What is considered advanced stage of PDH? - The Tankster has crossed The Bridge

[TheTankster]

Hi all. My name is Lisa and I have been reading all the helpful info on here for the past few months. You guys are great! My guy's name is Tank, 60-lb Staffy-Bulldog mix, we were told (he is a rescue found on the street), and could be anywhere from 10-12 years old. Maybe younger, maybe older?? We adopted him in 2005 and were told he was 3-5 years old then. The only issue he has had in the past is minor hip displasia for which he is taking two tabs of Arthrisoothe Gold Tablets (since August 2011).

Feb 2011, we moved from the only home he had ever known while with us. Perhaps it stressed him? And the disease kicked in? Because the PU/PD started in March/April. My hubby and I have had no sleep since then. He has always had a ravenous appetite though (still does). Then came the other symptoms: urinary accidents in the house, bloated (now just pot-bellied), loss of muscle (hind legs and chest and shoulders), bony skull, exercise intolerant, heat/sun sensitive (that results in panting), balding on torso just above tail stump and also at the back of his neck, flaking and thin skin, hyperpigmentation, stumbling gait (hind legs). It was textbook Cushing's. What's strange is he had always had a teeny tiny bald spot on his butt by his tail the size of an eraser on a pencil. For years. Now it is about three inches across and two inches wide.

In April 2011, we took him in for blood work - Chems, CBC, and UA.
Alk-Phos: 160 (normal 10-150)
CK: 266 (normal 10-200
Amylase 369 (normal 450-1240)
Cholesterol 496 (normal 112-328)
T4: 0.4 (normal 1.0-4.0)
CBC was all within normal ranges
UA: specific gravity 1.011
PH 7.0

Next we did a UCCR.
Urine cortisol 12.6
Urine creatinine 106.4
UCCR 37 (normal is <34)

At this point, my vet insisted she didn't think it was Cushing's although I gave her all those symptoms I listed above. She wanted to rule out a thyroid problem so Tank had a complete thyroid screen.

June 2011
Alk Phos 173
CK 304
Cholesterol 435
T4 0.6
This time,
WBC 4.6 (normal 5.7-16.3)
Absolute neutrophil seg 2990 (normal 3000-11500)

We also did, at her recommendation, a cortisol test. Yes, just a cortisol test. ?? I hadn't done much research on the diagnostics of Cushing's at this point. His cortisol level was 4.5 (normal 2.0-6.0). The vet was more convinced now that it probably wasn't Cushing's and recommended a Lyme Disease test, to which I politely declined.

This is when I took the matter into my own hands... after hundreds of dollars of getting nowhere and living off my skimpy unemployment check...

I sought the help of my vet friend at an emergency and critical care/internal medicine hospital (her specialty is emergency and not internal medicine but she offered to help me out, lucky me!) Urine culture came back negative, full body x-rays only showed mild hip displasia, eyes showed mild anisacoria, and a quick ultrasound revealed one adrenal gland slightly larger than the other. All signs pointed to PDH.

So while I researched more on this disease, I put Tank on Cushex which worked for about three weeks, controlling his PU/PD to some degree, with a slight regrowth of the bald spot on his butt. There is now stubble, not bare skin, which is how it remains today.

Not wanting the alcohol of Cushex in his system, I got him (human) adrenal support supplements that were loaded with mushrooms, herbs, minerals, herbs, and vitamins. I researched each ingredient to make sure none were toxic to dogs. After stopping Cushex, two weeks on the herbs controlled his PU/PD - somewhat. He was still drinking at all hours but it was slightly less than before. What was most notable was his drunken, stumbling gait when his hind legs were weak - no more. His head was even filling up with more muscle and he wasn't bloated anymore. So I decided to keep him on the herbs until other symptoms manifested, present symptoms worsened, or blood test revealed the herbs were not working, whichever came first.

Fast forward to Jan 2012. The calcium deposits in his skin (there was only two spots then) started turning red and crusting over, so I needed to take action again.

Blood work:
Alk Phos 823
CK 221
Cholesterol 679
Now ALT 119 (normal 5-107)
GGT 25 (normal 0-14)
TCO2 25 (normal 17-24)
T4 <0.4
Auto platelet 605 (normal 164-510)
UA specific gravity 1.002, ph 6.5, trace protein, rare bacteria

I agreed to a LDD test.
Pre 4.3
4 hour 4.5
8 hour 4.3

He started Anipryl Feb. 8 and the first time his PU/PD symptoms alleviated was just this past Sunday. He is down to drinking about 2 bowls of water/day from his usual 4-5. That is the only change. He still gets up at night, still exercise intolerant. What concerns me most is the calcium deposits. He went from two to... countless ones. They are all over his neck, ears, head, chest, torso, and the bald spot on his butt is now hard and turning red. This happened within the past month. My question is: should I get him on Trilostane immediately? I'm thinking that I don't really have the luxury of time to wait for the one to two months needed for Anipryl. Does it "get worse before it gets better"? He is restless and will just sit and stare at me, still rarely sleeps. :(

[Squirt's Mom]

Hi and welcome to you and Tank! :)

I don't have much time right now but I know others will be along to talk with you.

I do want to know why his hypothyroidism isn't being treated, tho? His values have been consistently low so I would think that should be addressed. Of course, there is a form of hypothyroidism, sick euthroid, that is the result of untreated Cushing's.

Many, most of the things you are seeing could well be due to thyroid malfunction. ;)

Hugs,
Leslie and the gang

[labblab]

Hi Lisa,

Thank you so much for providing such a complete history and so much helpful information. I wish I had the time right now to comment more completely. But I am in a bit of time crunch, so I want to cut to the chase.

If Tank's red, crusting spots are "calcinosis cutis," that is pretty much a definitive diagnosis of Cushing's. And yes, if you want to try to halt the progression, I believe you need to waste no time in lowering his cortisol level. Calcinosis cutis can be a really miserable result of elevated cortisol, and I don't think there is any way to effectively control the disorder if the Cushing's goes untreated. I'm so sorry that Tank is erupting in so many lesions. I'll try to come back later today or tomorrow in order to give you some more links re: this issue.

Marianne

[TheTankster]

Thanks Leslie and Marianne.

Like you said, Leslie, the vet said the hypothyroid could be from the Cushing's, which is the reason she hasn't treated it. Marianne, I have decided to get him on Trilostane right away and not wait for the Anipryl, which has surprisingly brought his water intake down in the past two days.

The vet has prescribed 60mg of Trilostane. I tried searching this info but do most do well on once a day dosing? She said if once a day at 60mg doesn't control it, she'll up it to twice a day. And where do you all buy from? I tried searching for this info in the forums too but couldn't find anything. Right now I go to Foster and Smith. Thanks so much for your help!

[Harley PoMMom]

I tried searching for this info in the forums too but couldn't find anything. Right now I go to Foster and Smith. Thanks so much for your help!

Try this link: Compounding pharmacy questions (http://www.k9cushings.com/forum/showthread.php?p=57769&highlight=compounding+pharmacies#post57769)

Hope this helps.

Love and hugs,
Lori

[mytil]

Hi and welcome from me too. I wanted to pass on the link to Trilostane dosages and monitoring information http://www.k9cushings.com/forum/showthread.php?t=185.

Are you still with the same vet who thought your Tank did not have Cushing's? I am wondering only because of the experience level of your vet in monitoring this with you and following the right procedures.

Keep us posted.
Terry

[labblab]

Lisa, here's a link to the thread of another member who is actively dealing with calcinosis cutis right now (and the thread contains a link to ANOTHER related thread). You will see that there is some discussion as to whether there may be greater success in using Lysodren (rather than trilostane) to treat dogs with calcinosis cutis. But I don't think there is yet a definitive answer in that regard, and we do have other members with c.c. who are also using trilostane.

http://www.k9cushings.com/forum/showthread.php?t=3870

Marianne

[Sabre's Mum]

Hi Lisa,

Welcome to you and Tank.

I believe that you have done the right thing with not wasting time on the anipryl and starting with the Trilostane if the skin condition is calcinosis cutis. Here is a link to a picture of calcinosis cutis (it it's early stage) from wikipedia http://en.wikipedia.org/wiki/File:Calcinosis_cutis_dog.jpg.

