Midge-Cushings+other problems-help please (Midge has passed away)

[Mel B]

Hi all

I was a member of the Canine Cushings forum before it crashed out. Not my fault it did so ... honest!:D Apologies in advance for the length of this post ...

In a nutshell, I have Midge, a 9.5 year old male cross West Highland White/Jack Russell (as far as we know ... he's from a shelter). He's had the chop (already done when we got him at 9 months). He has always been a sedate little dog, quite happy just to potter about, odd mad dashes around, but never one for manic running around etc like most dogs do. He's always had a very good appetite and likes his water, his shape was once described by a French vet as 'rotund'! This could be, however, because he was a little over-weight at the time as he'd pulled his leg so couldn't do much exercise. He is a barrel shaped dog with spindly legs - but he's always been like this so it could just be his cross breeding as Westies are more 'barrel shaped' and Jack Russells tend to have thin legs.

Anyway, in September 2008 he developed a sore patch on the front of one of his legs which wouldn't heal, it was lumpy and he used to nibble it - he's always been a nibbler too! Unfortunately it wouldn't clear up and eventually it spread to his feet, all 4 of them, which were sore and swollen, so walking was extremely uncomfortable for him. After many types of antibiotics, eventually the vet suggested we test for Cushings, which we did and she diagnosed him as being a Cushings dog (don't ask me for the actual tests/results, I don't have them, might be able to get them if really needed but a bit reluctant to bother the vet at the moment as you will realise as you keep reading).

Since then he's been on Vetoryl 30mg daily but whilst his Cushings appears to be under control (excellent levels apparently) the problem with the feet hasn't gone away although they are nothing like as swollen/sore as they were and he can walk fairly well on softish ground, but they are now covered in a few layers of a type of scale - the vet says this is caused by a yeast/bacterial infection - something to do with us all having a certain amount of yeast and bacteria on us normally which our immune system keeps in check but as Midge's body isn't functioning correctly it's not doing so. The 'infection' is patchin all over his body - around his eyes in particular, in his ears, round his bottom, nearly covering all of his feet up to his 'knees' and patches on his tummy and on both sides, with a few other smaller patches on his neck etc. They come out as crusty scaley patches and then eventually the skin turns black, due to, I assume, the bacteria being trapped in the moist yeasty stuff.

We have to try to bath him every day (Maleseb or another anti-bacterial shampoo), not always possible, to wash all the horrible yeasty stuff off, especially on his tummy which gets very hot and sweaty and this makes the yeasty stuff come back with a vengence - within 12 hours of washing him it can be nearly as bad again.

The vet also thinks he's got serious liver problems as his enzyme (?) levels are high - he's just had another blood test and his levels were way high again and to add insult to injury he's anaemic as well.

He's getting more picky about food, sometimes doesn't want to eat at all which is quite upsetting - he was on a fairly strict chicken/fish, rice/potato diet to try to help the liver but he's now won't eat rice at all, he's also not as interested in things as he was so we've had to resort to feeding him just about anything we can get down him so as well as the fish and potato which he will eat most of the time, we're having to supplement this with Frolic and Bakers complete dog food plus a couple of tinned hot dogs to get his tablets down him in a morning (ie to hide them in). I assume he's less interested generally partly down to his now being anaemic and feeling crappy but we're also worried that it could be the Vetoryl as well as this is contra-indicated for dogs with liver problems but there's not a lot else we can do for his Cushings. The side effect of Vetoryl include lethargy, loss of appetite and diarrhoea - he's not quite got this last one but his stools are not really solid, sometimes it's the consistency of toothpaste (sorry if that is not a nice image!).

The reason why I'm reluctant to contact the vet again at the moment is that both when I saw her on Thursday for the blood test to be done, and when my husband spoke to her on Friday morning, she suggested that Midge is suffering and things we should look at his quality of life - she's said this a few times over the past few months but to be honest she doesn't see him at home, on a 'good' day, he's not in pain or discomfort, will have a little potter, eat and drink normally and is more alert - of course when you take a dog to the vets they are anything but normal and she does acknowledge that dogs generally are at their worse in the surgery. He has got more of the yeasty patches on him since she last saw him a couple of months ago but they don't seem to be bothering him - he just looks manky. He does get quite hot, but he's always been a hot dog, which unfortunately adds to the yeasty problem as he sweats more and this encourages the yeasty stuff to come back.

We're trying to do the 'right thing' whatever that is for Midge. We don't want him to suffer but we also want to give him as much of a chance as we can. Whilst we were on holiday just over a week ago (in our motorhome) we took Midge with us and made a point of taking him out (in his buggy) and he was quite perky and interested in what was going on - he had a few gentle walks on the beaches we visited ... although he was turning into a homing pigeon by trying to go back to the motorhome some of the time.

Rightly or wrongly, we've stopped his Vetoryl at the moment - he didn't have a tablet yesterday morning, nor today, as we want to see if he 'perks' up off them to see if they are making him feel lethargic etc. As a result, we think, yesterday lunchtime and evening he ate loads of potato, fish and chicken, and again today he's done the same so he's certainly got a much better appetite since stopping the tablets - before that it was really a chore to get anything down him that was 'good' for him. We're closely watching him for any signs of anything untoward, or out of the ordinary, as we don't want him to have problems with being off the tablets. I know it's only been since yesterday, but he sees to be more relaxed without the tablets in his system.

The questions is what do we do now! Do we keep him off the Vetoryl and try to boast him by getting him to eat better and therefore hopefully improve the anaemia? Or should we put him back on it and see if he again has the same problems? Should we give him a tablet every other day and see if that is a good compromise? Should we be doing something to try to help the liver problem? Or is there something else we should be considering?

Any suggestions/help will be greatly appreciated.

Thanks in advance.

Mel B & Midge the Squidge

[Roxee's Dad]

Hi Mel,
Welcome back to our temporary home thanks to Natalie and K9diabetes.

I think you did the right thing by stopping the Trilo. It has always been said that we don't give these meds to a sick pup. The symptoms you describe, It seems to me that your Midge is a little low on the cortisol. Excellent levels really don't mean anything, in this game you / we have to work with numbers followed by treatment followed by numbers and it goes on until we find the right combination. Some pups do better on the higher end of normal and some do better on the lower end, but you'll never know unless you have the results in numbers.

I think everyone would agree that we would like to see the acth stim test result/s or the last few results. It would help alot. I'm sure your vet or assitant would be glad to make copies for you.

