Maggie - 10yr old Boxer on Trilostane - sweet Maggie has crossed The Bridge

[KarenJ]

Hi all,

I'm new here and so happy to have found this forum! Maggie is a 10yr boxer with Cushing's. She has had the ACTH test twice and both times, the results were inconclusive according to my vet. She also had another test that I don't remember the name of (fairly expensive) that was also "inconclusive". I do not have the test results but I'm sure I can get the numbers. She agreed to treat her for Cushing's because of the clinical signs. I declined the ultrasound because I did not want to risk the anesthesia so I don't know if it's pituitary or adrenal. Maggie has been on 30mg of trilostane 2x a day for 3 months now and seems to be doing okay - much better than before the trilostane. This is a conservative dose for her weight (71 lbs) and I'm considering upping the dose. She still drinks a lot and has not lost her potbelly at all. But her hair has grown back and the panting has stopped. I will be reading through the threads looking for advice, helpful hints, support, etc. I look forward to chatting with you all who love your dogs as much as I love mine!!

Karen

[Squirt's Mom]

Hi Karen and welcome to you and Maggie! :)

If you don't mind, would you get copies of the tests Maggie has had done to both diagnose her condition and the follow-up monitoring since she started treatment. This will help us a great deal in giving you more meaningful feedback. What we are looking for are CBC, LDDS, HDDS, and ACTH. Maggie may not have had both the LDDS and HDDS, or may not have had either, but if she did it would help if we could see them.

Starting low and going slow is a good thing with Trilo but if you think her signs are not being well controlled even if her numbers are in range, then it might be time for an adjustment. The tests will help us help you there as well. ;) Both the numbers and the signs/behaviors are important gauges in treating Cushing's. Sometimes a pup does better with the numbers running a little higher than recommended but that is based on the pups signs/behaviors. How is her appetite? Have you noticed a decrease in that area?

Some tips - it is a good idea to get copies of all testing Maggie has to keep in a file at home. That way if you ever have to see a different vet you have all her info in hand when you walk in the door. It is very handy to carry on vacations, too, in case something happens! Also, keeping a daily diary or journal of signs/behaviors, meds, supplements, any changes in diet, sleep patterns, pee and poop history, etc. This way you can more easily pick out any patterns that may be present and these journals are quite beneficial to our vets as well since awareness of these sort of things are important in treating Cushing's.

The ultrasound is the best test out there for our babies, IMHO. Of course, this test saved my Squirt's life by finding a tumor on her spleen. Once that tumor and half her spleen were removed, her cortisol returned to normal and has remained within range since. The tumor was causing false-positives on all her cush testing. ;) Without the US, she would have died from the spleen rupturing and I would have gone on thinking she had conventional Cushing's when she didn't. So, I cannot recommend this test enough. They will be able to see so many of the organs and get an idea of their general health status. It is well worth the cost and it is non-invasive. Squirt was only lightly sedated for all of hers but of course the belly got shaved each time! :eek::D

I'm glad you found us and am sure our Trilo parents will be along to chat with you as well. We are a Lysodren house since Squirt has Atypical (Trilostane is not recommended for pups with Atypical Cushing's). You and Maggie are no longer alone - we will walk with you every step of this journey.

Hugs,
Leslie and the gang

[Harley PoMMom]

Hi Karen,

Welcome to you and Maggie! So glad you found us but sorry for the circumstances that brought you here.

Cushing's is one of the most difficult diseases to get a confirmed diagnosis. The reasons are because not one test is 100% accurate at diagnosing Cushing's and non-adrenal illnesses can create false positive results. Also many of the symptoms from Cushing's disease are shared with other illnesses such as diabetes and thyroid problems has diabetes and or any thyroid issue been ruled out?

The three most common tests used in combination to help diagnose Cushing's is the UC:CR, ACTH stimulation and LDDS. If you could get copies of all tests that were done on Maggie and post the abnormal results here that would help us a great deal in providing you with more meaningful feedback.

From our experience here on the forum we have seen dog's that begin with a low starting dose have less adverse side effects. UC-Davis recommends a starting dose of 1mg per kg of a dog's weight. A starting dose of 1 mg per pound is usually considered a low starting dose.

We have a wealth of information about Trilostane/Vetoryl in our Helpful Resource Thread and here is a handy link to it:Trilostane/Vetoryl Information and Resources. (http://www.k9cushings.com/forum/showthread.php?t=185
)

Could you tell us exactly what symptoms Maggie displayed that led you or vet to test for Cushing's? Is Maggie on any other herbs/supplements/medicines? Any other health issues?

Please know we will help in any way we can so do not hesitate to ask any and all questions.

Love and hugs,
Lori

[labblab]

Hello Karen,

Welcome to you and your Maggie! I am glad to hear that Maggie seems to be doing OK right now, but I have to be honest and tell you that I feel worried about your ongoing trilostane treatment in the absence of any testing that is consistent with a Cushing's diagnosis. If you could find out the actual test results for all of Maggie's diagnostics, that would be great. If the other test in addition to the ACTH was the LDDS (low dose dexamethasone stimulation test), I am doubly worried. Because that test very seldom gives a "false negative" -- only 5-10% of dogs who test negative on the LDDS will eventually be shown to have the disease. And for dogs who DO test negative but who have strong clinical signs, the recommended back-up is the ACTH, which did not indicate Cushing's for Maggie, either.

Has Maggie exhibited any other lab abnormalities along the way, such as elevated liver enzymes, high cholesterol, or dilute urine? These are all common in Cushpups. Also, have other possible causes of her symptoms been definitely ruled out, such as diabetes or thyroid abnormalities? Another possibility is that her cortisol level may never have been elevated, but certain other intermediate adrenal hormones may have been or may still be. This is a condition known as "Atypical Cushing's," and the symptoms may mimic those caused by elevated cortisol. Testing for that condition requires sending a blood sample to the University of Tennessee in Knoxville, since it is the only lab in the country that performs analysis of a complete adrenal hormone profile. The thing is, if Maggie's cortisol is normal but she suffers from Atypical Cushing's, then trilostane would not be the recommended treatment. Depending upon the full profile results, other treatment options would be suggested instead.

Has Maggie had monitoring ACTH tests performed since starting her on the trilostane? They are recommended approx. two weeks after starting treatment and after any dosing change, then at a 30-day point, and then every three months thereafter. The ACTH stim tests are currently the "gold standard" for making any ongoing dosing decisions. Obviously, resolution of clinical signs is very important, but you can't determine the actual effect of the trilostane just by eyeballing the dog. And the risk in that case is that without objective testing, you may be right on the verge of overdosing (with serious consequences) without even knowing it.