We treated with Lysodren and had great success with getting Sabre's cushings (and his calcinosis cutis) under control. There has been some discussion in the past that Lysodren may be better for dogs with calcinosis cutis but having said this there are a dogs here on Trilostane with calcinosis cutis and the treatment has been able to successfully deal with the condition.

If you have any queries with dealing with the calcinosis cutis please ask away.

LOVE the pic of Tank on your avatar.

Angela and Flynn

[TheTankster]

Thank you, Lori and Marianne for the links! Great help!

Terry, thanks for the Trilostane link, and yes and no about being with the original vet - I only get the necessary bloodwork done with her now because she is less expensive than the internal medicine place. Plus, Tank is never nervous going there, as he has known the place for seven years. When I take him to the specialist's place, he won't stop shaking. His case is mainly being handled by my vet friend who helped me out with the ultrasound, etc.

Thanks a bunch, Angela! That's nice of you to say. It's his peekaboo shot. Glad to hear you have eveything under control with Sabre. :) Tank's drinking is still down to two bowls/day instead of his usual 4-5 (3 days now), and I have ordered the Trilostane, and I was still unsure of whether to keep the Anipryl going or not, but now I feel better after what you said. I feel bad that maybe I waited too long to get him on the stronger meds though. At least there's so far only one spot on him that looks like the picture on that link you sent. Hopefully, the rest of his bumps will not get that way. Thanks so much for your help!

Thanks to everyone who replied. I appreciate it!

[TheTankster]

Angela, I just noticed your avatar. Beautiful shot! Looks professionally done.

[marie adams]

Welcome Lisa and Tank!!!

I know how you felt when you figured out all the symptoms--when I finally found a link to Cushings Disease I understood better how it gradually came on without me knowing or the vet.

You have provide the right info for the experts and they are already helping you!!! Ask tons of questions because you will get answers or they will research it for you. You are in good hands!!!:)

Take care and welcome to the family!!!:)

[TheTankster]

Thank you, Marie! You all have made me feel so welcomed! You take care too!

[TheTankster]

Has anyone given Anipryl and Benadryl together? I am looking for a sleep aide for my guy, Tank, and have so far tried melatonin and chamomile. Neither worked. He is also starting to get itchy from the calcium deposits, so I was hoping it would help him with the itchiness as well. I researched online but some are saying it's ok, others saying, no way.

MODERATOR NOTE: I have merged your latest post about Anipryl and Benadryl with Tank's original thread. We like to keep all info about each pup in one thread. That way it is easy to look back through the history if needed.

[lulusmom]

Hi, Lisa, and welcome to you and Tank.

Anipryl is metabolized to l-methamphetamine which causes stimulatory actions in a dog. In other words, it's like being on speed so always give the dose in the morning, never at night. Are you giving Tank his Anipryl dose in the AM?

Did your vet confirm that Tank's skin problem is truly calcinosis cutis? I believe a biopsy is usually taken and sent to a speciality lab for interpretation. Dogs with cushing's are also prone to mite infestation due to suppression of their immune system so I'm also wondering if demodex and sarcoptic mites have been ruled out.

Glynda

[TheTankster]

Thanks, Glynda.

Yes, I give him the Anipryl at 6am.

No, we haven't checked for mites, but it doesn't seem like a mite problem. There are hard lumps and flat, wide "plates" everywhere, most with no hair loss. Thanks for the reply!

[Sabre's Mum]

Angela, I just noticed your avatar. Beautiful shot! Looks professionally done.

No .. just a fantastic camera and lens .... unfortunately we have progressed into the digital era and we can no longer afford the flash equipment we had "before kids" (and canine illnesses!!!).

Angela and Flynn

[TheTankster]

Does anyone else's Cush pup yawn and lick the air and lip smack all day and all night long? I read it's naseau but mine's been doing this before Anipryl.

[lulusmom]

Does anyone else's Cush pup yawn and lick the air and lip smack all day and all night long? I read it's naseau but mine's been doing this before Anipryl.

I have a dog, who I suspect has cushing's, who licks the air for what seems like 24/7. Cushing's is a disease listed as a cause for lip licking but I have no idea what the trigger is. This is just speculation but it could be the excess cortisol upsets their tummies. This isn't a new thing for my dog because he used to lick the air a lot when he had chronic colitis. Doesn't it drive you crazy that you can't just ask; "Why in the heck are you doing that?" If they could tell us what's wrong, we might be able to fix it. Since we can't, we'll just have to be grateful that licking is just an annoying symptom that is not fatal.

[addy]

Yawning can be a calming signal, sometimes they will yawn when they want to calm themselves. My Zoe does does not lick the air but she licks us all the time. I thought it was upset tummy but when we put her on pepcid, she still licked us and then started spitting up in the middle of the night so we stopped it. I think the licking comforts her.
Before she was diagnosed with Cushings she would snap at imaginary flies. That stopped when we put her on melatonin and now that she is also on Trilostane, it never started again. Go figure:o:confused:

Have you ever tried giving your pup a small late night snack? Not cold food.

hugs,
addy

[TheTankster]

Thanks, guys! Yep, I tell him that all the time - tell me what's wrong so I can fix it! :p And, no I haven't tried giving him a late night snack, as he does the smacking even right after he eats. Thanks anyway!

[Nikki]

Welcome to you and Tank!! I too am a new member. I just found this website late at night the other night and finally got on the computer today and really got to look around. My boy (Maxwell) is also suffering from calcinosis cutis. About half of his fur has fallen out and he has crusty gross sores everywhere :(. Also, he licks at the air all of the time!! We always laugh at him and wonder what he is doing.

[TheTankster]

Aw, poor Maxwell. This skin condition is not very common, I've been reading. Hope he doesn't feel too bad. Thanks, and welcome to you too!:)

[TheTankster]

OK, so three different vets are telling me that they don't prescribe prednisone when first starting Trilostane. I have been reading otherwise here, and there have been many times when the pred was actually needed. Should I keep pressing for the pred, or... Tank is 60lbs and starting dose will be 60mg. I really wish my vet would consider the UC Davis dose though, at half that.

[Harley PoMMom]

If it were me, I would stand firm on getting the prednisone. Many vets feel that since Trilostane has such a short half-life that prednisone on hand is not needed but I would still insist on having some in case of an emergency.

[TheTankster]

Thanks! I'll keep pressing. :D

[TheTankster]

My Tanky just had a seizure! This is his first. He seems ok now but I am taking him into see the vet tomorrow. It was SCARY. :( Anyone know if Anipryl causes this, or is it the pituitary tumor? I don't know where to begin.. I have not even gotten the Cushing's under control (Trilostane is on its way) and now seizures. I can't sleep now. :(

[Squirt's Mom]

How is Tank this morning?

[lulusmom]

Seizures are listed as a side effect of Anipryl. I noticed that you are in Los Angeles. You mentioned seeing a specialist in an earlier post. Was that an internal medicine specialist? Dr. David Bruyette is a renowned endocrinologist who is also the Director of VCA West Los Angeles. He is also one of the developers of Anipryl and an expert on macroadenomas. There is nobody in the world that knows Anipryl like Dr. B. and I don't believe any other endocrinologists has been involved with macroadenoma research to the extent he has. Dr. B's treatment of choice is Trilostane and he admits that he hasn't had very good luck with resolving calcinosis cutis with Trilostane. Dr. B seems to be the go to expert for most of Tank's issues so you may want to talk to your vet about contacting Dr. Bruyette to discuss Tank's seizures, the calcinosis cutis and appropriate treatment.

[TheTankster]

Thanks for asking about Tank. I took him to emergency this morning after his third seizure, and he had another one on the way. :( He is there for 24 hr seizure watch. And thanks, I was thinking about going to The West LA VCA. I didn't know Dr. Bruyette was one of the developers of Anipryl! I won't be putting Tank back on it though. Gonna try Trilostane, though seizure is listed as a side effect for this one too. I wonder if anyone's Cush pup started seizuring from Trilostane.. Thanks for the info!

[jmac]

Hi-
I just wanted to say a belated hello and welcome. I don't have any advice for you as far as the seizures, but I just wanted to check in and see how he is doing today. I hope the seizures were just a side effect of the Anipryl and he is doing better today.

Please let us know how things are going!