By liver problems, what do you mean? Was there an ultrasound done? or was it dx'd by bloodtest results only. Most cush pups have high liver enzemes.

Also wondering if his thyroid was checked, often times a thyroid problem will lead to skin and hair problems.

Was diabetes ruled out?

Yeast and bacteria problems...can be caused by many things. I would feed her some plain yogurt, possibly all the antibiotics have killed the good bacteria and yogurt is a probiotic and should help replace the good bacteria.

I'm happy you found us again and I am sure the others with much more experience than I will help you sort thru this.

John (Roxee's Dad)

[lulusmom]

Hi Mel,

I am so happy to see that you found us. I do remember your first post and the site may have gone down before you had an opportunity to answer some questions that some of us had for you. I had a copy of my post to you which contained a other posts as well. I've copied below in order to bring everyone current. Please read through and make sure you answer as many questions as possible. The more information we have, the better able we can provide you with more meaningful feedback.

Glynda


Hi all - New to the forum - be gentle with me!

I'm hoping you can help me as I am at my wits end ....

I have a dog, Midge, he's a cross West Highland White/Jack Russell, approx 9.5 years old. He started to have problems with a leg infection in September 2008 that wouldn't clear up, he then got like a yeast type infection which spread to all 4 feet (sticky creamy stuff), then he also got black crud on the feed which covered his pads. After blood tests and the cortisol level tests he was diagnosed with Cushings and has been on Vetoryl ever since. In the vets words the medication has "excellent control" of his Cushings which is good. Looking at the signs of the disease, and thinking back to how he's always been (we got him at 9 months old from a rescue centre) I think he's always had it but has always coped so we never really knew there was anything wrong.

Although the Cushings is under control, the problem we have is the other bits - the yeasty stuff and the black stuff, both on his feet and body. His eyes, nose and ears are affected too and he's had several ear infections. He now has lesions on his body, similar to the yeast type stuff which mats his hair together and they then turn the skin a bit black - possibly caused because of the moisture held in by the matted fur - keeping the fur clipped short helps a bit but we can't stop it totally.

We've had all sorts of antibiotics, creams etc, Maliseb shampoo with a nightly cleaning routine of bathing and then putting on the creams etc as appropriate. His feet 'yeast and black crud' problem improved a lot with the use of a human atheletes foot powder but we just can't shift the remaining black crud no matter what we do/use - it eventually covers his pads and it has to been picked/peeled off. Nothing seems to be helping much though with the lesions no matter what we do. One of the creams we were using I discovered was contra-indicated for dogs with Cushings so we had to stop that, but I wasn't convinced it was really helping either.

To add insult to injury he's also got a problem with his liver - his enzime levels were in orbit and although they did start to come down since December they shot up again, higher than ever, just over a month ago. Unfortunately the treatment for this is steroids and that is the exact opposite of what we should give him for his Cushings so we can't do so. Instead, since then, he's been on a strict diet of rice/potato, chicken/fish and vegetables for his dinner, plus hyperallergenic dry complete dog food for lunch - the only 'junk' food he's allowed is some sausage in a morning to get him to take his tablets - he's gotta have something nice to hide them in otherwise he spits them out like missiles!

He's very strong and eating well, much better than he was a couple of months ago, which is great, but as you can appreciate he is totally fed up and often has tantrums and duffs up his bean-bag with frustration!

We're at a loss what to do next really, we can continue with his daily bathing, picking etc but it can't be nice for him to have these lesions all over his body and the yeast/black around his eyes and nose really drive him nuts at times. He's so strong though that were not really considering having him put down, he's not bad enough for that and whilst he's willing to be strong and keep going so will we.

We're considering asking the vet about stopping his Cushings meds so that we can try to treat the liver problem ... it's not certain whether it's the Cushings or the liver that's causing his lesions etc problems but as it's got worse again, at the same time that the liver has, we're thinking it's more to do with that - but we don't know if that's going to make things worse!

Does anyone have any experience of Cushings and liver problems and what did you try ... did it work?

Or does anyone have anything to suggest that might help overall?

Thanks in advance for reading this ... I'll keep my fingers cross for a 'glimmer' of hope...

Mel B

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Hello and welcome. You will get lots of answers from here. I can tell you that liver and cushings can go hand and hand. Miko gets Milk Thistle for the liver and you can also try SAM-e. Midge is adorable. Christine

Miko's Mom
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Hi and welcome to our site,

I am so sorry to read about the skin problems your pup is having - poor little guy. Thank you for posting these photos as it gives a look at his condition.

Yep, Christine is right we will ask for more information.

Let us know the exact numbers from the ACTH stim tests performed to let us see the what the cortisol levels are. Also, ask your vet to give the exact numbers of the blood tests performed recently to see the elevations. The liver, yes is one of the organs that is affected by Cushings, but since treatment has begun I am wondering like you why the liver values are still very high.

It may not be the case with your pup - but I just wanted to add a note on Vetoryl as seen in the brochure - is that dogs with liver disease really should not be taking Trilostane.

How much Vetoryl are you giving?

In addition has your vet looked in the possibility of thyroid problems - please take a moment to read through this link - http://www.lbah.com/canine/hypot4.htm - some interesting reading.

Are you seeing a dermatologist on these skin and infection issues?

I know others will chime in shortly,
Terry
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Welcome from me, as well!

I just want to "second" what Terry has said about concern regarding using trilostane with a dog who has liver disease or damage from other causes. Here is a quote from the U.K. product insert for Vetoryl:


Quote:
Special warnings: As the majority of cases of hyperadrenocorticism are diagnosed in dogs between the ages of 10-15 years, other pathological processes are frequently present. It is particularly important to screen cases for primary hepatic disease and renal insufficiency as the product is contra-indicated in these cases.

Here is the source for this quote: http://www.dechra-uk.com/downloadfil...tDataSheet.pdf.

I encourage you to discuss this warning with your vet, to make sure that the Vetoryl is not causing additional harm. In the meantime, I am so glad that you have found us here, and I look forward to finding out more about your sweet Midge.

Marianne

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Hi and welcome to the forum.

I think Westies are one of the cutest darned dogs in the whole world and at one time I was thinking about sharing my life with one. I did quite a bit of research on them and decided against it as the breed has some serious health concerns. Westies are at the very top of the list for dogs with severe allergies and autoimmune disease. The latter seriously compromises the immune sytem and a dog is unable to fight off the smallest of infection. Copper toxicosis and portostymic shunts are also on the list of health concerns. The last three conditions can seriously impact the liver and symptoms can develop at any age so I am wondering if your vet has done any liver function tests or suggested a liver biopsy? An ultrasound is usually done but a biopsy is really necessary to diagnose the problem, including determining if the damage to the liver is steroid induced.

