Max, Maltese with cushings (update: Cutaneous Lymphoma) - MAX HAS PASSED

[bev]

Hi, my name is Beverly and my baby Max is a 12 year old maltese who weighs between 6 and 7 pounds (has fluctuated latlely). I have been reading on this site for about 2 months. I have learned so much. Thank you.

Our road to Cushings disease began because of skin lessions which I now know are calcinosis cutis. I took him to his local vet and was given medicated shampoo and sent on my way. (yes, I have changed his local vet) Max has a heart murmur and sees cardiologist at vet school. At annual appointment in July I showed her places on his skin. Dermatologist was able to see Max that day also and suggested that Max be tested for cushings.

Once home I read and read information on internet (however did not find this site till later) Max had several symptoms of cushings. Urinating in the house (he had been trained), would not come in from outside because of step up, I had to go out and get him, he was sleeping more and was sleeping very hard (loud noises did not wake him.) All of these I associated to age, as I have read many owners do the same. The more I read, I was sure he had cushings.

8/24/10 Urine test - Cortisol/creatinine ratio 22
T4 - 1.3 TSH level - 0.17 Free T4 (Dialysis) - 24

8/26/10 ACTH test - Pre - 8 Post - 22.6

9/20/10 Abdominal ultrasound done by Internal Medicine Vet
Summary: There are a couple indications on Max's abdominal ultrasound today that suggest cushing's disease. These finds include the mineralization within his kidneys and his slightly enlarged liver. Each of his adrenal glands are normal sized. Max only has one liver enzyme that is elevated.
ALT - 144U/L GGT - 20 Anion Gap - 20.5
With these results Internal Medicine vet felt like Max did have cushing's but was not certain enough to put on medicine because of side effects of medicine.

9/27/10 Low dose dexamethasone suppresion test
Just realized I do not have results but both local vet and internal medicine vet agreed that Max had cushing's disease.

10/4/10 Max was started on a Trilostane compound. Was given
.04mg twice a day (0.8mg each day.)
Within a few days I saw amazing improvement. He started on Trilostane on a Monday and that Friday when I got home from work he started barking when I got out of my car, what a wonderful sound, it had been a while since he had done that ( I had tears), for a while I had to come in and wake him up because he felt that bad.

10/19/10 ATCH stimulation test: Pre - 4.2 Post - 12.5
Internal medicine vet said numbers were good but wanted them to be better so Max was upped to 1 mg daily (0.5 twice a day)

11/1/10 ATCH stimulation test done - once again I do not have results but both vets were pleased with numbers and agreed he should stay on same dose.

Next ATCH stimulation test to be done in 60 days (12/31)

I am happy with how things are going but wanted to get others opinions. Was very scared that this was a death sentence for my Max, but from all I have read it is not!

Thank you again for reading.

[bev]

Also, even though he is feeling much better, his skin is not improving fast enough for me. Anything I can do?

[labblab]

Beverly, welcome to you and Max! I'm so glad to hear that Max is feeling perkier since starting on his trilostane treatment. :)

As you may already have guessed from reading other threads, we do tend to ask a lot of questions, and we also urge people to obtain and post exact test results whenever possible. So if you could obtain and post the results for Max's Low Dose Dex Test and also his most recent monitoring ACTH -- that would be great.

As far as the calcinosis cutis, we have had a few other members who have been faced with this condition in their Cushpups. In order to highlight your questions about Max's skin issues, I've added "calcinosis cutis" to your thread title. Also, here is a link to a reply recently posted by one of our Moderators that may be of interest to you:

http://www.k9cushings.com/forum/showthread.php?p=41065#post41065

I'm sure that other folks will also be by soon to welcome you and Max. Once again, I'm so glad that you have joined us, and I will be watching for further updates as to how Max is doing.

Marianne

[Sabre's Mum]

Welcome Beverly and Max.

Thank you so much Marianne for placing in a link to a post I recently made.

Calcinosis cutis can be quite frustrating for cush pup owners as from my experience whilst you see other symptoms disappearing, the calcinosis just doesn't budge .... BUT in our case it eventually did. I have archived all the posts of Sabre's old thread and I have just checked and I have not actually posted when everything had sorted itself out but I think it was nearer 5 or 6 months before we no longer had trouble with it as I recall that we still had his jacket on him and the weather was sunny and warm ... I just wanted to cover him up as he was a very sensitive dog ie feelings ... he could tell when people were looking at him with "that" look. In the meantime, until it settles done the only thing as an owner which you can do is try and stop or control the infections. I must note that we used Lysodren to treat Sabre’s cushing syndrome.

Lulusmom recently posted on the same thread that Marianne placed a link to. This is what she said:


Dr. David Bruyette is a reknown endocrinologist, as well as the developer of Anipryl, the first drug approved for treatment of canine cushing's disease. He is also a hug fan of Vetoryl (Trilostane); he is a featured speaker for Dechra, the manufacturer of Vetoryl; and Vetoryl is his treatment of choice in his practice. He praises the drug; however, he readily admits that he has had very poor results in resolving calcinosis cutis with Trilostane. I suspect, and this is me thinking out loud, that the problem might be because a dog with elevated cortisol will also be hypersecreting sex steroids. Sex steroids can contribute to calcinosis cutis and since Trilostane is known to elevate sex steroids. It makes sense to me that it could possibly exacerbate the problem, making it worse instead of better.

I just wanted to let you know this just in case the calcinosis cutis never seems to sort itself out. In the interim my personal opinion is to continue with trilostane in the hope that in Max's case the calcinosis cutis will abate.

In some cases the calcinosis cutis will rise to the surface and break through eventually healing with no evidence of any calcium deposits. In Sabre's case this only happened in one spot. Once his hair grew back the calcinosis cutis just stayed as a hardened lump ... some were plates of 4 x 5cm. These never annoyed him unless his cortisol levels were low ... then you would see a rolling Vizsla on the lawn!

If you have any queries please ask away.

Take care
Angela and Flynn

[Franklin'sMum]

Hi Bev,

Just wanted to welcome you and Max, and hoping that the calcinosis cutis resolves very soon. :)

Jane, Franklin and Bailey xxx

[bev]

Hello! Hope all are doing well. Sorry, I have not been by vet to get test results from last test, very busy at work.
Max is still doing very well on the trilostane, he has been on for almost 2 months. Skin is not really any better. Had one scare about a week ago, he had diarrhea and I was concerned because is something vet told me to watch for but thank God it was only what he ate. A friend was over and I believe her son gave him to much hamburger.
I have a question, I have read lots of posts by people whose dogs are on Trilostane. Max takes 1ml a day (.05 twice a day) liquid compounded, amount he is on compared to others seems low to me. Max is small but....
Also saw where giving medicine twice a day was discussed. Vet started him at twice a day from beginning. Saw where that is not always the case. Would like to know what you think of this.
Am truly pleased with how things are going but trying to educate myself. Would like to understand as much as possible so can ask vet questions when needed.
Thank you all so very much!

[apollo6]

Welcome Bev
And welcome to Max. My Apollo is on Trilostane, and in his case the skin infections and calcinosis cutis have improved a lot. MY little guy started in June 2010. I have seen a lot of improvement. But he has hind leg weakness due to muscle wasting.
Hugs Sonja and Apollo

[labblab]

I have a question, I have read lots of posts by people whose dogs are on Trilostane. Max takes 1ml a day (.05 twice a day) liquid compounded, amount he is on compared to others seems low to me. Max is small but....
Also saw where giving medicine twice a day was discussed. Vet started him at twice a day from beginning. Saw where that is not always the case. Would like to know what you think of this.

