10 year old Pointer girl - Saoirse has passed

[lauraperla]

Hello everyone, my Name is Laura. Our German Shorthaired Pointer Saoirse has had a Cushings diagnosis for 2 years now.

She has been treated with Vetoryl for 2 years now with varied success. The Vetoryl seems to work clinically - though with varied effectiveness- in terms of the adrenal control shown by the acth tests,(although her blood tests have consistently shown raised AP and cholestrol levels) but it has never managed well the physical Cushings symptoms she has - symmetrical hair loss in several areas of her body, increased thirst and urination, pot belly, muscle weakness, hunger.
Her present weight is 34kg (pre Cushings she was usually around 28kg) and her Vetoryl dose is 80mg per day split into 2 doses. The dosage has been changed by our vet multiple times in the 2 year period in a range of 60 to 100mg.

Getting to the end of my wits with it all, I requested a referral to a specialist veterinary hospital 200 miles away, and we have been there for 2 days this week for a consultant examination, bloods including acth, urine testing, an MRI scan and skin scrapes.

The consultant feels that the Vetoryl is not doing its job properly and wants to switch her to Lysodren. We are in Scotland and Lysodren is not licensed for general use in the UK, we would need to get special permission to use it which the consultant feels we have a good case for.
The consultant diagnosed that Saoirse also has severe arthritis (our local vet has been adamant that she had muscle wasting from the cushings and that was causing her mobility problems) and she has been started on a combination of metacam and tramadol.

We lost Saoirse's sister to cancer last October. I've felt since then that the Cushings (and arthritis) has really progressed dynamically.

Once the consultant has the most recent acth results he is going to contact me - probably early next week -to confirm his care plan for Saoirse.

I have been educated and informed so much by this site, you are an amazing group of people and I would like to thank you so much for providing this fabulous resource.

[Harley PoMMom]

Hi Laura,

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

Could you provide us with more details about Saoire and the Cushing diagnosis? Such as her weight and if you could get copies of all the tests that were done to confirm her diagnosis of Cushing's and post the results here that would really help us to provide you with more meaningful feedback, ok?

Vetoryl/Trilostane has to be given with food to be properly absorbed, did your vet mention this? Also the timing of the ACTH stimulation tests have to be done 4-6 hours after the dose of Vetoryl/Trilostane, has this protocol been followed?

One of the experts in Cushing's, Dr. Feldman, recommends a wash-out period of at least six weeks before switching from Vetoryl/Trilostane to Lysodren and vise-versa. Has this been mentioned by the vets?

Since other non-adrenal illnesses, such as diabetes and thyroid problems, share the same symptoms of Cushing's they should be ruled out, have they been?

I am so sorry for all questions but the more we know about your sweet girl the better we will be able to help you help her.

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

Love and hugs,
Lori

[lauraperla]

Thank you Lori.

Saoirse's present weight is 34kg, her pre diagnosis weight averaged 28kg.

I can confirm that her vetoryl is always given with food and her acth tests are always performed within that 4 to 6 hour window.

I have had considerable problems obtaining copies of any test results from my vets. They have advised me that it is not normal practice to give owners copies of results. However I stamped my feet and caused a scene in their reception last week saying that I had to have them prior to my trip to the veterinary hospital. They gave me copies of the last 3 acth results and the last set of bloods.

Result 14 Feb 2012 (80mg daily dose)
pre ACTH 77.5 nmol /L post ACTH 60.7 nmol /L
They also tested her Thyroxine that day, it was 10.2 nmol / L

Result 7 Dec 2011 (70mg daily dose)
pre ACTH 150.0 post ACTH 172.0

Result 8 Aug 2011 (70mg daily dose)
pre ACTH 72.6 post ACTH 125.0

Her 7 Dec 2012 (most recent tests) blood results were
ALB 29.00 ref 22-39
ALKP 851.00 ref 23-212 High
ALT 104.00 ref 10-100 High
AMYL 324.00 ref 500-1500 Low
BUN 3.80 ref 2.5-9.6
CA 2.66 ref 1.98-3
CHOL 13.44 ref 2.84-8.27 High
CREA 68.00 ref 44-159
GLOB 37.00 ref 25-45
GLU 7.18 ref 4.11-7.94
PHOS 1.68 ref 0.81-2.19
TBIL 8.00 ref 0-15
TP 67.00 ref 52-82
NA+ 150.00 ref 144-160
K 4.60 ref 3.5 - 5.8
CL 113

I do not have any numerical results from her blood tests this week at the hospital but their diagnosis summary advises that she has raised AP, triglyceride and cholesterol levels.