I know I've written a book here and asked a ton of questions. So I hope I haven't scared you off!! But truly, supplying us with Maggie's actual test results will be really helpful. And I would strongly discourage you from increasing her trilostane dose until you're sure you've tacked down an accurate diagnosis.

Marianne

[KarenJ]

Hi Leslie and Lori -
Thanks for the quick replies. A bit of history which led to the Cushing's diagnosis:

Maggie has had arthritis in her hind legs for several years. We originally treated her with Rimadyl when she seemed painful or stiff but moved on to Adequin (sp?) injections and now she takes a Dasuquin chewable once a day.

Early last year, she became somewhat incontinent. Would leak a bit when she slept and licked her self a lot. The vet prescribed Proin and it seemed to really help the incontinence. At that time, we lost our other female boxer suddenly to cancer (we didn't even know she was sick - that's another story). I mourned Ginger and probably didn't pay as much attention to Maggie's symptoms as a should have. But I noticed that she still needed to go out quite a bit and she lost most of undercoat on her back. I took her back to the vet who suspected a UTI and did a urinalysis. Her urine was very dilute so the vet said let's treat her for a UTI anyway...mistake number one. Finished the antibiotic, things seemed better for a few weeks. But then I noticed she was ravenously hungry and drinking a lot. My dogs eat and drink out of the same bowl so it wasn't real evident at first. I suspected diabetes so took her in for bloodwork. This time I saw the other vet in the office and she asked a lot of questions - said she suspected Cushings. That's when the testing began.

I will get the results and post them as soon as I do. I think Maggie has had the LDDS and the ACTH twice, no ultrasound yet. She is now on Trilostane 30mg twice a day. She's better but not as good as I think she could be. I hesitate to up the Trilostane though because of her arthritis. She's definitely more stiff now that she was pre-Trilostane, I guess because she's not "self-medicating" anymore.

The latest thing happened this past Monday. Out of the blue, she woke up from a nap and the inner lid on her left eye was swollen halfway up her eyeball. Not super red but her bottom lid was swollen as well. I flushed her eye and gave Benedryl. Got an appt. in the morning with the vet. My husband took her as I had a full day with work. He saw the other vet (not the gal that diagnosed the Cushings). He gave her a Prednisone shot and steroid eyedrops. Needless to say, the Cushing's symptoms are back with avengence this week! Peeing all over the house and drinking bowls full of water. I'm not too happy with the vet right now. I guess maybe the Prednisone was necessary, who knows. Sorry for the rant. Anyway, that's where we are right now.

Karen

[KarenJ]

Hi Marianne -

Thanks for your response and you definitely didn't scare me off! Maggie is my baby and I'll do anything to help her and make her senior years comfortable and enjoyable.

I think I answered some of your questions in my post to Lori and Leslie (didn't see yours until after that). I have been very uncomfortable with the "inconclusive" test results the whole time. Atypical Cushing's could be what we're looking at. Let me get her records so I can give you actual info and we'll go from there. Thanks to all of you! You don't know how happy I am to have found this group.

Karen

[Squirt's Mom]

Hi again,

Let me fill you in a bit on Atypical in case you aren't familiar. It is a form of Cushing's in which the cortisol is normal but one or more of the intermediate, or sex, hormones are elevated. These other hormones are Estradiol, Androstenedione, 17-Hydroxyprogesterone, Progesterone and Aldosterone. Of these five hormones, all are produced/released via the adrenals and can be controlled via Lysodren's action on the adrenal glands with the possible exception of the estradiol.

Estradiol can be produced outside the adrenals in fatty tissues, hair follicles and many other areas that the Lyso cannot reach. To treat the elevated estradiol, if it is elevated, a combination of melatonin and lignans are used. They are quite mild and easy to use with very few side effects.

In conventional Cushing's, pups who are being treated with Lysodren go through what is called a "loading phase" in which the Lyso is given twice a day until signs indicate the adrenals have responded as desired. At this point, the Lyso dose is changed to what is called a "maintenance dose", given a few times a week VS daily as in the loading.

In Atypical, there is no loading phase but rather the pup goes directly to the maintenance dose given several times a week. Not all pups require the addition of Lysodren, tho. It can take several months, 3-6, for the melatonin and lignans to tell us how effective they are going to be. IF these hormones are not controlled, lowered to a more normal range, with the melatonin and lignans, then the maintenance dose of Lsyo is added to those two supplements.

We have several Atypical pups here, including my own Squirt, so there are folks here who can share these experiences with you as well.

You are doing a great job, Mom!
Hugs,
Leslie and the gang

[KarenJ]

Well, I should have all the labs and records this afternoon. I can't wait to go pick them up so I can share them with you guys and get your thoughts! Just thought I'd check in. Happy Friday everyone!

Karen

[KarenJ]

Ok Gang - here's what I got from the vet. Here are the abnormal results from the initial bloodwork:

Super Chem
Alk Phosphatase 449 (HIGH) norm:5-131 U/L
Cholesterol 404(HIGH) norm:92-324 mg/dL

Urinalysis
Specific Gravity 1.013 (LOW) norm:1.015-1.060
pH 8.0 (HIGH) norm:5.5-7.0
Microalbuminuria 5.6 (HIGH) norm:<2.5 mg/dL

That prompted a LDDS which came back with these results:

Pre 1.6 ug/dL
4hr 2.4 ug/dL
8hr 2.0 ug/dL
ACTH Level (endogenous) 28.2 pg/mL

Started her on 30mg trilostane 2x a day at this point. One month later, an ACTH showed:

Pre 1.2 ug/dL norm:1.0-5.0 ug/dL
Post-Trilostane 3.2 ug/dL norm:1.5-9.2 ug/dL

I welcome any help in interpreting this. After the LDDS, my vet recommended an U/S and a visit to an IMS but I declined. I asked to start on the trilostane to see if it would work. Having second thoughts on that decision now. I know that the trilostane is not working as a lot of her symptoms are back. And she just doesn't seem happy :(

[labblab]

Hi Karen,

Thanks so much for posting these test results. Based on what you've posted, you actually have results that ARE consistent with Cushing's. So the light bulb is going off for me, and I suspect that perhaps the only piece of the puzzle that remains "inconclusive" for your vet is whether Maggie suffers from the pituitary or adrenal form of the disease.

