Chloe 12 yr. old beagle/spaniel, adrenal cushings...Chloe has passed

[Chloe's Caregivers]

Just found this site and could use some direction/help.

Our beloved Chloe, 12, 28# is a mixed-breed (beagle/spaniel) female we rescued from the nearby Humane Society. I'm sure like all of your dogs, she the sweetest thing on four paws in all the world.

We started down the path to a diagnosis of Cushing's in mid-September when she began to have recurring bladder infections. Went on antibiotics each time but came back almost as soon as she went off. Also increased drinking and accidents--which she NEVER had before.

Vet suggested standard blood work to determine if Cushing's might be causing suppressed immune system. Test indicated it was probable so she had an ultrasound on Wednesday. She has a tumor on her right adrenal. It appears to be benign as the tech and vet both said it does not show "wild" characteristics of malignancies. Vet consulted with another surgeon and that possibility has been ruled out as too risky given proximity of tumor to inferior vena cava vessel.

We are trying to figure out next steps in terms of the best course of drug therapy. We are looking at Lysodren vs. Trylostane/Vetoryl. Obviously both have pros/cons from the limited research we've done so far. I'm scared of the induction phase with Lysodren and the seemingly rather arbitrary way you figure out when to go into maintenance, plus the potential for serious side effects. Vetoryl seems like it's a little more straightforward to administer but again, some possible side effects as well as a huge difference in cost (which sadly is a consideration) are concerns.

I know this situation has probably been discussed on this forum many times before but we're trying to get up to speed as quickly as possible. If anyone can help us with your pros/cons on these two drugs, or point us to links or threads within this site with similar information, we'd be most appreciative. (I have already looked over the "Helpful Resources" area...more looking for personal experience and your opinions.)

So glad we found this place and thanks in advance for your guidance. We all share a deep love for these precious souls and it's great to have folks out there who are willing to help us work through this stressful situation.

[Harley PoMMom]

Hi and welcome to you and Chloe from me and my boy Harley. I am so sorry for the circumstances that brought you here but very glad you found this forum and we will help you in any way we can.

As far as treating with Lysodren/Mitotane or Vetoryl/Trilostane, IMO, either medication is safe when monitored appropriately and with owner observation and each med can have similar adverse effects.

So "owner observation" is always a crucial component of treatment.

Each has it's pros and cons, they work differently, they are both safe when monitored appropriately, yet they both can have the same and serious risks and adverse effects.

One or the other may work better for an individual dog.

Another important consideration is the degree of experience your vet has with whatever treatment he/she chooses. Cushing's requires a good partnership with one's vet.

Does Chloe have a ravenous appetite? If so, then this will help a lot with an induction phase of Lysodren. You see, any pause at all when eating during the induction phase is a sign that the loading of Lysodren may be complete and an ACTH stim test is needed.

We have many members that are treating their furbabies with either Lysodren/Mitotane or Vetoryl/Trilostane. I am sure they will be along to welcome you and share their opinions and knowledge.

We are here for you and Chloe so ask all the questions you want and we will answer them the best we can, ok? ;):)

Love and hugs,
Lori

[littleone1]

Corky and I also want to welcome you and Chloe.

Corky also has a tumor on his right adrenal gland. He is not a good candidate for surgery due to his age and his other medical issues. The tumor is also invading the vena cava.

Corky has been taking Trilostane for a little over a year now, and he hasn't experienced any problems with it. Corky's IMS started him on Trilo, as she felt it would be easier on him.

As Lori said, both drugs can have adverse side effects if they are not monitored. I personally feel better that Corky is taking Trilo and not Lyso.

Whatever med you and your vet/IMS decide on, I hope the treatment goes well.

Terri and Corkster

[Chloe's Caregivers]

Lori and Terri, thanks for your notes and info.

We like our vet "team" for the routine care issues we've experienced with Chloe but this is on a whole other level. We admit concerns that at least in part (and somewhat surprisingly), they are not completely well-versed in treatment options for Cushing's. Yet it would be hard to switch now. They do seem willing to consult with other vets and give us feedback though.

We'll be in touch with them (both are wonderful people--older male vet and younger female vet who has actually been more in tune with Chloe's issues...and frankly seems more concerned with following her as a "patient" She is attending a cont-ed conference in San Diego and was not present for the ultrasound). Hopeful between our research, this website's guidance and our vets we can figure out best course on how to proceed.

Thanks and will welcome any and all advice.

Chloe's Caregivers

[Harley PoMMom]

We are not surprised to find that many GP's are not quite as versed in Cushing's as we wish they would be. :( They just haven't handled that many cases, not like an IMS does.

With my boy Harley, he has a GP and an IMS. His GP oversees all his health issues but if she runs into a questionable issue with him, health-wise, she confers with the IMS.

I realize in your post you mentioned that you looked over the "Helpful Resources" area...Great Job!! I am going to provide some links that I hope will be useful and helpful.

Trilostane/Vetoryl Information and Resources
http://www.k9cushings.com/forum/showthread.php?t=185

Dechra's U.S. Product Insert
http://www.dechra-us.com/files/dechraUSA/downloads/Product%20inserts/Vetoryl.pdf

Lysodren loading Instructions and related tips
http://www.k9cushings.com/forum/showthread.php?t=181

Love and hugs,
Lori

[Buffaloe]

I am sorry Chloe has a tumor on her right adrenal gland. Adrenalectomies to remove tumors on the right gland are generally more difficult than on the left.

As you know, both Lysodren and Trilostane are used to medically treat adrenal tumors. There are several factors the professionals sometimes examine (situation with intermediate hormones, likelihood of malignancy, etc.) before choosing which medicine to use. Corky's adrenal tumor has been treated very successfully for over a year with Trilostane.

I know you will make the best decision for Chloe.

Ken

[Franklin'sMum]

Hi and welcome to you and Chloe,

I originally chose to treat with trilostane, as the thought of lysodren scared me silly. That was in July 2009. Since learning more about the illness, and drugs, I don't fear the lyso (as much). Sure, if we had to use it, I would be extremely cautious.
Whichever drug you choose to treat with, there are many here who can offer personal experiences and tips to give the pill/capsule.

Take your time in deciding, you want to be comfortable and confident with your decision. You also may want to see an IMS (Internal medicine specialist) and have the IMS work in conjunction with your vets.

There is also something called "CareCredit", which is a credit card for vet bills, and you can pay it off over time. You'll find more info about it I think in the helpful resources section.

Jane, Franklin and Bailey xxx

[Chloe's Caregivers]

Thanks everyone for your replies, advice and support.