I take a urine sample in every time we have a consultation, her urine is always dilute.

She had an abdominal MRI scan, this showed enlarged adrenal glands, a 'large and bright' liver. They also found an enlarged cyst like structure on her left ovary and they have sent samples to evaluate ovarian hormone function (she is not speyed but she has not been in season for at least 3 years).

I would imagine that the consultant would discuss the wash out period with me (although he did mention that there would need to be withdrawal from vetoryl prior to lysodren loading) when he confirmed any medication change but it is invaluable to know this in advance of any discussion with him.


I'll post the acth result from this week as soon as the hospital advise me of the result.

Thank you for looking at this for me

Laura x

[Harley PoMMom]

Thank you Lori.

Saoirse's present weight is 34kg, her pre diagnosis weight averaged 28kg.

I can confirm that her vetoryl is always given with food and her acth tests are always performed within that 4 to 6 hour window.

Saoirse's weight when converted to pounds equals 74.8lbs, so it seems that the dosage that she was on should of been adequate but if her symptoms are not resloved and/or returning or worse in the evening she might benefit from twice a day dosing.

Here's a excerpt from Dechra's Product Insert:
However, if clinical signs are not controlled for the full day, twice daily dosing may be needed. To switch from once daily to twice daily dosing, increase the total daily dose by 1/3 to 1/2 and divide the total amount into two doses given 12 hours apart.

This information and much more can be found here: Dechra's U.S. Product Insert. (http://www.dechra-us.com/files/dechraUSA/downloads/Product%20inserts/Vetoryl.pdf)



Result 14 Feb 2012 (80mg daily dose)
pre ACTH 77.5 nmol /L post ACTH 60.7 nmol /L
They also tested her Thyroxine that day, it was 10.2 nmol / L

Result 7 Dec 2011 (70mg daily dose)
pre ACTH 150.0 post ACTH 172.0

Result 8 Aug 2011 (70mg daily dose)
pre ACTH 72.6 post ACTH 125.0

I am so happy to see that the ACTH stimulation protocols are being followed! So many GP vets are not aware of this.

We are used to seeing the ACTH results in ug/dl, so I am converting these too: 2/12/12 - pre = 2.8 ug/dl, post = 2.2 ug/dl; 12/7/11 - pre = 5.4 ug/dl, post = 6.2 ug/dl; 8/8/11 - pre = 2.6 ug/dl, post = 4.5 ug/dl.



Her 7 Dec 2012 (most recent tests) blood results were
ALB 29.00
ALKP 851.00
ALT 104.00
AMYL 324.00
BUN 3.80
CA 2.66
CHOL 13.44
CREA 68.00
GLOB 37.00
GLU 7.18
PHOS 1.68
TBIL 8.00
TP 67.00
NA+ 150.00
K 4.60
CL 113

Do you have the reference ranges and units of measurements for these levels? If so, could you post these too.

I am so sorry for the loss of your other furbaby, it is so hard losing them and my heart goes out to you.

Love and hugs,
Lori

[lauraperla]

Lori, thank you.
She has been on twice daily dosing for the last 18 months. She gets 2 x 40mg doses at present, 12 hours apart. However when her dosing structure was modified to twice a day, the dosage was not increased as your extract from Dechra's information stipulates, simply her dosage at the time was divided in two. So maybe this could be why the vetoryl does not seem to be working? Again useful information to have when I have the teleconsult with the IM specialist whenever he gets the results from this week's tests.

Unfortunately the blood test print out does not give me measurement units but it does give me reference ranges for some so I'll edit those in.

Thank you for converting the acth to your usual units, its something I've been scratching my head about!

[Harley PoMMom]

Lori, thank you.

Thank you for converting the acth to your usual units, its something I've been scratching my head about!

To convert nmol/L to ug/dl you divide by 27.59. Took me a while to get that! :eek::D

[lauraperla]

To convert nmol/L to ug/dl you divide by 27.59. Took me a while to get that! :eek::D

Thank you! I am writing that down in big numbers on the cover of my Saoirse file!!!

[lauraperla]

Hello again everyone!
1 week on, I am still waiting for the IM consultant's feedback. I'm trying to be patient as I strongly suspect that he is waiting for a response from the licensing authority as to whether we will be allowed the special licence we need to use lysodren.
In the meantime I've been watching how Saoirse is adapting to the arthritis meds and it's so far so good, she certainly is much more comfortable and while still lame she's showing slight improvements in mobility. Last week at the end of our 2 days road trips to the hospital she looked wretched and miserable, she's much happier in herself. Thankfully she is handling tramadol well, unlike her big sister who struggled badly with it. No sickness from the meta am- she had one bout of vomiting this week but that was caused by stealing forbidden food (bee candy would you believe!!!)