The basic lab abnormalities that you posted are consistent with Cushing's (elevated ALKP, high cholesterol, dilute urine). Further, the LDDS results are undoubtedly "positive" for Cushing's. Even though you have not given the LDDS testing norms, usually the cut-off point for the 4 and 8-hour levels is approx. 1.4 ug/dl -- meaning that if the dog's result at the 8-hour mark is higher than 1.4 ug/dl (which Maggie's was), the result is consistent with a general Cushing's diagnosis. Sometimes the results point with a high degree of cofidence to the pituitary form of Cushing's. However, in Maggie's case, the results could be found in a dog with either form of the disease -- hence, the "inconclusive" result as to type.

I have some questions about the "endogenous" ACTH result. An endogenous ACTH is a different test from an ACTH stim test, and is a test that is not performed to diagnose Cushing's, in general, but instead to help differentiate between the two forms of Cushing's. It is not performed very commonly, and I will have to research it a bit more to be able to help interpret Maggie's result. But since your vet still wanted to push onward with an ultrasound, I am guessing that perhaps that result didn't give a clear answer, either, as to the type of Cushing's.

However, given the rest of these test results (coupled with Maggie's symptom profile), I now feel much more comfortable with the general Cushing's diagnosis and the trilostane treatment. Her numbers on her first monitoring ACTH test were good (for a dog on trilostane, ideally you are shooting for a "post" result between 1.45 - 5.4 ug/dl). But if her symptoms have returned and she has not had another monitoring test during these past two months, then it is certainly possible that you are right and that she needs a dosing increase. Before doing that, though, I think you need to have a repeat ACTH performed in order to see exactly where her cortisol level stands.

I'll come back later on and add some links that I hope may be helpful to you. And I'll also try to find some more info about the results of that endogenous ACTH test.

Marianne

P.S. OK, I'm back with some more info re: interpreting the endogenous ACTH test. Here's a quote from this source:

http://www.vin.com/proceedings/Proceedings.plx?CID=WSAVA2002&PID=2552



Interpretation - Endogenous ACTH concentrations in normal dogs range from 13 to 46 pg/ml. Dogs with adrenal tumours have very low endogenous ACTH concentrations (< 5 pg/ml) whereas cases with pituitary-dependant hyperadrenocorticism tend to have high-normal to high concentrations (> 28 pg/ml) (Gould et al., 2001).


According to this reference scale, it definitely doesn't sound as though Maggie's result was "very low" (which would be consistent with adrenal Cushing's), but it was right on the cusp as far as being classified as "high." We would have to see the testing norms for Maggie's test to know exactly how her results fared according to the lab that processed her results.

[KarenJ]

Thank you so much, Marianne! I have spent the past hour researching these numbers and also feel more comfortable that she has Cushing's. I will get her back in next week for a repeat ACTH. I tend to think it's the steroid eyedrops that are throwing her off kilter. But I don't want to stop the drops since they seem to be helping her eye. I may wait until we're done with the drops (7 more days) and see how she's doing after that. I don't want to do the ACTH if there's any chance of skewing the results.

[KarenJ]

Good morning all! I'm happy to report that Maggie is feeling rather spunky. She's been playing with Jake and her eating has tapered off back to normal. She's still drinking and peeing a lot but no accidents in the house since Wednesday. She looks much less bloated as well. Still getting me up in the middle of the night but I don't mind as long as she's comfortable.

I love this forum and reading about everyone else's journey. I hate the reason for why we're all here but so happy to not have to go through this alone. Thank you all!!

Karen

[KarenJ]

Just checking in! Update on Maggie - she has had a few pee accidents in the house this past week and has had me up 3-4 times a night to go out. In reading through other threads I learned that Trilostane must be taken with food. I guess I missed that before. I had been giving it at the same times everyday but did not pay attention to whether she'd eaten first or not. The past few days I have made sure she has her pill right after eating and I'm happy to report that she slept through the night for the first time in months! Happy mom today!! She is due for a followup ACTH and I'm curious to see what it shows. Take care all!

Karen

[Harley PoMMom]

Hi Karen,

Thanks so much for the update on Maggie. And, yes, Vetoryl/Trilostane is much better absorbed if given with food.

The timing of the ACTH stimulation test is crucial too, for it to be useful for monitoring it has to be performed 3-4 hours after her dose of Vetoryl/Trilostane. Here is a link about this from the blog of a renown Cushing's expert, Dr. Peterson: What's the Best Protocol for ACTH Stimulation Testing in Dogs and Cats? (http://endocrinevet.blogspot.com/2011/03/whats-best-protocol-for-acth.html)

Please do keep us posted on Maggie. ;):)

Love and hugs,
Lori

[Squirt's Mom]

Hi Karen,

Been reading along and so pleased to hear that Maggie is steady improving. :) Funny how vets leave out the little things like "give with food", huh? :p

You are doing a great job, Mom! Keep up the good work!

Hugs,
Leslie and the gang

[marie adams]

Welcome Karen and Maggie,

I can see the experts have already been helping you. They are so wonderful and caring. You are definitely in good hands!

I am so glad Maggie is feeling so much better and you got a good night's sleep. It is a wonderful feeling to see them start to feel better and get back control in their lives. :)

You are doing a great job!!! :)

Take care!!!

[Cyn719]

Hi. Just catching up on your thread. Ditto to what Marie said!
it's the best feeling when our fur babies are feeling good!:):)

Keep up the good work mom!!

Hugssss to you and Maggie xo

[KarenJ]

Thanks all!! I do have a question though - I noticed Maggie has these little shivers or tremors. Is that a side effect of the meds? Anything to be concerned about? :confused:

[Squirt's Mom]

Are you seeing anything else? Lower appetite? Loose stools? Listless or less active?

We sometimes see trembling in Trilo pups but as they adjust and the cortisol is more controlled, this usually stops.

Hugs,
Leslie and the gang

[KarenJ]

Her appetite has definitely tapered off. She is still eating but not ravenous (which I think is the goal). Her stools are good and she's no less active than usual. She lays around a lot but that's been the norm for her the past couple of years. I'll keep an eye on the tremors and watch for other signs as well. I was concerned that she may be shivering from pain since she does seem more stiff now that we're getting the cortisol under control. She's currently on no pain meds for her arthritis (I have Duramax that I can give her as needed but have tried to avoid that). I've read a little bit on pain management on here. Is there any drug that is better than others or ones I should avoid?