Skin issues developing before a dog is one year old would not be considered a symptom associated with Cushing's. Aside from the skin and liver issues, does Midge have any other symptoms such as excessive drinking and urination, voracious appetite, panting, pot bellied appearance, hindquarter weakness?

It would help us a lot if you could please post the results of all tests done by your vet to diagnose Midge. Did he tell you if she had pituitary dependent cushing's or an adrenal tumor? If you don't know the answer to that, we may be able to determine that by the test results you post. If an abdominal ultrasound was done, please post the findings here too. How long has Midge been on Vetoryl? How much does she weigh and what is her current dose?

Sorry for so many questions but the more information you can give us, the better able we can provide meaningful feedback. I am sure you will be hearing from others and we'll all be waiting to hear more about your precious girl.

Glynda (LulusMom)
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Midge is real cute; never saw a westie/jack cross before!
As others have mentioned, milk thistle & Sam-e are two good supplements to try. You can buy at Walgreens or go with a veterinary version of same (Denosyl, Marin or Denamarin, which is a combo of the first 2).

I can't comment on the trilo, but others have said it is not a good mix when the pup has liver problems.

My Aussie is on several supplements plus generic Anipryl. We are due for blood work soon and I'm hoping her liver values are down....hers were sky high several months back (2000 range). But she seems to have responded well to her meds since then and many symptoms have subsided/moderated. I have heard that Anipryl may actually lower liver values...we shall see.

Good luck

jrepac
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Hi Mel,

Welcome to you and Midge!

The other have given you some good info as usual so I don't really have much to add other than some links on Cushing's which will be at the end of this post.

When I read about the skin and feet problems my first thoughts were zinc issues and allergic skin diseases. I would strongly recommend that Midge be seen by a dermatologist. They have more training and experience with this sort of thing than a GP vet will.

I would also follow Glynda's suggestions about the liver. Liver diseases can cause the same signs as Cushing's and the stress can cause false positives on the tests. An ultrasound and liver specific tests, including a biopsy, would be tops on my list.

I am glad you found us and hope to learn more in the near future.

Hugs,
Leslie and the girls

the links

Kate Connick*
http://www.kateconnick.com/library/cushingsdisease.html

Long Beach Animal Hospital*
http://www.lbah.com/canine/cushings.htm

Drs. Foster and Smith*
http://www.peteducation.com/article....2+2097&aid=416

Newman Veterinary*
http://www.newmanveterinary.com/CushingDiag.html

Cushing’s signs and pics*
http://www.newmanveterinary.com/CushSignFrame.html

BMD Health Library*
http://www.bestbeau.ca/bmd_health_links_4.htm
(scroll down to see Endocrine Diseases)

Mar Vista Animal Medical Center*
http://www.marvistavet.com/html/cushing_s_disease.html

Vetstream*
http://www.vetstreamcanis.com/ACI/Fe...ctSheet052.asp

"Find a Specialist near you"
http://www.acvim.org/Specialist/Search.aspx

Leslie-n-Squirt



Hi and welcome from me as well,

I agree with the others and that a lot isn't clear. For one thing, high liver enzymes in itself, isn't considered a liverdisease. It's symptomatic of other processes going on in the body. So depending on how high they are, your vet should start testing (if he already hasn't done it) for any kind of liverdisease or any other condition that can cause high liverenzymes.

I'm a bit confused since you say: "his enzime levels were in orbit and although they did start to come down since December they shot up again, higher than ever, just over a month ago. Unfortunately the treatment for this is steroids". The treatment for high liver enzymes, is finding the cause of the elevation. So, if your vet told you that the treatment "for this" is steroids, I wonder if the vet already has some diagnoses of the cause of the elevation of the liverenzyms?

Also, all the creams, antibiotics, shampoos and powders you use for the skincondition...are they prescribed by the vet? (over the counter creams, ointments and stuff, aren't as safe/innocent as people sometimes think and might contain for example steroids you don't even recognize...and also everything you put on the skin will be absorped by the skin and enters the dogs system.) And what is the vet saying about the skincondition? According to the diet, it sounds like the vet thinks its an (food) allergy issue? I just have to say, that in case of a true food allergy issue, giving even a small piece of sausage once a day, may be quite enough to keep the allergic issues going.

Another thing I noticed, is that you stated that the one thing that really seemed to help, was the athlete's foot powder. Athlete's foot is caused by a fungus...was your dog ever checked for a fungus infection?

I think it would be wise to step by step start diagnosing what is going on exactly with his liver and skin. Randomly trying things like stopping the Cush meds is not such a good idea. It's best to look at all issues that are going on and diagnose them...maybe with the help of an internal medicine specialist (liver) or/and a allergyspecialst (skin)

Best of luck,

Saskia and Yunah,
The Netherlands.

[labblab]

Hi Mel,

I have only a moment to welcome you back and to post. But something that you mentioned caught my eye -- you've said that Midge is anaemic. Here is a specific warning contained in the U.K. Data Sheet published by the manufacturers of Vetoryl:


The product should be used with extreme caution
in dogs with pre-existing anaemia as further reductions
in packed-cell volume and haemoglobin may
occur. Regular monitoring should be undertaken.

The quote comes from here: http://www.dechra-eu.com/downloadfiles/Vetoryl120mgCapsulesProductDataSheet.pdf

I just checked, and I don't see the same warning included in the most recent U.S. Data Sheet for Vetoryl. But I would feel concerned enough about this issue to have my vet check with Dechra before reinstituting Vetoryl treatment if that is the route you decide to go. Hopefully, I can stop by with some more thoughts a bit later on.

Marianne

[MiniSchnauzerMom]

Hi Mel,

I, too, am glad you found us and wanted to add my "welcome back" to you and Midge. As Glynda has said, the more information you can provide from the questions that were previously asked the more it will enable us to give you feedback.

Sounds like you are feeling a tad unfortable about asking your vet for copies of Midge's labs and test results. I can certainly understand that feeling. In the past, asking for copies of tests was nothing that ever even crossed my mind. However, I soon learned the importance of having copies of all the testing on hand and have been keeping a file ever since for all of my animals (and myself too!) I urge you to ask your vet to provide you with copies of Midge's test results. As John (Roxee's Dad) said:

Your vet or assitant would be glad to make copies for you.