I don't feel there's much more I can tell you until I hear from the consultant, but I did want to ask for any recommendations you have for supplements. At the moment she gets glucosamine, fish oil and milk thistle daily and a probiotic too. Does anyone have any views or recommendations?

[jmac]

Hello Laura!

I just wanted to welcome you and Saoirse to the site. You are doing an excellent job advocating for your girl, and seeking out treatment and answers. Good for you! I am so glad you stomped your feet for test results-I absolutely think you should have them. My vet either gives me a copy while I am there or sends me one if they get the results later. They are a must in case I need to go to an ER clinic or if I am out of town, etc.

I am glad to hear Saorise is doing well on the arthritis meds so far. I am hoping you will hear from the vet soon about the recommendation for treatment.

You are right that you have found a wonderful and informative site with amazing people! The knowledge, dedication, and support is wonderful. I was so thankful to find these people!

We will be here to support you and Saoirse however we can!

Julie & Hannah

[lauraperla]

Thank you Julie for your welcome and kind words.
I am so thankful for finding this site, I feel that I am learning so much all the time and know that all you are teaching me is helping Saoirse too.
Thank you!

Laura and Saoirse xx

[lauraperla]

Update - teleconsult with IMS

I spoke with our IMS last Thursday (I've been desperate to get on and update you since then but poorly kids and countless activities got in my way).

Saoirse's ACTH test results were pre 1.08, and post 5.65 ug/dl. As this was only 2 weeks from her earlier pre 2.8 post 2.2 the IMS' view is that the Vetoryl is giving her erratic control. This is further supported by the fact that she has so many clinical signs of a Cushdog.

Having had a week (now almost 2) of tramadol and metacam with thankfully no side effects so far from either she is a much happier dog albeit still one with limited mobility due to the arthritis.

The IMS said he felt she was a candidate for Lysodren and we would be supported in getting the licence it needs over here but he is keenly aware of the fact that Lysodren can make an animal very ill indeed and the risks of getting it wrong are high and can have devastating results. He said that neither Lysodren or vetoryl will alter her life expectancy. Therefore our choice is to continue with the limited efficacy of Vetoryl - the safer option- or go for the riskier strategy of Lysodren.

I personally feel that the Vetoryl is really not working. If any of you came to my house today and just looked at her you would tell me that I have a dog with full blown Cushings and that I should seek treatment. And I think the lack of medicinal control from the Vetoryl, and thus side effects such as her pot belly and her muscle weakness, is contributing to her arthritis significantly. So my view is to go the 'riskier' route and switch to Lsyodren. Having talked through my reasoning with the IMS he said that if she were his dog, it would be the route he would take.

So we are now in the washout zone between the cessation of Vetoryl and the commencement of Lysodren. The IMS said we needed at least a week - with Lori's advice in my mind I said that I were concerned that a fast progression from one to the other may not give us a sound starting point. The IMS said he most of all would want to see her return to being fully cushingoid with an acth that supported that too, I relaxed a little after that because thinking of the timescales to get to that I think we will be at least 4 weeks in washout anyway.

After I came back from the hospital I started to monitor her water intake (I miss Saoirse's big sister terribly but I have to say monitoring water intake when you only have one dog is so much easier). When she was still on Vetoryl her average water intake was 88ml/kg daily, within 2 days of ceasing Vetoryl her intake was up to 125ml/kg and yesterday it went up to 183ml/kg. I am keenly watching half in interest half in horror to see where it ends up at!!!!

Both of our dogs had been 'home fed' dogs for several years and did well on it, but after Bracken, Saoirse's sister died, I struggled to keep Saoirse on a home diet that didnt give her the runs no matter how safe I played it. So reluctantly I put her back on to a complete food for mature dogs with added supplements etc. However I still would be happier with a home diet so I'm trying to see if we can at least manage a 70 home / 30 complete combi and see if we can keep her tummy steady on that. Its going ok at the moment leading me to wonder whether her earlier dodgy tummy was as much down to grief and distress as anything else.