Karen

[KarenJ]

Sorry, the more I read, the more questions I have! What is the general opinion about ultrasounds? I had opted not to have one because I don't think I would put Maggie through a surgery if they found something. But I'm starting to second guess that decision. What if it's something else causing the increased cortisol? Maybe it could be a simple surgery? I think I'm just so afraid they'll find cancer and I can't bear to lose another that way. They found a tumor on Ginger's spleen last year and went in to remove it. They found it was cancer and she died on the table. So the thought of surgery scares me to death. We lost Roxanne to lymphoma prior to that. I know Boxers are prone to cancer but it doesn't make it any easier. Thoughts? Would it be better to know?

[labblab]

Hi Karen,

I only have a moment to post, but here's a link to another thread where shivering/tremoring episodes are discussed (and there's yet another thread referenced within the link for you to read, too).

http://www.k9cushings.com/forum/showthread.php?t=2052

If Maggie is otherwise doing well, I doubt there's any cause to worry. But it's good that you are noticing all these things and making note of them.

Marianne

[Harley PoMMom]

Sorry, the more I read, the more questions I have! What is the general opinion about ultrasounds?

I feel the ultrasound is one of the most useful diagnostic tools, especially considering it's non-invasive. There is no other tool that can provide so much info and an "inside look" so simply.

The U/S is used to evaluate the size and shape of the adrenals, and check for symmetry. If bilaterally normal-sized or large adrenals are visualized in a dog diagnosed as having Cushing's, this is considered strong evidence of Cushing's due to PDH. If one, large, irregular and/or invasive adrenal is visualized and the opposite is not seen, adrenal tumor may be suspected. If adrenal tumor is identified, it's an excellent screening test for hepatic or other organ metastasis, or invasion of the vena cava.

In addition, it evaluates the abdomen for any unexpected abnormalities urinary calculi, masses. It views the liver, gall bladder, etc; many Cushing's dogs have gall bladder sludge.

Not all ultrasounds are created equal. A good quality ultrasound/interpretation depends on a few things; the tool used, the technician performing it, and the physician interpreting it. There is a great difference in the quality of U/S machines. Is it a human grade (Phillips, GE, Siemens). My gen vet had an old (? brand) that just doesn't have the power to capture crisp, high-resolution images.

Some studies are technically difficult anyway, and that accompanies with a poorer quality tool, results in a poorer image. The technician: most will perform their own and therefore, it should those most experienced with capturing good windows and images. That would be a board certified radiologist or board certified Internal Med Spec. Likewise the one interpreting it should be the most experienced as well, and that's one of the 2 above.

My boy, Harley, had pancreatitis, which was found on his first U/S. Harley never displayed symptoms of pancreatitis but a spec PL test later confirmed the U/S finding with a result of 528 (0-200).

Love and hugs,
Lori

[KarenJ]

Hi All,

Maggie had another ACTH stim test yesterday and I'm happy to report the results were good - 1.1 pre and 3.2 post! So I think the dosage she is on is good. I have been giving the Trilostane with food since 2/2 and have seen a big improvement. She is sleeping through the night now (woohoo!), no panting, drinking normal amounts and no accidents! She still has the little tremors, mostly when she's sleeping, but they seem to bother me more than her :). Her weight is still up about 7-10 lbs. (71.9) so I'm going to try to cut back a little more on her food. I know that will help her joints if nothing else. Hope everyone is having a good day!

Karen

[KarenJ]

I need some help and expert advice again. Maggie has been leaking urine for several days now. She is drinking excessively. Her appetite is down. In fact she did not eat at all Friday or Saturday. I was able to get her to eat some yesterday but she has not eaten at all this morning. Saturday she was very lethargic so I did not give her Trilostane - was afraid her cortisol was too low. However, Saturday night she had me up every hour to go out and to drink. Yesterday she seemed more herself except the leaking urine has gotten very bad. She leaves puddles everytime she lays down and you can just see the urine dripping out continually. She has no trouble peeing normally when she goes outside but will still leak immediately afterwards. Last night, we were up every few hours going out to pee and drinking again. I tried withholding water at night but then she just paces and whines. HELP! I have a call in to the vet but wanted to know if anyone had any ideas. Her last ACTH was 2/7 and it was good.

[Harley PoMMom]

Incontinence can occur for many reasons, including urinary tract infections, bladder stones, and a weak bladder sphincter. I would definitely have the vet look at Maggie and try to figure out the cause. An UTI or bladder stone can be painful and can cause the dog to lose their appetite.

The 2 medicines, that I know of, to treat incontinence are diethylstilbestrol (DES) or Proin (phenylpropanolamine hydrochloride.

Please do not restrict Maggie's water as this could lead to dehydration and be life threatening.

Please do keep us posted and hoping this is resolved soon.

Love and hugs,
Lori

[KarenJ]

Thank you, Lori. We have an appointment at 3:30 today. I'll let you know how it goes. Maggie was on Proin pre-Cushings diagnosis but we stopped it. I just started her on it again last week when i noticed the leaking again. She's such a sweet girl. She looks so sad when she gets up and sees the pee on the floor. I just hug her and tell her it's okay. I just hope it's something simple and she's not in pain.

Karen

[jmac]

Hi Karen,

Just wanted to let you know I'm thinking of you and Maggie, and hoping you'll figure something out at the vet today.

Julie & Hannah

[lulusmom]

Hi Karen,

I'm sorry to hear that Maggie is not feeling too well right now and am happy that you have made an appointment with the vet. In addition to the causes Lori has already listed, kidney failure is always a possibility with our seniors so the sooner you can have her kidney values and urine checked, the better. Just remember that if Maggie's kidneys are not concentrating her urine, it is dangerous to withhold water because she can become dehydrated very quickly and it can become life threatening.

Sending positive thoughts and healing hugs. We'll all be looking forward to getting an update after your vet appointment.

Glynda

[Cyn719]

Karen

Hope all goes well at appt. Give Maggie a hug for me too!! I understand - its so hard when our babies are having issues...hang in there.

love and hugs xoxoxo

[Jenny & Judi in MN]

My Jenny who has Cushings and Diabetes was on DES for a year (started last January, stopped this month).

Knock wood it has been 2 weeks and no accidents but we were up to giving her a pill every 4 days for awhile. Good Luck! Judi

[KarenJ]

Maggie seems to be feeling a little better. She ate a little dinner last night and actually slept all night too! She even had a little bounce it her step this morning while she was outside.:) The vet did a CBC and urine. We should have the results today. She specifically mentioned checking liver and kidney values. She's running thyroid as well. She said she wanted to check the urine concentration, sugar and for any bacteria. In the meantime she had me increase the Proin (I was giving 25mg once a day, she said I can safely increase to 50mg twice a day for a 72lb dog). She also said I can give her 50mg of Duramax once a day for her arthritis. I will post again later once we get the lab results. Thanks all!