Will be watching for your next post and update. Give Midge some extra pettin' from me!!

Louise

[forscooter]

Hi,

I probably missed you at the other board but am so glad to see your post here. The scales, the infections, it all reminds me so much of what my Scooter had. Same thing...the yeast, then it would ooze and scale over and get infected. The only thing that helped him with that would be a weekly bath with a colloidal oatmeal rinse. I would trim the fur back the best I could without hurting him to allow the oatmeal rinse to get as close to the skin as possible. You don't rinse that off....leave it on. Aveeno sells it in packets and I would just pour and pour it over him for at least 15 minutes at a time. Then, the rest of the week, I would take a mild shampoo, usually oatmeal and put a little on washcloth and pat it on and gently wash the infected areas only. And then rinse it off using the same technique. My fear was by giving an actual bath daily it made him worse...his skin got very dry and even more likely to get infected. I used the antimicrobial shampoos and for whatever reason I swore they made things worse....again almost too drying.

The other thing we added was a strong broad spectrum antibiotic. It took about a week but I did see some improvement.

As for the liver enzymes, I see you have been given great advice already. Scooter's enzymes were in perfect control so we felt it was more an allergen. I see you are feeding fish and potatoes which is excellent. I am wondering if you aren't dealing with allergies and the chicken and rice could be lending to the problem? A strict hypoallergenic diet may help things out too. Nothing but the fish and potatoes for a few weeks at least until you can see if it helps.

I know someone, I think Leslie (Squirt's Mom) told me that her vet mentioned that sometimes an older dog's immune system just can't handle things any longer....I am not quite sure what exactly she said now (sorry Leslie) as it was shortly after I lost Scooter. But, I do know she reassured me that I did everything I could and sometimes there just isn't anything else you can do.

But I do think these other things are worth trying out. I hope this helps some bc my heart truly goes out to you and Midge! I feel your pain and am so very sorry!!!!

Sending my very best healing wishes!!! Beth, Bailey and always Scooter

[rhodesian46]

Has a culture been done on his skin? Also it is extremely important that you have a vet that is knowledgeable on Cushings. I would see an Internal Medicine Specialist as they have more expertise

[Mel B]

Hi all

Update on Midge. He's still off the Vetoryl. The good news is that he's now eating properly again and generally appears to be much happier. He's more alert and when we went away for a couple of days he had a little potter on the beach and 'sniffed' the rocks etc, same when he had a little potter on the field - he hasn't really done this for ages! Today he actually got out of his bed to come over to us to say hello without us even asking him and we actually got licks!!! I feel like my little 'boy' is coming back again ... yes I know I shouldn't get too excited by all this, we don't know how long he will go on for but we feel it is better for him to have a quality to his life rather than be fed up and like a zombie.

Tonight he's eaten his hot dogs for breakfast with his vitamin tablets, plus some complete food biscuits (Bakers Complete), at lunch time he had more of the Bakers, and at tea-time he had an egg, 4oz of white fish, a little drop of very thin gravy and some potato, and he's just had a small jacket potato!

He's had his nightly bath and whilst my hubby was getting it ready, Midge went and laid in his favourite spot in there ... something he hasn't done for months.

I can't be sure but I think his skin is a little better, very difficult to say for sure as its only been a few days, but I don't think it's quite as 'angry' looking, possibly because the Vetoryl isn't supressing his immune system? he has't had a skin culture done but it's pretty certain it's his own system that's causing the problem ... the yeasty type stuff that's on his tummy every day is yucky and when we clean it off there's nothing else there, but it just comes back again. He's having some pro-biotic yoghurt daily to try to boost his 'good bacteria' and immune system.

The vet is aware of what we are doing and doesn't have a problem with it, we just have to watch out to see if he develops any liver problems due to the excess cortisol in his system again. He's putting some of the weight back on that he gradually lost and once we feel he's back to a better 'size' and hopefully his anaemia is not so bad, we'll look to getting him on a better diet again so that his liver isn't so stressed.

Tests - we've asked the vet for the results and she's going to get them together for us so we should have them in a day or 2 and I'll then post them on here for you to see.

Thanks for all your suggestions/help so far, much appreciated.

[Mel B]

Hi all (licks from Midge) :p

Midge is definitely feeling better, he's actually getting up from his bed more and more now and is happily standing to eat his food, he's drinking but now at least he stops himself when he's had enough, rather than us having to stop him, which is a good sign I think. His lesions are definitely not as crusty and the yeasty stuff on his tummy isn't coming back anything like as fast or as much as it was and he's gone 'flaky' ... in the sense that the crusty stuff on his body etc is coming away much more easily now. We've had a few goes at his feet and whereas normally he would be sore, its actually not really bothering him now. :)

I've now got the test results from the vets, not sure exactly what you need to see but here goes, I've just included the bits which are either high or low to save space (omitting other items given on the test result sheets which were normal):

19 Nov 08:
ALKP - 1168 U/L (high)
ALT - 507 U/L (high)
UREA - 4.3 mmol/L (normal)
CREA - 39 umol/L (low)

5 Dec 08:
ALKP - 1100 U/L (high)
ALT - 355 U/L (high)
UREA - 18.9 mmol/L (high)
CREA - 75 umol/L (normal)

7 Jan 09:
ALKP - 860 U/L (high)
ALT - 292 U/L (high)
UREA - 13.1 mmol/L (high)

23 Feb 09:
ALKP - 1629 U/L (high)
ALT - 253 U/L (high)

30 Mar 09:
ALKP - 1503 U/L (high)
ALT - 141 U/L (high)

30 April 09:
ALKP - 1569 U/L (high)
ALT - 159 U/L (high)
HCT - 17.6% (low)
HGB - 5.9 g/dL (low) (I assume this shows he's anaemic? :confused:)
GRANS 13.8 x109/L (high)
%GRANS - 88%
NEUT 13.3 x109/L (high)
EOS - 0.5 x109/L (Low/normal borderline)

All comments/views gratefully received!
:)

[Patricia ann Wh]

Hi,

I'm not up to date on your story. Could you fill me in a little bit.

Why is your dog "off" vetoryl.

How long and why??