My wife and I are doing some additional homework this weekend. Plan now is to have an extended discussion with our regular vet, Dr. Wass, who was away at a conference when Chloe had her ultrasound. She has been great at "drilling down" to try and establish just what has been going on and we feel a little more connected with her (we heard from one of the techs that she actually called in just to see what the ultrasound had turned up).

I note the suggestions about getting an IMS involved to consult with and we'll bring that up. Also Ken's interesting input about factors that might influence which drug option to choose. So thanks!

We've also been looking at various websites that might be sources for the drugs, perhaps at a discount over getting from our vet. Not sure if rules here permit anyone to offer advice on good sources for ordering, but if so, that would be helpful too.

Again, thanks all and we'll be sure to keep you posted on our situation.

[Harley PoMMom]

We've also been looking at various websites that might be sources for the drugs, perhaps at a discount over getting from our vet. Not sure if rules here permit anyone to offer advice on good sources for ordering, but if so, that would be helpful too.

Again, thanks all and we'll be sure to keep you posted on our situation.

Here are links to a couple Threads for ordering the compounding medicine, Trilostane/Vetoryl or Mitotane/Lysodren:

Buying Trilostane capsules
http://www.k9cushings.com/forum/showthread.php?t=2600

Compounded trilostane - Good or bad?
http://www.k9cushings.com/forum/showthread.php?t=2620

Any questions, please feel free to ask, ok?

Love and hugs,
Lori

[Chloe's Caregivers]

My wife met with our primary vet yesterday for over a half hour getting input and questions answered. We are feeling much better about their Cushing's awareness level, even though both vets admit they don't see that many cases. But actually from some of the other posts here, it seems like they approached the diagnosis fairly rapidly and took all the right steps including blood/urine tests and then the abdominal ultrasound. They've consulted with a board-certified canine surgeon as well as someone at the University's vet school. So we're reassured about having them as part of our care team and they are fully invested in Chloe's treatment going forward.

However, I do want your "second opinions" on these next steps to confirm it seems prudent and reasonable for our case.

From the ultrasound, she can not rule out a malignant tumor which is a 50/50 proposition with adrenal tumors. She still recommends we move forward with drug treatment anyway.

Vet is suggesting Trilostane. More expensive option (ouch) but we're willing to try it as she seems to think it's the best option. I understand Trilo is effective on both pituitary and adrenal Cushing's but is probably preferred option for pituitary. Are those treating adrenal Cushing's with Trilo happy with the results or have you had to switch to something like Lysodrine? Would rather start off on the strongest "foot" rather than having to switch down the line. I know there's an interval of time you need to wait if you switch from one to the other too.

Chloe weighs around 28-30 pounds. Starting doseage vet is advising is 10 mg given twice a day at roughly 12 hour intervals. Does this seem about right? And is spacing better than a single larger dose? Will her blood levels be adequate to get this under control with such spacing?

She gave us a supply of prednisone as a precaution. Recommends starting the Trilo early in the week but that means we'll both be at work and not around to constantly monitor the early phase of her treatment. What do you recommend in that regard, specifically, should one of us try to be around for a few days just to make sure Chloe's handling the drug OK? I can try to run home mid-day and check but there will be gaps of 3-4 hours where Chloe would be unattended and alone. So we're sort of concerned about that.

We are going to order our supply on-line based on several sites recommended by others in our earlier thread. When it arrives and we plan to begin dosing, Vet wants to be contacted. Also she wants to then schedule another "stim" test at the 2-week mark, then another at 30 days. Assuming things are looking good, they would then monitor at 3 months and go from there. Does that sound about right? Those stim tests aren't cheap either but it seems like the Vet is playing it "by the book" based on what is recommended for treating with Trilo. Correct?

What should we expect when we begin to administer Trilo and how quickly might we start to see signs of progress? Personal observations welcomed! Any and all words of advice or encouragement also appreciated. We're still worried but praying and crossing fingers this is the best for little Chloe!

Thanks,
Alan, Lynette and Chloe

[littleone1]

Hi Alan and Lynette,

Corky has an adrenal tumor. He's not a good candidate for the surgery. He is being treated with Trilostane. So far the use of Trilo has been a successful choice for him. He's been taking it for thirteen months now. His dosage has had to be increased over a period of time. He's now taking 40mg daily, BID.

He was a little over 20 pounds when he started the treatment. He was taking 20mg once a day, which was about 1 mg per pound. With giving Chloe 10mg BID, that would just about be the 1mg per pound.

After 10-14 days after starting the Trilo, a stim test should be done. Another one should be done after 30 days. If the dosage stays the same, then the next stim would be in 3 months. If the dosage has to be adjusted, then a stim would have to be done after 30 days.

I started to see positive results with Corky after a few days. There are some of the clinical signs that can take a longer period of time to be resolved. After Corky's second dose, I was concerned, because he almost seemed lethargic. I called his IMS and she said to wait to see how he was the next morning and to give her a call before I gave him the next dose. He was fine. With the cortisol level being lowered, it's almost like somebody come down after being high. This was the only effect that Corky had.

I hope everything goes well with Chloe's treatment.

Terri and Corky

[lulusmom]

Hi Alan, Lynette and Chloe. Welcome to the forum.

I'm sure sorry for the circumstances that brought you here but I'm really glad you found us. We'll help provide you with the information you'll need to be a great advocate for Chloe as well as tons of support in the way of hand holding. We're really good at both. :D Terri has gotten you off to a great start but I'd like to add my own comments, which you can find below in blue text. I have two dogs with pituitary based cushing's and both have treated with Trilostane and Lysodren so I am very familiar with both.


My wife met with our primary vet yesterday for over a half hour getting input and questions answered. We are feeling much better about their Cushing's awareness level, even though both vets admit they don't see that many cases. But actually from some of the other posts here, it seems like they approached the diagnosis fairly rapidly and took all the right steps including blood/urine tests and then the abdominal ultrasound. They've consulted with a board-certified canine surgeon as well as someone at the University's vet school. So we're reassured about having them as part of our care team and they are fully invested in Chloe's treatment going forward.

Good for you for assessing your vets experience with cushing's. Given what we've seen here, a good majority of gp vets are ill equipped to diagnose or treat cushing's. Because no one test can be relied on to be 100% accurate, it's a tough disease to diagnose which makes it the most misdiagnosed disease. Fortunately, it looks like your vet did a very conscientious job of confirming the diagnosis and it's really great that they are consulting with board certified specialists. Did the surgeon feel Chloe was a good candidate for surgery? How old is Chloe?

However, I do want your "second opinions" on these next steps to confirm it seems prudent and reasonable for our case.

We have lots of opinions and we're not afraid to share them. :D

From the ultrasound, she can not rule out a malignant tumor which is a 50/50 proposition with adrenal tumors. She still recommends we move forward with drug treatment anyway.