I think its going to be quite a few weeks, with our return to 'full blown' and then going through the loading phase on Lysodren. I am working as hard as I can to get myself up to speed with managing loading and also with fortifying Saoirse as much as possible for the weeks ahead. Once again the information on here has been a huge help but all tips from anyone who has gone through this kind of switch would be most welcome!
Thank you!
Laura and Saoirse xxx

[lulusmom]

Hi Laura,

My two cushdogs have switched from Lysodren to Trilostane and back to Lysodren. Both times we waited until the dogs were overtly symptomatic. That didn't happen overnight. I seem to recall that it was at least two months and by then the post stimulated cortisol levels were well above normal.

Glynda

[lauraperla]

Thank you Glynda x
Can I ask why you made the changes, and also if your two Pups were overtly symptomatic before the medication was stopped?

Saoirse has so many symptoms that have not resolved with 2 years of Vetoryl that I am almost scared to think of where 'full blown' will take us!

At present she has-
pd and pu, increasing daily! her urine is so dilute she looks like she is peeing water
Voracious appetite
Symmetrical hair loss across her tummy, on legs, behind ears,
Pot belly and horribly thin skin on her abdomen
Bad skin scaling on elbows and nose
Fragile brittle claws
Muscle weakness / wasting especially on shoulders, flanks
The classic cushings rat tail
Low tolerance to temperature variations

We know from her bloods she has high ALKP and cholesterol. We know from her recent scan that her liver and adrenals are enlarged. also from recent tests we know that her blood pressure is at the high end of normal. She also now has a grade 1 heart murmur, apparently it's very soft but nonetheless there.

I am getting worried that, being in such a state at the start of the washout period, she may not even manage to get through this phase. It feels like the tramadol and metacam are the only things holding her together at the moment. As you can probably tell I am having a wobble this morning! Probably need a tramadol myself lol!!!

Laura and Saoirse xx

[labblab]

Oh goodness, you poor girls, both of you! It sounds as though you already have half of the "wash-out" criteria covered: the full-blown symptoms. Like you, I can't imagine wanting things to get much worse as far as that is concerned. :( :(

So the other really important piece is waiting until Saoirse's cortisol has rebounded to a level high enough to warrant starting Lysodren treatment. I have seen differing professional opinions as to how long a wash-out period is ideal when swtiching from trilo to Lysodren. The longest is a six-week period given by Dr. Feldman at UC Davis here in the U.S. I have also seen one month cited by another expert. And although I can't locate the quote right now, I believe I've also seen at least a two-week period endorsed by somebody else. All this leads me to believe that it is not so much a single time period that is written in stone, so to say. But rather an awareness that although the switch should never be made immediately due to dangers associated with residual drug effects on the adrenal glands, the exact time-table may vary from dog to dog.

Your vet may already have done this, but he/she might want to contact one of the technical representatives at Dechra directly (manufacturer of brandname Vetoryl), relay Saorise's situation to them, and ask their opinion regarding both the preferred degree of cortisol rebound and duration of a washout period in her specific situation. Our experience here is that the U.S. Dechra reps are happy to talk about issues such as this, and I would hope that would be the same with the U.K. office, as well.

Marianne

[lauraperla]

Thank you Marianne, that is a super idea. I know that our gp vet has had good success with contacting Dechra in the past. Whether it is the gp vet or the IMS consultant I speak to next, I'll be sure to ask them to consult with Dechra too.

I am conscious that, as we all find with the animals we have in our homes and hearts, that Saoirse will also take her lead regarding whether all is ok with the world from me. So having had my wobble I am focussing on being positive and thankful for what we have. It is only a few short weeks since I walked into the vet appointment feeling that she had truly had enough. Our IMS consult was a repeat visit and truly did feel like the last chance saloon. It is a Spring day here, calm and mild. I have all the windows open and the door to our sun room is ajar so she can wander in and out as she pleases. As I type she is fast asleep on her comfy dog bed, not stressed in the least. I'm not working at the moment so I don't need to worry about leaving her and can devote a bit of time to making sure we are giving her the best of care. We live in a nice place with woods and fields close by, and a beach a short drive away. She can't manage much but a good snort in the undergrowth always lifts her. More than anything else she has a family that loves her to pieces, even with the deadly gas attacks we're enduring!!!!