Hugs,
Karen

[Harley PoMMom]

So happy to hear that Maggie is feeling better, it can be so worrisome when our furbabies are not feeling well.

We will be waiting anxiously with you for those test results!

Love and hugs,
Lori

[KarenJ]

Test results are back. Bloodwork was all good. Some white blood cells in the urine and the PH was slightly elevated so the vet wants to put her on an antibotic and treat as a UTI. So we'll go that route and see what happens. Thanks for all the thoughts and hugs! Will let you know how she's feeling in a few days.

And Judi, thanks for the info on DES. That's something to consider if this doesn't resolve.

Karen

[Squirt's Mom]

Hi Karen,

Glad to hear Maggie is feeling a bit better and I hope the antibiotics do the trick quickly!

Hugs,
Leslie and the gang

[Harley PoMMom]

Some UTI's have a strain of bacteria that are resistant to certain antibiotics. If the UTI is reoccurring than usually a urine culture and sensitivity test is done to see which specific antibiotic will kill the bacteria.

Hoping the UTI resolves quickly.

Love and hugs,
Lori

[KarenJ]

Well, Maggie still seems to feel good but the urine leakage is still a problem. She leaves a little puddle just about everytime she lays down. My spotbot is getting a workout! I did notice something kind of strange. She leaves a puddle mostly right after she's been out to pee. Not so much if she's been in for awhile. Like there's some left pooled inside after she pees that leaks out when she lays down. Does that make sense?

One thing I forgot to mention is the vet said her "thyroid level is low" but not unusual for Cushing's. I know that there are different thyroid levels so not sure what was low and if that could be causing the pee problem. Any thoughts?

She has been on the antibiotic for 7 days now so I would have thought I'd see some improvement if we were going to. What else would cause the leaking urine? Just old age? The increased Proin has not seemed to help either. She's doing so well otherwise. I just wish we could get this under control :(.

Karen

[Harley PoMMom]

One thing I forgot to mention is the vet said her "thyroid level is low" but not unusual for Cushing's. I know that there are different thyroid levels so not sure what was low and if that could be causing the pee problem. Any thoughts?
Karen

Hi Karen,

After doing some research on hypothyroidism causing incontinence, I have found that in humans, an under-active thyroid can cause incontinence.

Many dogs with elevated cortisol do have what is called sick euthyroid syndrome, this when a non-thyroidal illness will cause the thyroid not to function normally and when the elevated cortisol is controlled the thyroid will, again, function normally.

Has a free T4 test been done?

[KarenJ]

Hi all,

The free T4 came back positive for hypothyroidism. We started Maggie on .6mg Soloxine twice a day. Since then, she seems to feel worse. I don't know if it's related to the Soloxine or not but for the past two nights her breathing has become very rapid after she falls asleep. Almost like they do sometimes when they dream but it went on for at least 20 minutes. I woke her up and she seemed very disoriented. She was also very hot and her mouth was dry. I checked her gums and they were pink and responded well when pressed. I thought maybe she had a fever or was getting dehydrated. She did not want to get up but I made her and got her to drink some water. Once she started drinking, she drank a lot over the next hour. I put a water bowl next to her bed and heard her drink a lot through the night. She did not have to get up to pee which leads me to believe she may have been dehydrated.

I called the vet this morning and chatted about what I've been seeing in Maggie this week. She seems more lethargic and the tremors are awful. Drinking has increased and her appetite has decreased. She still is somewhat incontinent but that has improved quite a bit. I asked the vet about discontinuing all meds for awhile and she agreed. She said let's give her a 10 day rest then start again with just the Soloxine.

I'm happy with this approach since right now I don't know what's causing which symptoms or if it's even related to the meds. I will be out of town next week and my husband will have doggie duty so I'm very stressed about this. I feel better knowing he will not have to manage her meds and possible issues. But I am going to worry so much about her while I'm gone.

Thanks for listening. I just needed to "talk" to people who understand :o

Karen

[Squirt's Mom]

Hi Karen,

Talk any time, honey! ;)

I hope the rest from meds will help sort things out for Maggie and you. Let us know how she is doing over the next few days or so, 'k?

While you are out of town, we will be here to talk with your hubby if he feels the need, too. So let him know he isn't alone, either.

Hugs,
Leslie and the gang

[jmac]

Hi Karen-

Glad you stopped to "talk." That's what we're here for! I hope it helped. Sorry to hear Maggie is not doing so great, but I am glad to hear that the incontinence is a little better and that you got the thyroid figured out. I think it sounds like a good idea to give her a little break, and I can totally relate to being gone and having my husband have to do doggie med duty. It stresses me out beyond belief!

This is also the first place I want to come when I have news or worries because I know all of you understand my fears, worries, and the excitement of good news.

We are always here to listen when you want to talk.

Julie & Hannah

[KarenJ]

Thank you for being there for me and understanding! Maggie is sitting here on the couch with me watching TV. She just had some dinner and went out so I think she's ready to settle in for the night. I'm just cherishing our moments snuggling on the couch :). I'll check in tomorrow and let you all know how we're doing.

Karen

[addy]

Hi Karen,

Just stopping by to say hi and to see how Maggie is doing. I hope you had a nice cuddle evening on the sofa. Best kind of night to spend!!:)

I understand it is hard when so much all seems to be happening, especially to try and sort it all out. It is easy to get down and overwhelmed. I know I sure have been there the last two months!!!:o


We are always here for you so post away, vent, cry whatever you need. We have all been there so we know.

hugs,
addy

[KarenJ]

Well, it was a stressful night. Maggie was up an hour after going to bed and went out to pee, drank some and was panting. I wasn't too surprised since the Trilostane is probably out of her system now and the Cushings will start rearing it's ugly head. Back to bed but up again 2 hours later, same routine. Back to bed but she was up within the hour wanting to go out. This time, she was slow coming back in and wasn't herself. She kept standing next to me, kind of leaning. That usually means something hurts and I'll rub her belly, legs and shoulders to see if it helps. She acted like she wanted to lay down but couldn't. Lots of panting and pacing. I tried to get her to lay on the couch with me but she eventually laid on the floor in front of me. She was trembling so I covered her up and just hung out with her. She slept about 3 more hours and seems a bit better as the day goes on. Sleeping a lot but not trembling as much.