I'm so glad so so glad he's feeling better:);):D

Thanks, Patti and Jesse

[Squirt's Mom]

Hi Mel,

Thanks for the kisses, Midge! :D

I'm no good at reading lab results like these but others like Glynda and Debbie are and I am sure they will be along to give their input.

In looking at the results, tho, did something happen between the Jan and Feb tests? The ALKP numbers were going down until the Feb reading then nearly doubled. Was Midge sick at that time, or was he under some sort of extra stress then? New med? That seems to be a big jump to me, but as I said I'm no pro at this at all, so it could just be my funny mind doing it's funny stuff. :rolleyes:

7 Jan 09:
ALKP - 860 U/L (high)
ALT - 292 U/L (high)
UREA - 13.1 mmol/L (high)

23 Feb 09:
ALKP - 1629 U/L (high)
ALT - 253 U/L (high)

Well now, I was a lot of help, huh? :p

I am really glad to hear that Midge is doing better and better as the days pass. Sounds like stopping the Trilo was the right move for now. His skin sounds like it is improving as well and I'm sure that makes all of you more comfortable. :cool: I hope he continues to improve all around!

Hugs,
Leslie and the girls

[Mel B]

Hi Patti

In a nut-shell: Midge was not well on Vetoryl, he was getting weaker and weaker and not eating properly, in fact it was getting harder to get him to eat much at all. When he had his last lot of tests done on 30 April, we found that the levels were raised again and that he was anaemic too. After weighing up the way he was and the problem with trying to sort out the anaemia in a dog that doesn't really want to eat, we decided to stop the Vetoryl, which can apparently cause lethargy, anorexia etc to see if we could sort out the anaemia and then decide where we went from there once (hopefully) he was stronger again. After all, if we couldn't sort that out then he was just going to continue to get weaker and eventually he definitely wouldn't have the reserves to fight the illness and would probably have faded away. We weren't prepared to let that happen. He's been off Vetoryl for a week now (last 30mg dose was on 1 May 2009).

Hi Leslie:

Midge kept getting ear/eye infections around January a time and was not a happy lad at all. He was also very picky about his food and getting him to eat was more and more difficult, we had been trying to give him a better diet but when he wouldn't eat it was to some extent a case of just getting food down him. He had been on Vetoryl continually since November 2008. When we got the 'bad' results we then tried to change his diet to a purely chicken/fish, potato/white rice one, with just odd bits of other food (such as hot-dogs to get his tablets down him). He was also on antibiotics to try to see if they helped with his skin infection so these may have added to the levels, I'm not sure but since he's been off the antibiotics his levels have reduced - may just be coincidence?

Midge was on Antirobe from 29 Dec to early January but after the course had finished he went back on his original ones (can't remember the name) as the Antirobe didn't appear to be having having any effect. Later in January he got much more of the yeast/infection back on his feet, more than ever before so he was put back on the Antirobe for a second time to see if that helped this time. He was also extremely fed up at the time - having really good 'whinging' sessions and beating seven bells out of his beanbag, he also kept waking in the night having whinging sessions too and getting himself into a right old tiz.

In early Feb we had to do a lot more 'washing/bathing' of his feet, Midge didn't like but we didn't know what else to do. I suspect this increase in 'care' (he didn't do baths at the best of times!) and the ever spreading 'gunk' didn't help. The Antirobe finished around this time and he then stayed off it, it didn't have any effect at all, in fact I suspect it made things worse by killing off the good bacteria in his tummy and making him feel even more grotty.

By 22 Feb the infection on his feet had remained pretty static but the yeasty stuff had started to spread more to his legs etc and he'd started to develop more of the 'lesions', up till then he'd only had a few patches but then they were spreading like mad. I assume the horrible progression of the disease is what was 'reflected' in the Feb test with the raised levels? He was extremely fed up during this time and getting himself into a right stew too which won't have helped either.

Back to now - he's much more content and calmer, which is why I assume his results have improved a little since February.

(I've tried to get the 'dates' etc right - fortunately I was putting postings on my Motorhome forum's 'chatterbox' section so can at least refer to that for some of the info as my memory is totally addled!)

Mel

[Mel B]

Thought you all might like to see a photo of Midge so I've put him 'smiling' as my avatar, and a full photo of him in my profile.:)

[Harley PoMMom]

OOOHHHH Mel,
Midge has an absolute BEAUTIFUL smile :D:):D:) that goes with that absolute BEAUTIFUL face. ;):p;):p

Harley and Lori

[lulusmom]

Hi Mel,

I just took a quick look at your posts to refamiliarize myself with Midge's history and realized that you never answered some of our questions. The more information we have, the better able we can provide you with meaningful feedback. Sooo, let's backtrack a bit. I see that you have posted the blood chem results but is it possible for your to post the results of the diagnostic tests that your vet did to confirm a cushing's diagnosis. Those would be acth stimulation tests prior to treatment, low dose dex suppression test (LDDS) and abdominal ultrasound findings.

Aside from Midge's skin and coat issues, did he have any other symptoms associated with cushing's such as excessive drinking and urination, voracious appetite, panting, pot bellied appearance? Can you also give us the history of treatment. For instance, can you list the date you started treatment and the mg dosage and the dates of amount of any adjustment to the dosage. Please include the dates and results of the acth stim tests that were done after starting treatment and let us know if those tests were done within 3 to 6 hours after dosing? I realize that your memory may be a bit sketchy but your vet should be able to give you copies of all testing which has the dates and results.

Does your vet have any idea what is causing the anemia. If not, will s/he be doing additional testing to make this determination? I think Midge has a lot going on that is more urgent than cushing's at the moment so I agree that you made a wise decision to discontinue the Vetoryl. Actually, Vetoryl should never be given to a sick dog and when it comes to cushing's, any dog that is not eating is to be considered a sick dog.

Here is a link to info on anemia in dogs that might help you understand how it is diagnosed. It also touches on the bloodwork results. Debbie (Stardeb) is a long time lab technician and I am sure that she'll be by to give you her educated opinion on Midge's bloodwork.

http://www.sniksnak.com/doghealth/anemia.html

We'll all look forward to receiving more of Midge's history.

Glynda

P.S. Midge is adorable...his smile is contagious for sure.

[Mel B]

Hi Glynda

Some more info:

Midge had the classic symptoms/appearance: excessive drinking and urination, voracious appetite, panting, pot bellied appearance (he'd always been 'rotund'). He had always been a nibbler of his legs too. He had the ACTH stim tests done around 4-5 hours after his dosing each time (as recommended). He didn't have an ultrasound performed, not sure about the Dex test ... At the time he was having loads of testing done he was an extremely unhappy chappy, in a lot of discomfort with his foot infection, so the vet kept it to the minimum to prevent stressing him out too much.