Laura and Saoirse xx

[lauraperla]

Over 3 weeks on from cessation of Vetoryl, without a doubt we are absolutely full blown. Saoirse is now drinking 7 litres a day, equivalent to 205ml/kg. Her attitude to food has moved from keen to desperate. Talking to our IMS, I thought he summed it up perfectly, saying that it's almost as if the dog you know disappears as the disease takes hold and all you're seeing is the disease. The strange thing is that despite the further increase in her symptoms, she seems much better off the Vetoryl?
Based on the progression we feel has made to full blown we did an ACTH on Thursday. The IMS felt that as her cortisol was so poorly controlled anyway on Vetoryl, the ACTH is more for a starting reference point rather than to use as a current clinical sign. The plan is that we will start Lysodren loading next Wednesday at 1500mg per day ( she's 34kg at present). I had problems with my gp vet obtaining Lysodren but the vet hospital had it in stock and they have mailed it to me.
My heart is in my mouth thinking ahead to the next phase. I am praying with all my might that we load successfully and Lysodren helps her because the thought of it not working after the two year slog with Vetoryl is hard to contemplate.
Interestingly I was looking out photos for the IMS as cushings has completely changed her colour and when I look closely I can see she had small signs and was probably pre-clinical about 4 years before her symptoms became overt.
Please keep everything crossed for us! I will update you through our loading, probably unravelling more and more along the way.

Laura and Saoirse xx

[Sabre's Mum]

Hi Laura,

Thanks for the update on Saiorse. Following is a link to "Lysodren loading and related tips" http://www.k9cushings.com/forum/showthread.php?t=181. It is quite helpful to print out and have somewhere as a reference when you are loading.

Generally you are looking for the slightest change .... that hesitation in eating their food (when they previously are skoffing it down). The link gives you a info on what to look for.

One more thing .... do you have supply of prednisone at home for use just in case of an emergency?

Good luck with loading ... and we are always here to help out.

Angela and Flynn

[lauraperla]

Thank you Angela and yes I asked my gp vet for prednisone when we went for the ACTH and went through dosing protocols for it on the phone with the IMS vet.
It means so much to have all your support and help through this.
We both thank you from the bottom of our hearts.

Laura and Saoirse xx

[jmac]

Hi Laura,

I'm just stopping by to check on you. It sounds like you are on the right track, and I'm really hoping the Lysodren will work and you'll see some good results.

You already know that you have many helpful, knowledgeable, and caring people behind you, who'll do everything they can to help you and Saiorse get through this.

I'm wishing you the best of luck!

Julie & Hannah

[lulusmom]

Hi Laura,

The good news is that Saoirse has a voracious appetite and it is the appetite that is going to make it easier for you to determine signs of loading. As Angela has already mentioned, you want to look for even the most subtle of changes. Signs can be as slight as her lifting her head out of her bowl before licking it clean or taking longer than the two seconds flat to finish and most certainly not finishing her food at all.

Can you confirm that your vet has instructed you to split the 1500mg into two equal doses of 750mg to be given am and pm WITH FOOD? Did you discuss what to do and where to go in the event of an after hours emergency? Did s/he also instruct you to use the prednisone only if necessary? Some vets, who are not that familiar and uneasy about the side effects of Lysodren, prescribe prednisone to be given concurrently with Lysodren. This is not a good idea as the prednisone masks any sign of loading, which greatly increases the risk of an addisonian crisis. A very well known endocrinologist once said that if a dog loading on Lysodren gets sick, somebody screwed up. Based on my experience here, I think that's a pretty accurate statement. Also based on my experience, an experienced vet and a vigilant, educated pet owner are a winning combination in limiting or completely eliminating possible adverse reactions.

Take your time in going over the lysodren loading and related tips. Read it over and over..... and keep it handy while going through the loading phase. I've got two dogs with cushing's and have loaded them more than a few times, as have other members. You can do this, Laura. We'll be with you every step of the way.

Glynda

P.S. I had no idea how to pronounce Saoirse's name. For those of you who were also stumped, here's a great link that has the phonetic pronunciation and a little audio of what it sounds like. Now that I've heard it, I think it's a beautiful name and I can actually say it now. :D

http://inogolo.com/pronunciation/Saoirse

[lauraperla]

Hi Glynda,
How kind of you to look up her pronunciation ! Its an old Irish name, it means 'freedom' although with some older translations it's also said to mean 'bright'.
With regard to her Lysodren dosage yes I have been advised to give with food. However the IMS would liked her to have the full dose once a day; he did consider twice daily dosing but is happier with once. I did wonder a little about this but as he is so particular in ensuring she has the best care, I am going to go with it. He has talked me through when I'd need to antidote with prednisone and I have that here ready, although he is hopeful that with the monitoring we will do, we will not get to the stage where we need to give it. Our gp vet has an out of hours service as does the vet hospital, my first call would be to the hospital. Our IMS seems to be of a mind that the first and foremost sign will be water consumption, followed by appetite. Of course I 'll be vigilant around both and everything else besides!
She's been on a low dose of metacam for her arthritis (together with tramadol which she is still on and tolerates well) but we're withholding that while she's going through loading to ensure it doesn't cause any gi upset that might cause a false alarm.
Does the loading cause general changes, do they tend to sleep more for example? Just wondering as I know when my Dad was going through intensive chemo bouts he wasnt able to do much more than lie on the sofa.