It is true that in a lot of cases, a surgeon can't tell if the tumor is malignant until they can get in and see things up close.

Vet is suggesting Trilostane. More expensive option (ouch) but we're willing to try it as she seems to think it's the best option. I understand Trilo is effective on both pituitary and adrenal Cushing's but is probably preferred option for pituitary. Are those treating adrenal Cushing's with Trilo happy with the results or have you had to switch to something like Lysodrine? Would rather start off on the strongest "foot" rather than having to switch down the line. I know there's an interval of time you need to wait if you switch from one to the other too.

You have probably already read Terri's post and have seen that her Corky has done quite well on Trilostane. Lysodren is a tried and true treatment for adrenal tumors and until recently was the drug of choice. I think more and more vets are chosing Trilostane as the treatment of choice because adrenal tumors are highly resistant to Lysodren. Often times huge doses are required, which greatly increases the risk of gastrointestinal problems and other adverse reactions.

Chloe weighs around 28-30 pounds. Starting doseage vet is advising is 10 mg given twice a day at roughly 12 hour intervals. Does this seem about right? And is spacing better than a single larger dose? Will her blood levels be adequate to get this under control with such spacing?

Trilostane has a short half life and it's enzyme blocking abilities start to diminish well before 24 hours. Each dog is different and most dogs do well on once daily dosing but some will require twice daily dosing for good control throughout the day. While the manufacturer of Vetoryl (Trilostane) recommends that you start with once daily dosing, a good number of vets do start with twice daily dosing. This is based on a study or two that showed a good number of dogs benefit with twice daily dosing. The benefits of once dilly dosing are cost and convenience for the pet owner. One of my cushdogs did well on once daily dosing for two years and the other did well on twice daily dosing. Every dog is different so you never know.

She gave us a supply of prednisone as a precaution. Recommends starting the Trilo early in the week but that means we'll both be at work and not around to constantly monitor the early phase of her treatment. What do you recommend in that regard, specifically, should one of us try to be around for a few days just to make sure Chloe's handling the drug OK? I can try to run home mid-day and check but there will be gaps of 3-4 hours where Chloe would be unattended and alone. So we're sort of concerned about that.

Good for your vet for giving you prednisone. Most vets don't do this because unlike Lysodren, Trilostane does not have a cumulative effect and because of its short half life, dogs will bounce back rather quickly after withholding a dose.

I personally made sure I was home with my dogs for the first couple of days after starting treatment. As I recall, we started on a weekend so I could observe. I don't think it would be a problem if you waited until the weekend to start treatment but you should ask your vet.

We are going to order our supply on-line based on several sites recommended by others in our earlier thread. When it arrives and we plan to begin dosing, Vet wants to be contacted. Also she wants to then schedule another "stim" test at the 2-week mark, then another at 30 days. Assuming things are looking good, they would then monitor at 3 months and go from there. Does that sound about right? Those stim tests aren't cheap either but it seems like the Vet is playing it "by the book" based on what is recommended for treating with Trilo. Correct?

Your vet is following protocol so this is good. You're right the cost of stim tests are not cheap and having two cushdogs, I cry a lot. :D:D:D. Since your vet has not had a lot of exposure to cushing's, she may not know about the little gem I'm going to tell you about that will save you money. Most vets use a synthetic acth stimulating agent called cortrosyn for the acth stimulation test. This stuff is liquid gold. Instructions from the manufacturer says to use the entire .25mg vial; however, studies have shown that you only need to use 5mcg per kg of the agent. In Chloe's case, you would divide her weight of 30 lbs by 2.2 which equals 13.63kg. Chloe would need 68mcg (13.63 x 5) per stim test. Since there are 250 mcg in a vial, your vet should easily have enough cortrosyn for three acth stim tests from one vial. Tell your vet that she can split the remaining agent in tuberculine syringes and label them with Chloe's name. She can store the syringes for 30 days in the refrigerator and up to six months in a frost free freezer. Dr. Mark Peterson, a world reknown specialist in endocrinology was involved in the study, so if your vet has any questions on how to reconstitute or store, she can contact Dr. Peterson. His contact info can be found on his website.
http://www.drmarkepeterson.com/

What should we expect when we begin to administer Trilo and how quickly might we start to see signs of progress? Personal observations welcomed! Any and all words of advice or encouragement also appreciated. We're still worried but praying and crossing fingers this is the best for little Chloe!

Most dogs respond rather quickly to Trilostane as it can drop cortisol very rapidly in the first few days. Because of the rapid drop, some dogs will feel kinda crappy. Most dogs have become accustomed to the high levels of cortisol in their system so when it drops like rock, they can go through cortisol withdrawal. They usually adjust within a few days. Symptoms of cortisol withdrawal are much the same as cortisol that is too low so be sure to contact your vet if Chloe stops eating, vomits, has diarrhea, is more lethargic than usual, extremely weak and/or has tremors.

Every dog is different but if the dose is effective, you can expect to see improvements in symptoms rather quickly...a few days to a week. Just remember that most dogs will require an adjustment to dose. Since your vet has started Chloe on a conservative dose, which is a good thing, you may have to do some tweaking before you find the right dose. It's always better to start low and go slow so that's another gold star for your vet. In preparation for the acth stimulation test, the test must be done within 4 to 6 hours after the morning dosing. Trilostane is better absorbed with food, so be sure to give the dose with a small meal.

Thanks,
Alan, Lynette and Chloe

You don't have to do this alone. We're here with you and for you when ever you need us.

Glynda

[labblab]

Dear Alan and Lynette,

Just wanted to let you know that I have merged your new thread about Chloe into your original one. This way, all of Chloe's history and ongoing information will be contained in one spot. As time goes on, it makes it much easier for us to offer feedback and to avoid duplicating questions when all the info about a pup is "housed" in a single thread.

And also, I wish to offer you a belated "Welcome!" :)

Marianne

[Chloe's Caregivers]

WOW!!!

Thanks so much Lulusmom! Those responses are very reassuring as we move forward with treatment. Appreciate the detail and also advice on followup testing.

Chloe's tumor is laying right next to the inferior vena cava and the surgeon said he wouldn't touch it...has lost too many "on the table" with similar presentations. So while successful removal would have taken care of the issue entirely and Chloe's tolerated a few procedures requiring anesthesia--teeth cleaning, etc.--we're not going to risk it.

Chloe's 12 and up until about May or so, has been a very spunky pup. Now that we look back, we're guessing the advent of Cushing's probably started about that time and gradually produced the changes we are seeing today.

Very much appreciate all the support out there (and understand Labblab about why you combined our posts). This site is obviously a blessing. Very caring folks who know what we're all going through and the concerns we share for our best friends.