Hi Bev,

I am pretty much of a dope when it comes to liquid compounds. But for comparative purposes, I think you need to know the strength of the medicated solution rather than the amount. In other words, you can't compare 1 ml of liquid to 1 mg of a tablet -- that is comparing apples to oranges. So hopefully some other folks with more experience with liquids will stop by to comment.

As far as twice-daily dosing, some vets do prefer to start their patients off that way right from the beginning. I'm guessing this is because various research studies have shown that trilostane is active in the body for a relatively short amount of time -- typically no more than 12-18 hours. However, since it is a simpler regimen for owners and also the majority of dogs seem to exhibit satisfactory symptom resolution on only one dose a day, the manufacturers still recommend first starting out that way and only shifting to twice daily dosing if symptoms reoccur during the afternoon or evening.

I don't think it's harmful to dose twice daily rather than once daily. It just makes for a more complicated schedule for you as the owner, especially since trilostane is metabolized most efficiently when given with food (so you end up needing to feed at least a small meal twice daily, too). It's just harder to stay consistent on a 12-hour dosing schedule. Also, one experienced endocrinologist has warned us that dogs being dosed twice-daily may run a greater risk of having their cortisol level drop too low. Therefore, they need to be monitored especially closely for lab results and/or symptoms consistent with oversuppression.

Marianne

[bev]

Thank you for your information on Trilostane compound. I didn't understand that each compound was not the same.
I have a question about the cost of the compound. I am currently paying $88. for a six week supply. Saw several posts about Diamondback drugs and that they were reasonable. Unsure if what I am paying currently is reasonable or not? Get it currently from NCSU Vet school and Max takes 1ml liquid per day. I do understand that price would vary some depending on ingredient.

Getting Max diagnoised seemed like such an ordeal as well as VERY costly. After reading many posts realize that it could have been worse. From the appointment with dermatologist who suggested that it may be Cushings until he was diagnoised was 2 months and have dealt with wonderful vets. Max is the first dog that my local vet has treated with Cushings but Internal Medicine Vet has been overseeing, interrpetting test resuls and prescribing medicine. Also local vet has been knowledgeable so far and is willing to say "I don't know" if she is unsure of answer and she will discuss with Internal Medicine Vet.

Sorry if I go on and on. Nice to know someone is reading that truly understands. I continue to read as many post as possible trying to educate myself. Thank you all very much for sharing your knowledge.

Thanks again, Beverly

[bev]

Please take a look at my pictures. Have posted new pictures on Max's skin. Is this calcinosis cutis? Max has been on trilostane since end of September, instead of getting better it has gotten worse. Should I switch medicine in hopes another will control skin condition?
Please help!! I am very concerned and worried!

[mytil]

Hi Beverly,

I do not have direct experience with this condition, but looking at the photos they appear like soft blisters to me. What comments did your vet offer? Did your vet take any scrapings to determine if there is an infection?

There are several here that can offer more comprehensive comments on this. Here is an article you may want to read http://veterinarymedicine.dvm360.com/vetmed/Dermatology/Dermatology-Challege-Severe-facial-pruritus-in-a-B/ArticleStandard/Article/detail/659278

Terry

[bev]

Thank you for responding.

Max has a biopsy scheduled for Tuesday(tomorrow) morning. Vet put him on an antibiotic because his skin was very inflamed. She (vet) is unsure of what is going on, she called this morning with results from blood panel that was done on Wednesday (12/22). Both hemoglobin and liver insinzes were elevated but everything else was good.

Places on Max's skin are very scaley and hard. Alot like when we get a scab. Skin condition was original reason that I took Max to specialist and that was when he was diagnoised with cushings. Thought when he was put on medicine this would improve but that has not been the case.

Again, thank you for your feedback. I am very worried!!

Beverly

[lulusmom]

Hi Bev,

If you go back and read Angela's post, you'll see that calcinosis cutis is not easy to get the upper hand on and not every dog with this skin condition sees improvement with Trilostane. It looks like the only acth stim test that has been done was done back in November and Max's post stim was 12 ug/dl. This is definitely not within the desired therapeutic range so unless you've had another stim test done since then that shows Max within range, continued high cortisol could be the reason why you are seeing no improvement in the calcinosis cutis.

You mentioned that Max is getting 1 ml of Trilostane per day. 1 ml is the full syringe measurement, not the mg prescribed. For instance, if the trilostane is compounded at 40mg, 1 ml would equal 40mg and .5 ml would equal 20mg. If you look at the label on the bottle it should tell you the mg.

Glynda

[bev]

Hope all are having a good day/night!

Max had a skin biopsy done today.Hopefully will have results by Thursday. Was very glad they were able to do under local anthesia.

ATCH Stimulation Test is to be done on Thursday (12/30), thought I got results for test results from 11/1/10 but once I got home receptionist had given me 10/19/10 results again.

It was said that 12.5 for post test on ATCH Stimpulation Test was not the theraputic level, what should this number be?

Here are latest blood test results done on 12-23-10:
* Please note Max also has a heart murmur.

Total protein 6.9 Reference Range (5.0-7.4)
Albumin 3.9 (2.7-4.4)
Globulin 3.0 (1.9-3.6)
Albumin/Globulin ratio 1.3 (0.8-2.0)
AST (SGOT) 76 (HIGH) (15-66)
ALT (SGPT) 152 (HIGH) (12-118)
Alkaline Phosphatase 182 (HIGH) (5-131)
GGTP 31 (HIGH) (1-12)
Total Bilirubin 0.1 (0.1-.03)
Urea Nitrogen 25 (6-31)
Creatinine 0.6 (0.5-1.6)
BUN/Creation Ratio 42 (HIGH) (4-27)
Phosphorus 3.8 (2.5-6)
Glucose 91 (70-138)
Calcium 10.1 (8.9-11.4)
Magnesium 1.6 (1.5-2.5)
Sodium 150 (139-154)
Potassium 5.1 (3.6-5.5)
Na/K Ratio 29
Chloride 110 (102-120)
Cholestrerol 222 (92-324)
Triglycerides 92 ( 29-291)
Amylase 566 ( 290-1125)
Lipase 378 (77-695)
CPK 166 ( 59-895)
Hemoglobin 20.9 (high)--10-19-10 20.0 (12.1-20.3)
Hematocrit 60.6 (HIGH)--10-19-10 54.0 (36-60)
WBC 6.1 (4.0-15.5)
RBC 8.08 (4.8-9.3)
MCV 75 (58-79)
MCHC 34.5 (30-38)
Platelet Count 335 (170-400)

Truly understand none of these numbers, I am a social worker and have no clue about any number but Hematocrit and only know what numbers should be for people, so in other words, PLEASE HELP!?!?

Thank you for your guidance. Was extremely freaked out at first, then calmed down, now am getting back to being overwhelmed. Have been told could take up to six months to resolve skin issues and we are only at three months on medicine. Guess I just didn't realize it might get worse before it got better.

Thank you again,
Beverly

[bev]

Also, label on Trilostane says

Trilostane 10MG/ML oil suspension 6 ML

Please translate???

Thanks, Beverly

[Sabre's Mum]

Hi Bev

I have had a look at your photos and it is hard for me to say definitively that it is calcinosis cutis. Parts definitely look like it but other areas ... I would say I am not sure. The biopsy we definitely give you something more to work with. If I recall correctly Sabre’s biopsy showed ... “calcinosis”.

With regards to you not seeing his skin condition getting better .... it took some time for Sabre’s calcinosis to get to a stage where we no longer need to worry about it. He was treated with Lysodren and it would have been at least 4 to 6 months before infections were held at bay and everything hardened up and hair grew back. It really was one of the last “cushings symptoms” that was controlled ... in saying this he always had calcinosis plates but they were not an issue ... just "there".