He was only tested for Cushings after many different types of antibiotic were tried to sort out the problem. Once he was diagnosed he was put on Vetoryl 30mg from the off and the dose was never altered as we were told the lab said it had 'excellent control' at that dosage.

Anaemia - The vet and I suspect the cause of this is due to his immune system being under strain with the infection and suspected liver failure, plus his lack of appetite which therefore meant he wasn't getting the nutrients he needed, it was a downward spiral which we had to stop, hence our current removal of the Vetoryl. I don't have any more test results info so I'll have to go back to the vet for that.

Midge is better than he was on the Vetoryl but obviously he's not 'cured'. He's eating normally, pottering a little more, and seems more content generally. His skin lesions are not as angry and are much much drier, his sweating has lessened, he's quite relaxed. He's not getting the horrible ear infections now which were pretty constant. He's happier and that is what matters, whether he's got a week, a month, or a year, so long as he's feeling better that it what is important, quality rather than quantity of life.

The question is - does anyone have any ideas on where we go from here/what to do? If he continues to get better should we consider putting him back on the Vetoryl?

[Mel B]

Hi again

Midge is still doing well and feeling a lot better, he's drinking but not excessively now, and he's eating like it's going out of fashion! He's much more alert, his hearing has improved no-end and his feet are almost back to normal - his pads look like pads again, and his legs, despite still being very blotchy/black hardly have any yeasty stuff on them at all. His tummy is a lot better and gets very little yeasty stuff on now, even when he sweats. He does get warm though. He's happy to get up out of his bed without encouragement, pottering from room to room if he thinks there's a chance of a 'treat'. The problem is that I don't know if this renewed interest in food is a good or bad thing.:confused:

We're still in a quandary of what to do next ... has anyone got any experience of giving Vetoryl (Trilo.) once every couple of days, rather than daily? It would be great to hear if this has helped or caused problems. He weighs around 9kgs at the moment and was prescribed 30mg a day but after the way he was zonked out, lethargic and unwilling to eat I'm very reluctant to put him back on it daily in case he declines and/or gets anaemic again. I've partly got my 'little boy' back now and I don't want to 'lose; him again if I can help it.:o

[BestBuddy]

Hi,

One of the last resort options for my Buddy when he was having problems with trilo was to consider dosing every two days. This is definitley not normal but I do believe there have been at least one of our members do it this way.

My specialist said that he had at least two dogs on strange trilo dosing, I think one was every 48hours and one was every 36hrs. I trusted the doc. and would have given this a try because the worst (in my mind) that could happen was that it wouldn't control the cortisol and the next ACTH would have told us so.

I do think that with trilo being newer that there is a lot to learn about but like all newish drugs it takes many years before we can truly understand how it works.

Jenny

[AlisonandMia]

Sometimes we do see dogs on Trilostane being dosed on alternate days and similar arrangements but it isn't done very often and doesn't seem to be a successful regime long-term - and I've never seen it recommended or even discussed in any research or dosing information.

Vetoryl is available in 10mg capsules and these may be useful in allowing you to use a lower daily dose which would have to be preferable to giving what looks like a too-big dose every few days and hoping it works out ok. I've heard someone in the UK say that their vet didn't want to stock it (10mg size), possibly for commercial reasons. The 10mg dose hasn't been on the market that long and some vets may not be aware that it is available, either and thus believe they are stuck with trying to work something out using 30 mg caps. I don't know how the prescription/supply system for veterinary meds in the UK works but I'm pretty sure that even if your vet doesn't want to carry 10mg Vetoryl caps you should be able to obtain them somehow (with a script, of course.)

Here's a link to Dechra's info on the 10mg cap: http://www.dechra-eu.com/downloadfiles/Vetoryl10mgCapsulesProductDataSheet.pdf

And a link to the Vetoryl product info page on Dechra's site: http://www.dechra-eu.com/viewproductdetails.asp?ID=89

Alison

[Mel B]

Hi guys - found you all again!:)

Midge is still with us .... unfortunately though over the past few days he had a bit of a relapse in the sense that his lower tummy is constantly getting the yeasty stuff on, really sticky and slimy, and it's made him very, very sore.:(

We can't place what has caused this except that he did have a bit of an ear infection again, which cleared up very quickly, but all we can think is that it has stressed his immune system again hence the current problem.

I've now got some calamine lotion from the chemist (used to use it myself when I had chicken pox several times as a kid) and he's having twice daily washes of his tummy with the calamine applied when he's dried off. Its a white/pinkish coloured thin liquid (sorry, don't know if you have it in the States etc). It's used to reduce itchiness and also soothes (as it's quite cold) so we're hoping it will help him. We have tried other creams etc but they all leave a greasy residue which holds moisture onto the skin so actually can make things worse. As calamine lotion dries quickly and goes chalky on the skin it doesn't cause more problems. He's only had it put on him once today so far and already he seems a bit happier/less uncomfortable so we'll keep using it and see what happens.:o

He's still off the Vetoryl, for 3 weeks now, and we haven't noticed any adverse problems/differences to be perfectly honest other than he's eating and doing other things much better as mentioned before. We're still holding off putting him back on it in case it knocks him back again - with his sore tummy he's got enough to contend with.

He's now on meatballs instead of hotdogs to take his tablets, much easier to hide the tablets in in a morning!!!:eek: Other than that it's the good old potato, chicken, fish, rice with some nice complete 'good quality' dry food biscuits, if he gets a bit 'sniffy' with his food, a little of the meatball tomato sauce thinned with water soon gets his tastebuds a tingling;).

[Roxee's Dad]

Hi Mel,
Good to hear from you again, sorry that Midge is in sort of a relapse. I hope the lotion continues to work well and Midge recovers quickly.

Please do keep up posted.

[lulusmom]

Hi Mel,

Being retentively challenged, I reread your thread for a third time and noticed that you have not posted the results of the tests your vet did to diagnose Midge with cushing's. These would be a low dose dex suppression test (LDDS), acth stimulation test, urine cortisol:creatinine ratio and to differentiate between pituitary or adrenal dependent cushing's, a vet will usually request an abdominal ultrasound and/or a high dose dex suppression test (HDDS). Your vet should be happy to give you copies of those tests so that you can post the results here. Did your vet diagnose Midge with pituitary or adrenal dependent cushing's?