Thanks again,

Alan, Lynette and Chloe

P.S. Right now we're thinking of starting dosing with Trilo this coming Monday but will see if shipment gets here tomorrow or not. Will be sure to let you all know how it goes.

[Chloe's Caregivers]

Chloe got her first dose (10mg) this a.m. after FedEx FINALLY delivered it yesterday...don't get me started about that episode.

My wife didn't have to work today so she's around to keep an eye on her and I am able to be home tomorrow and most of Friday. So we should have someone with her for the better part of the next 5 days just in case of a problem.

If you have any tips on signs to watch for in the early dosing phase (both positive and negative), that would be helpful. She's on a fairly conservative dose and we're hopeful there aren't any side effects but still have our share of worries and conerns. And morale support from those who have walked this road before always is appreciated!

Will let you know how it goes.

Alan, Lynette and Chloe

[Rebelsmom]

Usually the first signs to look for will be loss of appetite, vomiting and diarrhea. Rebel has been an trilo for almost 8 months now and is doing wonderful. I hope you have the same results.

Melissa

[Chloe's Caregivers]

Started Trilostane 11/17, 10 mg. twice daily for appx. 30# dog. Vet wanted to take conservative approach to treatment and tweak dose as needed. We were nervous about possible side effects and stayed close to home for about 4 days. Fortunately, no negative reactions to date.

Anxiously waited for any positive signs through the first week but no real changes noted. Then at right about the one week mark, her water intake dropped almost in half overnight! We're continuing to monitor and it seems to be holding. We were away for almost 9 hours Thanksgiving Day and worried we'd come home to accidents but good old Chloe came through again, even with Cushings...no problems!

Other than the water intake, no other really noticeable changes and she still has a very healthy appetite. But we have our first blood tests since we began medicating this Wednesday and should get results back early next week. Then we'll get a much better idea of where things are at and go from there.

Anyway, just wanted to report back in on how things are proceeding. So far, so good. Continuing to read and learn here.

Thanks,
Alan, Lynette and Chloe

[Roxee's Dad]

Great update and news. Glad that you are seeing some improvements and I am sure there will be more to follow. Hope the test goes well.

[Chloe's Caregivers]

Had 1st post-trilostane dosing ACTH stim test yesterday. Our vet (a Saint!!) left message on our machine this p.m. and said Chloe's tests are really looking good! Well within ranges to the point they are checking on reducing dose. We can't say enough about how our vet team has performed for us despite acknowledging they don't see many "Cush Pups." We (and Chloe) are blessed to have them on our side.

Meanwhile, Chloe has reduced water intake dramatically and actually RAN (and I mean full-out RAN) back from the mailbox today--what a JOYOUS SIGHT TO SEE (ears flopping in the wind)-- for about the first time in 5 months (:)). She seems much more comfortable, alert and more like the Chloe we've loved these past 12 years!

Will be interested to get actual blood test numbers to see what they show. But after 4 months of stress and seeing our beloved Chloe in decline, things seem to be moving in the right direction.

Another test in about a month. $ is a concern but right now, it's all worth it. Thank you all for your support and the info you provide to folks like us going through this journey! We will continue to read and post. Our thoughts are with all those who are dealing with Cushing's and especially their dear "Fur Babies."

As Red Green (my role model) would say, "We're all in this together."

Alan, Lynette and Chloe

[Squirt's Mom]

Hi ya'll,

Ain't it grand to see your old baby coming back again!? :D:D I am so happy for you all and hope you have many more moments of joy with precious Chloe.

Looking forward to seeing those numbers but based on her behavior, it sounds like ya'll are doing just great!

Keep up the good work and do keep in touch!
Hugs,
Leslie and the girls :D - always

[jesse'smom1001]

Hi Alan, Lynette, and Chloe. My Jesse started Vetoryl 11/26 so it looks like we are going to be on roughly the same time line. My girl's Cushing's is pituitary, but other than that we may have some similar experiences to share.

My vet advised me to start the meds the Friday after Thanksgiving. She stated a crisis was possible on day 10 - 14 and she did not want that to happen on the holiday weekend. Like yours, she gave me the emergency supply of prednisone and told me to watch for lethargy, vomiting, diarrhea, and refusal to eat.

We were told to repeat the ACTH challenge on day 10 so we are going in Monday to do that. We are on day 9 now and have had no problems.

I was also worried about leaving Jesse alone when I returned to work. I have a 40 minute commute so I can't pop in at lunch to check on her. I liked that I was with her 4 solid days at the beginning due to the long holiday weekend. When I asked the vet about leaving her unattended she stated the trough in drug blood level occurs about 4-6- hours after administration, so Jesse would likely not have a problem until after I returned from work anyway. She said as long as I checked on her right when I got home there shouldn't be a problem.

I think Jesse has already cut back a bit on her water intake. I was worried I might see some behavioral changes, but so far she is her same old happy, active self. Like your Chloe, she is a humane society rescue. She is an 11 year old, 58 lb English coonhound.

Good luck to you and Chloe!

[jesse'smom1001]

Well duh, I got lost in your posts and did not realize you had started the meds 2 weeks ago. I am so glad your baby is doing well. I am hoping for similar good news when we get our ACTH stim results Monday.

Nancy and Jesse

[Squirt's Mom]

Hi Nancy,

Glad things are going well for Jesse and hope that she continues to improve day by day!

Let us know how the vet visit goes tomorrow!

Hugs,
Leslie and the girls :D - always

[Chloe's Caregivers]

Wanted to post Chloe's numbers and get any feedback you want to offer. 1st stim test last Wed. (12/1--2 weeks after commencing dosing). Talked to vet again on Friday and got the actual numbers e-mailed over the weekend. They are as follows (at least I think I'm stating these properly): baseline coritisol level of 3.2 ug/dL with Chloe's 1 hour ACTH stim test level of 12.2 ug/dL. We're being told that baseline levels should be between 1.0 and 5.0 and 1 hr. levels between 10-20. If that's the case, Chloe looks like she's well within the proper ranges.

Do those numbers look pretty good to you experts?

Vet is suggesting no change in meds at this time...if anything she wondered if dose might be lowered (Chloe is on 10 mg trilostane 2X/day) but we'll continue as-is for now. She said levels might continue to drift downward over next few weeks. She also thinks another stim test might not be necessary for up to three months as long as we don't observe any negative changes in Chloe. As you know, these tests are expensive and we would love to limit them but also want to do what's best for our pup. Advice?

As far as other changes we've noted, we were watching TV over the weekend and all of a sudden started hearing squeaky-toy noises coming down the hall...Chloe had dug out one of her favorites and wanted to PLAY!! We just stared at each other for awhile since she hasn't wanted to do that since probably last March! We attributed her lack of interest in playing to normal aging, so it was pretty gratifying to see some of her old spunk returning. And she's done that several times since too. Her water intake is way down, no more recurring bladder infections (she's been off antibiotics for that now for almost a month) and her appetite is very healthy.