I was not a "trilo" Mum but I can tell you that the therapeutic range for a pup on trilostane is to have a post ACTH stim reading between 1.5 and 5.5 ug/dl. There are times when it can be higher if "clinical" signs of cushings have disappeared but this generally is recommended to be of a post reading no higher than 9.4 ug/dl. For more information please refer to the Dechra product insert from this link http://www.k9cushings.com/forum/showthread.php?t=185.

Take care
Angela and Flynn

[lulusmom]

Hi Bev.

I'm glad to see that Angela dropped by to comment further on calcinosis cutis as well as address your question regarding the desired therapeutic range for post stimulated cortisol. I just wanted to mention that the bloodwork looks pretty darn good to me but it would help if you posted the normal reference ranges for the high values. Even without the reference ranges, I think this bloodwork looks pretty darn good. The abnormalities you posted are definitely ones that we see here quite a bit. Hopefully, Debbie, our very seasoned lab technician expert will drop by to give you her take on things. Her opinion is worth a lot more than my two cents worth. :D

Okay, so now we know that Max is getting 5mg (.5ml) of Trilostane twice a day. This is definitely not a heavy duty dose so it is very possible that Max's cortisol is still too high. The good news is that if you need to up the dose, it's a lot easier to do that with the liquid form of the drug.

I'll be staying tuned for your next update.

Glynda

[bev]

Thank you very much for your help understanding numbers.
When I took Max today for his ACTH Stimulation test I did get his correct test results from 11/1/10.

Cortisol Pre test 4.4
Cortisol Post test 10.0

After going to website that you suggested, I do agree that part of the problem could be Max needs a larger dose of Trilostane.
Local vet calls me over phone to discuss Stim test results. I now know that each time I need to ask for exact numbers. When she (vet) called after Nov. test she said numbers where better but wanted to discuss with Internal Medicine Specialist at NCSU, her first thoughts were to increase Max's dose. However, she called me back and stated that she had spoke with specialist at NCSU and he wanted Max to continue on same dose. Being uneducated on exactly what pre/post numbers mean I trusted what vet decided. I am so thankful for you all explaning to me exactly what numbers mean so I can play a more active role in Max's treatment.

Because of holiday weekend stim test results will not be back until Monday. If numbers have not improved I feel like I should insist on medicine being increased. My feeling is that if numbers are better, it will not be by much. His behavior tells me he doesn't feel as good as he could, although is sooo much better than he was.

Have forgot to mention that when we started this journey the end of July, Max had lost 1.5 pounds (down to 6 pds). He has put this weight back on (at 7.25 pds.) Was thinking that also could affect the amount of Trilostane he is given.

The one symptom that still remains is Max contines to drink a good deal of water. Did not realize at first (have two other animals in the house that drink out of same water bowl) but now that I have been paying attention realize that he even gets up at night to go drink water.

Also, added reference ranges to previous post.

Once again, thank you for your guidance. It is truly invaluable.

Beverly

[bev]

Hello all,

I received devastating news today. The places on Max's skin are not calcinosis cutis, the biopsy showed that it is cancer,Epitheliotropic Lymphosarcoma (mycosis fungoides), this type of cancer is in his red blood cells (his count has been high and they thought it was related to cushings.) I have cried most of the day (also my grandfather was put in nursing home today) After much discussion with the vet, I have decided to not do anything. At this point he is still a happy dog and is in no obvious pain. He is still eating and drinking fine. At the time things change then decisions will be made. I have watched my grandfather struggle in pain for the last 10 days and will NOT put Max through that. Vet said she could/would do referral to vet oncologist but prognosis was not good, it was her opinion that if I did choose treatment that it would be more for me than him because of his quality of life.

So many do not understand and I am grateful to have found people who do. The pain I feel is almost overwhelming BUT I still have my Max and will continue to love him and give him the best life possible while I am lucky enough to still have him.

On a positive note, ATCH Stimulation test came back with a 6.4 ug/dl post test. Not in range it should be but much closer. Will continue treating cushings because there has been much improvement since beginning trilostane.

Beverly

[Sabre's Mum]

Bev

I am so sorry to hear the latest about Max. Photographs are sometimes quite hard to make out and biopsies are the best way to go. Max, as always, will be showered with your love .

Take care
Angela and Flynn

[Casey's Mom]

Bev I am so sorry to hear about Max - I know you will shower him with love.

Love and hugs,

[lulusmom]

Hi Bev.

I am so very sorry that you have been dealt a double blow. Getting Max' diagnosis was bad enough but having to wrap your head around your grandfather's condition too....well, I'm sure you are reeling from it all. I know that none of us have to tell you to enjoy every moment you have with Max so I'll just say that we're here to listen, bounce things off of or answer any questions you may have.

Hugs,
Glynda

[Squirt's Mom]

Hi Bev,

I read your post early this morning and just had to leave the site for a bit. :( My heart is breaking for you. :( So much heartache was handed to you all at once.

So many words have been typed and erased as I sit here trying to find something that might ease your pain...all so empty. Having been in a very similar situation with my dad and a much loved cat, all I can say is that I empathize and am so, so sorry.

Bev, know you are safe here with us. The pressure on your soul is going to become quite heavy in the days ahead and when you need to press that release valve, we are here to listen.

I think your grandfather and Max are two very lucky beings to have you by their side.

Hugs,
Leslie and the girls - always

[clydetheboosmom]

I'm so sorry to hear your news. I hope that you can feel our love and support for you and Max, and I hope it brings you some small comfort.

Lynne, Clyde & Bailey

[littleone1]

Hi Bev,

I'm so sorry to hear about Max. Enjoy every minute with him and give him everything he loves. He knows he is loved very much. You are in my thoughts and prayers.

Hugs,

Terri

[bev]

Thank you all for your kind words. It helps to know that there are people who understand my love for Max. I am slowly coming to terms.
I truly had not prepared for the biopsy results. Was so sure skin problems were because of Cushings. Max had his stitches from his biopsy taken out and I was able to sit and talk with vet. I have decided to take him to NCSU Vet School to atleast have a consultation. I do not want to pursue chemotherapy but have questions about ways I can improve his quality of life (if that is possible because he truly is spoiled)
He has seen cardiologist, dermatiologist and Internal medicine vet so why not the oncologist. LoL
When I went in today, vet and I went ahead and talked about what I wanted when it becomes time for Max to leave me. I long ago decided I would have Max cremated and then when I pass, I want him buried with me.
Again, thank you all so much.

With a broken heart, Bev

[Casey's Mom]

Just checking in to see how you are doing Bev. Let us know when you can.

Love and hugs,

[bev]

Hope this finds everyone doing well!

Tomorrow morning Max has appointment with Oncologist at NCSU Vet school. Very nervous!! Have lots of questions that I want answered but at the same time am scared of what answers could be???

Was getting a handle on Cushings and now this....

Wish us luck and for me strength. Max is my baby and I am not handling any of this well.... My sister in law is going with me so I will not be alone. Will update.

As always, thanks to you all!!

Beverly

[frijole]

Bev, Just letting you know we will all be with you and Max today as well. Sending strength and love, Kim

[Casey's Mom]

Yes the cushings angels will be with you sending love and best wishes.

[Squirt's Mom]

Hi Bev,

You have a whole host of folks with you and Max this morning! :) You can't see us but we are all surrounding you, lending you our strength and hope.

Let us know what you learn.

