Bonnie and Angel Criss

[gpgscott]

Welcome Susan and Kiska,

You will soon find out we have another dear Kiska, a husky.

I am jumping in here after reading what you have posted so far.

Trilostane is a complex med which confuses the body into thinking cortisol is not needed, in doing so it impacts on several other hormones and mostly in a detrimental way. Please make sure you have gone through the links already supplied.

The initial cost of the full adrenal panel is really only the upcharge from a standard ACTH to the full panel as both require a stim. It must however be submitted to UTK (information in link re;Atypical), if it is submitted to a third party which then submits it to UTK we have been advised upcharges are much more. It should only be about $100.00 upcharge.

Nordics are prone to Atypical, don't know why but that is what we are told by experts.

My Moria a 15+yo purebred lab is Atypical and a little over a year ago was also diagnosed as hypothyroid. The thyroid treatment has helped immensely but I think it might take more than a week to see the change.

My Dr. three years ago was so adverse to treating Cushing's he just shut me out, saying that what she probably had was 'overtreated'. These people helped me figure it out and I am sure Moria would not be here today without their help.

I really don't think it is responsible to treat any dog, much less a breed known for Atypical issues with Trilostane without first performing the UTK full adrenal panel. I think it will save the pup grief from an inappropriate treatment, and I think it will save you $ in the long run.

Best to you all. Scott

ETA, Susan, would you please post the results of the LDDS, it is a good idea to keep a file on hand of all testing.

[lulusmom]

Welcome from me too.

I agree wholeheartedly with Leslie and Scott. If you are contemplating treating with Trilostane, get the UTK adrenal panel done first. As others have said, Nordic breeds are predisposed to hormonal imbalances and if Kiska already has elevated sex hormones, you will, at some point, regret your decision. My dog, Lulu, has pituitary dependent cushing's with elevation of all intermediate/sex hormones. Unfortunately I either never knew or more likely forgot that Lulu had elevated sex hormones. She started treatment with Lysodren and was doing great on it for a year but because she is so tiny (4.8 lbs), on my pharmacists advice, I switched her to Trilostane. Big, big mistake!!!! After a year, she lost the fuzzy coat that she regained with Lysodren and her skin continued to get blacker and blacker, skin got thinner and thinner, plus her appetite was raging. I was chatting with her new IM about her issues one day when we discovered that her prior IM (left the practice) had ordered a UTK adrenal panel before confirming a diagnosis. As I recall, three out of the five intermediate/sex hormones were elevated. We immediately discontinued the Trilostane, went through a 30 day wash out period and then ran a new UTK panel. This time all intermediate/sex hormones were elevated and they were off the charts. Lulu has been back on Lysodren for almost a year and is doing well; however, I'm not sure if she will ever regain her coat. :(

I started thinking about our members' dogs and how many were a Nordic breed. Of the ones I could recall, I don't remember any Malamutes, Samoyeds, Siberians or Pomeranians that did not have elevated intermediates. I have a horrible memory but a quick search turned up three Malamutes, Wylie, Kiska & Osa; three Pomeranians, Lulu, Harley & Tigger and one Samoyed, Chrissy Ann. Poodles are also predisposed and again, I can't think of a member with a Poodle that had a UTK panel done that wasn't diagnosed with atypical cushing's. Maybe others will chime in with names of others that I have forgotten.

The odds that Kiska has elevated intermediates are great.....I'd almost bet my next paycheck on it. If you had chosen to treat with Lysodren, I would have kept quiet because Lysodren normally takes care of the intermediate hormones as well as the cortisol. Because Kiska is a Samoyed and you chose to treat with Trilostane I felt compelled to speak up.

Glynda

[Wylie's Mom]

Hi Susan & Kiska and Welcome!

I agree too with Leslie, Scott & Glynda about the Atypical. My Malamute, Wylie, has both regular Cushing’s & Atypical Cushing’s. Since you mentioned “budget” (most here can relate), Lysodren often ends up being better for the pocketbook, too. But first, a complete diagnosis will save you the most time & money in the long run. If I were in your shoes, I would have the UTK panel & and an ultrasound done. The UTK panel also includes the test you would need before treatment (ACTH stim test, which is also another diagnostic measure for regular Cushing's). The ultrasound (on a high resolution machine & with an experienced person to read it) can give you better confirmation on the diagnosis, plus it can tell you so much about the condition of your pup’s organs, which may affect your treatment decisions.

For future reference, in a nutshell, you can often save money on prescriptions by 1) using online pharmacies 2) using a prescription program like at Walgreens 3) using a generic like Mitotane instead of the Lysodren brand 4) ordering in higher quantities 5) ordering larger sized pills/capsules (and split if feasible)… Before trying #4 or #5, you should first see how Kiska responds/reacts & get a better idea of dosage.

Like many here, I cried and was very overwhelmed at first… but, the more you learn, the more comfortable you will become with all of this and you’re off to a great start by finding this forum;).

-Susy

[jrepac]

re: medicine costs, it pays to shop around the various pharmacies; I've gotten/seen some good prices from 1-800-pet-meds and Drs. Foster and Smith. I've also heard that costco is quite good. Shockingly, I found Walmart to be one of the more expensive ones.

[kaliuma]

We're going to go ahead and start Trilostane, 60 mg twice a day on Friday. We will do an ACTH stim test in 7-10 days, again in 30 days, at 3 months and then every 6 months.

My vet (previously a veterinary oncologist now a GP) has experience with lysodren, but not T. He consulted with an endocrinologist colleague and has gone over all Kiska's records with him. He likes the reported safety profile and I feel that because Kiska is his pilot case, he is giving her extra special attention. He is going to provide T. at the lowest price I could find it online which is $69 for 30 60 mg pills, so that will be about $140 per month.

He doesn't think it's atypical Cushings. The one side-effect we both read about was adrenal necrosis, but all the studies seem to focus on one dog.

I'm concerned that the medicine and testing is going to quickly evolve out of our ability to pay. We do have a veterinary college a couple hours away. Any advice on managing cost is appreciated.

I'll report back in after treatment begins. Keep your fingers crossed! Any idea of how soon we should expect to see improvement in the PU/PD?

Susan

[kaliuma]

jrepac - do regular pharmacies sell veterinary drugs like trilostane?

