Introduction and help with night time restlessness

[happydogs]

Hi all! I registered here, hoping to find help for our 15.5 year old pup. It is a very long story so I'm not going to post it all here... just to say, Randall went through all of the (very expensive) Cushings tests and was diagnosed with the disease. We are seeing an internist who is very experienced and has treated hundreds of Cushings dogs. Yet she said that he's a very unusual case (again, long story...).

Anyhow, he was started on Lysodren. Things appeared to be going well at first and the ACTH stim tests showed that his Cushings was better controlled after a month. But then, very subtly, there were tiny changes in the way Randall would eat. And every 3rd or 4th bowel movement would be abnormal. We mentioned this to our vet every time it occurred, and after a week she said she thought something else was wrong. We stopped the Lysodren immediately and brought him in for testing.

Fast forward, Randall was diagnosed with severe liver disease. In fact, they said it looked like inoperable cancer and based on what they saw, gently told us to prepare for a decline in a few weeks.

Fast forward again, we're now 6 months after the diagnosis. His liver function has much improved (he has been on all sorts of supportive meds and nutraceuticals) and he is generally a happy boy.

Here is the problem, though (ok, a couple of problems): first, he's not able to take Lysodren anymore due to his history of liver disease. In fact, since most meds are metabolized by the liver, there's a lot of stuff he can't take. That's why we haven't tried Trilostane either.

Instead, our vet suggested we try Anipryl, even though she said in her experience it has only been effective in about 5% of Cushings cases. However, Anipryl is very safe so we tried it. It hasn't worked.

Now Randall's symptoms are progressing. He has always been a happy bouncy dog who loves running... rock solid housetraining... didn't drink a lot (even when he was first diagnosed with Cushings)... slept like a baby.

Now, though, there is some muscle weakness (so he doesn't run as much anymore, but will always bounce to his feet if he thinks there's a walk coming). He's drinking a huge amount and has had a couple of accidents too.

The biggest problem though is at night. Now he has trouble settling. He'll sleep for a half an hour or an hour, then he'll stand up panting and go for a drink. He looks so miserable standing there, panting. Repeat for hours and and hours, until he finally falls asleep at around 6am (and he'll sleep soundly to around 11am or noon).

I hate seeing him this way. Does anyone have suggestions on what has worked to help your pups settle at night?

By the way... I'm well aware of the general consensus about "remedies" like Cushex drops. We're trying them anyways in case it helps to alleviate his symptoms (we know it doesn't treat the underlying disease, only hope that it will give him some relief at night).

Sorry for this embarassingly long post! Only hoping someone can share some words of wisdom. He has always been active and happy, so much so that our ancient boy was mistaken for a puppy on several occasions! It's so hard watching him decline this way. It's only been in the last 2 or 3 months that it feels like he's "turned old"... :(

[frijole]

Hi. I am glad you found us.. many of us have had dogs with restlessness at night as it is a cushing's symptom, along with the panting. I have successfully used melatonin. It relaxes my girl and she sleeps much more soundly. Don't get the fast release kind - get the regular kind... I buy mine from GNC. They are 3 mg and I give 1/2 tablet for my 15 lb dog. I give it to her about an hour before bedtime.

What I am NOT sure of is how it might interact with the Cushex drops. I know it is safe with lysodren. I don't know what is in Cushex. And believe me, we have had discussions on them. We even went and asked for documented proof ... unsuccessfully. But I do understand that when we are desparate we will do anything.

I am wondering why your vet thinks that you can't give lysodren. I would think it would HELP the liver.. I just don't recall (but I can forget things ;)) someone giving up on it due to liver issues - stomach/digestion yes but liver... ?

Anyway... I would try the melatonin - its cheap and I bet it will help. How much does your dog weigh?

Good luck. Kim

[Harley PoMMom]

Hi and welcome to you and Randall from me and my boy Harley! So sorry for the circumstances that brought you here but glad you found this forum. We will try to help you in any way we can, ok?



I hate seeing him this way. Does anyone have suggestions on what has worked to help your pups settle at night?


Has your vet mentioned melatonin? Some of our pups are using this with lignans as part of a treatment plan for Atypical Cushings. Melatonin, in some pups, does seem to have a calming effect. Some pups even become quite sleepy when taking it.

If you are thinking about trying melatonin, use only the regular melatonin not the fast-acting or rapid-releasing kind.