Julie & Hannah

[TheTankster]

Thanks Julie and Hannah. I just picked him up today. He is on phenobarbital and completely not himself (not that he's sedated, his personality). Hope it's temporary like they said. It's tougher when Cushing's isn't under control, as phenobarbital makes him drink even more. Anyone have a seizure Cush pup out there? I don't know where to begin. BTW, doc said it's probably not the Anipryl, as it should be out of his system already. :(

[jmac]

I am glad to hear he is home with you, but sorry to hear he is still not himself. I do know there are people with dogs who have seizures and Cushing's; in fact, I think there was someone not too long ago who took their dog off the phenobarb. and put it on something else so they could use one of the meds for Cushing's. I can't remember who it was, and I don't know if it is in the title of their post, but maybe someone else will remember. Someone else will for sure be able to give you some better advice as far as what to do.

What did the vet suggest? Do they have an idea of what may be causing the seizures? Where are you supposed to go from here?

Remember, we're here for you, so please know you are not alone.

Julie & Hannah

[Harley PoMMom]

Anyone have a seizure Cush pup out there?

Hopefully these member's Threads will help: http://www.k9cushings.com/forum/showthread.php?p=69952

http://www.k9cushings.com/forum/showthread.php?p=69957

[labblab]

Oh, I am so sorry about Tank's seizures! I know how horrible it is to watch your baby going through that. :( :(

One of my non-Cushpups (a 7 y/o Lab) developed grand mal seizures "out of the blue" one year ago. To date, we have not identified a cause, but we are VERY fortunate that her seizures have been totally controlled by phenobarb thus far. But during the first couple of weeks on the drug, she was definitely affected. In her case, she was lethargic and dopey and uncoordinated (stumbled when climbing up steps, etc.), and her thirst and urination significantly increased. Appetite was hard to gauge, because she's a Lab and they always will eat anything that is not tacked down! In many ways, she resembled an untreated Cushpup during those first days on the phenobarb. The mental/coordination issues soon resolved, however, even though she still drinks more water now than prior to treatment.

In Tank's case, one unfortunate thing is that phenobarb is probably not the best anti-seizure med to use in conjunction with trilostane. Because of phenobarb's effect on the liver, there can be a greater risk of trilostane overdosing and also liver problems. Here's a quote that I added to another member's thread (Dechra is the manufacturer of brandname Vetoryl):


OK, I just spoke with one of Dechra's technical reps, and what he told me pretty much coincides with what you were already thinking. Even though there is no documented interaction between trilostane and phenobarb (he is unaware of any clinical trials that specifically addressed that drug combination), dogs who are being treated with both drugs need to be monotored very diligently both in terms of liver function and also trilostane efficacy. He is aware of dogs that are currently being treated with both drugs, and no particular problems have surfaced thus far. But theoretically, phenobarb's effect on the liver could alter the way in which trilostane is metabolized by any given dog, leading to the potential for trilostane overdosing in the absence of appropriate dosing adjustments. Everything being equal, potassium bromide would probably be a preferable treatment choice for a dog suffering from both conditions.

So everything being equal, potassium bromide might be the better choice for Tank. But I know that the top priority right now is to get the seizures under control, and it takes a much longer time for the bromide to build up to a therapeutic level as opposed to phenobarb. Given Tank's multiple problems, it might be good if your vet could consult with a neurologist as to the best approach given Tank's multiple problems. Or once again, Dr. Bruyette might be your best "first" resource, since undoubtedly he has treated Cushpups who also suffer from seizure disorder.

Marianne

[lulusmom]

I have a cushdog, Lulu, who has infrequent seizures. Her seizures are mild compared to some I've seen. She doesn't foam at the mouth and they usually only last a minute or two. She's usually fine within 5 to 10 minutes...she comes out of it like nothing happened. I've noticed that every time it's happened, it's been around meal time when she is overly excited. I get pretty excited about food too so thank goodness I don't have seizures. :D

[TheTankster]

Thank you, everyone for the links and the advice and the kind words. Tank continued to have focal seizures yesterday, even on the phenobarbital, but none today. Yesterday, he also vomited up his food and had diarrhea all night long, and also had no appetite. Today, he is better. No vomiting/diarrhea, and he has a good appetite. He's still not my old Tank though. :( Sometimes I feel like he doesn't know who I am or where he is. He is also still having tremors and stumbles a lot and is uncoordinated. Hopefully that will pass soon. The doc thinks it's most likely the pituitary tumor, as the obvious reason behind the seizures, but might be something else causing it. I am seeing a specialist on Tuesday.

[labblab]

While it may be the case that Tank's pituitary tumor is enlarging and resulting in the seizures, apparently that is not a typical symptom according to at least one article in our Resources section. So maybe there is something else going on, instead. I'm really glad you'll be talking with a specialist.


Seizures, while often associated with other intracranial neoplasms, are an uncommon manifestation of PMAs [pituitary macroadenomas].

Here's a link to a thread that tells a lot more about large pituitary tumors:

http://www.k9cushings.com/forum/showthread.php?t=229

As far as the dopiness, "spaciness" and uncoordination, we definitely saw that in our Peg when she started on the phenobarb. Although I guess you started seeing some of those issues even before Tank started on the med? It took Peg a couple of weeks to stabilize on the phenobarb and stop stumblng, etc.

Please do keep us updated, and again, I am so sorry that you have this additional worry about the seizures.

Marianne

[TheTankster]

Thanks, Marianne. I'd read somewhere, too, that PMAs don't usually cause seizures. I'm thinking maybe hypothyroid? My vet (ex vet now!) thought the low thyroid was due to Cushings. If I'd have only known the consequences of not treating a low thyroid... Where 's my common sense that something else will go wrong if I don't correct this problem... Racked with guilt! I did this to my poor Tanky. He is feeling miserable and it's my fault. I miss him so much. Under phenobarb, he is completely different. The stumbling and lack of coordination i don't mind. It's his personality change that breaks my heart. All the cute little things he used to do, no more! Temporary, I hope. I'm new to pheno but is it normal for a dog to be so sedated he doesn't even get up to go pee or to drink water, especially considering he should be PU/PD x 2. After Tank's morning dose, he slept for 7 hours. I had to physically get him up and out to pee, as he started leaking in his bed. He eats and drinks then goes back to sleep. He can't stay standing until he finishes peeing either. Yesterday was completely different. He was more up and restless. Seven hours after one dose, he was even almost running (double trotting!). And balanced. Not wobbly. He was also more alert and responded to a sit command. But today he just slept all day. Oh sorry, I didn't mean to turn this into a phenobarb/seizure thing. Can't wait for Tuesday. Hope we can start his Cushing's treatment right away, as I want so desperately for him to feel at least a little better for now. Marianne, has your Peg had any seizures since on phenobarbital? I definitely want to talk to the specialist about sodium bromide. And also about hypothyroidism. Thanks for that link! Oh and no, he wasn't acting like that before meds.

[labblab]

Oh, please do not be so hard on yourself! I do the same thing -- feel so guilty over things that I wish I'd done differently. But everything is ever so much clearer in highsight :o. And as for the thyroid, it is not uncommon for vets to hold up for a while re: treating the thyroid when Cushing's is also diagnosed at the same time and when the testing implies that the thyroid results are likely secondary to the Cushing's. There are lots of different things that can cause seizures in dogs -- even high triglycerides, I discovered! So at this point, it's hard to know what the culprit is in Tank's case.

Knock on wood, my Peg has not had a single seizure since starting on the phenobarb. We are VERY, VERY lucky and realize that is an unusually good result. Our vet keeps preparing us that it is almost inevitable that she will seize again at some point, but we are very relieved that she has done so well thus far. She acted very drugged up during those first days on the phenobarb, but not as lethargic as Tank is sounding. If he stays this knocked out, I'd talk with the specialist about perhaps lowering his phenobarb dose a bit, at least for a few days. It does take time for the dogs to become normalized on the drug, and also for the phenobarb to reach a steady, therapeutic level in their bloodstream -- I'm thinking maybe two weeks or so? But Tank does sound particularly zonked out to me. You will definitely want to test the phenobarb level within a specific time frame, again I'm thinking it's between 2-4 weeks to make sure it's neither too high nor too low. And once that therapeutic level is reached, maybe you can start adding in the bromide in anticipation of a switch over time.