[kaliuma]

Thanks Suzy! Again, I'm still getting used to the forum (my first!) so bear with me. When I first logged in I didn't see many of the posts which actually address the additional questions I listed.

I'm making some tough decisions and won't always be able to take everyone's advice. That said, I truly appreciate it and will always take it under consideration. Please don't judge me!

I had an additional question - I've read that elevated cortisol can mask arthritis symptoms. Kiska does have arthritis. When the dog is treated, they can actually feel more stiff and sore as their cortisol levels drop. Any experience with this? I'd like to avoid tanking the poor creature up on too many drugs. We've tried Deramaxx (upset her stomach) in the past, although I think aspirin (on a full stomach) did just as good, or better job.

[Wylie's Mom]

Hi Susan,

I don’t have much time to post right now but… I’m a bit surprised that your vet wants to try Trilo when he has experience with Lyso, but I guess the reported safety claims makes it enticing. IMHO – I think which ever drug you choose, the biggest factor would be the person on the frontline who is responsible for looking for any signs and symptoms…YOU;). Please don’t disregard Atypical Cushing’s at this point:

http://www.petinsurance.com/Plans-and-Coverage/Dogs/Plans-for-Dogs/~/media/pdfs/409_Exclusions%20by%20breed_Dogs_R.ashx
http://www.michvma.org/documents/MVC%20Proceedings/Nichols2.pdf
http://www.samoyedhealthfoundation.org/diseases/alopecia-x

I’ll post later about the arthritis..
-Susy

[littleone1]

Hi Susan,

When Corky was originally diagnosed with Cushings, I had noticed that this past winter was the first one that he had not been holding his right hind leg up when he was starting to go for his walks. He does have arthritis, due to pins in both of his hind legs. I didn't know why, but now I know. Even though he might have some pain from arthritis, it's better to treat him for his Cushings, as not treating this can result in more severe problems and damage to his organs.

I do have Metacam to give him for his arthritis, if it is really needed. Otherwise, I have baby aspirin.

Terri

[Harley PoMMom]

Hi Susan,

Welcome from me and my boy Harley, he has Atypical cushings + PDH. Please do not think we are ever judging you, all we are trying to do is let you know our own experiences so you don't have to find yourself in the same dilemma as we were. Both Trilostane and Lysodren are very good drugs for cushings, but Lysodren is suited better for a cushing pup that has elevated hormones and cortisol also.

A vet/IMS can not confirm Atypical cushings, as far as I know, without doing the UTK full adrenal panel, so I don't know how your vet refuted the fact that Kiska might have Atypical cushings without a UTK full adrenal panel being done.




I do need to figure out a budget. What a terrible reality! But I have one child in college, another starting next year, and both my husband and I are being required to take unpaid furlough days at work. Any suggestions for saving money while delivering the best treatment for Kiska is appreciated! My vet is open to me ordering Rx from an on-line pharmacy. He also is helping me understand which tests are absolutely essential.

Thanks again!
Susan (my real name!)

IMHO, Lysodren would be the most cost effective choice, only because you wouldn't need to run the UTK full adrenal panel since Lysodren lowers most of the intermediate hormones and the cortisol.

Lysodren can be purchased at your local pharmacies or compounded.


We're going to go ahead and start Trilostane, 60 mg twice a day on Friday. We will do an ACTH stim test in 7-10 days, again in 30 days, at 3 months and then every 6 months.

My vet (previously a veterinary oncologist now a GP) has experience with lysodren, but not T. He consulted with an endocrinologist colleague and has gone over all Kiska's records with him. He likes the reported safety profile and I feel that because Kiska is his pilot case, he is giving her extra special attention. He is going to provide T. at the lowest price I could find it online which is $69 for 30 60 mg pills, so that will be about $140 per month.

He doesn't think it's atypical Cushings. The one side-effect we both read about was adrenal necrosis, but all the studies seem to focus on one dog.

I'm concerned that the medicine and testing is going to quickly evolve out of our ability to pay. We do have a veterinary college a couple hours away. Any advice on managing cost is appreciated.

I'll report back in after treatment begins. Keep your fingers crossed! Any idea of how soon we should expect to see improvement in the PU/PD?

Susan

I would feel really scared about a vet would never handled Trilostane, I just don't know why he doesn't want to use Lysodren.

Improvements can be seen pretty quickly, please keep a very close eye on Kiska.

Will be keeping all fingers, paws, tails, toes and anything else I can find to cross for you and Kiska. :D

Best of luck to you and your precious girl.

Hugs.
Lori

[Squirt's Mom]

Hi Susan,

I agree with everything Lori has said, but this is your baby, your decision.

Please just keep in mind that her signs may not go away that in fact they may get worse. If you do see that happening, then it will take time to take other action, ie stopping the Trilo, letting Kiska go without treatment for a bit, tesing via UTK and more than likely switching to Lyso. On the other hand, she may do just fine on the Trilo and have no further complications. That is certainly my hope.

We do have a member here who's pup is Atypical and they are using Trilo. You can read Palmer's story here:

http://www.k9cushings.com/forum/showthread.php?t=560

Keep in touch often and let us know how Kiska is doing.

Hugs,
Leslie and the girls

[Wylie's Mom]

Hi Susan,

FWIW – I use Mitotane/Lysodren for Wylie (80lbs)… it costs me about $45/mo. at his maintenance dose level. Even if the cost per pill is less costly with Trilo, Trilo usually requires more pills in the long run; and therefore, more cost overall.

Don’t worry about being judged… you couldn’t possibly take everyone’s advise (especially when they are different or conflicting):rolleyes:. It will definitely be difficult at times to decide on which advise to take – just keep an open mind. Becoming more informed will make it a bit easier to decide. We are not vets, but not all vets would give the same advise either. Just know that everyone means well and wants the best for you and Kiska. Whichever route you take, we are here to help.