Here's some information about melatonin that I quoted from Treatment Option Sheet from the College of Veterinary Medicine/University of Tennessee:


Melatonin. Often used as a first treatment, especially if alopecia is present, since it is cheap, has few side effects and is available in health food stores or via nutrient suppliers on the Internet. Typically, a dose of 3 mg is given q12hrs (BID) for dogs <30 lbs; a dose of 6 mg is given q12hrs (BID) for dogs > 30 lbs. Regular melatonin is usually used rather than rapid release or extended release products. Melatonin has anti-gonadotropic activity (effective for ferret adrenal disease), and it inhibits aromatase enzyme in tissues (decreases androstenedione and testosterone conversion into estradiol) and 21-hydroxylase enzyme (effectively lowers cortisol level). Allow at least 4 months for treatment effects to be effective. Response time is variable between dogs.

http://www.vet.utk.edu/diagnostic/endocrinology/pdf/TreatmentInfoAtypicalCushings201005.pdf

Hope this helps.

Love and hugs,
Lori

[happydogs]

Kim and Lori, thanks for responding so quickly! As you can probably tell, I'm very concerned for our boy and want to do what we can to help him. I will ask our vet about the melatonin when we see her next week.

Kim, the internist said that Lysodren should never be given to "compromised" animals as it is an extremely strong and potentially toxic drug. There is a possibility that it even caused the liver damage although we'll never know for sure. It's also a possibility that there was pre-existing liver disease (although his blood panel was clean prior to starting the Cushings tests) and the Lysodren made it worse.

Regardless, we won't be taking a chance with it again. The month after his liver disease diagnosis was terrible. He was a very sick doggy. There were several days where we thought we'd have to let him go. The supplements (Zentonil, Marin, some drugs too) have helped his liver recover to the point where his appetite is very good and he is no longer nauseous. He's his happy self again!

Other than additional supplements (he's on so many)... any suggestions on how to help him settle at night?

[happydogs]

Oh, I forgot to answer your question... our pup weighs 27 pounds. He's about 1 or 2 pounds overweight for the first time in his life. We're still trying to manage his food intake (most of the drugs/supplements have to be taken with food) along with his decreased exercise ability.

[frijole]

Lori and I probably confused you.

I use the melatonin to help my dog sleep at night. It works great. Lots of others here have as well.

Lori's dog has atypical cushings and uses melatonin and lignans to TREAT the atypical cushings.

So really, the melatonin could help not only with sleep but might also help with the cushings. To use it to treat cushings you use a larger dose than I do (for sleep issues). That is the chart that Lori posted.

Kim

[Casey's Mom]

I also use Melatonin to help my dog sleep at night. She does get restless at times even though her cushings is controlled with Lysodren. When I asked my vet she said sometimes when they get older they have more trouble sleeping.

My girl weighs 40 lbs and gets 3 mg.

Hope this helps,

[Squirt's Mom]

Hi and welcome to you and Randall! :)

Now we are gonna play 20 Questions! ;)

Could you tell us what tests were done to diagnose Randall's liver disease and what the actual diagnosis is? We know that some liver conditions/diseases can mimic Cushing's. Do you have copies of Randall's blood work, usually called a CBC panel, that shows her liver values and could you share those with us? In Cushing's it is common for the liver values to be highly elevated as the liver is stressed trying to process all the extra hormones coursing through the body but those elevations do not always mean liver disease.

Would you mind sharing what supplements Randall is taking currently? How much and how often?

Do you have copies of the Cushing's tests that Randall had done and would you share those with us as well, being sure to include the units of measurement (ug/dl, mnoL/l, ect.) and the normal ranges for that lab (different labs use different units and norms)?

Now for some info/food for thought:

From DrugDigest -

" Melatonin is broken down in the liver, so individuals who drink large amounts of alcoholic beverages and those with known or suspected liver diseases should avoid taking it. If liver function is diminished, high levels of melatonin could build up in the blood, possibly leading to side effects."

Altho this info is intended for humans, this is a stronger warning than that concerning Lysodren usage with compromised livers.

From the Lysodren product insert:
http://packageinserts.bms.com/pi/pi_lysodren.pdf

"LYSODREN should be administered with care to patients with liver disease other than metastatic lesions from the adrenal cortex, since the metabolism of LYSODREN may be interfered with and the drug may accumulate."