[frijole]

I used lysodren for 4 1/2 yrs so I understand your concerns and questions about what to look for.

Alot of dogs will sleep a bit more during loading as their bodies adjust to the drug. Also some dogs might have upset stomachs which is why some use Pepcid AC (note AC version is important) and give it prior to the lysodren to sooth the stomach. Others including myself placed the pill inside cream cheese, peanut butter, or any soft cheese. It helps coat the stomach.

Dogs also might have some flatulence as a result of the drug but once they adjust to it that goes away.

Really that is it. I don't know if I would discontinue the metacam because when you lower the cortisol you are lowering something that actually was helping mask pain. I would anticipate an increase in pain and therefore the need for increased pain management.

During loading I would not introduce any new foods or treats. Stick to basics so that way if she gets sick you know it isn't from food. I hope this helps. Kim

[lulusmom]

Hi Laura,

Lysodren is has a cumulative effect so giving the dose once a day or twice a day, the effect on the adrenal tissue is the same; however, because the number one side effect is GI disturbance, it is recommended that the dose be split in half and administered am and pm so as to try to mitigate possible stomach issues. I would be very interested in understanding your IMS' rationale as to how once daily dosing works better than twice daily.

I'm a geek when it comes to cushing's research and I've purchased several audios of lectures given by "the" experts like Drs. Edward Feldman and David Bruyette. Dr. Feldman, who has contributed greatly to the medical texts used in veterinary teaching hospitals in this country, tells his audience that even though a lot of texts indicate that water consumption is what you need to watch for, it is the appetite that is a much better gauge. This is because a small number of dogs who have had PU/PD (excessive drinking and peeing) for a very long time go through what is called medullary washout. This means the kidneys have lost all of the solute that is necessary to concentrate the urine. Sometimes it take the kidneys a while to get jump started again so decreased water consumption may not be seen until well after cortisol has been brought down to a therapeutic level. Had I used water consumption to determine if my Jojo was loaded, we would have had an addisonian crisis on our hands. It's been four or five years into treatment and he still has chronic PU/PD. He was a shelter rescue so I had no idea how long he had sucking up water and peeing lakes. I'll stick to my guns here and say that if your girl has a voracious appetite, watch her eat very closely for changes.

Glynda

[lauraperla]

Thank you Glynda. I am in admiration of your geek status, I am learning so much from it!
I suspect that my IMS once a day regime preference comes as much from wanting to minimise the human handling of the lysodren, particularly as we would need to split the tablets which he is much opposed to. He is on holiday this week so I can't discuss it with him before commencing, do you think to try and reduce the gi worry but to keep with his wish not to split tablets I could dose 2 x 500mg am and 1 x 500mg pm? She is fed twice daily.
Very very useful to know about the medullary washout. As her Vetoryl treatment at best decreased but never stopped the pu/pd I'd reckon she has been pu/pd for well over the 2 years. Today as a test I called her while she was eating to see if she would respond - not a chance!
Thanks once again for all your help.
Kim I am a little alarmed at the thought of even worse flatulence!!!!

[lauraperla]

I just got the results from Saoirse's ACTH test last thursday, they were pre 6.2 post 13.6
4 weeks ago they were pre 1.08 post 5.65
6 weeks ago they were pre 2.8 post 2.2
In Dec 2011 they were pre 5.4 post 6.2
Aug 2011 they were pre 2.6 post 4.5
I haven't had a chance to discuss this with our gp vet although the message she left seemed to indicate that she didn't feel the latest results were as high as she would like. Our IMS is on holiday.
Any thoughts you have looking at the set of results would be much appreciated.