About the arthritis… I don’t truly have experience on this, I’ve never had Wylie checked for it, but sometimes he does seem a bit stiff. What you can do for Kiska is start giving her supplements. I would be careful of any NSAIDs like Deramaxx & aspirin for a Cushpup, but if you find that the aspirin is the only thing that helps, it’s better to keep her comfortable… however, I would try other things first. I only give Wylie supplements like Fosters & Smith Joint Care tablets, fish (body) oil or sardines, vitamin E & Hyaluronic Acid. Others here (with pups that have confirmed arthritis) have found success with Adequan shots or other products. Here’s a rather lengthy, but good link regarding joint care/arthritis:

http://www.dogaware.com/arthritis.html

Keep us updated!
-Susy

[haf549]

Hi Susan:

Once Kira's Cushing's symptoms were under control, I noticed that she sometimes had a tough time getting up, when she was lying around a lot. When the weather was bad, she was very stiff. I mentioned that to the vet and he said that because the cortisol levels were now under control, the arthritis could get worse. Cortisol helps control the pain of arthritis and when the levels are lowered, of course the arthritis will get worse. Poor Kira was always stiff and in obvious pain for a good part of the spring and early summer. However, I had been giving her glucosamine/chondroiten supplements since she was 8. I increased her dosage from 450mg a day, to 1000mg. Slowly, over the summer, I noticed that she seemed to be better. Now, I don't know if it was due to the increase in the glucosamine/chondroiten supplement, the warmer weather or that she was just getting used to the stiffness, but she was definitely better over the summer. She was running again, chasing squirrels and generally more playful. Now that it's getting colder again I'll see if it was just the warmer weather or the supplements. If Kiska has arthritis issues, you will probably notice that they get worse. Try the glucosamine/chondroiten. NSAIDS aren't a great idea with the trilo. Though, that said, when she seemed really bad in the spring, I would occasionally give her 25mg of metacam for a day or two; but never more time than that.

Heidi

[kaliuma]

Hi Everyone,

An update on Kiska. She has been on 60 mg Trilostane 2X/day for 3 weeks (a little under 4 mg/kg/day). Though my vet recommended retesting her in 7-10 days, I have waited because I was scared. But now I am watching her symptoms abate. Her drinking is back to normal, she still loves to eat but doesn't seem ravenous, her ears are perked up, she is climbing back on the furniture, "talking" to me. Her walks around the block seem like a joy - rather than a punishment - for her again. Regardless of what her future holds, I'm so happy to glimpse her "dogginess" again! She doesn't seem to be having any side-effects, so maybe we lucked out. Maybe I was right to trust my gut. Maybe things won't stay so rosy. She will have an ACTH stim test this week.

I have been reflecting on my feelings about Kiska. What do I think she wants? What do I want for her? I think the answer lies in her "dogginess". I think she wants to feel physically comfortable, free of suffering, to eat and drink to contentment, and to be able to connect with her pack of people. She didn't have any of these things three weeks ago and she seems to have them now. How far can I go to preserve her dogginess? Especially without the full support of my family? They love Kiska, but are far more pragmatic and less attached than me.

I'll keep you posted as to the results of her test.

Susan

[haf549]

Susan:

I'm so happy to hear about Kiska, that she is doing so well. That's exactly what you want to see; a return to normal (whatever that is for your pup).

I'm sure that the ACTH will reflect the changes in Kiska. One thing to consider, regardless what the numbers on the test say, Kiska's symptoms have abated and that is the ultimate goal. If Kiska's numbers come back on the high side, don't think you need to increase her dosage. My vet said to me that the ultimate goal was to control the symptoms, not to control the numbers.

I'll keep checking and look forward to seeing the results of Kiska's test. I'm really glad of your current happiness and Kiska's returning to her normal self.

Heidi

[kaliuma]

Heidi,

Thank you so much! That is what I am thinking too. This experience has been so stressful, it is just great to see Kiska obviously feeling better. I will keep your vet's idea in mind, controlling the symptoms. That is exactly what my gut is telling me, especially for this old girl. I don't want to subject her to too much testing/treatment.

Thanks again for your support,

Susan

[labblab]

Dear Susan,

This is a very belated "welcome" from me -- I am sorry that I have not had the chance to reply to you before this! But I am so glad that you are seeing such good results from Kiska's treatment. And I'll be keeping my fingers crossed that the ACTH results fall within a range that seems appropriate for her. As Heidi has said, your goal is to see improvement in Kiska, and not just to be chasing numbers. And the experience of many of our members here is that dogs may continue to experience cortisol drops during the first 1-2 months of treatment, even while remaining on the same dose. So I agree that, even if Kiska's results come back at the higher end of the therapeutic range, it may be wise to hold off on an increase. If anything, it might be the opposite issue that you will want to be vigilant about -- making sure that her cortisol level does not drop too low. One of our members is a veterinary endrocrinologist, and he has advised us that dogs who receive trilostane twice daily may be more prone over time to having cortisol levels dip too low.

I am touched by your soul-searching about Kiska's "dogginess." Even under the best circumstances, we can feel so torn by our love and responsiblity for our pups who are unable to directly tell us what their own life choices would be! And given the financial and emotional hardships that so many families are facing, it is not at all surprising that not all family members will be on the "same page" as far as options. But it does make already difficult treatment decisions even harder.

Having said that, I think it is very good news that Kiska is responding so well to the trilostane. There are many dogs who stabilize quickly while being treated with either Lysodren and trilostane, and who go on to live out happy "doggy" lifespans :). It is ironic, but oftentimes we don't get to share their ongoing stories here for that very reason -- their treatment is uneventful, and they and their families have no further need to check in with us. So that is my hope for you and Kiska (not that you won't stay with us, of course!) -- but that the remainder of her treatment will go just as smoothly as these first three weeks.

Once you DO get her ACTH test results back, we may be able to offer out a few more suggestions re: getting the best possible price for her medication. Because every dollar helps, doesn't it!

OK, I'll go ahead and close for now. But I'll be really anxious to hear how Kiska's testing goes. So please be sure to let us know!

Marianne

[Squirt's Mom]

I have been reflecting on my feelings about Kiska. What do I think she wants? What do I want for her? I think the answer lies in her "dogginess". I think she wants to feel physically comfortable, free of suffering, to eat and drink to contentment, and to be able to connect with her pack of people. She didn't have any of these things three weeks ago and she seems to have them now. How far can I go to preserve her dogginess? Especially without the full support of my family? They love Kiska, but are far more pragmatic and less attached than me.