At 5am, I was sure this would be her last day with us. She seemed to be in pain and unhappy and that is unacceptable. Her quality of life is all that's important to me. But I talked to hubby and he said let's just take it one day at a time. I'm so worried that he will have to deal with a tough decision while I'm away next week. I know he'll do the right thing and trust him completely with her but hate for anyone to go through that alone.

I did give her 1/2 a Deramaxx last night hoping it would help her sleep. Not sure if that was a good thing or not. She is so stiff. I'm almost looking forward to the increase in cortisol if only to help her joints some.

Anyway, I'm rambling now. I just wanted to say that she seems to be okay right now. She's eating and drinking, pooping and peeing so I think those are all good signs :). Hugs to all of you for being here for me!! I'll post again before I leave Monday morning but will not have internet again till Friday.

Karen

[KarenJ]

I didn't get a chance to post again before leaving Monday morning so here's my Maggie update: Saturday afternoon, she had what we think was a seizure. I spoke to the vet and she had me start her back on the Soloxine. She said that hypothyroid can cause seizures. She believes the rapid breathing episodes where she was totally out of it may have been seizures as well. She has been off the Vetoryl for 9 days and back on the Soloxine for 7. Her tremors are gone now but the incontinence is back with avengance - worse than ever. I have her in "panties" right now :o. She has not had anymore seizure type episodes and she seems to have a bit more energy. The drinking and panting have increased as expected. Her appetite is still a little less than normal. I spoke to the vet today and she wants to give her one more week on just the Soloxine before running anymore tests or introducing any other meds. I hate the waiting game but I am happy to say that Maggie is better than she was a week ago!

Karen

[addy]

I hate the waiting game but I am happy to say that Maggie is better than she was a week ago!

That sounds good to me!!!!!:D:D:D:D:D:D:D

Waiting is so darn hard. I hope Maggie has a good weekend and I hope you do too:):):):)

hugs,
addy

[KarenJ]

Thought I'd check in again and give a Maggie update :). She seems to be feeling great! Other than the incontinence, you'd never know there was anything wrong. She's doing great in her panties, doesn't even mind wearing them now :p. Her drinking is still increased and of course I let her have as much as she wants - which leads to lots more peeing of course! And we're still up 2-3 times a night to go out.

She is not panting excessively and her appetite seems to be normal. Her fur is really soft and she has a lot more energy now. So, the Soloxine really seems to be working. I'm supposed to call the vet Friday to discuss next steps. I'd appreciate any thoughts on getting the incontinence under control. I'm thinking maybe DES. I don't want to put her on Proin again. It did not seem to help and made her very anxious and jumpy.

Of course, with the increased drinking, it makes it that much more difficult. I'm home all day so letting her out frequently is not a problem. But, right now, her incontinence is so bad that she really doesn't ask to go out that often. I guess her bladder doesn't fill up since it's constantly leaking. I've even tried making her go out every 2 hours. She'll go out and pee, no problem. But it's not like she really needs to go and the incontinence remains the same.

Anyway, any thoughts or suggestions would be much appreciated! Hugs to all :)

Karen

[lulusmom]

Hi Karen,

DES is a synthetic estrogen that can enhance corticosteroid activity, meaning an increase in cortisol. It can also have some pretty nasty side effects, especially in older dogs, so in your shoes, I would make absolutely certain that you are dealing with incontinence (loss of bladder sphincter muscle tone) as opposed to pu/pd which is common in cushing's when the kidneys lose their ability to concentrate the urine.

Glynda

[KarenJ]

Thank you, Glynda. I'll do more research on DES. I thought it was pretty safe. The part that confuses me is that even when the pu/pd was at its worst (before Cushing's treatment) she was never incontinent. Now it's a constant drip and when she lays down, pee just runs out. I don't want to put her back on Vetoryl when her only Cushing's symptom right now is pu/pd. But maybe I'm getting ahead of myself and need to wait to see what the vet thinks.

Karen

[KarenJ]

Heading to the vet with a urine sample. She is going to run a urinalysis to check levels and for possible UTI and also a creatine ratio.

Assuming the ratio is high and no UTI, she is suggesting that we start the Trilostane 30mg once a day instead of 30mg bid and see if the pu/pd and incontinence resolve. I'm really afraid of the Trilostane. I don't want to see Maggie the way she was 3 weeks ago. I brought up Lysodren and the vet balked at that. She has no experience with it but said she is willing to go that route if I want to.

Am I over thinking this?? Is the incontinence really just the Cushing's and I need to suck it up and treat it?? Do I risk the Trilostane or switch to Lysodren? Is this maybe hormone related?? Should I try Proin again? I'm nearing my wit's end. I know so many of you have other more serious issues with your babies and this probably seems minor in comparison. But keeping Maggie clean and dry not to mention the rest of the house is a constant struggle. And lack of sleep is probably playing a role here too :o.

Thanks again for the support.

Karen

[KarenJ]

Well, her UCCR was 85. And the lab neglected to run the urinalysis :mad:. The vet called them and they are supposed to run it this weekend. I should have the results tomorrow morning. I think I've decided to start the Trilostane again, 30mg once a day. I'll monitor her pu/pd for a week and see if there's any improvement. I kind of doubt that 30mg is going to do much but I'm so scared of the ill effects of the Trilostane that I want to go really slow.

[jmac]

Hi Karen,

I don't have any advice to offer you, as this is out of my realm of knowledge, but I wanted you to know that I was checking in on Maggie. I'm sure some others will be along soon to help you out more. I'm thinking of you and Maggie and hoping for the best. I'm glad she doesn't mind her "panties" anymore, but I sure hope you can get her some relief...and some for you, as well.

Julie & Hannah

[KarenJ]

Hi Julie,
Thanks for checking in :). I got the urinalysis back and it was normal (for a Cush dog that is!).

Specific Gravity 1.007 1.015-1.050 norm
pH 8.0 5.5-7.0 norm
Micoralbuminuria 7.8 <2.5 norm

All else was negative or normal. So the plan is to start the Trilostane this evening. Hopefully it will reduce her urine output and not have any bad side effects.

Karen

[labblab]

Karen, if you are switching to once-daily dosing for Maggie, giving her the trilostane at night will greatly complicate the monitoring process. For value in making dosing decisions, monitoring ACTH tests should be performed approx. 4-6 hours after administration of the trilostane (along with a meal). Unless your vet is open 24 hours, you will have to wait until the next morning to take her in for monitoring tests. And since trilostane is generally only active in the body for around 12 hours, it may already have totally exited her system by the time you would be testing the next day. This will render the monitoring ACTH testing useless, because the generally accepted dosing guidelines are based upon ACTH results that reflect the peak action of the medication.