Hugs,
Leslie and the girls - always

[lulusmom]

Hi Bev,

Waiting anxiously for an update on appointment with the oncologist.

[bev]

Hello all!

Well today went a lot differently than I had thought it would. I went expecting to hear the worst.

Max received his first dose of chemotherapy today. I made a very uniformed decision when I decided (or thought I decided) for Max to not have chemo. Max is on a treatment called CCNU (lomustine). With this treatment he will have to take a pill every three weeks.
A PILL! (I will be watching for vomitting, diarrhea and making sure he is eating, a lot like what I was already watching for because of Trilostane) Was very surprised that was all there was to it. (nothing painful) I am not able to give CCNU, I will have to take Max to Vet School/hospital every three weeks for 4 - 6 treatments. Length of treatment depends on liver enzyme levels. CCNU causes liver enzymes to rise and because of Cushings Max's levels were already elevated. They put him on Denamarin which is to help protect his liver. He also was put on 5mg prednisone for 3 weeks and Clavamox 62.5 mg x twice a day for 10 days. That is now a total of 5 medicines each day!!!

In one week he will need to have a CBC done, then another CBC one week after that. Then on third week it will be time to take him back for another treatment.

Even though I did not see or talk to him, Max did see the IMS Vet today. Oncologist consulted with him and he then took at look at Max. Still worried but feel tons better now that we have a plan and I have questions answered. At this time there is no way to know if it will add extra weeks, months or years to his life but each day is a gift.

Thank you all so very much for your kind and encouraging words, they mean so much.

Beverly

[Squirt's Mom]

Hi Bev,

I am so glad to read your post this morning! What a great outcome! I, too, would have been expecting a more invasive, painful approach to treating the Lymphoma but I am so glad it isn't what we thought it would be! :cool:

Oh, and you are so very right - each day with our babies is a blessing! We never know what the next minute might bring, even to our healthy babies, so it is important to remember how blessed we are for each and every second we have with them.

Please let me know how Max does with his treatments. I continue to hold you in my thoughts and prayers.

Hugs,
Leslie and the girls - always

[StarDeb55]

Bev, I am so very happy to hear about Max's treatment. Just to let you know why he has to have a weekly CBC, they will be closely monitoring his white blood cell (WBC) count. Any type of chemo will suppress the bone marrow & the production of WBC. You probably already know that WBC are critical in helping our baby's bodies to fight infection. If Max's WBC were to drop too low, his oncologist will probably hold off on the CCNU for a period to allow his WBC count to come up. You don't want the WBC count to go too low, or there will be an increased risk of infection. Since I already told you about Barkley in my PM, this happened to him once during treatment. We had to hold off on his next round of chemo for close to 3 weeks, if memory serves, but his counts finally bounced back enough to get the last round of chemo. As a precaution, he was placed on antibiotics during this timeframe.

Debbie

[bev]

One thing I forget to add is Max weighed 8 pounds yesterday!! Most of his life he has weighed around 7 pounds, in July his weight had dropped to 6 pounds and this concerned me and I added wet food to his diet, guess for now I no longer have to worry about this, LoL.

Also, I need some advice. Max is not scheduled for another ATCH Stim test, he had one done end of December and when local vet and I discussed when next test would need to be done, she stated that because of cancer diag. that wasn't sure how closely we would monitor cushings. I am thinking that we do need to monitor with ATCH tests every 3 months like we orginally discussed. Thinking maybe that I will call IMS vet and ask his opinion.

As always, thanks to you all, you have truly made a difference,
Beverly

[StarDeb55]

Beverly, with the prednisone, even though a very low dose, are you still giving the Cushing's meds? Pred will replace the cortisol that the medication, trilostane?, is trying to stop the production of by the adrenals. This was never an issue for Barkley as he was never on prednisone, so we maintained his Cushing's treatment with his normal schedule for ACTH tests.

Debbie

[bev]

Yes, Max is still on his trilostane. Oncologist did discuss issues with predisone and raising cortisol level, Max is only on predisone for three weeks and then will be discontinued. Oncologist felt that benefits outweighted the negatives for this short period.

Beverly

[bev]

Hello everyone!

We are one week and a day after Max's first chemo treatment. It is amazing how much his skin has improved in one week (I will post pictures) If I had not seen it myself, would be hard to believe.

Max is acting like he feels good, better than he has in a while. Although he had 3 acidents in the house this week which has not happened in a while, thinking it has to do with prednisone. He is still eating very well, especially as he gets boiled chicken most days. He turns his nose up at wet dog food these days (not the cheap kind either.) Yes, he is spoiled. He has always been but when diagnoised with Cushings it went up a few levels and now with cancer on top of it, getting kinda ridiculous but I have no one to blame but me, LoL!

Max had CBC done yest. and there are a few numbers that are of concern (especially WBC)


WBC 0.7
reference range 4.0-15.5
Platlet count 443
refence range 170-400
Neutrophils 203
reference range 2060-10600
Lymphocytes 245
reference range 690-4500
Talked with Oncologist from Vet school today. Just going to keep monitoring him for now since he seems to feel ok. He will have CBC done next Wednesday so will be hoping numbers are better. Discussed that because of WBC falling so low, next dose of CCNU (chemo) would be a smaller dose.

As I continue to read posts it seems so many of the cushings dogs also have other health problems. Never thought I would see the day Cushings seemed like an almost minor disease!! With all of your help, I was understanding Cushings and was feeling much better and understanding that Cushings was not a death sentence but now.... One thing that helps is Max truly acts like he feels good, maybe sleeping a little more if anything.

Also, when full blood work is done, what do I look at to tell liver enzyme levels? Was thinking it was AST (SGOT) & ALT (SGPT)?
What does Alkaline Phosphatase, GGTP & BUN/Creatinine Raio all tell you? These have all been high in past. Thanks in advance for your help and answers!

Beverly

[bev]

Hello!

Was just reading through some threads (which I seem to do a lot lately) and realized that Max has had some muscle weakness in back legs. He would not come in house from back yard before beginning trilostane. He had never had a problem with this but suddenly one day he would not come in, he just would bark until I went out and got him. I was out of town for work and Max was staying with my mom and she called me fussing because it was raining and she had to go out and get him (I know it is mean but I thought that was kinda funny!) This confussed me because it was a very small step but once on trilostane (after just a few days) he began coming back in by himself. For some reason this did not click until now, that is what you all were speaking about hind leg weakness. Guess I will just be glad the problem has resolved itself with the help of medicine.

Hope everyone has a good weekend!

Beverly

[bev]

Hi,

Posted new pictures of Max's skin, truly has amazed me. Still a long way to go with his skin but looking better!!

[Harley PoMMom]

Also, when full blood work is done, what do I look at to tell liver enzyme levels? Was thinking it was AST (SGOT) & ALT (SGPT)?
What does Alkaline Phosphatase, GGTP & BUN/Creatinine Raio all tell you? These have all been high in past. Thanks in advance for your help and answers!

Beverly

Here is a link to a website that has information about lab reports: http://www.broadwayvh.com/site/view/83223_AssessmentDescriptions.pml

Max's pictures are wonderful, he sure is a cutie!! :)

Love and hugs,
Lori

[BestBuddy]

Oh Bev what wonderful new pics.

It was so sad to look at his poor little neck before but now it is quite clear there is improvement. More to come I hope.

Jenny

[Sabre's Mum]

Bev ... those are fantastic pics. Wow ... what a difference.

All the best
Angela and Flynn

[bev]

Thank you for the link for understanding test results. Printed them out so I can study (LoL)

[bev]

Hope everyone is having a good week so far!