Dear Susan,

So often I have found myself contemplating the same thing and I come back to the same conclusion each time - Squirt will tell me by her behavior what she needs and how she feels...her "dogginess." :) We have been together for so long, through so much together, and I believe she will continue to "tell" me what needs to be done. My job is to pay attention and listen to her and I do my best. That is all any of us can do - our best for our babies regardless of the situation. I know you have that bond with Kiska and that you will continue to listen to her and respond with love as you always have.

Jim loves dogs but he never considered living with four in the house at the same time! :eek::D:p There has been some noise and grumbling with each addition and with every vet bill (of which there are many! ;) ) but he has grown to love them almost as much as I do. :cool: Even tho he still make noise from time to time! :p But folks like us here at K9C are rare people; we take these babies into our hearts just as we would a fur-less baby and many folks just don't understand that connection, while we will fight to the bitter end for it. In my opinion, those who don't understand are missing out of one the most beautiful, pure, and joyful relationships possible, and I feel sorry for them.

You just keep on doing as you have been and know that like-minded folks are here that you can talk with any time! ;)

I am so glad that Kiska is doing well on her treatment! :D It is wonderful that you are seeing your baby coming back to her old self and I hope that trend continues. Like Marianne, I still want to hear from you both regardless of how things are going, ok? Ya'll are family now, ya know! ;)

Hugs,
Leslie and the girls

[MiniSchnauzerMom]

Hi Susan,

It was so heartwarming to read your reflections about Kiska and I'm very happy for you and your baby girl that she's responding so well to her new Trilostane treatment. Congratulations!!!

Will be looking forward to your next update on Kiska.

Louise

[kaliuma]

Hi Everyone,

Thanks again for your support! Kiska had her first ACTH stim test a few weeks ago and was found to still have high cortisol levels (will find results and post later).

Our vet consulted with his internal medicine colleague and it was decided to bump her dose up just a little. 10 mg. I was dubious. Not only is this an expensive option, but would 10 mg really mean anything for a 75 lb. dog? Well, her clinical signs continue to improve! She is panting and drinking less and wagging more. I may try to go another month before getting another ACTH stim test as they are just so expensive. But so far, so good.

I hope to have some real time to sit back and read all your stories some time soon. Again, thanks and best to all,

Susan

[Harley PoMMom]

Hi Susan,


Hi Everyone,

An update on Kiska. She has been on 60 mg Trilostane 2X/day for 3 weeks (a little under 4 mg/kg/day). Susan


but would 10 mg really mean anything for a 75 lb. dog?

So is her total dose going to be 70 mg of Trilostane 2X day?

According to the Dechra U.S. Product Insert:


Individual dose adjustments and close monitoring are essential. Re-examine and conduct an ACTH stimulation test 10-14 days after every dose alteration. Care must be taken during dose increases to monitor the dog’s clinical signs and serum electrolyte concentrations. Once daily administration is recommended. However, if clinical signs are not controlled for the full day, twice daily dosing may be needed using combinations of capsule sizes to slowly increase the dose

http://www.dechra-us.com/File/prod_vetyrol.pdf

Also another very important factor in the ACTH stim test is getting it done within 4-6 hours of giving Kiska her dose of Trilostane.


After approximately 10-14 days at this dose, re-examine the dog and conduct a 4-6 hour post-dosing ACTH stimulation test.

http://www.dechra-us.com/File/prod_vetyrol.pdf

We do understand the financial hardships that come with this dratted disease, believe me I know and others here do too. But the protocols for the ACTH tests are set for very good reasons. Maybe your vet will let you set-up a payment plan?

We would really like to see Kiska's test results when you get them and I am so glad that she is still improving.

Love and hugs,
Lori

[mypuppy]

Dear Susan, Hi, I'm Jeanette and wanted to say a quick welcome to you and Kiska--she is beautiful and very precious I know, as all of our pups are to everyone here on this forum. I first have to tell you that I am no expert with this Cushings condition, but my 7 year old Lab was diagnosed in October, 2009 with it, and ever since life has not been the same. In fact, I read your earlier posts, and as many others here, I can relate to your pain when receiving that initial diagnosis. I cried my heart out thinking my dog's going to die, and then I joined this forum and found so many wonderful, experienced, animal lovers here who have helped me get through these past several months up to this very day. In fact, I just got back from my specialist after having started Princess on trilo only to find out that her levels were too low on the dose she was on, so we stopped the medication and my IMS and I chose to stim her again to make sure everything was going well with her. I will get results of her stim tomorrow and I guess we can then decide what's next in terms of restarting her meds at a lower dose. By the way, I had a similar situation with my gp when Princess first started demonstrating her Cushings clinical symptoms, however, my gp never picked on Cushings and thought it was a behavioral problem. And as one very wise person on this forum pointed out "you have to go with your gutt feeling", and so I actually did and I referred myself to a specialist and that is where they did further work-up on Princess and where we came to the PDH (pituitary Cushings). DO NOT despair. There is lots of hope for your pup. Stay on this forum as much as possible in order to get educated on new info, tests and test results. It has helped me and Princess immensely. I hope it does good for you and Kiska as well, and I wish you both well. Best regards, Jeanette


Hi Everyone,

Thanks again for your support! Kiska had her first ACTH stim test a few weeks ago and was found to still have high cortisol levels (will find results and post later).

Our vet consulted with his internal medicine colleague and it was decided to bump her dose up just a little. 10 mg. I was dubious. Not only is this an expensive option, but would 10 mg really mean anything for a 75 lb. dog? Well, her clinical signs continue to improve! She is panting and drinking less and wagging more. I may try to go another month before getting another ACTH stim test as they are just so expensive. But so far, so good.

I hope to have some real time to sit back and read all your stories some time soon. Again, thanks and best to all,

Susan

[kaliuma]

Thanks everyone - I can't say enough about how great it is to have this forum!

I will post more extensively tomorrow when I pick up Kiska's ACTH stim results.

In the meantime, I have a question: has anyone ordered medication from Canada? I found out from OSU-Vet School that Modrenal (brand of trilostane used outside the US in humans) is the same as Vetoryl. In fact all the testing was done on Modrenal. It is quite a bit less expensive than Vetoryl brand.