One warning: phenobarb lowers the T4 reading on thyroid tests :(. So that's one more complicating factor as far as monitoring Tank's thyroid status during the time he is on the phenobarb. We did a complete thyroid panel on Peg at the time she started seizing (we were actually hoping that might be the cause since it is so easy to treat). But her thyroid panel was normal at that time. Since starting on the phenobarb, her thyroid results now come back "low." So that's a question I have for my own vet -- how will we ever know in the future whether or not she truly suffers from low thyroid?

Again, I'm really glad you only have one more day to wait before seeing the specialist. And I hope that Tank will start perking up a bit more today.

Marianne

[TheTankster]

Thanks, Marianne. Glad Peg is doing well on phenobarb. It is day 4 (or maybe 5 if you count the phenobarb given at emergency) and Tank is still sleeping all day and night. Still uncoordinated, can't stand without falling, can't walk or pee without falling. There was one time where he'd "forgotten" how to drink and it took him 30 minutes to figure it out. Not one hint of improvement from phenobarb side effects. I am calling the vet today to see if I can lower his dose. BTW, appointment with specialist moved to Thursday. :( When the therapeutic level of phenobarb is supposed to be at its highest (4-8 hours), that's when he's most zonked out. He won't even stand. :( I know it's dangerous to reduce the dosage but mostly for those that have already established a therapeutic level, I believe. I don't even want to give him the next dosage.

[TheTankster]

Anyone hear of Trilostane or Lysodren treatment reducing overall inflammation and then the pituitary tumor starts causing neurological problems (if there was any inflammation around it in the brain)?

[lauraperla]

Hi,

My IMS spoke to me about this last week, our gsp has PDH. He said that in some cases they do see that a pituitary tumour's growth can be suppressed in a dog by the excess cortisol in their system, and when the issue is addressed with successful treatment and the cortisol is reduced, the growth of the tumour is accelerated in the longer term. However he did say that this is in his view not the case in most cases, and he would expect to have seen some early signs of the pituitary tumour being a significant mass prior to lowering of cortisol, some clear neurological concerns at very early stages of the Cushingoid signs appearing, for this to be a factor he was worried about.

Having passed that on though I wouldn't worry that this is the underlying cause of Tank's current woes, having been through multiple issues with dogs over the years it looks much more like you have dosing adjustments needed, maybe some drug intolerances going on, I hope your appointment on Tuesday helps you and Tank with this further.

Laura and Saoirse xx

[Squirt's Mom]

Since cortisol is a natural anti-inflammatory, what you described is possible, tho unlikely, as Laura said. This anti-inflammatory property of cortisol is why we see a rise in discomfort due to arthritis in our cush babies with the pre-existing condition.

Most PDH pups have what is called a micro tumor and it remains classed as such for the duration. There is a small subset of pups who's tumor will start to grow and become what is then called a macro tumor.

If you are interested in learning about macro tumors via some of our members who have dealt with them, here is a link to our Everything Else section -

http://www.k9cushings.com/forum/showthread.php?t=3567

Hope things are going well for Tank and you!
Hugs,
Leslie and the gang

[TheTankster]

Thanks, Laura and Leslie. Tank is not doing well. I tried another dosage drop of pheno and even at 1/4 tab only once a day, he reverted back to falling and peeing in bed and unable to drink and eat. So I took him off it completely and he had improved significantly with just a minor head bob once in a while. His last dose was Friday morning and he is now walking well, balanced when drinking, and most importantly, his myoclonus is gone, and mentation was improved. Until Trilostane. He was two days into 30mg BID and he suddenly got diarrhea and stopped eating and drinking and acted as if he were on phenobarb again. So I stopped the Trilostane. Unfortunately there are neurological signs that won't go away and now that he is free of drugs, he is more alert and, now, miserable, acting as if he is in pain. I cannot bear to see my Tanky so miserable and no way will I allow him to be in any kind of pain. We are thinking of letting him go, but just can't get ourselves to do it. I know it's selfish of us, but it's hard letting him go. He is so tired and his body has put up with so much...This has been the worst 12 days of my life.

[nibbles-mommy]

Don't post here much, but my dog Nibbles is diabetic and was treated for cushings for awhile. He is at least 16yo. We are feeling the same things you are feeling in regard to quality of life. His hind legs have failed so he needs alot of help getting around and has become extremely dependent on us. I look at him and he still has alot of life left in him and I think he'll let us know when he's ready to go. It's really a personal choice to make.

Has Tank had any more seizure without the phenobarb?

[TheTankster]

No, he has not had any more seizures. He just has an occasional twitch and/or blink, mostly when a hand or object goes near his face. He looks miserable. Glad your Nibbles has made it to a nice, ripe old age and has a lot of life left in him. My guy is tired. He just started nosing over his water bowl today, shoving it away. He'd never done that before. He's tired of his Cushing's. :(

[jmac]

Just wanted to tell you I am thinking of you and Tank. I am so sorry to hear he is struggling. It is so hard to make the decision to let them go. I have gone through it twice on my own and a few times with family dogs we had growing up. It is so difficult. For me, there came a time when I just knew. It was tough, but in the end, I knew I did the right thing and felt good that I had ended the suffering. I believe you will know when it is time. I wish I had some knowledge about how to help you with the medications, but I would talk to your vet about that, or rely on some of the more knowledgeable members. For now, just spend time loving Tank and enjoying your time with him. Please know we are here to support you in whatever you decide.

You and Hank are in my thoughts...

Julie & Hannah

[Harley PoMMom]

We are thinking of letting him go, but just can't get ourselves to do it. I know it's selfish of us, but it's hard letting him go. He is so tired and his body has put up with so much...This has been the worst 12 days of my life.

It is one of the most hardest decision we as fur parents have to make but it is done with the most deepest love we have for them.

Just wanted you to know that we do understand how you feel and are here for you.

Sending huge and loving hugs, Lori

[lauraperla]

I am so so sorry that Tank isn't doing so well. I feel for you so much, we lost our beloved Bracken to cancer last Autumn and it was heartbreaking.
Please know and take what comfort you possibly can from the fact that as Tank's special person he will still be feeling your love and care even at this worst of times.
Much love to you all.

Laura and Saoirse xx

[mytil]

I have not posted but have been following....I am so very sorry he is not doing well. We are all here for you.

(((hugs)))
Terry

[Squirt's Mom]

Morning,

It's a difficult place to find ourselves in with our babies...pondering a decision that is too agonizing for words.

A friend here talks about a "dog-worthy life". This is a life that includes interest in family and routines, enjoys eating, barking at things they usually do, enjoying the smells they encounter outside, and so forth. Here is a link that includes a sort of check list of things to consider -

http://alexadry.hubpages.com/hub/How-to-Determine-a-Dogs-Quality-of-Life

Please know that we are here anytime you wish to talk. This is never an easy decision and you are not alone during these days. If you need a sounding board, we are here, tho we cannot tell you when it is time. Tank and you will come to that decision and I think he will help you decide.

Hugs,
Leslie and the gang

[TheTankster]

Thank you, everyone, for the kind words. It means so much to me during this awful time. I have him here at one of his favorite parks, but he doesn't want to even walk a few steps on the grass, so I put him in the backseat with his head propped up on a pillow and left the door open for him so that he could see the birds and the trees and other dogs walking by. He just closes his eyes and that's it. :( The quality of life for him is gone. It's difficult though when he still eats and drinks and is able to get up to pee and poop (though he'd forgotten where to go for that), and sometimes I see glimpses of my old Tanky come and go, but other than that, there is nothing that he enjoys. No spark anymore. No tail wag. I don't know if I should wait a little longer or end everyone's suffering right now.

[Squirt's Mom]

I wish we could tell you what the magic clue is or make this decision for you but this is one where we truly have to trust our guts and our hearts, listen to our babies, and we must do these things on our own. No one knows your Tanky like you do. Whatever you decide, we will be there, right by your side. We trust you just as much as The Tankster does and we all know you will do the best for him just as you always have.

Hugs,
Leslie and the gang

[lauraperla]

Thinking of you both today.

Laura and Saoirse xx

[jmac]

Just checking in and letting you know I am thinking of you and your Tanky...how sweet of you to bring him to his favorite park, and even to make modifications to try to give him some pleasure.

We're here for you...

Julie & Hannah

[Casey's Mom]

I have not posted yet but have been following. Love, hugs, and prayers coming your way.