I sure do remember calamine lotion! I don't remember much of my childhood but I'll never forget the smell of calamine lotion. My nostrils are flaring just thinking about it. :D I think my mom went through a case of that stuff when my two sisters and I had measles at the same time. That was eons ago so it's been around for many, many, many years. I also remember that it helped a lot with the itching and I often wonder if it's the reason that my favorite color is pink. I hope it continues to help sweet Midge.

Glynda

[MiniSchnauzerMom]

Hey! Mel,

Glad you found us again and sorry to hear that the yeasty stuff has returned and is causing Midge discomfort. I'm glad the calamine lotion is giving him some relief though. Ah, yes, I too remember calamine lotion. As a child my Mom coated me with the stuff when I had chicken pox.

I reread your entire thread also just to refresh my memory and I see where Midge had an ACTH after being put on Trilostane but no reference was made to specific diagnostic testing prior to being put on the drug to confirm Cushings. Numbers on a lab report, if that is all that was done, is not enough to diagnose Cushings. If more than one diagnostic test was done and Cushings was confirmed, I apologize profusely for being pesky!

Question....Has Midge ever been seen by a veterinary dermatologist for his skin issues? In my personal experience I found that the veterinary determatologist, after giving my Munchie the once over and doing some testing, was able to make a determination and successfuly treat the cause of his skin problem where the general veterinarians were treating the effects and never getting to the root of things. Skin is a derm doc's specialty so it makes sense to me. Just another option to consider.

Give Midge some extra pets from me. Love your avatar with Midge's big smile. Look forward to your update!

Louise

[Mel B]

Hi again guys, can't stop for long unfortunately.

No, I haven't got the any other test results form the vets yet, I'm back there on Friday with one of my other dogs (Lily who's just been spayed) so should be able to get more then.

I'm intrigued though, from your questions is there a possibility that it might NOT be cushings? If that's the case, then what else can it be? He's got all the classic symptoms. Unfortunately he's not doing too well at the moment, his yeasty problem is still causing him to be sore, and he's now started to get a bit more picky with his food although he is hungry, he's drinking more and gets quite warm (which just ads to the yeast problem!). The vet is 100% sure that the 'other' problem he has is his liver failure which is compromising his immune system, hence the problem with the yeasty stuff and his anaemia which thankfully doesn't appear to be as bad as it was.

I'm starting to fear the worse though ... he was doing so well but these last few days he's been gradually getting worse. My husband is finding it really difficult now to deal with (he's a softy anyway). Trying to get the balance of quality of life and not make Midge suffer is very difficult at the moment, I think if he's still like this by Friday he might end up with an appointment at the vet too and I suspect it won't be a happy outcome.

[Spiceysmum]

Hi Mel,

How is Midge today, hope he is feeling a bit better now. Thinking of you all.

Linda and Spicey

[Mel B]

Hi everyone

We've had a bit of a rough time with Midge hence why I've been 'away' for a while. He started to have some trouble breathing over night on Tuesday last week with some coughing so it was a case of a swift visit to the vet in the morning and she gave the diagnosis that he had fluid in his right lung which was crackling, caused more than likely by a chest infection or could even have been heart failure (we lost one of our dogs in 2006 to this at 17 and was fearing the worse). So Midge had a steroid jab and an antibiotic jab - even though not a good idea for a cushings dog we had no choice as it would've been the end of him within 24 hours otherwise. Back again on Thursday lunchtime and thankfully he was breathing much better, the vets are simply amazed at his strength and will to keep going - none of them expected him to last so long! So a one week course of antibiotic tablets was prescribed - we had decided, though, that if, at the end of these he wasn't any better then we couldn't really ask him to keep fighting ....:(

As we were at the point where we didn't know if we would have him much longer, we decided to go away for the weekend locally in our motorhome and he had a lovely time - he pottered a little on the beach and had a lay on the sand for a while whilst the other dogs played, plenty of cuddles and fussing and the odd potter about on the grass near where we we stopped overnight. He even got some of our fish and chips as a treat!:D

The really good news is that thankfully he's appears to be over the breathing problem so it appears to have been a chest infection after all (thank goodness).

Now he's a bit more perky, looking at us to see what we're doing and also potting from room to room a little which is good rather than just laying in his bed. He's not drinking quite as much as he was which is a good thing too. Unfortunately his nails are in a bad state again though, and lots of yeasty stuff - probably caused by the stress of his chest infection - but this seems to be slightly better today than it was so hopefully it will keep improving. He's just had his bath, without protesting for once, and is currently preening in his bean-bag having just scoffed his jacket potato supper.:)

With all the fuss though didn't remember to ask for the test results at the vets!:o

[Roxee's Dad]

Hi Mel,
So glad that Midge recovered from her breathing problems. Sounds like you had a real nice time on the weekend and enjoyed every bit of Midge's camping experiences. Very nice to hear. Hope he continues to improve and you have many more weekends experiences with him.:)

He has a very happy and handsome smile:D

[Spiceysmum]

Hi Mel,

Pleased to hear that Midge is alot better now after his scare and enjoyed his weekend break with you both. We are away in our caravan this Saturday for a week, just when the weather is going to break up from this glorious sunshine! Still, the dogs love it and hopefully we will too!

Linda and Spicey

[Mel B]

It's been a while since I've been on here and the news it not good I'm afraid. Midge kept getting ear infections and tummy upsets which we were keeping on top of, but then he got a bad tummy upset and diarrhoea and had loads of medication which sorted him out, and we'd even bought extra to take on holiday with us, but around a week later it all came back with a vengence with chronic diarrhoea, and was having a little difficulty with eating his food as it kept sticking to the roof of his mouth as it was dry - vet seemed to think that his liver had finally decided to give up the ghost and that this would be how things would be from then on, with him deteriorating and suffering. It was an extremely hard decision to make but we decided enough was enough and he was put to sleep (24 June) - I got a lovely load of licks and a cuddle first though but it wasn't long enough ... it never could have been.

It was especially upsetting as we were getting ready for our holiday in the motorhome, departing 2 days later, and he was getting quite perky at the thought, but the vet thinks that this itself might have added to his problem as he was possibly getting too excited, however, as he had a bad case of upset tummy the week earlier, when he didn't realise, it was possibly just coincidental. We had already considered cancelling our trip away to France and had been on to Eurotunnel (channel tunnel crossing from UK to France), to see how we went about changing the dates or cancelling so it wasn't a problem to do so, but even doing that, the vet felt he would just deteriorate anyway, regardless of what we did ... it was basically the beginning of the end - I would've loved to have had a last holiday with him as he so loved being in the motorhome and seeing new places and people. At least he had a good holiday with us in April for a week when we went down the coast and he had some potters on the beach.