As you know, this warning will apply to any med, supplement, herb, ect that is metabolized via the liver.

Another product that may help with the restlessness is Bach's Rescue Remedy.
http://www.bachflower.com/

I'm glad you and Randall found us and look forward to hearing more about the both of you. When our babies get sick it can be a real roller-coaster ride for us parents and we all understand that oh too well around here. Our common love for our babies and our determination to do the best we can for them binds us together and forms a family which you and Randall are now part of. We aren't vets and we don't have all the answers by any means but we do have an astounding array of experience and first-hand knowledge that we are more than willing to share. In addition, you will find the very best old-fashioned hand-holding and support right here. You and Randall are no longer alone - we will be with you every step of the way.

Hang in there!
Hugs,
Leslie and the girls :D - always

[happydogs]

It's so nice to find a group of people who not only know what we're going through, but who are also so welcoming. Thank you.

Ok, onto the 20 questions...

We had every test for Cushings done (and some repeated). We use a specialist vet clinic and the internist there said she has never before seen a case like Randall's, even after treating hundreds of Cushings dogs. They did a complete blood panel, a urine test, high and low dose dex tests, ACTH stim tests, and an ultrasound. All the numbers are filed somewhere now, but essentially it turned out to be very confusing (which is why a couple of tests were repeated). Two of the tests indicated that Randall has pituitary-dependent Cushings. The other tests suggested he has adrenal-based Cushings. They said it was a possibility he could have both forms.

What they saw on the ultrasound was confusing as well, as apparently there was a nodule on one of the adrenal glands which was slightly bigger but still within normal size. Normally the other gland will be small to compensate for the larger gland. But in Randall's case, both glands were within normal size.

Prior to Cushings diagnosis, all of his values in the blood panel were normal with the exception of a very slight elevation in ALKP, which all the vets said was a "non-specific enzyme".

We started the Lysodren loading phase and were in touch with our vet every single day. Everything went fine. Then we started maintenance therapy and again, everything was going fine for several weeks. ACTH stim tests were done regularly and showed that his Cushings was coming under control. He was doing great, eating well, sleeping well, still running like a puppy, excess panting gone (he didn't have any other symptoms at the time).

After about a month we noticed subtle signs that something was wrong (see previous post). We stopped the Lysodren and went back to the clinic for a bile acids test. That test showed significant liver damage (118 fasting / 195 post-prandial - normal levels < 15 fasting / < 25 post-prandial). Blood panel revealed significantly elevations in ALKP, ALT, AST, and AMYL. We followed that up with an ultrasound which showed a liver covered in nodules.

Fast forward and his last bile acids test (about 6 weeks ago) is down to 3.5 fasting / 41 post-prandial. He's having a repeat test next week.

While we worked to get his liver better, we had temporarily stopped treating the Cushings. In the last 3 months though we started using Anipryl because it's supposed to be "safe". No results... that's why we have to look elsewhere for a means to ease his symptoms, even if we can't treat the underlying disease.

Supplements: Zentonil, Marin, colostrum, a vitamin supplement, salmon oil, and a glucosamine/MSM/chondroitan mixture.

Drugs: ursodiol, metronidazole, anipryl (we'll be stopping this shortly since it doesn't appear to work).

Alternatives: acupuncture, Zeel & Traumeel, and Dog Gone Pain. We use these last 3 for pain control as he's not able to take the heavier-duty drugs for this.

We don't give him anything without first discussing it with the internist first.

Good news, last night he had a good night and slept through most of the night with only a couple of drink breaks! We will still look into Bach's Rescue Remedy and the melatonin and see what the vet says. We want him to be as happy and comfortable as possible, for whatever time he has left.

[apollo6]

Welcome
from Sonja and Apollo.
Apollo is on Trilostane, has had liver , pancreatits problems. Can't give input on the restlessness. Some members use milkthistle for dogs for the liver. I started Apollo on it about a month ago.
I use Cushex in combination with the medication and supplements to help with his other functions. But the cushex a lone only helped to a point then Apollo plateaued and needed more. He has the hind leg weakness, due to muscle wasting. Apollo turned 12 this October.
We will be here for support. I will be praying for you and Happydog.
We love these guys so much.
Hugs Sonja and Apollo

[happydogs]

Thanks, Sonja and Apollo! We use milk thistle too (it's contained in the supplement called Marin) and will be starting with the Cushex, if only to see if it helps his symptoms.