[lulusmom]

Hi Laura,

Unfortunately, I am not sure about the exact reasons that makes it risky to switch from vetoryl to lysodren or vice versa too soon. However, knowing that both drugs are very serious and both can have long lasting effects, it seems logical to me that you want to make absolutely certain that the effects of either are no longer apparent before restarting treatment. I've included a url below to an interview with Dr. Feldman that touches on the washout period. There's some other good information in there too.

http://veterinarynews.dvm360.com/dvm/Medicine/Cushings-disease-and-other-adrenal-gland-disorders/ArticleStandard/Article/detail/672663

Some specialists would be okay with making the switch to Lysodren with a post stim of 13 ug/dl, as long as the dog is overtly symptomatic; however, I personally would not be comfortable with making the switch until the post stim is higher. When I switched Lulu, her circumstances were a bit different. She had a post stim of 20 ug/dl and was still not symptomatic so we waited and waited. Finally she started acting cushingoid again and an acth stim test at that point showed a post stim number of 25. Green light!

When you are ready to load, I think your suggestion of 1000 in the am and 500mg in the pm would be perfectly fine. That's what I would do if Saoirse were my own and I would explain to my vet exactly why I am more comfortable with splitting the daily dose.

My dogs didn't become flatulent with Lysodren but neither of them were flatulent before treatment. Here's hoping that Saoirse has a gas free loading.

Glynda

[lauraperla]

Thank you Glynda.
Were we reliant purely on ACTH and she was otherwise asymptomatic I would most definitely erring on the side of caution.
The fact that she is so overtly symptomatic is what is throwing me a little.

[Sabre's Mum]

Hi Laura

I just wanted to second what Glynda said about signs of loading. My vet also told me that a reduction of water would be the loading signal ... in fact if I recall she wanted to see it to a certain level ie so many mls per kg! But in fact in Sabre's case it was an apetite sign .... the water actually reduction of a substantial amount happened for Sabre a couple of days after loading.

I think Glynda's suggestion of splitting the dose is a good one ... in fact I think that is what I did during the loading phase. Then I bought a pill cutter, some gloves and cut the tablets. With kids in the house I just put all the tablets, pill cutter and gloves in an empty ice cream container and I used to deal with them in the garage. Even though I had gloves ... I still throughly washed my hands afterwards.

Angela and Flynn

[labblab]

Laura, has your vet had the chance yet to contact Dechra about the switch-over issue? I'd still be curious about their input, given the specifics of your situation.

Marianne

[lauraperla]

Marianne our gp vet seems a bit distant from the issues at the moment I know our IMS has consulted extensively but don't know if that includes specifically with Dechra.
Angela yes I have been told to look for a target 60ml / kg, as we are at a whopping 235ml/kg at the moment, and saoirse's consumption on Vetoryl was averaging 88ml/kg, I'm tending to feel that appetite will be the more reliable monitor. I like your idea of a pill splitter too. I'll get hold of one today.
Saoirse had a rough night last night. Unsettled and unhappy, I ended up heading to the guest room and spending the night with her there, napping whenever she managed to settle. I wondered if her blood pressure is now up to worrying levels, it was high even when she was being treated. I'm not sure how much more this poor wee doggy can take.

[labblab]

Laura, if Saoirse is so highly symptomatic, I personally would find it hard to wait a whole lot longer before beginning treatment again. I do believe that the specifics of each dog's individual situation will be taken into account when arriving at a decision re: an acceptable "wash-out" period. For instance, here's a quote from Dr. Mark Peterson, who is another high-profile endocrinologist here in the U.S. This quote is taken from a Q&A which he has published relating to "Trouble-Shooting Dogs on Vetoryl," (http://animalhospitalofmtpocono.com/NEPVMA/docs/1c%20Vetoryl%20FAQ-troubleshootingMP.pdf) and relates to a switch from mitotane to Vetoryl. So I don't know whether a higher ACTH would be the goal when the switch is being made in the other direction, as in your case. But it definitely seems as though the symptom severity is also a big factor in the decision-making.


5. I want to switch a patient from mitotane to VetorylR. How should I do this?

The product insert recommends a 1-month break from mitotane before starting Vetoryl and a ACTH-stimulated cortisol > 9.0 ug/dl. However, many dogs show clinical signs of Cushing's syndrome shortly after discontinuing mitotane, and an ACTH stimulation test may be performed sooner if this occurs.