Really hope things continue to progress as they have been. Also hope and pray all of you other Cushing's "parents" outcomes are as positive as ours has been--so far anyway!

Alan, Lynette and Chloe

[labblab]

Wanted to post Chloe's numbers and get any feedback you want to offer. 1st stim test last Wed. (12/1--2 weeks after commencing dosing). Talked to vet again on Friday and got the actual numbers e-mailed over the weekend. They are as follows (at least I think I'm stating these properly): baseline coritisol level of 3.2 ug/dL with Chloe's 1 hour ACTH stim test level of 12.2 ug/dL. We're being told that baseline levels should be between 1.0 and 5.0 and 1 hr. levels between 10-20. If that's the case, Chloe looks like she's well within the proper ranges.

Alan, Lynette and Chloe
It is wonderful that you are seeing improvements in Chloe since starting the trilostane! It is always both gratifying and heartwarming to see your pup reclaiming her energy and pleasure in life. :)

As for the test results, did Chloe have an ACTH stim test performed prior to beginning the trilostane? I quickly scanned your thread and did not see any results reported (but I may have missed them). If you do have them, if would be great for us to see them for comparison purposes -- in order to see how much Chloe's cortisol has lowered on this dose of trilostane and in this amount of time.

Just to clarify one very important thing...the "post" ACTH range of 10-20 ug/dl is the normal range for a dog that does NOT have Cushing's. The desired therapeutic range for a dog being treated with trilostane is actually much lower. According to the manufacturer of Vetoryl, the ideal "post" range is 1.4 -5.4 ug/dl. However, if symptoms are well-controlled, a "post" result as high as 9.1 is considered acceptable. So as you can see, Chloe's current result is higher than the desired end goal.

However, your vet is correct that the cortisol level does tend to continue to drift downward during the first weeks of treatment. So the recommendation is often made to not increase the trilostane dose further during the first month of treatment as long as some symptom resolution is being seen and there has been improvement in the "post" ACTH result. But at that point, the dose should be increased if the "post" result remains higher than the recommended therapeutic range.

As much as I would like to tell you that you may not need another ACTH test for three months, I don't think you will want to wait that long, regardless of Chloe's improvement. At the least, I would encourage another ACTH in 2-4 weeks in order to see whether her cortisol has dropped any further. If not, per the dosing/monitoring guidelines of Dechra (manufacturer of brandname Vetoryl), I think a dosing increase is in order. Here's a link to Dechra's U.S. Product Insert. You will see their guidelines for the therapeutic ACTH treatment range, as well as a lot of additional helpful info:

http://www.dechra-us.com/files/dechraUSA/downloads/Product%20inserts/Vetoryl.pdf

Marianne

[Chloe's Caregivers]

Marianne, et al:

I should have had my wife write my last update! After checking with her (she was the one who talked to our vet), I think we're pretty much on the right track with your advice.

First, we had an earlier (pre-dosing) dexamethadone test done but I don't think that's the same as a "stim test??" If those results would be helpful to know, I'm sure we could get them.

Second, I was incorrect on the next stim test schedule. Vet wants to do one in January (roughly 6 weeks into treatment) and then thinks if things are on track, we don't need to do others for 3 months or possibly more. And vet is targeting a level of 8 or less for Chloe. That's still apparently a little higher than recommended but she is basically saying that in part, the dog's behavior helps let you know when you're in the groove.

Sorry about that. Next time I'll let Lynette post (she's an RN). Then you'll know it's accurate!

Alan, Lynette and Chloe

[lulusmom]

Hi Alan,

You clarified things beautifully and I think you and your vet are on the right path. It does help to have as much information on Chloe as you can provide so if you have the results of the original testing that was done to diagnose Chloe, we'd love to see them.

Glynda

[lulusmom]

Hi Alan,

Just following up to see if you were able to get your hands on any of the test results.

Glynda

[Chloe's Caregivers]

Hi Glynda (and everyone out there),

Got latest test results back late last week. I don't have them in front of me now but will post again with them. (We have a couple additional q's for our vet on the cortisol level we're seeing...vet thinks it's OK but if we're interpreting the report correctly, believe it's still a little higher than rec'd.)

Overall, Chloe is doing well. Water intake way down, spunkiness level up, seems happy, more comfortable, higher energy, better mobility and eating well.

However a couple of other things have cropped up and not sure if it's related to Cushing's/meds or not. First, she's losing little clumps of fur all around the house. Not just typical shedding but actual tufts coming off mainly her hindquarters. Also her skin has become dry and flakier. I've read about hair loss issues with Cushing's but she's been on Vetoryl now for close to 3 months and this wasn't happening before. Ideas?

Also, in the last three weeks we've noticed a sudden and REALLY significant decline in her hearing. Today, she had no response to door bell ringing at all and she's always reacted with barks both to that and sound of door opening. I tried ringing it again and she just laid in her bed, no reaction. She also seems to hear things that aren't sounds...reacts even though it's dead quiet. I've heard going on meds can cause some probs that might have been Cushing's-repressed come to the forefront. I would expect that for perhaps arthritis, etc., but HEARING??

Everything else has improved so much I guess we should be very happy but to now have her go basically deaf in such a short time takes the edge off a bit. I know older dogs go through this but just seems so sudden to us.

Advice?

[lulusmom]

Hi Alan,

Please do post the results of the latest stim test. As I recall the Chloe's post cortisol on the prior acth stim was 12.2 ug/dl, which is too high. No adjustment in dosing was made at that time so I will be curious to see how far, if any, cortisol has dropped since then. I believe your vet felt the post stim was okay as it was within the normal range. This says to me that your vet may not be well versed in how to assess the acth stim test for purposes of monitoring treatment. If you will go back to Marianne's (labblab) post of 12/8/10, you will see that she provided you with info on the acceptable therapeutic ranges. I will be interested to see if your vet has correctly interpreted this latest acth stim test.

With respect to the hearing loss, I can honestly say that I have never heard or read anything that mentions this as a symptom that is associated with cushing's; however, I suppose a dog with untreated cushing's could very well develop a serious infection leading to loss of hearing. Some ear drops can cause hearing loss. Has Chloe had any ear problems recently requiring medication? Is she receiving any other medication aside from the Vetoryl?

Glynda

[Squirt's Mom]

Hi Alan,

My Trinket is blind and has been taking an anti-biotic suspension (oral) of the "mycin" family. In doing some research on her condition and the med she was on, I found that it can cause deafness. When I expressed my concerns to her vet, he told me that all meds with the suffix -mycin have the potential to cause deafness whether given externally as in drops or creams or given orally, etc.