Does your vet know you're planning to dose her only in the evening?

Marianne

[KarenJ]

Marianne,

You bring up a good point. And yes, my vet is aware that I plan to give Maggie her pill at night with her evening meal (which is generally around 9:00). This may or may not work out and I may have to switch to giving it to her during the day instead. It's all going to depend on how it affects Maggie. If I see good results with an evening dose, I'm going to want to stay with it. I will discuss the ACTH testing dilemma with my vet in 2 weeks when I have a consult with her. I gave her a pill last night and she actually slept from 1:30 til 7am which is the longest sleep we've had in awhile. Could just be a coincidence but I'm happy for the much needed rest.

Karen

[Squirt's Mom]

Hi Karen,

Unless your vet can do an ACTH by 3am at the latest, you will be wasting your money on the tests as they will be inaccurate after that time. Most of the med will gone by the time she is tested when the office opens in the mornings so it will come back with a higher post than truly shows the effect the med is having - which may result in increased dosing which can lead to overdose. Testing times with either med isn't an option - the testing schedules are critical for accurate results and accurate results are critical for determining the effectiveness of the current dose of med. Just food for thought....;) I hate to see Maggie put at higher risk than necessary and hate to see you waste money on tests that will have no meaning.

Hugs,
Leslie and the gang

[KarenJ]

I understand. I would not have the test done outside of the recommended window (4-6 hrs after dosing). Actually, knowing my vet, she would probably do the test at 3am if I asked her to :). Thinking ahead, the latest they could do the test during normal business hours would be 7pm. That means giving a dose around 2pm. That may be a viable option since right now, Maggie usually eats at 9am, 2pm and 9pm. I do have a question I'm wondering if anyone can answer. How critical is it that the doses be 24hrs apart? What if, say a few days before her ACTH test, I start giving her pill at 2pm? That would mean the day we switch, she would be getting two doses 16 hours apart rather than 24.

Karen

[labblab]

Karen, if I'm understanding your question correctly, I think it would be best if you can switch Maggie to the 2 p.m. dosing schedule for at least a full week before testing. And for the test results to accurately reflect her metabolism of the drug on a once daily dose, yes, I do think it's important that a full 24 hours separate the dosing on the test day itself and also the days immediately preceding the test. Having said that, I don't think it will matter if there is only a 16-hour separation on the day of the switch -- as long as there are several subsequent days of 2 p.m. dosing prior to the test.

Marianne

[labblab]

Karen, I've continued to think about you and Maggie this morning, and just wanted to stop back by and double-check why you've decided to give Maggie the trilostane at night rather than in the morning. With the short effective "life" of the drug, it really does mean that it will likely provide little benefit to her during the day when she is awake and active. Plus, it makes the monitoring testing so much more complicated.

I've re-read your thread and do understand that you are hoping to avoid a repeat of earlier problems. But you are cutting her dose fully in half. And by shifting to evening dosing, I'm just fearful that she will receive little benefit from the medication that she does receive. Hopefully this dosing schedule will work out as you wish. But if it does not end up resolving her Cushing's symptoms, the first thing I'd do is make a shift to morning dosing and see how that goes instead. Just a suggestion to throw out there!

Marianne

[KarenJ]

Marianne,
I decided to try the nighttime dose because she is so lethargic on the Trilostane and the tremors are awful. I was hoping that the effects would not be as prevalent during the day if we are only dosing at night. However, that said, after only one 30mg pill last night, I am noticing the tremors today already. And she is has been asleep most of the day as well. Is it possible that she just can't take the Trilostane? I am totally open to suggestions. Should I request a full adrenal panel and see what her other hormone levels are? Could this be atypical Cushings and maybe the Trilostane is not the drug of choice? As I mentioned, her only symptoms while she's been off the Trilostane the past 3 weeks are increased drinking and incontinence. Her appetite is normal, no panting, and she seems to feel great.

I am not opposed to giving the Trilostane in the morning. I guess I'll just skip her dose tonight and give her a pill tomorrow at breakfast. Sigh. I really don't know what to do anymore.

Karen

[Squirt's Mom]

Hi Karen,

Is Maggie just acting tired or is she lethargic - slow to respond?

Tremors are one of the side effects of Trilo for some pups, unfortunately, and the Trilo goes to work quickly, sometimes making the pup go through a withdrawal from the cortisol. This withdrawal can make them tired for a few days until they adjust.

I think morning dosing is a wise decision. ;)

Hugs,
Leslie and the gang

[KarenJ]

Right now, she just seems tired, not lethargic. She's responsive and we just went for a walk around the yard :). When I took her off the Trilostane 3 weeks ago, she was definitely lethargic. She's not like that right now.

I just hate these tremors :mad:! I'm really second guessing the decision to start back on the Trilostane. Maybe since we were half way thru the washout period, I should have held out and gone with the Lysodren....there are no easy answers, are there?

Karen

[KarenJ]

Maggie had her morning dose this morning - at 4:30 only because that's when she decided she wanted breakfast :D. No, she's not spoiled ;). I will continue dosing in the morning for the next two weeks leading up to an ACTH test.

So far, the tremors are back but not horrible. She is very sleepy but I wouldn't call it lethargic. Her pu/pd does seem to have decreased. She is still incontinent requiring diapers full-time. But she isn't requiring a change as often so that's good news.

She's still taking her Soloxine (.6mg AM and .3mg PM).

One day at a time :o. Thanks all!

Karen

[KarenJ]

I'm sad to report that Maggie is not doing well at all today. I think we may need to let her go to be with Ginger at the Bridge. She is lethargic, has not eaten drank or peed since yesterday. I did not give her her trilostane yesterday since I couldn't get her to eat. She is very cold and pale. She is unable to stand on her own without falling over. I spoke to her vet this morning. She is waiting to here from us on what we want to do. I've been sitting with Maggie all morning with her head in my lap. Hubby is sitting with her now so I could take a break. I can't stand to see her this way. Her eyes look so sad. Thank you all so much for your support over the past weeks. I never would have got through this without you. I will post later with an update but right now I'm pretty sure it will not be happy news.

Karen

[jmac]

Karen,
I am so sorry to hear she is not doing well. I wish I had some advice for you, but I have not used either drug and I cannot give you advice. I don't know if this is a reaction to the drug or not. Is there any chance of trying lysodren instead? I have not gone and read through your whole post again. I just wanted you to know that I am thinking of you and Maggie and sending my thoughts and prayers to you.