Max had CBC done yesterday and I recieved results today:

Hemoglobin 19.9 (12.1-20.3) (refrence range)
Hematocrit 56.7 (36-60)
WBC 6.5 (4.0-15.5)
RBC 7.49 (4.8-9.3)
MCV 76 (58-79)
MCH 26.6 (19-28)
MCHC 35.1 (30-38)
Platlet count 102 (170-400)
Neutrophils 5525 (2060-10600)
Bands 0 (0-300)
Lymphocytes 715 (690-7500)
Monocytes 195 (0-840)
Eosinophils 65 (0-1200)
Baseophils 0 (0-150)

Much better than last week. VERY HAPPY about WBC! last week it was at 0.7 and I was very concerned!
This week the only thing that was not in reference range is platlet count. Last week it was too high at 443 this week it was at 102. This is a difference of 331. That seems like a drastic change.
Thank you Lori for referencing website that explained what all these numbers mean, really helped.

Max is still acting like he feels good. Those of us who have had sick dogs get excited over small things like he barked when I drove up and he was able to come back in from outside by himself!! I know you all understand.

What a true blessing this website and all of you have been to me and Max! Although at this point I may be spending too much time on this site. Have read many threads and when I read the stories of dogs and their passing I sit here reading with tears streaming. Maybe I am preparing myself for what will one day happen : ( Hoping for that day to be atleast a few years in the future.

I think the most important thing I have learned from you all is to educate myself! With your help I am beginning to understand and starting to make heads or tails of things.

With much gratitude,
Beverly

[Sabre's Mum]

Hi Bev

Thanks for the update ... results are looking heaps better. With regards to the decreased platelets I will give you a link which states the side effects of lomustine ...

http://www.marvistavet.com/html/body_lomustine.html


Platelets, cells involved in blood clotting, also drop in number with lomustine but generally recover by the time for the next dose. If they have not, the dose is generally delayed.

All the best
Angela and Flynn

[bev]

Thank you for that information Angela. After I posted I did more reading and reports stated that during first week WBC count would be low and during second week platlet count would be low. Guess his body was acting as predicted.

Max gave me a scare on Friday. When I got home from work he had diarrhea in the house and had aslo thrown up. That night was not interested in his night meal. Watched him carefully and skipped his morning meds and things seem fine now. He acted good yesterday and acting ok this morning. Only skipped the one dose of medicine. Unsure if this was the right thing to do but meds are to given with food and he was not interested in eating? How serious is it to skip one dose?

Will be glad when this first three weeks is over (2 more days) Max has been on predisone and several cushings symptoms have returned (biggest one has been he is unable to hold his urine) Was warned that would be side effect but benefit of him taking outweighted the short term side effects.

Well Max has second chemo treatment on Wednesday as long as liver enzymes are acceptable. His liver has become my biggest concern. With Cushings disease already making enzymes high not sure how many chemo treatments his liver will tolerate?

Max and I are getting ready to head to nursing home to visit my grandfather. He is still holding on, has had a few good days here and there but overall things remain the same. My grandfather's name for Max is "ugly". He only calls him that to hear me fuss (because ofcourse I do because Max is handsome) it amuses him so, he just laughs and laughs and that is good to see.

Hope everyone enjoys this Sunday and be blessed!

With eternal gratitude,
Beverly

[Sabre's Mum]

Hi Bev

From my understanding, (being a former Lysodren user ... not trilo) missing a dose will not matter. In fact with both Lysodren and Trilostane it is not advisable to give either drug if the dog is unwell.

I can fully comprehend the side effects of prednisone. Our little Flynn ... was on very high doses (getting 60mg per day) for some time and he was up every few hours every night to have a toilet stop!

All the best for Wednesday.

Angela and Flynn

[bev]

Hi!

Hope everyone has had a good week. So thankful tomorrow is Friday!

Very worried about Max today. He had his second CCNC treatment yesterday. When I picked him up he seemed good. We were home about an hour and a half and it was time to feed him and give him meds, he refused to eat (boiled chicken) also tried giving him some cheese because he really likes but he also refused that. Before I went to bed I tried to feed him again and he did eat several bites which made me feel better. Then again this morning he refused to eat. Because he would not eat did not give him meds. (reminder: He is on trilostane 2 x a day, enalepril 2 x a day and denamarin once a day.) Had a meeting at 8:30 but was able to make it back home to check on him about 10:30, he still would not eat and I also noticed while he was sleeping he would shake (shiver), not constant but every 5-6 seconds. At that point I called oncologist, she called me back, she told me to give him anti-nausea medicine. Long story short, I had no medication so she suggested I contact vet here and ask her to prescribe some. She gave him injection of cerenia. Went and got hamburger and he did eat one small hamburger patty tonight, way better than nothing.

I am on edge, just feel like something is not right. He is sleeping now. Pray tomorrow is better. The scary thing is there is so many different things it could be, cushings, cancer, liver, medicine or what???

Oncologist wants next ATCH stem test done in 30 days (March 9) wants to wait 30 days because he has been on prednisone.

Thanks for listening. Even though I have never posted on anyone else's thread, I do keep up with each dog, just don't feel educated enough to comment.

You are all a true blessing!
Beverly

[Sabre's Mum]

Good to hear from you and Max. I am sorry I can't provide any advice to you on Max as I have never had a dog go through treatment with lomustine. Great he is eating a little bit.

Take care and all the best
Angela and Flynn

[bev]

Hello, hope everyone had a nice Valentine's Day.

I have a question. Please help. Struggling with giving Max his Denamarin pill. He has caught onto me and refuses everything I try. (yes, I lose the battle to a 7 pound dog.) He has not been eating well since his chemo treatment on Wednesday, so this has made it much harder. I know it is very important for him to take so helps protect liver, so does anyone know of a liquid equlivalent. His trilostane is liquid and I am able to get him to take. Tried looking online but I must not be searching for right thing. Guidance Please.

Also need guidance about where to obtain compounded tilostane. When we were at vet school Wednesday they informed me that the would only be able to give Max one more presciption for his trilostane because ATCH test were being done by local vet. Although my local vet has sent a copy of each test to them. Was upset by this, vet school is an hour and a half away and it is much easier to get done locally. Remember you all speaking of Diamondback drugs(sp). Could somone give me information on (i.e. does vet contact or do I?)

Thank you all in advance for your guidance.

Greatfully,
Beverly

[bev]

Hello!

Hope this finds everyone and their babies doing well.

Max seems to be feeling good today. We had some bad news on Wednesday. Went to vet school to get his third round of chemo. His liver enzymes were through the roof (over 1000) and he was unable to have any treatment. With liver enzymes already being high because of Cushings, his liver is not tolerating the chemo.:( They gave me several options (other types of chemo) but at this point I have choose to stop treatment. I may change my mind but at this point hoping liver values will decrease enough this week so he can get one more CeeCNU treatment next week. 2 of the 3 chemo options the gave me involved prednisone, so in treating cancer would be making Cushings worse. When I asked about this stated they would adjust levels because of cushings?
Have thought about nothing else since Wednesday when I was given the news. Wondering what Max wants me to do? The vet is his most hated place, Wed. he shook all the way to vet school which is almost an hour and a half away because he knew where we were going. Sat down yesterday and counted how many times we had been to vet in 6 months, 26 times. So unsure, should I continue? Prognosis is not good. Feel like if I don't continue treatment I am choosing to sit and watch him die.
Max goes on Wednesday to have ATCH stim test, CBC and liver panel done. Guess we will go from there. He is eating, drinking and has plently of energy at this point so am trying to keep positive and enjoy him while he is here.
On top of the emotional toll this has taken, you can only image what 26 vet visits has cost. New chemo treatment would cost at a minimum of $5,000, also he would have to go once a week, which means I would have to take off once a week. On a social workers salary it has been draining. Honestly would gladly pay if they could assure me cancer would go completely into remission and it would give him extra years but of course that is impossible. For now we are both tired!