I had learned here about ear drops containing -mycin causing deafness but was not aware all drugs with this ending had the potential. So check any meds she may have been on recently just to be sure.

Hugs,
Leslie and the girls - always

[addy]

This is really true and for humans too. I was given high dose of zythromycin (not sure of spelling) and have had ringing in my ears and stuffed ears now for 3 years from it.:mad:

Always ask and try to avoid the antibiotics that are toxic to ears.:eek:

Hugs,
Addy

[Chloe's Caregivers]

Finally getting back with latest results. Chloe's baseline coritsol was 1.1 ug/dL and her ACTH stim test 1 hr. cortisol was 9.3 ug/dL. This is roughly after 2 months on trilostane.

Our vet is OK with this level. She knows it is on the high side of the range (just barely over recommended), but feels it's important to keep dose conservative if possible (to repeat, Chloe is just under 30# and is on 10 mgs. triolostane 2X daily) and to also factor in how the dog is presenting. In Chloe's case, we've seen a remarkable turnaround in her energy levels, alertness, etc., etc. so vet seems to think we're OK staying as-is unless we notice further changes.

She said if we felt strongly we wanted to increase dose, she'd write a new prescription. But she also pointed out there are risks in higher dosing too. Unfortunately they don't offer a 5 mg. dose of Vetoryl so we'd either have go to a 20/10 dose administered 2X daily, one dose of 30 mg., 3 of 10 mg. (spacing?) or have a 5 mg. dose formulated. This also means another round of stim testing to monitor new levels. Not real keen on the idea (and expense) but having traveled down this road, also want to do the best by Chloe. What are we risking long-term by allowing these levels to remain somewhat elevated?

I know our vet(s) don't see a great many dogs with Cushing's but we feel they've both done an excellent job with Chloe, diagnosing, checking with the University, consulting closely with us. Don't want to seem like we're second-guess them but then again, Chloe's our dog and we're footing the bills!

Thoughts and advice welcomed.

Regarding deafness, Chloe's never had an ear problem in her life despite her "Beagle ears" (which amazes us given that our previous dog, a Springer, had almost constant ear infections throughout his 14 years and eventually did go deaf too). She was on a series of antibiotics back in Sept./Oct. when she had recurring bladder infections (due to suppressed immuno system from what we later found to be Cushing's). But deafness didn't crop up until about the last 3 weeks and progressed rapidly. She can hear a little bit only if you whistle or yell near her ears. We are thinking of another vet visit just to be sure we're not missing something that's treatable given everything else we've tried to do for her.

No one has yet commented on her fur loss. She continues to drop small clumps/tufts. Picked up about a half-dozen yesterday. This hasn't happened before now (shedding yes, clumps no). Anybody else have this associated with a Cushing's dog?

Sorry for the long post. Haven't given an update for a while but appreciated checking in on everyone else from time to time and as always, your posts and helpful advice is much appreciated.

Alan, Lynette and Chloe

[labblab]

No one has yet commented on her fur loss. She continues to drop small clumps/tufts. Picked up about a half-dozen yesterday. This hasn't happened before now (shedding yes, clumps no). Anybody else have this associated with a Cushing's dog?

Alan, Lynette and Chloe
Hi Alan and Lynette,

Unfortunately, I only have a moment to post right now. But I did want to have the chance to respond to this question, and to reassure you that it is not uncommon to see massive fur loss and other coat changes after a dog's cortisol is once again normalized subsequent to beginning Cushing's treatment. Here's a link to a thread posted by another member in which this issue is discussed. This member's dog is taking Lysodren, but we've seen the same phenomon with trilostane.

http://www.k9cushings.com/forum/showthread.php?t=2527

I'm very sorry to read about Chloe's deafness, but glad that she is otherwise showing improvment.

Best wishes,
Marianne

[wallyblue]

I am sorry to hear about Chloe. I know all too well the devastation of having an animal develop cushings. My heart goes out to you and Chloe and I will keep you in my prayers.

[Chloe's Caregivers]

After getting a whiff of a funky smell coming from Chloe's ear over the weekend we decided to get her checked out. Crossed our fingers that this might be why she's lost hearing. It's the beginnings of a yeast infection, so are now treating both ears for that topically (and she's NOT happy about it). Vet says this does not explain deafness however and unfortunately believes it's permanent. He said it is not unusual to have older dogs lose hearing fairly rapidly. (His own lab went deaf in about two weeks.) So guess that's indeed what we're dealing with. She seems happy otherwise. Chloe is such a tough old gal (someday I'll give some insights on her remarkable life) and based on what she's overcome so far, we're guessing she can handle this latest handicap as well.

Anyone out there who could comment about my earlier post regarding her last stim-test and the 9.3 ug/dL level? (please see a few posts above this one for full info and all our questions/concerns). Would appreciate any input as this is on the high side of recommended.

[Squirt's Mom]

Hi Alan,

Here is what the Vetoryl manufacturer has to say:

http://www.dechra-us.com/files//dechraUSA/downloads/Client%20Literature/38965_Technical_Brochure.pdf


good control is indicated by favorable clinical signs as well as post-acth serum cortisol of 1.45-9.1 μg/dl (40-250 nmol/l).

Some pups do well with their levels a bit higher than recommended so we always say look at the pup. If Chloe's signs are gone with a post of 9.3 ug/dl, then it is probably alright to leave the dose where it it. If she is still bothered by her signs, then an increase is in order.

Trilo can be compounded into any size needed other than those made by the manufacturer. So if you needed an increase of 5mg, that can be done.

I am sure some of our Trilo parents will be along to give you more insight soon.

Hugs,
Leslie and the girls - always

[frijole]

Hi. My dog lost her hearing very quickly too. Could you please tell us what kind of meds the vet gave your for the ears? Thanks. Kim

[Chloe's Caregivers]

Kim,

We use an ear cleansing solution first, then apply "Mometamax" 15 mg. to both ears for next 7-10 days.

Alan, Lynette and Chloe

[lulusmom]

Hi Alan,

My Trinket is blind and has been taking an anti-biotic suspension (oral) of the "mycin" family. In doing some research on her condition and the med she was on, I found that it can cause deafness. When I expressed my concerns to her vet, he told me that all meds with the suffix -mycin have the potential to cause deafness whether given externally as in drops or creams or given orally, etc.

I had learned here about ear drops containing -mycin causing deafness but was not aware all drugs with this ending had the potential. So check any meds she may have been on recently just to be sure.

Hugs,
Leslie and the girls - always

Mometamax has gentamicin in it and it has been reported to make dogs deaf. It also causes cushing's with long term use.

[frijole]

Thanks Glynda - that is exactly what I feared and why I asked the question. Please trust us on this and stop giving the meds. We've experienced it here first hand.