Would like to know if anyone has ordered medication from Canada and if there is anything special I need to do other than have a valid prescription in hand.

[labblab]

I cannot speak to your question about ordering from Canada, but I did want to tell you that at the time that I was treating my Cushdog five years ago, Modrenal was the only form of trilostane that I was able to personally import (at that time, I was ordering it from the U.K.). Like your understanding, mine was also that this "human" drug was identical to the trilostane that was being marketed for veterinary purposes. One drawback at that time was that Modrenal was only sold in 60 mg. and 120 mg. capsules -- nothing smaller. I don't know whether that has changed, or whether that is any issue for a dog of Kiska's size. But if not, we will all be interested to see whether you are able to successfully order the med from Canada. Please keep us updated.

Marianne

[kaliuma]

Thanks Marianne. Good to hear that we have the same information. Right now 60 mg is perfect as Kiska is on 130 mg/day (yes, 130 - seems kind of ludicrous the more I know but will keep her on this dose at least until her next ACTH stim test). I would still need to come up with the extra 10mg if that turns out to the remain the stable dose.

I have thought about compounding the correct dose myself. I worked as a chemist for 6 years and have access to the appropriate equipment. I will do what I need to provide Kiska treatment and still be able to send my kids to college. I'm not even kidding one bit!

Best!
Susan

[bgdavis]

I didn't order trilostane from Canada, but did get Crissy's (became an angel 3/11/09) Lysodren from there for several years. It was less expensive than buying in the USA.

You do need to send your vet's prescription to them. Here's the link to the place I used.

http://www.canadianpharmacylink.com/aboutus.html

Bonnie and Angel Criss

[lulusmom]

Hi Susan,

Here is some information that acushdogsmom posted for another member regarding availability of Trilostane in Canada. She also touches on vets/specialists that prescribe Trilostane in the Toronto area.


Yes you can get Trilostane (Vetoryl) in Canada. It was approved for sale in Canada last year I think it was. Vets buy it from a company called Vetoquinol and then the vets sell it to their own clients directly.

You may possibly be able to buy Vetoryl for a bit less from Petpharm, who will sell prescription meds as long as you can provide them with a Veterinarian's prescription. They are an online pharmacy for pet meds, but they are a division of Broadview Pharmacy which is a real pharmacy in Toronto. My friend used to go right in to the back of Broadview pharmacy, to the Petpharm division, to pick up her dog's prescriptions there instead of getting them mailed to her by Petpharm. And I used to buy all my supplements (Denosyl etc) from Petpharm, even though I'm not in Ontario (where they are located). I preferred phoning in my order (rather than ordering online). They were always honest and had very good customer service when I dealt with them.

http://www.petpharm.org/index-can.htm

http://www.petpharm.org/list-can.htm

http://www.petpharm.org/contact-can.htm

Their actual price list (Vetoryl, 10 mg, 30 mg and 60 mg is on pg 4):
http://www.petpharm.org/Petpharm_canprices_Nov18_2009.pdf

(note that prices are in Canadian dollars)

As for Vets who use Trilo in Toronto, I'm sure that there are many Vets in Toronto now using Trilostane. Maybe you can see your old Vet and get consults with a Specialist too? You can maybe have them work together on your case. :)

I'm not good with Toronto geography, so I don't know if these are close to where you want your Vet to be or not, but we've had several folks here in the past who took their dogs to see one of several Internal Medicine Specialists at the VEC SOUTH in Toronto ( 920 Yonge St. - (416) 920-2002 )

Here's a link to their webpage that talks a bit about the four Internal Medicine Specialists who work there:

http://www.vectoronto.com/staff_internal_medicine.php

(Here's the link to their main page http://www.vectoronto.com/ )

I think that the folks we had here who took their dogs to the VEC used Dr. Mason and Dr. Norris at VEC South, although one may have used Dr. Finora, I'm not sure. I do remember that they were very happy with the expert care that their dogs got there. The Internists at VEC South are probably all very good and very knowledgeable about diagnosing and successfully treating Canine Cushings. (I think I also remember that they may have tended to prefer treating Canine Cushing's with Vetoryl/trilostane rather than Lysodren)

Also, although we haven't had an update from him very recently, we have a member here who not very long ago took his dog Lulu to see Dr. Mason at VEC. And I think he was pleased with Dr. Mason. Here's a link to Lulu and Bomi's thread:

http://www.k9cushings.com/forum/showthread.php?t=1140

We've also just had someone on the board who went to see an Internal Med Specialist in the Scarborough area named Dr. Foster. Her dog doesn't have the kind of Cushing's that needs to be treated with trilostane - just Atypical Cushing's I think, but she really liked Dr. Foster.

http://www.k9cushings.com/forum/showthread.php?p=19648#post19648

Both VEC and the Scarborough Clinic (TVEH/Morningside Clinic) have 24 hour Emergency services available, too.

[kaliuma]

Great information on Canada options. Thanks!

Kiska's post ACTH stim result was 7.1 on 120 mg of trilostane divided into two 60 mg doses. Now she is on 70 mg in the morning and 60 mg at night. She will have another ACTH stim test the week of January 4th.

She seems to be doing OK but I do see more signs of her arthritis acting up, i.e. hard to get up and down on a slippery floor. I am now giving her 50 mg of tramadol am and pm and she seems to sleep much more comfortably. Also when we walk, she will really trot along instead of lagging behind.

I have a fairly strong sense that Kiska is in her last months. I may be wrong and will continue to try to give her the best care possible. But I don't hold out strong hopes that she will be restored to full health. I think she may have had Cushing's for a long time before she was diagnosed - her hair thinned over the years and she has had quite a bit of general anxiety ever since I adopted her at 5 years of age. In retrospect my previous vet seems pretty clueless to have not suspected Cushing's sooner. I think her overall health has suffered. It is helpful to look at this square in the eye with a group who knows how painful it is to do so.

But we're doing OK for now and will be home over the holidays to give Kiska what she likes best - to be with her people.

[labblab]

But we're doing OK for now and will be home over the holidays to give Kiska what she likes best - to be with her people.
That's truly the best medicine of all, isn't it?????????? :o :) :o :)

Susan, I have to say that the ACTH result of 7.1 sounds really good to me, given your balancing act between lowering cortisol and also dealing with Kiska's arthritis.