Thank you for taking time to read.
Beverly

[Harley PoMMom]

Hi Beverly,

I give my boy, Harley, milk thistle. Milk thistle is a liver support supplement which does come in a liquid form.

Here is a link to the product that I give to Harley: http://www.vitaminshoppe.com/store/en/browse/sku_detail.jsp?id=VS-1915

Hope this helps.

Love and hugs,
Lori

[frijole]

Bev - I too gave my dog Haley milk thistle. Her alk phos was around 2000 I believe and it took it down to the 700s and I was elated. I am hoping someone who has dealt with the cancer can chime in.

It is great news that Max seems to be doing well... sometimes we forget about that part. Hugs to you both. Kim

[StarDeb55]

Bev, the thing you need to ask about using pred which is more important than Max's pre-existing Cushing's, is that pred usually only gives a very short term remission, 3-6 months. The even worse part is that once pred is used, you are usually out of any further chemo options when the pred remission is lost, as pred makes the tumor resistant to any other chemo. This is the information that I got from Barkley's oncologist when he was diagnosed. Please remember that Barkley had generalized lymphoma, not cutaneous lymphoma. That difference very well could mean that the use of pred affects the cutaneous form much differently.

Debbie

[bev]

Hello!

Hope this finds everyone doing well and enjoying your weekend!

Well, I changed my mind. On Thursday Max started a new type of chemo called COP (each letter stands for a different drug, vincristine, cyclophosphamide & prednisone.) At this time Max was only given the C & P, not the prednisone. On Wednesday, 3/9 he had ATCH stem test and cortisol level was low so he needs to be retested in two weeks, after that they will add prednisone. He has chemo treatment once a week for 4 weeks and then every 3 weeks for 5 months (total 6 months). Debbie, I did ask about what you said, no treatment after using prednisone and thankfully there is one more type of treatment that can be used after this.

3/9 ATCH stem results:

Pre 1.3
Post 1.2

Not sure how accurate this is. I truly am not sure vet waited 4-5 hours after trilostane was given. Gave Max trilostane about 7:45. Had to drop him off early at vet (8:15) because I had a meeting out of town, also he was having CBC and liver panal. Local vet is closed from 12-1 for lunch and this is the time he would need to be tested.

When due for next text (3/23) will not take him until1:00 to make sure it is in correct time frame. Because of cortisol level local vet consulted with IMS and they told me to reduce dose from 0.5 mg 2x day, cut to 0.3 mg 2x day.

I left out how bad liver enzymes were: (range)

ALT (SGPT) 1139 (12-118)
Alk Phosphatase 2730 (5-131)
AST(SGOT) 296 (12-118)
BUN/Creatinine Ratio 33 (4-27)


Was hoping that Max would be able to get one more CeeCNU treatment (because he had such positive results) but because of liver levels this was not an option. Now am very concerned about liver (if it is not 1 thing then it is 2) Asked oncologist about using milk thristle. She said the Denamarin is better. Earlier was having problem getting Max to take Denamirin, I was able to go to local pharmacy and they compounded his Denamarin into a liquid form. (so thankful for this) Vet said they would check liver values again on Thursday to see if they had come down. She could tell I was freaked by liver values, she told me, yes, they were bad, however, not near the worst she had ever seen. If liver values not decreasing by next week, they will perform a bile acid test to get a better idea of liver function. Oncologist did tell me that things with Max were a little different, kinda having to see as we go, because he is so small.

Max has eaten very little since chemo treatment on Thursday. Have gotten him to eat a few bites but truly not much. About 10 minutes after we got home on Thursday Max threw up, was more liquid than anything else. Because of him eating so little, I have not given him his trilostane since Thursday morning. Is this the right thing to do?

He seems to feel ok, sleeping a little more. He has not lost any weight which is positive. I hope I am making the right decisions for my baby. I couldn't live with my decision to not try another form of chemo. Felt like I was giving up and letting him die, when there were other options out there. When I called oncologist back to tell her I had changed my mind and wanted to try other options, she said she wasn't surprised. Said she thought I would.

Am thankful for my mom. She took Max last week and is taking him this week. Vet school is 1 hr 15 min from here and it is getting hard to take off once a week. (although, if I have to, I will) So my mom took him and dropped him off and I got off early and went and picked him up. Kinda feel like I should not be off work and spending all that money at the same time, LoL. Not only the money I am paying vet but also money I spent shopping while I wait (has to be there from 9:00-4:00)
This is all truly stressful, this morning I just laid in bed for a few hours with Max and just enjoyed him. No matter how he is feeling, he always has plenty of kisses for me.

Thank you all so much for listening and responding. You are all invaluable to me and Max.
Beverly

[StarDeb55]

Bev, I'm very glad to hear this. I should have been more specific with what I said. Prednisone can be used strictly by itself with no other medication. The use of prednisone alone is what I was concerned about.

Debbie

[bev]

Thanks Debbie,

Reguardless, you gave me useful information. Worrying because Max still is not eating much.

Bev

[Sabre's Mum]

Thanks for the update Bev. It sounds as though your oncologist is working out the options for Max as things change their course.

I was not a Trilo Mum but if Max is not eating much and is vomiting I would with hold the Trilo until he is feeling better ... his numbers were on the lower range or Trilo use and was in fact non-stimulatory (pre number is higher than the post number and therefore no cortisol in reserve - if this makes sense!).

All the best and take care
Angela and Flynn

[bev]

Thanks Anglea!

Max actually ate his dinner tonight, also, Always leave his dry food out and actually saw him eat some of that! When we went on walk tonight he was out in front of me enjoying himself ,hiking his leg on everything in site, LoL.

[bev]

Hello to everyone.

Max had to be put in hospital at Vet school this morning. Yesterday was the worst day he has had so far. Would not eat and just layed around, broke my heart he looked so pitiful:(. He had appointment at vet school this morning so I waited till then to take him in. His white blood cells have bottomed out (don't know specific numbers.) They put catheter in to give him fluids and started him on antibiotic IV. They hope he will be able to come home tomorrow but all depends on how he responds. This will be a long night. Max has never had to be hospitalized overnight. Really scared and worried.

Beverly

[labblab]

Oh Beverly, I am so sorry to read this news. I am holding you in my heart and Max in my prayers.

Marianne

[lulusmom]

Hi Bev,

You and Max are still in my prayers.

Glynda

[Sabre's Mum]

Bev

I am thinking of you and Max.

Angela and Flynn

[Squirt's Mom]

Dear Bev,

Sending positive thoughts, healing white light and prayers for all. If they will let you, maybe take a shirt or Max's blanket for him to have with him there. It may bring him comfort.

Hugs,
Leslie and the gang

[bev]

Thank you all for your support and kind words. Just doesn't feel right being home and Max not being here.

Last talked to vet about 4:30 today. Max's fever had come down some, had been 103.9 and was down to 103.1. Vet said he was sleeping. If they would let me I would make a pallet and sleep there with him. I know that is the best place for him right now. Guess he is in something like ICU because they said he had 24 hour care. Vet said he would call me before 9 am and let me know how he was. Would only hear from Vet before then if something was wrong.

They also did x-ray of his heart today to check heart murmur. Said had not changed at all since 2008, before Cushings and Cancer. That was atleast good news. Max had been coughing a lot on Wednesday which had me concerned.