[Chloe's Caregivers]

Is very much appreciated. The knowledge we've gained from this site is amazing and has been SUPER helpful and important to us.

Understand it's also difficult to find ourselves suddenly distrusting our vets recommendations after all we've been through and their efforts/ability to figure most everything else out successfully to date.

What are your suggestions as to treatment for her current ear problems? Keep in mind she has not had a prior ear issues, that her hearing was fine and took a turn for the worse only well after Cushing's was diagnosed and treatment started, she was not on this med before just yesterday, etc. She definitely has something going on in there based on her behavior (shaking head, scratching ears more than ever, funky smells and so on). Need to do something for her.

Should we just keep ears clean with cleansing solution and let nature take its course?

Again, please know how very much we value you all and your help. These last few months have been a real roller-coaster ride We just want to do what's best for Chloe. As you know, it's tough and very emotional to go through this, especially when you're forced to ever more directly accept that the evil dog "life clock" is always ticking.

We need to constantly remind ourselves...from the time we first bring them home as pups to this very day...how precious each and every moment we have with them is. And that is precisely why such blessed, profoundly loving and wise creatures are on this earth...they teach us to do the same with all those around us.

Alan, Lynette and Chloe

[frijole]

Alan and Lynnette - we are all glad to help.

I never had to deal with the ear issue - just have read it here on more than one occasion. I searched the forum and found that some eardrops have cortisone in it which you need to avoid as well.

Then I found this quote from another poster which might help you. Either way - I'd call the vet. Kim

from http://www.drsfostersmith.com/produc...m?pcatid=14742

Gentamicin is the ingredient that seems to cause the deafness problems (if they arise). It has long been believed to be a problem only if the dog has a perforated eardrum, however, recent thinking/findings are it can be a problem without perforation. Some vets may not be aware of this.

Franklin's new vet gave me "Cortravance cutaneous spray solution for dogs" when she diagnosed his allergy, which contains ' 0.584mg/mL hydrocortisone aceponate', and she said it can be used for a couple of days on the inside of his ear flap. (I don't spray it, but wet cottons ball with it, and wipe/dab the cotton ball on his ears).

Jane, Franklin and Bailey xxx

[Sabre's Mum]

Sabre, our Hungarian Vizsla, had ongoing ear issues over his life. We generally used Surolan or Canaural previous to his cushings diagnosis but both of these contain steriods. We did use a product once (whilst being treated for cushings) which contained dexamethazone but for the life of me I cannot recall the name. When his ears were really bad we just had to relent and put him on a course of Surolan. The beauty of dexamethazone, to my understanding, is that it does not affect the ACTH stim.

We did at one stage try a solution of tea tree oil and water (VERY diluted - as I recall only one or two drops in a large bowl of water) but there are also issues with this treatment if you search the web.

I hope you can find a solution.

Angela and Flynn

[labblab]

Hi Alan,

Since Chloe has an active ear infection, I definitely think you need to continue to treat with medication in addition to cleansing -- but to treat with something other than the Mometamax. You said earlier that it appears that she has a yeast infection. In that case, she may only need an antifungal product, and not an antibiotic at all. The Mometamax is a "combination" product containing an antifungal, antibiotic and anti-inflammatory. I think that vets often prescribe these combination products so all the bases are covered and for ease of application (so that owners are not having to administer mutiple eardrop products).

If I were you, I'd call your vet and discuss Chloe's medication, telling him/her that you are already concerned about Chloe's apparent hearing loss and that you are very worried about giving her an antibiotic that can produce ADDITIONAL loss. You'd prefer to give her drops containing medications without this risk (Or at least, with lesser risk, since unfortunately many ear treatments can have some effect on hearing in a small minority of dogs. But as others have pointed out, gentamicin is particularly suspect in this regard). Also, if this means administering separate eardrops (some drugs cannot be made up in combination suspensions), tell your vet that you don't mind the extra hassle.

The last thing we want to do is to undermine your confidence in your vet. But we've discovered that the issue of hearing loss and eardrops is one that is often overlooked or minimized by many vets. I just went through this same dilemma with my own vet, whom I adore. One of my dogs has terrible allergies and is plagued by frequent ear infections that can be difficult to control (and infections themselves can lead to hearing loss if they are not resolved). Gentamicin can be very effective at clearing ear infections, so it is tempting to use. But when my vet prescribed it (also as part of a combination suspension), I really balked and discussed my concern with him. As long as I didn't mind giving two different sets of drops, he was willing to prescribe a different antibiotic along with a separate antifungal agent. Thankfully this new combination did clear the infection, and now my vet and I are both on the same page as far as future treatment for my dog (since I know there will be more infections down the road :(). There may come a time when I feel it is worth the risk to give gentamicin if my dog's infections don't respond to other agents. But in the meantime, we ended up having a very interesting conversation about different antifungals and antibiotics, and I felt as though I learned a lot in the process!

Marianne

[Chloe's Caregivers]

Glynda, Kim, Jane, Angela, Marianne and everyone else out there in K-9 Cushing's land for your input and expertise.

We will pursue alternatives to current course of ear treatment with our vets based on the above info as diplomatically as we can. Will post an update once that takes place.

We're slowly starting to learn that nothing follows a straight line with this stuff.

Alan, Lynette and Chloe

[Chloe's Caregivers]

First, a thank you to all for this site, your care/concern/support and wise advice and counsel. I can't believe there is a better spot to land for anyone dealing with Cushing's.

Our Chloe, now 13, is doing wonderfully on her daily regimen of trilostane. I'm one of many here who can say that if effectively diagnosed and treated, Cushing's is NOT always a death sentence. True, it takes time, money and devotion but our dog's quality-of-life now compared to last summer-fall has been worth all of the above.

Chloe is happy again!! She has the energy to run and romp, sniff out all those great spring scents, play with her toys, jump up between us on the couch and chase away those "evil" deer. (Like last night when we didn't spot one when we let her out...but she sure did! Wow. Talk about a speeding bullet.) Her coat is shiny and soft, her lethargy, excessive drinking, chronic bladder infections and accidents are a thing of the past--right now anyway. (We've left her at home for over 8 hours at a time with no problems.) It has been such a blessing to have her back to herself again, both for her and us.

We had our annual vet visit on Tuesday for routine stuff, rabies, heartworm, etc. They continue to consider her condition stable, with no further stim tests needed until late this year, unless we notice changes.

I just wanted to give you all this update, especially for those either first encountering this disease or worrying about treatments and quality-of-life concerns. There ARE success stories. There ARE effective treatments out there. And you CAN get your precious dog back!

Every day, hour & minute we have with Chloe is one we feel blessed to have gained with her. We can't predict the future and we know there is an inevitable sad ending to come, but like her, we're living in the moment right now and loving it!