Have you found anything that helps with the muscle wasting? We have just started seeing it in our pup. He has a bit of trouble getting up from hard floors (carpeted floors are fine) and has slowed down on his walks.

Also forgot to ask everyone... do any of your Cushings pups have coughs? Ours has had a chronic cough for about a year. We've tried a couple of types of antibiotics (which help a little, but not much) and very short courses of prednisone (which obviously we want to stay away if possible - although it does help pretty significantly). The cough always ends up coming back. :(

[Harley PoMMom]

What breed is Randall?

[happydogs]

He's an American Eskimo.

[Harley PoMMom]

Our cush pups are not prone to coughs. Coughing may be a sign to get the lungs or heart checked out. It also could be a really bad tooth infection with the infection draining down his throat...could be alot of things, these are the three things that I can think of.

My non-cush pup, Bear, has a collapsed trachea which does make him cough. This "cough" is a "goose honk" cough tho, very distinguishable sound.

[happydogs]

Bear is a cutie! I didn't mean to imply that the cough is a part of Cushings. Just mentioned it because it's something else our pup is dealing with. He won't cough in front of the vet (of course) so it's hard for her to figure it out. Chest xrays are clear, heart is great, teeth are very good with only mild tartar. The only time the vet ever heard him cough is over the phone once. From that she thinks it's a collapsing trachea too. I just wish we could figure out how to help ease the cough.

[addy]

Hi,

Just noticed the metronidazole. You know that can affect the liver right? My Zoe is on and off of it for her colitis. Another friend of mine's pups is on it as well, maintenance dose twice a week and she has to have him checked. Thought I should mention it:) Might not be pertinent but one never knows:confused:


Less Common Side Effects
•More serious, less common side effects of Metronidazole include diarrhea, depression, weakness, low white blood cell count, blood in the urine and liver complications. Signs of toxicity, if present, tend to begin 7 to 12 days after the beginning of treatment. In most cases, these side effects resolve in a matter of days after stopping the medication.

Hugs,
Addy

[Harley PoMMom]

There are treatments for a collapsed trachea and especially the cough but one needs this to be diagnosed first.

Harley, my cush pup is in my avatar and thank you for the compliment. :)

Love your avatar of Randall, he sure is a handsome fella!

Love and hugs,
Lori

[happydogs]

Thanks, Addy (by the way, love your pup's photo, what a sweet little face). We are aware of the issues that metronidazole can cause for the liver. Randall is on a half dose exactly because of that. The vet thinks it is beneficial to keep him on it because it decreases the bacterial count in his sytem (she's trying to keep hepatic encephalopathy at bay). He gets a bile acids test every 2 months to check on his liver function, so fingers crossed that things will continue to be okay.

Lori, sorry for the misidentification... Harley is a cutie (and I'm sure bear is too)! :) We have looked into all the different methods of diagnosing Randall's cough... unfortunately they require sedation or anesthesia which we cannot do because of his liver disease. The last time he was very mildly sedated was during his last ultrasound and he was extremely groggy for DAYS. It was scary. For now, we have to try to treat his cough as best we can without knowing the exact cause.

[Harley PoMMom]

Many times, very light pressure placed on the trachea during the physical examination can raise a suspicion of collapsed trachea.

Radiographs (x-rays) of the chest can identify the trachea and its shape, so they might help.

Here is a post from one our members, Saskia, about collapsed treachea:


I will leave everything concerning Cushing's to the ones that know a lot more then I do. But I wanted to comment on the collapsed trachea issue...

Sorry for being so blunt, but your vet is dead wrong when she says there is nothing that can be done about a collapsed trachea. A collapsed trachea can't be cured but it needs to be treated. If left untreated it will get worse more rapidly and may result a lot sooner in lung and heart disease due to the restricted airflow and liverdisease due to the liver getting too little oxygen.

I personally would go see a specialist to get a confirmed diagnosis of collapsed trachea and to get more information about the location, the severity of the collaps, etc. A specialist would also know what medications to give such as for example a broncodilator and/or cough supressants. A specialist could also advise you to start give omega 3 fatty acids since it is a natural way to reduce inflammation. And managing inflammation is the cornerstone of the treatment. Also a specialist would tell you to start liversupport because many dogs with a collapsed trachea will devellop liverdisease. He would tell you to keep your dog calm and cool, keep the dog away from smoke and dust, to try and manage the weigth ( I know, difficult when dealing with Cushing's as well) Stress, anxiety and fear are enemies to a dog with a collapsed trachea. So looking into ways to (naturally) calm the dog would be wise as well.