My heart resonates with your worries about her long-term prognosis. I think the same was true with our boy -- he had suffered for an extended time "under the radar," before we even realized that anything was significantly wrong with him. But now you know, and you are doing your very best to balance Kiska's treatment with her entire health profile. And that is the best gift that you can be giving her this holiday season!

One more note. You have mentioned the possibility of ordering Modrenal in order to lessen the financial stress on your family. I don't know whether or not you have considered a compounded version of trilostane in lieu of either brand-name Vetoryl or Modrenal. There are several compounding pharmacies here in the U.S. that offer their own trilostane products, at virtually any dose that you could need. Some vets feel comfortable with prescribing to compounding pharmacies, other vets do not. So I don't know whether or not your own vet would feel as though this is a viable option. But I did want to mention this possibility (although I am guessing that you may already be aware of it, given your experience as a chemist...).

Please continue to update us re: Kiska's progress. And I wish you, Kiska, and your entire family a joyous holiday season!

Marianne

[Carin]

Susan, I'm just catching up with your thread, but to second both things Marianne said, 1) my longtime vet, who had a lot of experience treating with trilostane, was very happy to have Duncan at a dosage where his "post" stims were slightly high, right in the 7 range. Dunc did well at that level for quite a long time. And 2) on compounding pharmacies, I've found compounded trilostane from Franck's to be reliable and very affordable compared to ordering from Masters in the UK, which is what I did for the first year or so of Dunc's treatment. It's worth calling around to see what prices you can get from the compounding pharmacies members of this forum have used. And ask about discounts for ordering more at a time; at Franck's, it's a little cheaper if you get a 90-day supply - though of course that's risky if the dosage is likely to change frequently, as it is with a new diagnosis. I have my doubts about whether you'd do that much better ordering from Canada, especially as the CAN$ is close to at par at the moment.

And don't despair! When Duncan was first diagnosed at age 12, I read about projected life expectancies with alarm, but here he is at 15, and apparently in remission at that.

Carin

[Harley PoMMom]

Hi Susan,

I agree with Marianne, the post ACTH of 7.1 sounds good to me too and according to Dechra's product insert you can have a post up to 9.1 as long as the clinical signs are well controlled.


After approximately 10-14 days at this dose, re-examine the dog and conduct a 4-6 hour post-dosing ACTH stimulation test. If physical examination is acceptable, take action according to Table 2.

Table 2: Action at 10-14 day evaluation

Post-ACTH serum cortisol Action
ug/dL nmol/L
<1.45 <40 Stop treatment. Re-start at decreased dose
1.45 to 5.4 40 to 150 Continue on same dose
>5.4 to 9.1 >150 to 250 Either: Continue on current dose if clinical signs are well controlled OR: Increase dose if clinical signs of hyperadrenocorticism are still evident*
>9.1 >250 Increase initial dose

Happy to hear that you'll be home for the Holidays so you all and Kiska can enjoy each other.

Happy Holidays to you, Kiska and your family.

Love and hugs,
Lori

[kaliuma]

Hey Marianne, Carin and Lori, thanks for the encouragement! I will explore the compounding option this week.

I have two more concerns that didn't seem urgent before, but now that Kiska seems stable I'm wondering if you have had any experience with this. First of all, her coat isn't improving yet. When should I expect to start seeing it fill back in? She has a rat tail (poor thing!) and her undercoat is pretty much gone. Because she has long top hair, she doesn't look too bad, given everything. The spot on her leg where they did the initial ACTH stim test really isn't growing hair yet. Should I be concerned? I'm thinking this may just take time.

The other issue is (how do I say this delicately?) involving a lot of stinky gas. Could this be from the trilostane? Or the tramedol? Any suggestions? The gas is annoying but I also worry that it means her stomach may be upset. Her appetite and elimination seem just fine.

[kaliuma]

One more thought....I was giving Kiska her meds in peanut butter but thought that she might be getting too many fat calories. Now I am wrapping them up in whole wheat bread. Could the extra fiber in the bread be causing the gas, I wonder? She is getting about one whole slice per day...

[littleone1]

Hi Susan,

I'm glad Kiska is doing well on the Trilostane. Sometimes it could take up to several months before their coats start coming back in. Corky's is almost all back now. He's been on Trilo for 2 1/2 months now.

I'm sorry I can't give you any information about the gas issue.

I hope her arthritis pain will ease up.

Terri

[Franklin'sMum]

Hi Susan,

I don't know if it's the same with pups, but too much fibre can cause gas in people. (Dr Oz was on Oprah a couple of weeks back, and somebody had the same question about gas.)

Glad Kiska's doing well otherwise,

Jane and Franklin xx
________
Maine Marijuana Dispensaries (http://maine.dispensaries.org/)

[Harley PoMMom]

Hi Susan,

You probably won't see any real growth where she was shaved or in Kiska's coat in quite sometime, it's usually the last symptom to see improvement in, but the hair/coat does come back, so hang in there, ok.

Re; the gas: Has the gassiness just started with the Trilostane, or has her food been changed? Usually the primary reason for gas is food but whatever is up, gas can be uncomfortable for them, so talk to your vet about using a little probiotics, live yogurt culture, or even some Gas-X pills to help resolve the gas.

Hope this helps.

Love and hugs,
Lori

[Carin]

Susan, Duncan has been gassy on and off for years. My vet said it's fine to give Gas-X, too. (You can get the Gas-X liquid drops for infants; one dropper-ful is about the right dose for a 50lb dog, as I discovered with my larger dog who gets gas. Just read labels carefully to be sure you're not getting Gas-X plus extra ingredients or flavors.) If you want to eliminate the bread without going back to peanut butter, a little low-fat cream cheese is perfect for pills and has a lot less fat than peanut butter. (I would avoid peanut butter anyway; I used to give it inside treats and I think it contributed to my middle-aged female getting pancreatitis from too much fat.)