Thanks again for all your help, support and love!

Alan, Lynette and Chloe

[Squirt's Mom]

Hi ya'll!

What a WONDERFUL update! :) I am so happy that you have your old Chloe back and that you are enjoying life with her again. It is amazing the difference the right treatment will make, huh?

Keep up the good work and let us hear from you every now and then!
Hugs,
Leslie and the gang

[lulusmom]

Hi Alan and Lynette,

Thank you, thank you, thank you for sharing your wonderful update on Chloe. I was moved to tears......very happy tears. Woohoo!!!

Glynda

[Chloe's Caregivers]

Thought I would update a very stale original post about our Chloe to give folks going through a Cushing's diagnosis hope.

Chloe turned "sweet 16" on 2/5 (at least that's the date we celebrate her BD...unknown as a rescue). She was diagnosed in 2010 and has been on Vetoryl since. She is still a happy dog and a wonderful part of our life. We've had ups/downs with health issues. Almost lost her to a raging urinary tract infection in November...she is now on prophylactic antibiotics daily.

But she still runs back from the end of our driveway when I pick up the paper in the morning, ears flopping up and down. Truly a joy to behold. And she can still hop up on our couch (with a booster) to nestle into her blanket while we watch TV.

We are blessed by her presence each morning. She is the happiest at this time of the day and she is an example to us as to how we should approach every simple gift and most the basic of experiences in life.

I know not everyone getting the diagnosis of Cushing's will go down the same road we are on. But do want you to know that with good diagnosis, good vet care and monitoring and modern drug therapy, a positive outcome is possible.

We don't know how much longer Chloe will be with us. But to have her relatively healthy, very obviously still having a strong will and a joyful approach to life, we are truly blessed.

God bless all Cush pups and caregivers!

Alan & Lynette

[molly muffin]

Thank you so very much for your wonderful update on dear Chloe. Truly an inspiration to us all and such hope that it gives others. Thank you, thank you for posting and letting us know.

hugs,
Sharlene and Molly muffin

[Chloe's Caregivers]

Friends,

We said goodbye yesterday afternoon to our precious Chloe. We are devastated to lose her but it was a peaceful and in a way, wonderful life ending for her.

Even though she dealt with Cushing's for over 4 years, Chloe lived to age 16 1/2 in remarkably good health (with the inevitable occasional setbacks). We feel so fortunate to have found this forum for help and for the success we experienced in her treatment with Vetoryl.

For her age, while she was definitely slowing down, her patterns of daily life and behavior changed quite little. But over the past few months, her food intake started to decline and she became very picky about her diet. After rejecting every dog food and treat known to mankind, that led me to constantly innovate on her diet. Boiled chicken and brown rice for a while, sweet potato or pumpkin with chicken, ground beef and brown rice, adding broths to the concoction to change it up, etc. She'd eat well for a few days, only to become picky again. She began to lose weight, which the vet wasn't terribly concerned about since he said it would take pressure off her joints a bit. But right up to the end, Chloe still looked forward to our "Pizza Nights" when she waited patiently for the crust-treats she loved almost as much as her all-time favorite...bits of "Beef Sticks" made by a local sausage company!

On July 5 we celebrated her 16th year of being a part of our family!! In the subsequent weeks, while continuing to eat sparingly, we were running out of options she'd consume. Even so, she was accident free in the house, moving slowly but well, and clearly not suffering any significant pain. Her tail was still wagging like the old days and she still was there to greet us when we got home. We took things day by day.

Right up until Tuesday afternoon, she was doing quite well given her age and issues but took a sudden turn that night. We awoke to find her crumpled up and unable to get to her feet. Some neurological event had obviously occurred. After monitoring her for a while and talking to the vet, we made the decision to put her to sleep later yesterday p.m. My wife and I called in to each take the day off to be with her

After doing so, I started to type everything I could remember about Chloe's history with us, personality traits and quirks, special memories and so on. By 10 a.m., with my wife's help, we had over 12 pages. At that point, with a glorious day outside, we moved Chloe, still unable to stand, on her bed out to our deck in the shade to enjoy the day as best we could. It was stunningly beautiful, low 70's, bright blue sky and puffy clouds. We continued to do our remembering and writing and now I have 5 more pages of notes to add!

We shared the day with Chloe, giving her constant pets, hugs and kisses. She was comfortable, in no real obvious pain, and was able to take water through a syringe to stay hydrated. We remembered that we had a kit for casting paws in cement that we'd gotten back when she and the kids were young but never got around to using. So we mixed it up and while my wife held her, we FINALLY preserved her little feet for more memories.

There were laughs and lots of tears too. But to sit with her, her nose still twitching occasionally to sniff the scents, to look at our flowers, see the hummingbirds and feel the cool breeze, it made the experience more bearable. Toward late afternoon, I removed her collar one last time and we each took some alone time with her. My wife wanted to see if she would take one last drink from her bowl so we held her and yes, Chloe was able to take a "dignified" drink one more time on her own.

Shortly after that the vet showed up (we had him come to our house instead of bringing her in...so much better all around). She went very peacefully and quickly, crossing the Rainbow Bridge while we held her in our arms. We took some more time alone with her and said our final goodbyes. As he left, knowing how our day was spent, the vet remarked, "That was the perfect last day for all concerned." We will look back some day and agree but for now, it's too hard to accept.

The house is cold and empty today and all the routines of 16 years of care and love for her are now shattered. It will take much adjusting and our eyes are sore and swollen from the tears that continue today. But the blessings Chloe gave us every day, the way she lived her life, her quality of life almost right to the end and even the way she passed is an experience that we will never lose in our hearts.

Thanks to all of you for this special board and may God bless all the other pups traveling the Cushing's journey.

[molly muffin]

Alan and Lynette my heart goes out to you and the tears fall freely.
I know your hearts are breaking today and will be for some time to come.

What a wonderful life you and Chloe lived together. So many wonderful memories and she truly was a success story with cushings. Even with the bumps every now and then, she survived it and lived a good life. A life of love shared is a life well lived.

My sincerest condolences.

hugs
Sharlene and molly muffin

[Trish]

My condolences on the passing of Chloe, so sad for you all. But boy, what an inspiration for the new members here to read her story and how she had such a good life for so long with cushings, you were truly devoted owners and I am very sure she passed feeling the most loved dog in the world. Big hugs for you all x

[pansywags]

My condolences on the loss of your Chloe - but what a beautiful chronicle of a loving goodbye! I got cheated out of my plans for last-days love with Pansy so I just love reading about people who are able to make beautiful memories along with their goodbyes.

Thank you so much for sharing all this with us. It makes me so happy that you were able to give her such a good quality of life for so long.