The really annoying thing was that he was very, very strong at this point, he was standing for long periods, and quite alert and eating well - he had even followed my hubby into the workshop a couple of days earlier to see what he was up to - he hadn't done this for months! I've heard it before that people and animals sometimes rally before the end, maybe this is why ... I don't know and never will.

We brought him home and he is now buried in the garden in a nice sunny spot amongst the shrubs - he would've approved as he used to like to build 'beds' in the shrubs and snuggle.

I miss him dreadfully, caring for the little critter so intensively really does mean we both got extremely close to him ... having to get the motorhome ready for the off and remove all his kit etc from it was extremely difficult. The holiday was very strange indeed - I missed my little hairy beast having a snooze on my knee as we travelled, not having to do all the bits and pieces for him was really strange and we felt at a loose end. Not having him pottering around at the places we stopped was upsetting, we tried not to let it show too much as the other dogs were missing him too - Romy, who had been with him since we got her at 18 months (now nearly 6 years old), was very depressed that her little buddy had gone so lots of cuddles were in order.

Coming back home after 3 weeks away was very hard ... I really didn't want to have to come back and see all his bits and pieces - we'd put most of it in the garage but his bed was still in the kitchen - he used to sleep in it in our bedroom each night so we could comfort him if he woke up. At some point I'll clear out his stuff (baby bath, buggies etc), but at the moment they can stay in the garage until I feel up to it.

Anyway, that's enough of that ... he wouldn't like me to get all mopey and upset, I'll just think of his cheeky little grin ...

Just wanted to let you know what happened and say thanks for the advice.

Mel B

[Gabrielle]

I'm so sorry you lost Midge. I don't know what else to say. I know there's really nothing but "I'm sorry" at a time like this. And I truly am. It's heartbreaking to lose a cherished one like that.

He was a beautiful boy. I wish he could have had more happy years.

Love and Hugs

[MiniSchnauzerMom]

Mel,

Thank you for coming back and telling us about Midge. I am so sorry that you had to make the decision and your Midge is no longer with you. You are in my thoughts and prayers.

Peace be with you, sweet Midge.

Louise

[Spiceysmum]

Mel,

So sorry to hear about Midge. My thoughts are with you all.

It must have been really sad to go on holiday without him but you have to think of all of the times he did go with you, walking on the beach and paddling in the sea. These are the memories that will stay with you forever.

God Bless,
Linda and Spicey

[Harley PoMMom]

Mel,

I am so sorry for the loss of your beloved Midge, your decision to release Midge from his suffering was one made from your heart and a deep love for Midge, we all understand that depth of love and the pain you are going through now.

I wish there was more than just words that I could say that could ease your pain...but they are just mere words...but know we are here and do understand and I hope that brings some comfort to you.

You are in my thoughts and prayers.
Peace sweet Midge.

Love and Many hugs to you.
Lori

[Wylie's Mom]

Mel,

I'm so sorry you had to let Midge go... we will always remember his "cheeky little grin" its priceless.

My thoughts are with you.

(((Hugs)))
-Susy

[Roxee's Dad]

Mel,
I am so sorry for your loss. Midge was well loved and will be missed. I just know Midge will be watching over you and your family.

[jrepac]

very sad to hear about Midge....I am sure he will be missed

Jeff

[Squirt's Mom]

Dear Mel,

I am so very sorry to hear about Midge and I know you are heart-broken.

You and your hubby worked so hard to keep him comfortable and happy during his times of illness; your boy knows this and is forever grateful to you for all you have done on his behalf. Even more, he is grateful that you spared him from a future of suffering and deterioration.

Midge is now free from all his infections, meds, and pain, running free across The Bridge with all those who have gone before. He will be with you always, watching over you just as you did him.

Our deepest sympathy to you and your family,
Leslie, Squirt, Ruby, Goldie and Crystal

If It Should Be

If it should be that I grow weak,
And pain should keep me from my sleep,
Then you must do what must be done,
For this last battle cannot be won.

You will be sad, I understand,
Don't let your grief then stay your hand,
For this day more than all the rest,
Your love for me must stand the test.

We've had so many happy years,
What is to come can hold no fears,
You'd not want me to suffer so,
The time has come, please let me go.

Take me where my need they'll tend,
And please stay with me until the end,
I know in time that you will see,
The kindness that you did for me.
Although my tail its last has waved,
From pain and suffering I've been saved.

Please do not grieve, it must be you
Who had this painful thing to do,
We've been so close, we two, these years,
Don't let your heart hold back its tears.

Author unknown

[Squirt's Mom]

Dear Mel,

I wanted to let you know that Midge has been included in our memorial section. His name is listed along with all our babies who have gone to The Bridge in 2009:

http://www.k9cushings.com/forum/showthread.php?t=132

It would be an honor to link Midge's name with a photo in the album section so his sweet face can be remembered here always. If you have a picture you would like to be linked to his name, you can send it to k9cushings@gmail.com.

In time, when you are ready, we have a special place for you to post a memorial, or tribute, to your sweet boy. No rush, tho. Only when you are ready. We would be pleased to share in celebrating his life with you.

http://www.k9cushings.com/forum/forumdisplay.php?f=8

Hugs,
Leslie and the girls

[ladysmom06]

Mel,

I am so sorry for your loss of Midge. My thoughts and prayers are with you at this sad time.

[k9diabetes]

I am so sorry that you had to let Midge go. I know how hard that decision is, knowing if it's time to give up after you have struggled for so long and beaten so many odds. We would never be able to do it if we didn't love them so much.

Sending a hug skyward to Midge,

Natalie

[ChristyA]

I am so sorry for your loss.
Christy

[gpgscott]

Mel,

I am sorry that I am not familiar with your story and Midge.

I am though very sorry that you and she have parted and I want to tell you that all of mine will get special hugs tonight in her memory.

Scott

[Dollydog]

Hello,
I'm so sorry for your loss and understand the emptiness you must be feeling right now. Some pets just have an extra special place in our hearts. Please take good care of yourselves as you adjust to this new stage of your life,
Jo-Ann & Lady