Carin

[labblab]

Hi Susan,

I just wanted to add one more note re: hair and coat issues. Just as the others have said, it can take a while before you notice improvement. And actually, things may seem worse before they seem better :(. A number of our dogs have actually ended up sloughing a lot of their "old" hair after beginning Cushing's treatment, prior to having a regrowth of new hair. In some instances, the "post-treatment" hair may even have a bit of a different quality -- softer or fluffier. I remember freaking out when my boy started blowing huge patches of fur after we started up with trilostane. I thought, OMG, what is happening now??? :eek: But in those areas of hair loss, I soon saw soft patches of baby fur :). It seemed as though he was entering into an entirely new shedding cycle once his cortisol level was normalized. But it took some time before all that took place and he settled in with his new coat.

It is always good to hear from you, Susan. Please give Kiska some pats for me!
Marianne

[haf549]

Hi Susan:

Prior to her Cushings diagnosis, Kira had had some surgery and the shaved spots didn't seem to want to grow back. When she was diagnosed with Cushings, that kind of explained it. However, they did eventually grow back and now her fur is VERY soft and fluffy. Actually, she feels amazing to the touch. It took a good 6 months for me to notice though.

Don't know much about the gassiness. Sorry.

Heidi

[kaliuma]

I got some Gas-X yesterday and it really seems to have done the trick! She actually seems more comfortable too - less moving around and groaning during the night last night and her stomach doesn't seem as distended.

Thanks for all the feedback on coat issues. It is very reassuring to hear since it does seem that her coat is getting thinner, not thicker since we started treatment!

In not so great news, Kiska stumbled coming down the stairs this morning. She didn't seem to hurt herself at all, but it scares me to think what would happen if she actually fell down the whole flight. My plan is to start spotting her as she comes down. I was also thinking about making a sling out of a towel to put under her torso to help her down, but am afraid it might make her feel even less stable. Our bedroom is upstairs and since Kiska's whole reason for living is to be with us every moment, making her sleep downstairs just doesn't seem like an option.

[Carin]

Susan, great news about success with gas-x. For help going down the stairs, it might work just to have her wear a harness and have a short city lead/handling lead - the ones that are only about a foot long - so you can steady her and slow her down to help her step carefully. It doesn't give support under the back end per se, but I find with Dunc, part of the problem with stairs is that he's used to going a lot faster than he actually capable of going, so he tends to skibber and hop and then lose his footing. If I hold onto his regular walking harness, he steps carefully, one step at a time.

Carin

[kaliuma]

Great idea Carin! Just wish I'd kept Kiska's backpack which could have doubled as a harness. We bought one for her back in our delusional days when we thought that she would want to go backpacking and carry her dog food. We put the pack on her and she just looked at us like "you've got to be kidding". :p

[BestBuddy]

A fabric shopping bag with the sides cut out makes a pretty good support sling. It ends up by looking like a long strip of fabric with handles which are easy to hold and support. It's not meant for heavy work but it is a bit of reassurance and seemed to give my dog confidence when I used it on him.

Jenny

[Carin]

The Sure-Fit Harness here (http://www.sitstay.com/dog/supplies/servlet/CategoryDisplay?catalogId=10001&storeId=10001&categoryId=13976&langId=-1&parent_category_rn=13272&top_category=) from SitStay.com is the best harness anywhere. I use it on all my dogs.

Carin

[kaliuma]

Just a note to let everyone know that we had Kiska euthanized at home yesterday (Friday 1/29). It was peaceful and painless for her. She died moments after enjoying a chewy treat, surrounded by her pack of loving humans.

Kiska was never really well after her diagnosis and recently developed severe lameness to the point she could barely walk or groom. Her Cushing's was never truly under control (as much as I wanted to think it was) and seemed to be getting worse. She was losing more of her coat and her belly was distended and looked uncomfortable. Her muscle tone was poor and even before the serious lameness she had lost interest in going for walks. Her flame was dimming and I decided as her alpha pack member, that it was time for her to rest.

Thank you for your support. I plan to write a memorial for Kiska when I can think a little more clearly. I am most happy to share my experience of home euthanasia if you are interested.

Kiska was a beautiful dog down to her soul, our little honey bear and our funny "pig bear dog". She will be missed.

Love,

Susan

[Roxee's Dad]

Dear Susan,
I am so sorry to hear of Kiska's passing. My heart hurts for you. I'm sure Kiska is watching over you.

[zoesmom]

Susan - I haven't been on around here as much as I used to, so I never posted to you. But I just wanted to say how sorry I am about your beautiful Kiska. I hope you will share her 'whole' story with us when you feel up to it. Sue

[Harley PoMMom]

Dearest Susan,

I am so sorry to hear of the loss of your beloved Kiska and my heart goes out to you at this most painful time. And I am sure she was very comforted knowing you were with her.

Please come back whenever you want to because you are family here and we understand what you are going through, we will always be here for you, Susan, remember that, ok.

Peace sweet Kiska.

With Heartfelt Sympathy,
Lori

[frijole]

Susan, Sorry to hear of Kiska's passing. May memories of the good times sustain you as you heal. Come back and let us know how you are doing when you are up to it. Kim

[BestBuddy]

Dear Susan,

Your love of Kiska shows through in your posts. One of the most loving and selfless things we can do for our animals is to let them go when it is their time. You know the pain you will have by letting them go and do it anyway.

God bless

Jenny

[Kelly_Louise]

We are only new here, but want to send our sincere condolences to you on the loss of your Kiska. Cushings can be so heart wrenching... and I'm sorry that Kiska could not conquer this disease.

Sounds like she was very loved, and I imagine the decision to let her go would have been terrible - but done with only her best interest at heart.

I'm sure she is running free, healthy and pain free over at Rainbow Bridge.

Hugs to you and your family, and all who loved Kiska.

Kelly, Chloe and Sasha

[Casey's Mom]

Susan, so sorry to hear of Kiska 's passing, my heart breaks for you and your family.

It sounds as though you had a very peaceful loving time with her at the end which is wonderful. Peace be with you Kiska,

Love and hugs,

[Franklin'sMum]

Dear Susan,

I am so sorry to read of Kiska's passing. My thoughts and prayers are with you and your family at this very sad time.

Sincerely,
Jane and family
________
Coach Purses (http://icoachhandbags.com/)

[littleone1]

Hi Susan,

I'm so sorry to hear about your loss. Kiska is now at peace. My thoughts and prayers are with you.