[TheTankster]

Thank you again, everyone. Your words mean a lot. Tank's eyes have failed him now. It was bad enough that he had a stroke and had forgotten where to go and what to do. Now he can't see on top of that. It's so cruel. He doesn't deserve this. We took him to his favorite walking places yesterday and he did walk slowly and tentatively but no tail wag or signs of enjoyment. I felt like we were forcing him. He does eat and drink, but after that, he just goes straight to the bedroom where his bed is. He does not hang out with us in the kitchen anymore. Do you think it's cruel keeping him like this? :(

[lvasilio]

I had to make a very hard decision for one of my beloved dogs last year. There are no words to describe what you go through when you are trying to decide. I looked into his eyes and realized it was time. I know he gave me that sign and while i miss him every day, he is at peace. i trust you will make the right decision for all of you. God Bless you all. And remember there is always the rainbow bridge.

[lulusmom]

Hi Lisa,

I am so sorry that Tank's quality of life has deteriorated so quickly. Every symptoms you've mentioned to us makes me think that you are definitely dealing with an enlarging macrotumor. Brachycephalic breeds (short snouted) are predisposed to larger tumors so the pieces of the puzzle fit. Unfortunately the only way to diagnose is an MRI, which is very expensive. Incurring that expense would only make sense if you were open to radiation treatment for Tank, which is also costly and not always an easy procedure on the dog.

Sometimes our incredible love for our dogs makes it difficult to know when our babies are telling us that they've had enough and are ready to say goodbye.....and even when they do, we look for any sign to hold onto. Quality of life is everything and if you truly think he has no quality of life, and it does sound that way to me, then I think you should start thinking about letting your boy go. I'm sure not much else has been on your mind but I wanted to give you my opinion and my support for whatever decision you make.

Marianne (labblab) has been through the heartache of a macrotumor so I'm hoping that she will be by to share her thoughts with you.

I'm sending huge hugs, positive thoughts and channeling as much inner strength as I can to help you through this very difficult decision.

Glynda

[lauraperla]

Hi Lisa
I so so sorry. I worried and worried about whether I would know when it was time for our beautiful girl that we lost last year; but on the day I knew that she'd had enough. We called the vet out to our home, it was very peaceful she went in my arms.
I know your heart will break into pieces, and my heart aches for you.
Sending love and hugs to you and Tank.

[labblab]

Oh, I'm so sorry that Tank doesn't seem to be rallying and is doing so poorly. Are you still withholding both the phenobarb and trilostane at this point? Any more seizures?

As Glynda said above, my husband and I decided to end the suffering for our own beloved Cushpup who we believe had an enlarging pituitary tumor. He had developed a series of worsening neurological issues, culminating in the inability (or lack of desire) to eat and drink anything at all. For us, that was an acute situation that felt like a final crossroads. We either had to make arrangements for IV support or choose to let him go. So in that sense, our decision was forced. And as hard as it was to lose him, we felt that was the choice that was the kindest for him.

In a way, perhaps your decision is even harder because there is not a crisis that is forcing you to act. So with each hour of each day, you are left to wonder: is this the time? Are we beyond hope? And I'm afraid that truly, this is a decision that only you, your vet, and your family can make. But from what you have described to us, I don't believe there is a single person here who would question your love for Tank or your decision to release him if that is what you think is best.

You have loved him dearly, and given him the gift of his forever home. You have sought medical advice and treatment to try to help him past these physical problems. But the problems are mighty, and it sounds as though his body is so very tired. Whatever you decide, we will be here to support you so that you can continue to support Tank. But if you decide that there is no longer joy nor dignity for Tank, we will understand what you are facing.

Sending so many hugs to you and to your sweet boy,
Marianne

[mytil]

Just wanted to let you know I am thinking of you and Tank.

Terry

[TheTankster]

Thank you again, to everyone who expressed their concern and gave their advice and opinion - words cannot express how much it means to me. Hugs to everyone for that.

On Tuesday, I took Tank to get some antibiotic and anti-inflammatory ointment for his eyes. He had dry eye and the vet said it was probably being caused by the macroadenoma. Afterwards, I took him to "our" park on the bluffs, a popular spot for watching the migrating whales. We shared lunch... walked on the grass, in the sun... and then I propped his head up on a pillow in the backseat, left the door open so he could see outside with what little sight he had left. It broke my heart every time a dog passed by and the sound of tags against collars would make him raise his head to investigate, but he could see nothing. We spent the afternoon there, and he seemed... content, even a bit perky, and it left me hopeful. Nevertheless, as we drove, I told him that if he were tired and wanted to be free, that he can let me know by not eating and drinking anymore, or by having a seizure. Because if any of those did not happen, I could not get myself to take action to end it for him. (I had asked Tank for permission a few days prior, to let him go if he seizures again because I could not make him go through trials of various medications again. And my husband agreed that he did not want Tank to go through that anymore.)

That night, Tank had a seizure. I was devastated. I told him, yes, I asked for a sign, but why so soon!! It took us over an hour to finally gather the strength to take him in - we kept changing our minds, saying we should try potassium bromide or something else and maybe he wouldn't have any harsh side effects... but he would still be blind. And still not know his routine or his way around the house. And still be unable to go for his beloved walks. And still just be in his bed all day. It was the longest car ride of our lives. I kept changing my mind. Even in the room, waiting, I kept changing my mind and wanted to bring him home. It was gut-wrenching because he was still walking and eating and drinking. He even walked into the room after they put his catheter in (I had asked him to be sedated first because I couldn't bear to see him so alert, but the vet sedated him AFTER she brought him in. It tore me up.) We fed him his favorite chicken before we left the house, and even though he was still disoriented from his seizure, he ate it all. How could we let him go when he is still so physically up and about like this?? If he had stopped walking, stopped eating... or started having breathing problems or was in obvious distress, it makes the decision so much easier. I now feel like it was me who took his life and there will always be "what if's" and regrets and guilt. My husband has been bawling for the past two days and is taking it extremely hard, and I feel like I should have just brought Tank home. But at the same time, what would he be doing right now if I did - getting up every hour to drink and pee (he needed help each time because he hobbled around, lost), hurting from all the calcinosis cutis that had formed into hard plates and erupted everywhere, unable to see anything, just in his bed all day, possibly feeling nausea or getting diarrhea from new seizure meds, still feeling icky from still uncontrolled Cushing's, headaches and vertigo from the macroadenoma (he was restless at times, unable to settle comfortably in his bed), feeling the effects of his hip dysplasia and arthritis... what kind of life is that for him? I don't mind taking care of him or spending money we don't have on him (credit cards are racked up now and I was laid off a year ago). I was up at all hours for the past year tending to him and even though I haven't had two hours of continuous sleep in that long, if he were on the road to better health and could see again, I would've kept trying. But I failed to fix him. I changed my mind so many times that night. I wanted him alive regardless of the condition he was in. Even the vet was trying to change my mind because, as you said Marianne, there wasn't an obvious crisis that was there. But I told her my Tanky is tired. That the pheno made him fall a thousand times a day (day after day after day while the vets told me "he would get used to it") even when I tried to steady him and prevent it, and that it didn't help his hip dysplasia or arthritis any. That because he couldn't see, he would bump his head into things, not helping the pain he already had from his tumor, or miss a step and come crashing down and knock his chin on the concrete when I couldn't get to him in time. That he would often sit up or turn around in his bed, or just sit and look me in the eye when he could still see, and I knew he was uncomfortable, that something was going on inside him that he couldn't communicate to me. I always thought it was pain, and I couldn't do anything about that either because of his prior reaction to Tramadol and the vet said there was only NSAID's which she didn't want to give because of possible ulcers. That because he lost his sight, he was unable to do the only thing he enjoyed-go for walks. He was always more of a sight dog, not a scent one. He liked to watch ants crawl across the dirt, or watch spiders or butterflies. He never explored and sniffed around when we walked, just moved forward, taking everything in with his eyes. I can only imagine how he must have felt when he could no longer see. It was probably the biggest factor in all this. If he still had his eyesight, I would have broken my promise to him, to my husband, and to myself, and brought him home to try new seizure meds. I would have kept trying.