So please, consider to take Bonnie to a specialist for her collapsed trachea and let yourself be well-informed about the treatment options, lifestyle changes, etc. My Boncuk had apart from other medical issues, Cushings and a collapsed trachea. The difficult part is that because of the Cushing's, they shouldn't get steroids but at the same time, a collapsed trachea, definately when it's more advanced, needs steroids. It's hard to watch a dog suffocate. With the right treatment, you can slow down the process considerably. My boncuk's trachea was, at diagnosis, collapsed over the entire length of the trachea (so both inside and outside the chest) for about 30%. Less then a year later, the collapse had progressed to 70%. It can be tricky to treat both conditions at the same time...so prevention is the absolute key here. When the condition is not well managed and the dog goes into an acute crisis, there is only one treatment, steroids. So you can see why prevention and knowledge about prevention and using the right drugs is so very important. And I understand that my Boncuk's collapse was pretty severe and hopefully Bonnie is nowhere near that. But you need to know where you stand in order to know how to treat and manage and to prevent the collapse from progressing faster...

And I don't want to confuse you further, really, just hope to be helpfullwith this information,

Saskia and Yunah :)

[AlisonandMia]

Hi and a belated welcome from me to.

How is Randall's liver function now - is it back to normal? He will almost certainly have elevated ALP and maybe very slightly elevated ALT due to Cushing's but apart from that is his liver function back to normal now as per lab tests?

The liver is an incredibly resilient organ so if the cause of the liver problem has been removed it is likely it will be able to regenerate and return to normal.

Alison

[apollo6]

Could you tell us your name, it just makes it more personal.
Happydog is beautiful to start out with.


Have you found anything that helps with the muscle wasting? We have just started seeing it in our pup. He has a bit of trouble getting up from hard floors (carpeted floors are fine) and has slowed down on his walks.
As far as the muscle wasting, hopefully with medication the muscle wasting should get better , I have been told.
Apollo has the hind leg weakness , which is common in cushing. Sometimes after the cortisone levels have decreased it can be arthritis , hip problems , etc.
Sonja and Apollo

[happydogs]

Hi Sonja, I guess a name would be helpful! My name is Angela.... thought I'd mentioned it before, but I seem to be forgetting a lot lately.

Thanks for the welcome, Alison & Mia. Randall's liver function has vastly improved but unfortunately the ultrasound looks like inoperable cancer... but apparently all the supplements have helped the undamaged tissue to regenerate fairly well. We'll know next week whether or not he's still doing relatively well once we do the bile acids test.

Lori, thank you for looking up that information about collapsed trachea. Our vet did put pressure on his trachea, but she said it was more pressure than normally needed to induce a cough due to tracheal collapse. His cough has been puzzling but we're still going to try to figure out what to do to help him. The humidifer really seems to help (we live in a cold, dry climate).

[apollo6]

Dear Angela.
We will be praying for your sweet Happydog.
Sonja and Apollo

[missbeagle]

Angela -

As far as the cough goes, my 15 yer old yellow lab had a super bad cough two years ago that wouldn't go away. We tried antibiotics, and anti cough meds, but when the meds stopped, the cough always returned.

The vet took some x-rays and my lab has a constricted/collapsed trachea. He coughs when he breathes and the sides touch each other that causes the cough. (Does he normally cough when he is finished drinking? Like he has something stuck in his throat?) The vet also tested him for thyroid problems. He ended up having both of them. The thyroid meds eventually took care of the cough and he no longer coughs at all. Something to do with the thyroid weakening his tracheal muscles.

You might want to try raising his water bowl so he doesn't have to bend as far. Or ice cubes, so he has to lick his water instead of gulping.

Good luck with Randall,

Gretchen and Rusty the beagle in NC

[happydogs]

Gretchen & Rusty - thanks for this! Randall does cough after drinking .... did your vet mention why this is? (I didn't even think to mention it to our vet, but I will now). His most recent bloodwork, about 4 months ago, did NOT show thyroid problems but I will see if the vet thinks he needs another test. He actually doesn't cough that much according to our vet... about 2 dozen times a day... but it's terrible to watch him do it. Xrays are clear and don't show problems. I will try raising his water dish, but don't want to give ice cubes as it would restrict his water intake. He drinks quite a bit as most Cushings pups do.