When deciding to try chemo I did not think (was told) it would effect Max's quality of life but it is. Not sure whether he will have anymore chemo or not. He is on such a small dose and it is still making WBC's too low. Right now not thinking it is worth it because is making him sick :( Wish he could tell me what he wants.

Again, thank you so very much. Your words are invaluable. Gonna try and see if I can get some sleep.

Beverly

[bev]

Hello!

Max was able to come home today! Picked up at 4:30. He is on 2 antibotics, has to go back on Wednesday. Until then they want me to hold off on trilostane. His neutrophils fell from 3295 to 7 in one week. That is what had him so sick
His liver enzymes came down, almost half of what they had been a week ealier, so that is good.
Not sure what I am going to decide about continuing chemo?

Again, thank you all so much!

Beverly

[lulusmom]

Yay, glad to hear that Max is back home!! Poor guy has been through the wringer and I'm sure he's much happier to be with mom again. Given the current circumstances, I couldn't agree more about putting cushing's on the back burner. Please keep us posted.

Glynda

[Squirt's Mom]

Hi Bev,

SO GOOD to hear that Max is back home with you! :D It will do you both so much good to be together again. Having to leave our babies at the vets over nite is just really hard. I have been known to use one of those pallets on the floor you mentioned. ;)

I think I would forget about the Cushing's right now, too.

Hugs,
Leslie and the gang

[bev]

Hello,

Hope everyone had a good week! Max is doing much better! We went to vet school on Wed. and all of his blood worked look good. I debated but in the end, he had another chemo treatment. Two weeks ago he was given a combination of 2 drugs (vincristine & cyclophosphamide) Because of his side effects he only received one chemo drug this week and received 25% less of that drug. His skin seems stable at this point. Vet thought it was a good sign that skipping a chemo treatment did not change skin condition, he does still have 3 sores on him but they are about a tenth of the size they were when we started. He had lost a little bit of weight, 0.6 ounces, not much but when he only weights 7.3 concerns me a little.

When I was at vet school talked with another lady who had a maltese with cushings. Told her about this site. Felt bad for her baby because after 14 months still had not found medicine that dog could tolerate and be effective, her (the dog) had such thin hair. :( Guess I am lucky that Max has had good results with trilostane and only took about 3 months to get diagnoised and on proper medication. This lady said she had a bad experience with trilostane.

Max is back on his trilostane now, also Denemarin and Enalapril.

Hope everyone has a great weekend! As always, thank you all so much for your wisdom and support, would be lost without your guidance.

Beverly

[bev]

Really need help and guidance. I am so at a lose for what to do. Max did not receive chemotherapy this week because once again his neurophils were too low. That were at 75 this time:( So I was told to bring him back in Monday (tomorrow)

Not sure I am going to take him. We are both so tired but I feel that stopping treatment is giving up on my baby. He acts likes he feels ok, not great. He sleeps a lot. Is eating ok, again not great, but atleast he does eat a few bites. He is on a anti-nasea medication.

Another thing Max hates, all these medications. Currently he is on his trilostane but did decrease dose from 0.5ml x twice daily to 0.3ml x twice daily. I really want him to stay on Cushings meds because they make him feel so much better. Well I should say I give him trilo some days because on days he does not eat much I do not give to him. He is still on Denamirin. Currently he is also on clavamox. I have given up on enalaphril. His heart murmur has not changes in over 2 years and he has missed many doses before so just easier, one less drug I have to make (trick) him to take.

Max has not had a ATCH stem test since end of December. He has been on and off his trilostane so much :(

Everyone keeps saying that only I can make these decisions, that I know what is best but I want somebody to tell me what to do. I don't want to give up but I don't think it is fair to keep putting him through this. All I seem to do is sit and cry.

Your advice/opinion would be greatly appreciated.

Beverly

[labblab]

Dear Beverly,

My heart goes out to you as you struggle to decide what is best for your dear boy. I know that the responsibility for that decision can feel so painful and so overwhelming. I wish I could help to shoulder part of it for you. But I also know that, unfortunately, it is a decision that only you can make.

However, I also want you to know that we will be right here beside you, no matter what you decide and no matter what path Max ends up taking. And even though I cannot ease your burden of decision, I am hoping that I can shift your thinking just a bit. And that is to suggest that NO decision that you make will constitute "giving up on Max." You have done everything and left no stone unturned as far as giving him the best possible chance to enjoy as many quality days as possible. If your decision at this time turns out to be, "This is enough. This is enough to ask of him and this is enough to ask of myself" -- that is not giving up. It is wanting Max's final days and hours together with you to be as peaceful and as uncomplicated as possible, far away from needles and examining rooms. Sometimes we are able to give the gifts of both time and hope through treatment. But one day, the moment may come when the greatest gift is the comfort of quiet and peacefulness at home, surrounded by love.

I do not know whether or not that time has yet come for you and Max. But when it does, you will not be giving up. I believe you will instead be caring for Max, and preparing him for that moment of passage when his spirit is ready to be released from all illness and pain.

Many, many hugs to you, Beverly, and to your sweet Max.
Marianne

[Squirt's Mom]

Dear Bev,

A couple of years ago I made a decision not to take any surgical action to "fix" my Crystal. Because of the early neglect, she had numerous skeletal deformities. Her femurs, her hips, her spine, her shoulders - all deformed; many of her joints deformed and those that weren't couldn't function as intended because of her conformity. I took her to several ortho docs who said they could "fix" this or that - a graft here, an artificial bone there, and so on.

Ok. You can "fix" her - but at what cost to her. How many hours of joy would be taken from her in operating rooms, recovery rooms, repeated vet visits, pokes and prods and drains....for each and every surgery? If one fails, what happens then? What happens to the other areas that have been "fixed"?

I had to decide her life for her. And I couldn't bring myself to put her through so many surgeries, to take from her those times when she was so obviously deliriously happy to be alive. So my decision was to help her in every other way that I could to live as normally and as pain-free as possible for as long as possible.

It is not a decision that I regret one little bit. Given the same opportunity, I would make the same decision today.

Her life was cut short by a car, not her problems, but every moment with her was and is so very precious. Even those times she was in pain and not able to do as she wanted meant so very much to both of us - simply because we could share them.

It came down to what our sweet Saskia calles a "dog-worthy life." I didn't see my decision as giving up on Crys but rather as giving her the most I could for what ever time she had on this old Earth. For me, and I believe for Crys as well, those minutes of joy were more than enough to make up for the hours of painful hope she faced otherwise.

Not everyone understood nor supported my decision but they didn't see my baby's soul, they didn't know her as I did. For Crys, I made the right decision.

Max knows you are doing all you can to help him and he knows that because you love him so very much you cannot make the "wrong" decision for him. We know the same thing, honey. Whatever you decide will be the right decision for you and for Max, and we will stand beside you regardless.

Many hugs and belly rubs,
Leslie and the gang

[StarDeb55]

Bev, the final decision is so very hard, after you have helped them fight for so very long. I learned this so well with Barkley. I was so worried that I would hold onto him for too long for my selfish reasons, & not see or understand what he needed & wanted done. My oncologist assured me over the 20 months that she took care of both of us that Barkley would tell me when he was ready, & that he had had enough. She was absolutely right is all I can say. To this day, I sometimes wonder how I could have doubted that Barkley would give me such a clear signal that it was time when the 2 of us had been glued together for so long, but he did.

Debbie

[bev]

Hi all!