There will always be regrets and doubts. I miss him every minute and have been a complete mess. The circumstances around his death are why it's so painful. I had a Rottie who was with me for 15 years before he died on his own at home. I was not so broken up about that because he had lived a long life and went on his own. Tank was with us for not even seven years. It will be seven years end of April. It was too short! And he did not go on his own. I decided to let him go. Now I wonder if he even wanted to be let go. Maybe he was content in his horrible condition. And I agonize over how he might be still wandering the hospital, blind and lost, looking for help from us. I want to believe that he is now healthy and happy, that he has left behind his battered body, and is running and spinning and being truly "alive" again. I asked him to give me a sign that he is ok because even though I still want to be there for him to protect him and make him as comfortable as I can and give him all that he wants and needs, I can no longer see him so I can no longer do it. I hope he understands. I hope this is what he wanted. And I hope he will come meet me when it's my time to go. I can't wait for that day now.

He was brave to the end, never complaining, let me do anything to him, always went quietly with the doctors and techs... he was the sweetest dog ever, just so laid back and chill, let a dozen kids sit on him and pull his tail and ears and just tolerated it all... brought over a baby opossum once in his mouth and dropped it at our feet, didn't harm it in any way, just like he never harmed his squirrel friend whom he once let steal from his mouth a walnut. There's a video of him and his squirrel friend (we named Girly-Chu) at thetankster.com. It's a website I played with years and years ago that I haven't updated since forever. I will take it down soon, as it's too painful for me to even think about now. They say time heals, but the only way I, or my husband, will heal is when we get our healthy and happy Tanky back.

Thank you to everyone who has helped me and Tank through all this. When I first posted here, I was looking forward to being on the road to recovery, and looking forward to him feeling well again. I never imagined it would all end merely twenty days later. Did it end well? I'll never know. If this is what Tank wanted and he is healthy and happy now, then yes, I can say it did end well. I only know that it did not end well for me because of the circumstances and because I do not have him physically in my life anymore. I hope he will, one day, allow me the privilege of being in his life once again, like he did that day almost seven years ago, and let me hug him and sneak him vanilla ice cream, and create good times and sweet memories, and take leisurely walks in "our" park by the lighthouse like we once did not too long ago. When that time comes, it will not be soon enough, and it will be an agonizing wait, but I'll see you again, my sweet Tankyboy, one day soon at the Rainbow Bridge.

I miss you.

[Harley PoMMom]

Dearest Lisa,

I am so very sorry for the loss of your sweet boy, Tank. My heart goes out to you at this most painful time. I truly believe your decision to free Tank was the right one so do not let any guilt creep in as it has no place to do so. You have made this difficult decision from the depth of your heart with love and taken Tank's pain and made it yours.

We do understand the heartbreak you are feeling and are here for you. May the happy memories soon began to replace the sad ones.

With Heartfelt Sympathy,
Lori

[Squirt's Mom]

First, I want to tell you and your husband how terribly sorry I am for your loss and the pain you both carry in your souls.

Second, while I know you cannot see this now trust me when I tell you that today Tank is free, whole, strong, and oh so very grateful to the both of you. What life cruelly took from him, you gave back with your final gift.

Many of us here can relate to the feelings you are experiencing now - the second guessing, the endless "what ifs", the overwhelming guilt, even fear and anger. I still put myself through the same thing about my sweet Crys but the fact is, nothing else could have been done by anyone - there was no recovering, no anticipating better days ahead, and no other choice to make as a result. What matters most is this - our precious babies left this old Earth on the wings of our love, lifted high and freed from their suffering bodies. As an old friend here said, "We take their pain and make it our own." There is no greater love than this.

Please know that we are here anytime you wish to talk, you or your hubby.

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


Love’s Final Gift
By Cheryl Goede

I know it is hard on you, there are no words that can describe
the piercing sorrow which does not lessen with time.
...
When you had to bring me with you, on that last car ride to make,
all the while knowing the course of action you needed to take.

I know you feel guilty, I feel your sorrow, it’s true,
I could always sense your each and every mood.

When they called my name I knew that your heart was breaking,
you carried me to the room…getting closer to my new awakening.

The friendly doctor I know gave me treats and spoke low,
he was giving you the time that you needed to let me go.

All left the room, and you gathered me close,
as you wondered how you could do this for me when you needed me the most.

I tried to convey, my last wishes to you,
I looked into your eyes with all the love you are used to,

Mom and Dad, this earthly body has served me well,
but the time has come for us to part, to no longer dwell.

You understood the signal, and knew it was time for me to go,
but before I leave there is just one more thing you should know.

I will look out for you, each day I will guide,
my spirit in some way will always be nearby.

Before I make it to the Bridge to stay,
I will return the love tenfold in hopes for my debts to be paid.

For when that new pup or dog will enter your world,
a new love will blossom and slowly unfurl.

I hope you realize that new dog is Love’s Final Gift,
sent from me, your baby girl.

That new dog was chosen by me, to lessen your pain,
like the gentle warmth of the sunshine after the rain.

When you hear him bark, it’s my bark too,
when he cuddles you close, it’s what I would do.

So open your heart when the time comes to see,
that the love he gives comes also from me.

Take comfort, hug him, and reminisce
as he gives his love freely in the form of a dear doggy kiss.

It’s what I would do, if I still could,
and what you would want that is understood.

But the time has come to let me go,
to make that unselfish choice, even though tears will flow.

Hold me, cherish me, until my last breath,
but please don’t look at this as my death,

Someday we will be together again, come close for one last kiss,
I know this it true, as it is my soul’s last earthbound wish.

Now I can feel my spirit floating it is traveling high,
as though I were a cloud in the endless blue sky.

Please find peace, you have honored my life with this,
For I have been reborn through your Love’s Final Gift.

[Squirt's Mom]

Tank has been added to our In Loving Memory list for 2012 where he will always be remembered and honored as part of his k9cushing's family.

http://www.k9cushings.com/forum/showthread.php?t=3918

In time, as you are ready, we would be especially honored to share in the stories of your lives together. We have a special forum for tributes/memorials here -

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

[nibbles-mommy]

I haven't been posting much but have been following Tank. I know exactly what you are going through. And i'm very sorry for your loss. I have such feelings of regret also and almost walked out with him a bunch of times. I've updated Nibbles' thread.

[Cyn719]

I am so sorry for the pain you and your husband are going through...I know this was so hard for you to do....no words can help right now but I do hope you know you both gave Tank a beautiful life and he knew that......i know it does not make it easier but he gave you the sign you were looking for ....

Sending you lots of support, strength and prayers

Angel Tank will never be forgotten

Xoxo

[TheTankster]

You have made this difficult decision from the depth of your heart with love and taken Tank's pain and made it yours.




Lori, thank you so much for all your support. Tank says thank you, and I say thank you for the above words.

[TheTankster]

Tank is free, whole, strong, and oh so very grateful to the both of you. What life cruelly took from him, you gave back with your final gift.



Leslie, thank you for the beautiful poem, and for those beautiful words.

[TheTankster]

I am so sorry about Nibbles. It sounds like he had the heart to go on, but his body did not want to follow. It would have been cruel to keep him around, just like it would have been cruel to keep Tank around any longer. I hope you are doing well. Hugs to you.

Cindy, thank you for your kind words. Tank was and always will be my angel.

[nibbles-mommy]

I haven't been posting about Nibbles. But when I saw your post and how torn you were with your decision, I wanted you to know that you aren't alone.

Like I posted about Nibbles, "In my mind it was the right decision, but not in my heart."

You have my deepest sympathies.

[Jenny & Judi in MN]

I am so sorry. It sure sounds like the Tankster was not enjoying his life anymore. I really really think you did the right thing. hugs, Judi

[lulusmom]

Lisa, I am so terriby sorry for your loss. My heart melted every time I looked at Tank's picture...such an adorable pose. Now my heart breaks for you and your husband during this very difficult time. My thoughts and prayers are with you both.

Glynda

[k9diabetes]

I'm so sorry to learn of Tank's passing and how difficult it is for you.

When you have a dog with something that isn't getting better and is robbing them of a quality of life, it is very hard to know "when" is the right time. But in that situation... there really isn't a wrong time. The only wrong time is to have waited so long that they have suffered physically. You let Tank go when there was nothing more to be done to give him a quality life back and before he was suffering, which is a loving thing to do.