Julie & Hannah

[Squirt's Mom]

Hi Karen,

Do you have any prednisone on hand? If so, give her a dose and see if that will help. Her cortisol may be too low. If you don't have any, ask the vet about this before you make "the decision". It really does sound as if her cortisol may be too low and that can easily be remedied.

I pray that is what is going on and she will soon rally.

Hugs, prayers and healing white light for all,
Leslie and the gang

[KarenJ]

I gave her predisone this morning but it didn't seem to help. We are meeting the vet in 20 minutes and will see what she thinks.

[Squirt's Mom]

Oh, honey, we are all right beside you, wrapping you, Maggie and hubby in our arms. That soft fluttering you may feel is our Angel Wings surrounding you all.

Many hugs,
Leslie and the gang

[KarenJ]

We said goodbye to our sweet girl. I feel in my heart it was the right thing to do. She is no longer in pain and we held her in our arms while we said goodbye. It was very peaceful. Again, thanks to all of you for your support. I will continue to check in as I feel very close to this forum and any way I can help, I will. Love and hugs to all of you.

Karen

[Squirt's Mom]

Oh, Karen,

My heart is breaking with yours. You worked so hard to make her life the best possible at all times. I know she left this plane on the wings of your love, full of gratitude for this greatest gift of all.

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


A Special Gift

They're a very special gift, to be cherished and loved;
You're chosen for each other by God Himself above.
It's a match made in heaven so it can't be wrong;
You're tied together by a bond that's oh so strong.

All they'll ever ask from you is to be loved and fed,
And at night make sure they have fresh water and a bed.
In return, for so little, the rewards are so great!
You'll get a companion for life with some very special traits.

When you are lost and the end seems so far away
They'll walk by your side, they'll help you find your way.
When life gets you down they can put a smile on your face
As they run you in circles with their fast pace.

You'll share the good with the bad, you'll be happy and sad;
And through it all you have a friend, the best you ever had.
You're time together will be special and unique;
It will be as priceless to you as a rare antique.

Then, before you know it, the day will arrive
When suddenly your life takes a steep dive.
The furry friend who's been with you for all of these years
Has now passed on and left you in tears.

As you sit and wonder what did I do?
Why is this all happening to you?
Into each of our lives a little rain must fall,
And you must be strong to answer the call.

Your little one's spirit has flown home on the wings of a dove,
To a special place that awaits them in heaven above.
St. Francis will meet them; when they get home
He will take them to a meadow where they're free to roam.

There in the meadows, down by the pond,
Your furry friend will remember her loving bond.
She'll look into the water, then you appear;
She can see you're frightened, she can feel your fear.

Through the bond that still ties you from heaven above
She looks down upon you, she sends you her love.
Because you loved her and because you care
Whenever you need her, she'll always be there.

There, in the meadows, they patiently wait for the day
When you will celebrate your life together, each and every day.
Waiting for that day; when you come walking back home
When together for an eternity through the meadows you'll roam.

Author Unknown

[Harley PoMMom]

Dear Karen,

I am so terribly sorry for your loss and my heart goes out to you. Keeping you in my thoughts and prayers.

Godspeed sweet Maggie

With Heartfelt Sympathy,
Lori

[Squirt's Mom]

http://www.gratefulness.org/candles/candles.cfm?l=eng&gi=K9C

[jmac]

Karen-
I am so very sorry for your loss, but I am glad it was so peaceful and that you didn't feel any hesitation with your decision. That means it was the right thing to do, which is difficult when we want them to stay with us. You did what Maggie needed you to do and took away her suffering.

Thinking of you...
Julie & Hannah

[frijole]

Karen, I am so sorry. RIP Maggie. Run free of pain sweet angel. Know you were loved and will be missed. Kim

[marie adams]

Dear Karen,

I am so sorry for your loss of Maggie. I second everything Julie said. It is never easy and if it was we wouldn't always have tears in our eyes when each of our family here goes to the Rainbow Bridge.

Maggie is free to run with all of our babies--they are happier and healthier there with smiles on their faces.:)

Best to you and your family at this time.

[Jamie]

Karen,
Sorry to hear about your loss. After putting down our 14 year old Chocolate Lab last week due to old age, we know the pain first hand. Those first days are the worst but we just keep talking about all her good days with us and it helps. Maggie is in a better place and her memory will always be in your heart. You gave her a wonderful life and the very best of care.
Our thoughts are with you and your family.
Take care,
Jamie, Ken and Jessy

[Casey's Mom]

Karen, I am so very sorry to hear of your loss of Maggie. RIP little angel and run free . . .

Love and hugs,

[Cyn719]

Karen

I am so sorry for the loss of Maggie. I know how your heart aches but you did what you did out of the love for her. You have beautiful memories to hold onto .... You gave her a wonderful life.

Sending you lots of strength, support and prayers.

Hugs xoxo

Run free Angel Maggie xoxo

[k9diabetes]

I'm so sorry to learn of Maggie's passing. She was obviously much loved.

It sounds like something much worse than Cushing's was going on with her. With our dog back in 2008, we only happened to stumble on the fact that he had cancer two weeks before he got weak, pale, and lethargic. If we hadn't done a chest x-ray to check for heart failure when we did, we would have had no idea what was happening to him.

Godspeed to Magge and my deepest sympathy to you and your family.

Natalie

[Lady's mom]

I'm so sorry to read about Maggie. All our dogs are precious, but boxers are a little more so, it seems.

I feel hour loss.

[lauraperla]

Karen I am so sorry for your loss.
I hope the memories of the times you shared together brighten these dark days for you.

Laura and Saoirse xx

[lulusmom]

Karen, I am so incredibly sorry for your loss. No words can explain the pain you must feel nor are there any words that will ease that pain, but please know that my thoughts and prayers are with you.

Godspeed sweet Maggie.

Glynda

[Roxee's Dad]

Dear Karen,
I am so very sorry for your loss. Rest in Peace sweet Maggie, You are our newest and brightest star in the sky.........

[KarenJ]

Thank you all so much for all the kind words, thoughts and prayers. It has truly helped me the past 2 days knowing there are others who understand and love their dogs as much as I love mine. I have spent a lot of time hugging my other Boxer baby, Jake, and helping him through his grief as well. I will continue to check in on everyone. Take care all.

Karen

[busyman370]

Karen,
You did everything humanly possible for Maggie, and you can be sure that Maggie knew how hard you were trying to help her.

She knew she was valued and cared for, and that was a constant and reassuring comfort to Maggie all the way along.

Fred.