Terri

[haf549]

Susan:

I'm so sorry to hear about Kiska's passsing. It sounds like she had a loving passing though. It must be somewhat comforting to have it done in your home, rather than a sterile veterinary clinic. My thoughts are with you at this time of sorrow.

Heidi

[ladysmom06]

Susan,

I am so sorry of your loss of Kiska. My thoughts and prayers are with you. My deepest sympathy.

[mypuppy]

Dearest Susan,
God Bless you and Kiska...I pray for the strength to make it through this time. You are loved and your precious Kiska will never be forgotten. Deepest regrets to you and your family....I'm sending you all my love...xo Jeanette

[kaliuma]

Oh my gosh, thank you everyone for your beautiful outpouring of support! It was truly agonizing to make this decision and carry it through but at the same time there was and is a strong undercurrent of peace.

I can't tell you how much EACH AND EVERY WORD means right now. Though my tears flow while I read them, my heart feels decidedly lighter. I look forward to being able to share my wisdom and support to you and the forum as times goes by.

Love, love, love,

Susan

[Squirt's Mom]

Dear Susan,

I know Ruby and many others met Kiska as she crossed The Bridge, carried on the wings of your selfless, loving sacrifice...the greatest gift we can give our babies.

May peace find you and Kiska's love guide you always.

Our deepest sympathies,
Leslie, Squirt, Goldie, Crystal and always, our angel Ruby


Valhalla

"You were with me to the very end and even after I had "gone" you held me, and as my soul left my body and I looked down and saw you crying, I wanted so much to tell you that I understood.

You did this for me.

I tried to tell you in my own way that it was time for me to leave, and I thank you for understanding.

No other will take my place, but those I left behind will need your love and affection as I have had.

You still think of me, and there are times you try to hide your tear-filled eyes....but please...be happy and think not of sadness, but of how I made you happy and made you laugh at the funny and smart things I did.

There are no fences in Valhalla, for no one has the desire to "dig out".

There are no thunderstorms in Valhalla, therefore fear is never present.

There are no fights in Valhalla. Everyone is congenial. There is no hunger. There is no thirst.

There is much to explore. Many of us who are older take care of the little ones and guide them. It's fun watching them run with their ears flopping and their curly tails wagging.

We have four seasons in Valhalla, and, most of us agree, winter is our favorite.

So you see, my loved one, I am very happy...

When it comes time for my friends to leave, I will meet them at the gates of Valhalla, and I will acquaint them with this beautiful and serene place, and I will take care of them for you.

Thank you for loving me, caring for me, and having the courage to let me go with dignity."

Jane S. Morris

[MiniSchnauzerMom]

Dear Susan,

I am very sorry for the loss of your sweet baby Kiska. Peace sweet Kiska.

With Deepest Sympathy,
Louise

[frijole]

Susan, I join the others in extending my sympathy. I hope that all the wonderful memories of a happy and healthy Kiska keep you going as you deal with the loss. Meanwhile know our newest angel is in a better place. RIP dearest Kiska. Kim

[ChristyA]

I am so very sorry for your loss. I know the pain is deep and will take time to heal. I hope soon the wonderful memories of Kiska in her healthy times will outweigh these hurtful moments.
Christy

[bgdavis]

Susan,

I'm sorry to read that Kiska's time on earth has ended. I know she was greeted at the Bridge by another 13 year old Samoyed, Criss Ann.

Bonnie and Angel Criss

[kaliuma]

All,
Thanks again for all your kind words. I really miss Kiska and allowed myself to look today on-line at other rescue dogs. I adopted Kiska at 5 years of age from a rescue organization. My husband and I have decided to TRY to wait a year before adopting again, but I'm not sure if we'll make it. Although we will never replace Kiska, her absence reaffirms for me how much I love dogs and love having dog energy in my home. I don't think of dogs as humans, not better or worse, but different and beautiful in their ability to form such deep attachment based on such simple expectations: Be here with me. Feed me. Touch me. OK, this is sounding more like a memorial than a thank you - it really helps to write. But thank you, thank you, thank you.
Love,

Susan

[Dollydog]

Hello Susan,
I haven't posted my condolences on the loss of Kiska till now but have been checking in on you.
You have so elegantly described what it is to have a dog in our lives. It's been over 4 months for me without one and I'm looking forward to the day when we have another one. Travelling and being away from home, plus a family wedding this summer is helping me stay focused. I'm also staying away from dogs that need a home, just looking online.
Please take care of yourselves and will be looking forward to your updates,
Jo-Ann & my Dollydog angel :)

[kaliuma]

Hi Jo-Ann,
I am sorry for the loss of your Dollydog. And thank you for your kind words. I'm in a similar situation in that I have a daughter leaving for college this fall which will leave us empty nesters. How I looked forward to this day! And how I dread it at the same time! :p So this spring will mean traveling to look at colleges. After she is settled my husband and I want to do some traveling ourselves. All this to say that maybe right now it is time for us (you and me both) to heal. Then when it's time to adopt again we will do so with light hearts and clear minds!
Love,
Susan

[gpgscott]

Susan,

I am sorry that I missed the posting about your loss of Kiska.

I am glad for all of you that she was at home and surrounded by family.

Sincere condolances.

Scott

[labblab]

Susan, I want to thank you so much for coming back to tell us of Kiska's passing. Although there is such sadness in the loss, there is also a comfort for us that comes from being able to join you in honoring her life and her spirit. You may already know this, but we have a special memorial thread where Kiska is now listed:

Remembering All Who Have Left Us (http://www.k9cushings.com/forum/showthread.php?t=1588)

She will always be here now, joined in memory with our other Cushpups who have also made their passage. And when and if the time comes, we would welcome anything you might wish to post for Kiska on our "In Loving Memory" forum. In the meantime, I wish you and your family my best. It sounds as if this is a time of changes and adjustments -- but also a time for growth and new possibilities. I know that Kiska will always hold a special place in your heart. And any pup who finds a home with you in the future will be such a lucky little one. Never to replace Kiska, but instead to enrich your lives with another sweet spirit.

Please stay in touch with us. My best wishes to you always,
Marianne

[clydetheboosmom]

I'm so sorry I missed your post....please know you have my thoughts and prayers, always....

((hugs))

Lynne, Clyde & Bailey