Thanks again, great tips for us to start more investigation.

[missbeagle]

Angela -

Coughing/gagging after drinking according to my vet has something to do either with the tracheal collapse or laryngeal paralysis. My yellow lab has a mild case of laryngeal paralysis too, due to the tracheal constriction (we could see that from the x-rays) and the thyroid problem. It's all located in the same area.

Hope this helps..

Gretchen and Rusty in NC

[happydogs]

Well, we just got back the results of Randall's blood tests. The good news is that his bile acids is still stable, so his liver is function reasonably well! He also does not have diabetes or thyroid problems, also good news.

The bad news is that it looks like he had kidney insufficiency. :( My poor old dog has gone through so much in the last year, with cancer, Cushings, liver disease, and now this.

Can anyone recommend a lower-protein, low-phosphorous food, that's hopefully good-tasting to dogs?

Thanks...
Angela

[frijole]

Well, we just got back the results of Randall's blood tests. The good news is that his bile acids is still stable, so his liver is function reasonably well! He also does not have diabetes or thyroid problems, also good news.

The bad news is that it looks like he had kidney insufficiency. :( My poor old dog has gone through so much in the last year, with cancer, Cushings, liver disease, and now this.

Can anyone recommend a lower-protein, low-phosphorous food, that's hopefully good-tasting to dogs?

Thanks...
Angela

Lower protein and good tasting - try Holystique (salmon) from Solid Gold (google it). I'm not sure about low-phosphorous but seriously you can call them and talk to them. Explain your situation. I have found them to be very helpful. I am so sorry. Lord your little one has had a lot of problems. Sending best wishes, Kim

[lulusmom]

Since you are inquiring about low protein foods, I assume the vet has formally diagnosed Randall with chronic renal failure, yes?? Can you please post the abnormal results of the bloodwork and urinalysis that were done to make this diagnosis.

Please check out http://dogaware.com/health/kidney.html for some good information regarding kidney disease and diets. You may be surprised to learn that unless a dog is in chronic renal failure, restricting protein may actually be detrimental.

[happydogs]

Thanks Kim, and lulusmom.

Lulusmom - actually, Randall was diagnosed with probable renal insufficiency (not failure) and we're looking for a tasty lower protein (not low protein) food.... the internist had mentioned that some of the values she was seeing could be skewed by very high protein diets, like the one Randall eats. I think what we may do is switch the type of protein instead... more eggs/fish/cheese (all of which he loves), less chicken/turkey/etc.

Anyhow, the vet wants to re-test in about 4-6 weeks. Right now, here are the abnormal values from his test -- remember too that he has Cushings and liver disease too, which the vet said can also skew some of the values:

ALKP 362 (5-131) U/L
BUN 23.3 (2.1-11.1) mmol/L
Calcium 2.93 (2.23-2.85) mmol/L
Triglycerides 3.46 (0.33-3.32) mmol/L
Amylase 1436 (290-1125) U/L
Lipase 834 (77-695) U/L

Other values that were very close to being out of the reference range:
Creatinine 141 (44-141)
Urinalysis - Specific Gravity 1.016 (1.015-1.050)

Through all of his issues Randall has never been a 'textbook case'. He remains happy and active despite his issues and we are hoping to keep him that way as long as possible...

Angela

[lulusmom]

Hi Angela,

Just checking in to see how you and Randall are doing. Looking forward to hearing from you.

Glynda

[happydogs]

Hi Glynda, thanks for checking in on us when there are so many other things going on here. Randall is still generally doing great, active and happy, although his joints have been stiffening up a little (I suppose this is expected, at his advanced age, but I still can't help but wish it weren't so). He also had the first ear infection of his life a couple of weeks ago. Otherwise, he is playing in the snow and eating well. We are going in for a repeat blood chemistry panel in about 10 days, to try to figure out if he really is in the beginning stages of kidney problems. For now, we are just taking it one day at a time and enjoying having him with us. :)

Angela

[lulusmom]

Hi Angela,

It is always wonderful to get great updates so thank you for sharing the latest on Randall. It does my heart good to know that he is doing well and is so happy. I'll be standing by for your update on his blood chemistry panel. In the meantime, give Randall a big hug from me.

Glynda