Our dog Chris was diagnosed with cancer two weeks before we let him go. One day he started bleeding internally from the tumor and was very weak. Not in pain most likely, just very tired. But he couldn't take himself out to potty and that was devastating for him. He panicked and flailed... that's when we knew that even though he was still "with" us and even though he ate two of his favorite thing in the world a few hours before we took the final journey to the vet, that his life was only going to get worse in the future and there was no fixing it.

You tore apart your own hearts to do what was right for Tank.

Natalie

[lauraperla]

Dear Lisa,
I am so sorry for yours and your husband's loss.
These early days of raw pain are awful, my heart aches for you.
Your boy knew he was loved and special and you were blessed with the same in return, please take what comfort you can from that love.
Thoughts are with you.
Laura and Saoirsexx

[mytil]

Dearest Lisa,

I am so very sorry your sweet boy has passed on.

I know how incredibly difficult the decision is to make and how your heart is completely torn into a million pieces. Please be kind to yourself about this. He was telling you Mom, it is time for me to go and do not worry we will meet again and I will be happy and healthy then.

Deep peace of the quiet earth to you and your husband, deep peace.
Always in Loving Memory of your boy
((((hugs))))
Terry

[jmac]

Lisa,

I, too, am so sorry to hear about Tank. I understand what a difficult decision that must have been, but I believe you did the right thing. It is so easy to feel guilty and wonder, but as I read your post it was clear that all of the joys Tank had were taken from him. It doesn't sound like he could have been happy in the state he was in. It is so much more difficult not to think of ourselves and what we want, and instead to do the best thing we can for our pets-help them to go, so they can again feel happy, pain-free, and healthy. That is what you did for Tank.

I'm thinking of you and your husband...

Julie & Hannah

[frijole]

Lisa, My heart ached reading your post about Tank as I could relate so much to what was a very hard and unselfish decision. Its a month tomorrow since I did the same and it still hurts. Just know you were a terrific mom and you did what was best for dear sweet Tank. I hope our babes our both playing together as we speak. Bless you and our newest angel. Sending love, Kim

[mypuppy]

Hi Lisa,

I don't believe I had ever posted on your thread, but in times like these, this is when our K9 family all unite to show our support and deep pain in the loss of our beloved furbabies. I am deeply saddened for your great loss of Tank. What a cutie he was, and I went on that website and watched the video with him and the squirrel, and it just brought tears yet smiles at the same time. What a sweet, sweet gentle soul he was indeed. May you one day cherish all those wonderful and sweet memories of your precious baby to help erase his final and awful moments. Please do not look back on all of it. We here on the forum can only sense the great love and care you provided for that boy, as we know so did your sweet Tank. He will always be with you in spirit.

May God Bless you and your precious Tank always.

Tight hugs and love, Jeanette and Princess

[Sabre's Mum]

Lisa,

I am so sorry to hear of you loss of The Tankster. Please don't be hard on yourself for the decision you have made to release him. You made the kindest decision for Tank.

My thoughts are with you and your husband.

Take care
Angela and Flynn

[TheTankster]

Thank you to each and every one of you who offered such comforting words of consolation.

Debbie, I am with you on how you feel about Nibbles. My mind rationalized and told me what to do, but my heart is broken into a million pieces over it.

Natalie, you also "tore apart your own hearts to do what was right for" Chris. I always keep going back to how much more difficult it is when our guys still have a good appetite, like Tank and Chris did. But I would like to think that I don't ever want to let it get to that point in the first place, when he stops eating, for then perhaps I waited too long.

Kim, I am deeply sorry about Annie, and yes, I do hope they are playing together, too. :)

Jeanette, thank you for seeing Tank and his squirrel friend, and for your kind words. I know he is with me in spirit... now if only I could hug a spirit. :o

Thank you, Glynda and Judi, Terry and Laura, Julie, and Angela. I go back and read everyone's posts every now and then and find comfort from it all. It takes away the pain for a moment, and then I beat myself up again all over. One day I hope I can finally conclude that I made the right decision, but for now, all I can do is try to heal.

Thank you again for all your kind words.

[marie adams]

Dear Lisa,

I am so sorry to learn of The Tankster's passing.

I so agree with the saying of I know in my mind I made the right decision, but my heart is breaking into a million pieces. I think that says it all for all of us. It brings back the vision of the day we made that decision knowing it was coming, but not wanting to make it final.

Tank knows you did the right thing in letting him go onto the Rainbow Bridge. It is easy for people to say not to feel gulity, but it runs through your mind--it even still runs through mine--what if....but I know in my heart there really wasn't a what if because at the time it was the right decision.

Please keep coming back to help with your healing--it really helped me and I am still here....:)

((((HUGS)))))

[Casey's Mom]

Oh what a beautiful tribute to your Tankster. He was so very lucky to have wonderful parents like you and your husband. You did all you could and don't for a minute beat yourself up about it.

I put my girl to sleep two months ago now and still miss her terribly but in my heart I know that it was time, that even though she didn't show it she was in a lot of pain. We will see them again one day I am sure of that.

Love and hugs,,

[TheTankster]

Thank you Marie and Ellen. I am sorry you had to go through the same thing, but your angels are with you now. I still feel like I killed my Tanky. And that I didn't do enough for him. I feel like I should have let him be until he was no longer mobile and no longer eating... So what if he was blind and so what if he always left the room to be by himself, so what if he never wagged his tail... Maybe his condition didn't bother him at all. Maybe it was just me who thought he had no quality of life left... I still see him walking into the room for his injection. It haunts me everyday and night. I still see his "unseeing eyes". I still feel like I ended it all too soon and regret it every minute.

[lulusmom]

Lisa,

Based on the short time I've come to know you, there is no doubt in my mind that every choice you made for your precious Tankster was the right one. Unfortunately, the most difficult decision we will ever have to make for our babies is one that comes back to haunt us. The feelings of guilt, the second guessing and even self loathing are the normal reactions of a loving, nurturing and emotionally wounded human with a shattered heart, who longs to have their baby back in their arms.

I read an article earlier in the week in a little throw away newspaper entitled Preparing for Goodbye. I kept it in my purse because I had every intention of scanning it and sharing it with you when I found the time. Fortunately I was able to find it online and have provided the url below.

http://www.usaweekend.com/article/20120323/HOME05/303230016/Preparing-goodbye

(((Huge Comforting and Heart Healing Hugs)))

Glynda

[mytil]

Dearest Lisa,

You did everything you could for Tank, including letting him go with his dignity. I know this may not seem like comforting words just now, but in time they will.

I truly know the incredible pain you are feeling and hindsight of what if I did more or did it sooner. You just plain miss him and it physically hurts.

I lived with this pain for a very long time, years ago when I had to make that same decision with my soul doggie, Mytilda. I still miss her, but after all these years I can remember the great times and smile.

Remember, there is no set time line for grieving. It is a process. But know we are all here to listen and comfort you.

My continued (((hugs)))
Terry

[Jenny & Judi in MN]

my heart breaks for you that you are still eaten up with guilt. I think you loved Tank so much you'd be doing this either way.

A woman I work with had a cat she loved so deeply. For 9 months getting her to eat was a struggle but she would eat. Her health was deteriorating but this woman could not make that hard decision.

She came home from work one day and her cat, who i know she loved more than anything, had had a seizure and was paralyzed and blind laying in the hallway. We don't know how long the poor baby laid like that. They took her to the vet and ended her pain.

She beats herself up that she waited too long. And she probably did. But that cat knew she was loved unconditionally and I'm sure has forgiven her.

If I had to error in making this choice I wouldn't want to see my fur baby in the hallway the way she found her cat.

I'm so sorry about Tank. Judi

[addy]

Oh dear, I don't think Tank would want you to be feeling guilty. What if is easy to fall in to. Please don't go there because you and Tank deserve so much better than that.

It is, after all, about quality of life and leaving this world with dignity. You are heart broken and grieving and it may take along time to let go of the pain of your decision. It is such a hard decision to make but it is always made out of deep love and respect for a sacred trust and bond.

We are here for you and you can always come and pour your heart out.