Max and I are doing well at the moment! Since I last posted he did receive one more dose of chemo. This time he reacted ok (white blood cells did not drop as low) but before his next appointment, I began seeing the small tumors on his body reappear. So basicly the chemo was not working and his cancer had come out of remission. My thinking is that they had lowered his chemo dose to such a low level it was not effective. So I choose to stop. All he had been through with chemo and cancer was back?? Chemo just no longer seemed like a good idea. So for now, he is a happy little guy!! Eating good, activity level good, and even all blood work (including ATCH stim test) were good!

My grandfather lost his battle with Parkinson's disease last Tuesday night. Even though I miss him sooooo, I am grateful he is no longer in pain! Until the end, Max would lay in the bed with him. It was very sweet!

On a happy note! I am trying to adopt a new dog. He is a rescue, half maltese and half yorkie, between 6-7 pounds! Very cute, he is around a year old they think. Have worried that I am disrespecting Max by getting another dog. Why I am going ahead and adopting now, while he is feeling good! At this point it is self-preservation for me. They came today to do a home inspection so I have my fingers crossed that I will be able to go get him on Saturday. Currently he is in a foster home about 3 hours away.

I hope all of you and your babies are doing well!

Much appreciation,
Beverly

[addy]

Hi Beverly,

I am so sorry to hear of your Grandfather's passing. My husband's father had Parkinson's so I know how devastating it is.

Take each moment with Max and cherish it. I am glad he is doing well and hope it continues. We take baby steps one day at a time.:)

Congrats on the new puppy. Don't look at it as disrespecting Max. A new puppy might be a good tonic for him:)

Hugs,
Addy

[Squirt's Mom]

Hi Bev,

I am so sorry about your Grandfather. It is never easy to lose those we love. :( My paternal Grandmother had Parkinson's as do several of my aunts on that side of the family. It is not a kind disease but that doesn't make the pain of losing them much easier. My sympathies to you and your family.

It sounds like Max is facing his life with joy today, which is all any of us can ever ask or hope for. I hope the two of you make many wonderful new memories!

Enjoy your new baby and be sure to tell us all about him!

Hugs,
Leslie and the gang

[bev]

My heart is broken as I type this. Max took his last breaths this morning. I had promised him I would not make him suffer, it was the hardest thing I have ever done. I remember when I thought Cushings was a death sentence, at that time little did I know cancer would be his killer.

I thank you all so much for the education you gave me. I believe that getting his Cushings under control gave Max a better quality of life.

R.I.P. Maxamillion, forever in my heart,
Bev

[BestBuddy]

Dear Bev,

Max was "one in a million" and you have shown him how much you loved him by letting him go. I am so sorry because you have to deal with the day to day pain of missing him but soon I hope you have all those golden memories to keep him close to your heart.

Jenny

[lulusmom]

Bev, I am so terribly sorry to hear that you lost your sweet boy today. My thoughts and prayers are with you.

Godspeed sweet Max.

Glynda

[addy]

Dear Bev,

I am so sorry to hear of Max. Godspeed little one. Fly free.

Love,
Addy

[mypuppy]

Dear Bev,
I have never posted to you, and I have somewhat been here behind the scenes and on private messaging, but when I read about one of our cushpups leaving us, it deeply breAks my heart. I am so very sorry for the loss of your precious, sweet Max. It hurts so very much I know. I am sure this will take a long time to heal. I do hope your wonderful memories together will help ease some of your pain. My deepest regrets go out to you.

Hugs, Jeanette

[labblab]

Dear Bev,

I, too, am so very sorry for your loss. But thank you so much for returning to tell us what has happened, so that we may join you in always honoring and remembering your sweet boy. Max has now been added to our special memorial thread:

http://www.k9cushings.com/forum/showthread.php?t=2865

He was such a brave boy, and your love has supported him throughout every step of his journey. My hope is that we may now be of support to you in your grief.

Sending you many hugs on this sad evening,
Marianne

[StarDeb55]

Bev, I am so very sorry that Max has lost his final battle. I truly know that when both of you have fought so long & hard against 2 terrible diseases, lymphoma & Cushing's, that his loss is crushing. This is exactly what I felt when Barkley told me that he had had enough, & wanted to go. I know words have small meaning, now, but I can tell you that you will eventually be able to look back on all the happy times & good memories you have of Max.

Debbie

[frijole]

Bev, My heart goes out to you. May the wonderful memories of a healthy happy Max sustain you as you cope with a huge loss. No doubt Max is running wild and free of pain right now. RIP dearest angel Max. Kim

[littleone1]

I am so sorry for your loss Bev. My thoughts and prayers are with you.

[Sabre's Mum]

Bev ... I am so sorry for your loss of your dear Max. My thoughts are with you from down under.

Angela and Flynn

[rbeasl]

Bev,

I've never posted to you, but I just had to send you my deepest sympathy. My prayers are with you and your family. I also have a maltese just starting with treament with lysodern. When I read about one of our little furbabies passing it really hurts deep, because this site feels like family because we are going through the same thing. Your Max went through so much. What a brave little guy. You really did an excellent job with him and you should be a proud Mom. As much as I love Honey, I never ever want to see him suffer. It is just not fair.

Stay Strong and think about the good times.

Love
Rhondalyn and Honey

[Roxee's Dad]

Dear Bev,
I am so very sorry for your loss. Max knows he was loved. Rest in Peace sweet boy, you are our newest and brightest star in the sky.

[bgdavis]

Bev,

I'm so sorry to hear that little Max subcumbed to the cancer. You both fought a gallant fight. He was loved and will be missed.

Bonnie and Angel Criss

[Squirt's Mom]

Dear Bev,

My heart just broke when I read your post. You and Max fought so hard and so gallantly throughout his illnesses. He couldn't have had a better person by his side. He knows how much he is loved, how much he is missed, and how much you gave of yourself for him. And when it was clear he couldn't fight any longer, you gave him the greatest gift possible - freedom from his worn and ravaged shell. As someone once said here, you took his pain and made it your own. There is no greater love than this.

Please know we are here for you anytime, Bev. Our tears fall with yours, our arms will always be open, our ears always willing to listen.

Our deepest sympathies,
Leslie, Squirt, Trinket, Brick and our Angels, Ruby and Crystal

[k9diabetes]

I am so sorry to learn of Max's passing... What a beautiful little dog he was and obviously much loved.

Natalie

[bev]

Everyone's kind words mean so much. I read messages a few days ago but was unable to reply at that time, I was overcome with emotions.

Max had a several tumors on his skin and they had begun to abscess and were becoming very painful. I knew his time was very close on Thursday June 30. Took him to vet to have tumor on his ear bandaged and vet and I discussed. For the next 5 days, over the holiday weekend, I was only away from him for about 3 hours total because I felt that by the time vet opened on Tuesday that it would be time, and it was. What was hard for me was that everything I had been told and had read said a big factor was whether or not he was still eating. Max was still eating, eating dogfood at that, but the vet discussed with me that Max was doing everyting he could to please me because he knew I didn't want him to go. I now believe she was right. I could see how bad he looked but kept thinking, well, he is still eating but that and going outside to bathroom was about all he was doing. When he went outside to bathroom, I would carry him and put him down outside, he would do his business but as soon as he came through door he wanted me to pick him up again. Looking back, I was carrying him about 90% of the time. As much as I second guess myself, it was time.

I had him cremated and got his ashes back yesterday. I have ordered a beautiful engraved urn to put them in.

Very thankful that I had been persuaded to get a new dog. Pepper has been a blessing. I will post pictures of him. Pepper is a rescue and had been abused so I had to gain his trust. He knows I am sad about Max and will not leave my side now that Max is gone. It is a lot different having a dog from the time he was 3 months to getting a rescue who had been abused at 4.

Again, thank you. This site has been a true blessing to me.

Missing my Max, Beverly