I followed your thread and the love that jumped from the pages was true. I hope you find comfort in your memories soon. I am so sorry it is so hard. The pain is so terrible because the joy was so great.


love,
addy

[TheTankster]

Glynda, I needed that article. I really needed those words. Even though you and everyone in this forum has given me so much support in your own powerful words, it was nice to read that article. I forwarded it to my husband, but I don't know if he will read it. He is taking this harder than I am. I am also going to print it out and keep it, as they might one day take it offline. Thank you so much.

Judi, I wouldn't want to see Tank like that either. But I'm still haunted by "too soon". If he ever ended up like that poor kitty, it would be "too late". With euthanasia, there's never a right time.

Terry and Addy, your words are comforting and they mean a lot to me. I still come back here and read all your posts. Thank you so much.

Today I am picking up Tank's ashes. Just thinking about it... I don't know what to think. It will be what's left of my cuddly chunky monkey. No longer huggable. :(

[MBK]

Lisa,

I haven't been here for awhile, so I never had the opportunity to "meet" you. But, I just read Tank's story and saw his pictures and my heart is breaking for you. Tank was a lucky little guy to have been rescued by people like you and your husband. You loved him so much and knew him so well that your decisions for him HAD to have been the best. You did everything possible for him and in the end your were selfless to let him go. You have nothing to feel guilty about. I hope time lessens the pain you and your husband are feeling. Take care of each other.

[Squirt's Mom]

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

[TheTankster]

Thank you, Mary Beth, for your kind words. But it was my husband and I who were the lucky ones. :)

Leslie, lighting a candle for Tank made me cry. Thank you so much for your kind gesture.

We picked up the ashes Friday and brought him home with us that night. The next day, we walked all his favorite routes, stopped by his favorite parks and favorite Petsmart, and our old home where he spent six of his seven years with us, and left a little of him everywhere... I jokingly tell him how unfair it is that he gets to be by the ocean all the time now, and I am stuck in the icky city.

The guilt is still there, and I continue to beat myself up about it being too soon. I would have taken him to a neurologist and an ophthalmologist... I had actually found the place to take him. I only needed to make an appointment. Maybe if I waited a little longer, he would not have had anymore seizures, and it wouldn't have been a cluster episode where he needed Valium and needed to be on phenobarb, like last time. Why didn't I just wait a little longer... maybe if I didn't use the eye ointment (which had steroids in it), what if I had stayed with once a day Trilostane instead of twice a day (that was his first day on twice a day dosing)... if only i had done a CT or MRI to confirm it was truly a macroadenoma causing all these symptoms and nothing else could be done about it... maybe if I had turned off the TV sooner... stupid little what if's, but why's, and maybe's... I hope in time I will feel better about it all. Because right now, all I can think about is the day I get to see my Tank again, at Rainbow Bridge.

[marie adams]

Dear Lisa,

I wish I could take the guilt away for you. I too went through that a year ago. The what ifs, if only, and I should haves--I think we all go through this. I also lost my mother two months after Maddie so last year just was so stressful and sad.

To add to the stress we got Ella another Aussie at 8 weeks old--kinda of forgot all the puppy antics. She just turned 1 yesterday so it should be smooth sailing---sure...!!:eek:

Please let us know how we can help you through this...:o Take care!!

((((HUGS))))

[TheTankster]

Thanks, Marie. I'm so sorry about your mom and Maddie. What a tough time it must have been for you. But on a brighter note, I hope Ella is keeping you busy in a good way. :)

You and others on this forum have already helped in a huge way. Thanks so much. You guys take care.

[TheTankster]

After reading about Sage and Koby, I realized I never really gave a complete list of all the neurological symptoms Tank had. Most are familiar to other members here. In fact, I think all the symptoms he exhibited, I've seen others here describe.

Before Cushing's treatment, he would what we called, "zone out", or "space out". One minute, he was just standing there, next minute he had his head lowered and would stay in that position for a long time, sometimes until one of us would nudge him back to life. He started doing this about two-three years ago. There were also (two) instances when he just dropped to the ground, fell flat on his side, was stiff, then recovered instantly after we helped him up and gave him water to drink. This happened after the Cushing's symptom began, just last summer. We'd always attributed it to the weather being hot and him getting only minimal amount of water (both times we were out walking). This made me suspect diabetes insipidus, but that's a whole different story... There was also a squinting of the right eye. Not severe and only on occasion.

Before treatment and after Cushing's symptoms began, vet noticed mild anisocoria, when the pupils of the eyes are different sizes from one another. He also started shivering, just in the shoulder area, and more pronounced on only one side. I think it was the left. He would stop if I covered him with a blanket. It was winter at the time, so I left it at that, but at the same time, I found it odd that the rest of his body remained so still. About that time, he also started with a head bob, a dip of the head (forward) once or twice. There was also the "drunken gait" and weakness of the hind legs. He also licked the air a lot and opened his mouth wide, but most of the time, they weren't actual yawns. He even did this at night. And he stretched his neck a lot - nose pointed skyward and stretched and groaned.

After Anipryl, he had cluster seizures, four hours apart,each time.

After stopping Anipryl and starting phenobarbital for the seizures, the head bobbing worsened a hundred fold to the point where he could not balance to drink or pee. Or even sit up straight. I can't forget his sad, sad eyes as he looked at me, rocking so unsteadily I had to help him sit up. Excruciating memories. Myoclonus also started - a sudden and sharp jerk of his head, backwards this time,the opposite direction of the head bobbing. He'd had this before as a side effect of a single low dose tab of Tramadol, which was also a recent occurrence, just last summer after Cushing's symptoms began. It happened more often when a hand or an object would go close to his head, but it also happened when he would just be laying there, and never when his head was at rest. Always when he had his head up. On occasion, with the myoclonus, he cried out, as if in pain, but I'm not sure the reason behind it was actually pain because in the past, he used to cry out in surprise, when something startled him (he was a scaredy-dog, afraid of everything). He then "forgot" how to drink - once it took him half an hour to get started. Other times, it would take him a few seconds to get going. When he ate (was handfed),he would stop intermittently,and all actions would freeze, even in mid-chew, as he zoned out for a few seconds,then resumed eating. One morning,he woke up with yellow discharge from his right eye and was either squinting it or keeping it shut. Vet said it was dry eye... He also, we're guessing, had a stroke. He did not know his way around the house,or his usual routine of when to eat breakfast, where to pee, etc. And he tried to get into tight spaces, like behind chairs, into cabinets...

After stopping phenobarb and starting Trilostane, head bobbing slowly diminished to an occasional single bob. Right eyesight started to diminish as well. He didn't circle, but he tended to walk toward the left, I'm guessing because he could see better out of his left eye. Within days of this occurring, he could barely see out of either eye anymore. He kept his walking to a minimum and when he did, he bumped into things. His hearing was still very acute though. He also started sniffling a lot, and sneezing (no discharge though). Myoclonus turned into only slight tremors and eye-blinking. He started "yawning" again, but this time, would not be able to open his mouth all the way, for he reacted as if something painful would stop him from opening any further, and he would jerk to a stop. The day hisTrilostane was increased back to its original dosage, he had another seizure.

I also saw in a different post somewhere else, of something Tank did, and it was a focal seizure. When he had his first set of seizures, they always started with fast blinking of the eyes and a curl of the lips, as if snarling, and after a few seconds of this, the grand mal started. He kept doing this even after he started phenobarb - the blinking and the "snarling" - but it never went beyond that, and it stopped entirely after a day. Until the day I increased the Trilostane. Same thing - blinking and "snarling" and then the grand mal. I don't remember where that post was or who the mom/dad or cushpup was, but he/she was unaware that this is a true seizure. A focal seizure and not "the big one", but it's still a seizure, so if you read this, or if someone knows who it is and can relay the message, please watch your baby!

Hope this helps.

[LillyMae]

Well, I just finished reading your story of Tank & am now bawling my eyes out. I would like to say how sorry I am for your losses & that Tank was very lucky to have you & the other way around. I know the joy these babies bring to your heart & home & the void in both when they pass on & I know that you are a better person for having shared your Love with your sweet Tankster. My LillyMae also has cushings & has some of Tanks symptoms & I thank you for posting his symptoms for myself & others. I also would like to add for others reading here that some of the symptoms you have mentioned can also be symptoms of Chiari malformation . Our sweet Sassy passed away at the age of 11 yrs from this terrible congenital & hereditary deformity.
R.I.P Sweet Boy
Hugs, Deb & Mae