I know I am harping about the possibility of contacting Dechra, but if they could shed any light, I do think it might be helpful. They should certainly understand the physiological effects of Vetoryl on adrenal function, and therefore be able to offer some comment re: a desirable ACTH result and the potential risks of switching prematurely. If you don't want to rely on your vet talking to Dechra, perhaps you would even want to make contact yourself. Here in the U.S., the Dechra technical reps are willing to correspond directly with pet owners. That may not be the case in the U.K., but it still could be worth a try. Here's the contact info for the U.K. offices:

http://www.dechra-eu.com/contact-us.aspx

Marianne

[lauraperla]

Thanks Marianne.
I just tried to speak with Dechra and was told 'we cannot advise you as we have not seen your animal. You will have to go back to your vet'.
I would probably bet our house on an ACTH taken today being higher than last week based on all her physical symptoms. If she continues much longer at the full blown phase I think she will be permanently damaged likely through renal problems or hypertension. I'm not keen to go back to Vetoryl and i apologise if this may upset some but if our option is to continue and not treat soon then i think for the sake of the dog we would seriously be considering euthanasia .
So unless I hear different from the vet hospital I'll plan to start treatment tomorrow.
Thank you again everyone for your time, advice and concern. It means more than you know xx

[Squirt's Mom]

Hi Laura,

We are a Lyso house and it is my preferred treatment. I'm not good with "new" things, preferring things that are tried and true. So the relatively new status of Trilo makes me uncomfortable tho when I first started this journey, it was what I thought wanted to use because I fell into the myth that it is "safer" than Lyso. As you have learned, it is not. Trilo has the same risk potential as Lyso does - what makes it seem safer is the short life in the body. They are both life-saving drugs for our babies, but each pup is different and the drugs work differently in the body so one pup may do great on Trilo while another does better on Lyso. ;)

You and Saoirse are going to do just fine. How could you not? You're a great mom and you have great support. ;):p And I think you, and the others who have already spoken, are on the right track starting the load soon. She is overtly symptomatic and the tests results are on the rise. OH! I just remembered a spreadsheet we have available that one of our members put together for us. You can use it to log water intake. Here is the link - http://www.k9cushings.com/forum/showthread.php?t=3583

Keep up the good work!
Hugs,
Leslie and the gang

[labblab]

Laura, just out of curiosity, I'm going to try sending an email to the U.S. Dechra office since they seem to be more willing to at least pass along general info to owners. I won't try to get into your specific case, but will ask whether or not they have a general recommendation in terms of desired ACTH rebound when switching from Vetoryl to mitotane.

But regardless of their response, I do understand your perspective on this. My own Cushpup was so horribly symptomatic prior to beginning treatment that I also thought we had little recourse had we not been able to grant him some relief. In his case, thankfully, the trilostane did help and very quickly. But we started treatment back several years ago when we had to import the drug from the U.K. So from the time we made the decision to try trilostane (he was the first trilo patient in our area) until we got the drug, there was a delay of at least a couple of weeks. I frantically checked the mailbox every morning, and almost broke down our door racing back into the house on the day it finally arrived. I could not get that capsule into his mouth quickly enough!!!!!

I do understand why parents of dogs with only mild or moderate symptoms may feel some hesitation and even reluctance on the day that they start giving the medication. But that was not the case in our house :o. I cannot tell you the relief I felt, knowing that FINALLY there was something we could do to try to help our boy.

We will be keeping all fingers and paws crossed in our house that things will go well for you. Sending best wishes for loads of good luck.

Marianne

[lauraperla]

I've just spoken to the gp vet and she is happy that we start tomorrow.
Leslie thank you for your kind words and suggestion of the spreadsheet. I have a chart on the fridge! (I'm sure I've spotted the kids eyeing me suspiciously in case they are next!).
Marianne thank you for your concern and for emailing; also for your understanding of where we are at, I don't want to seem in a mad charge to start dosing her, but I cannot stand the helplessness of watching her deteriorate.
She's now snoozing happily in the sunshine on her bed on the deck outside. Very strange weather here, it's like a summer day. After our early hours disturbance I could happily join her!
Thank you again,
Laura and Saoirse xx

[lauraperla]

Day 1, we've started

[Jenny & Judi in MN]

good luck! When I was loading Jenny on Lysodren she spit up some water and I didn't think that counted as vomiting. Gave her another dose and she was violently ill.

So when in doubt, check!! Judi

[marie adams]

Hi Laura,

When I started my Maddie on treatment it was with Lysodren. I never noticed any side effects with her. I had to load a few times, but it was always the food that I watched for a sign. The loads after the very first one were harder, but it was there to see just had to look harder. I know the water played a part in the changes--the other change I would see once she was on maintenance is her urine became more yellow instead of clear. I was fortunate she never had accidents in the house.

I was lucky and didn't have to split pills that much. Maddie started off at 70 lbs so we could use the 500mg pills once in the morning and once at night on the days she had to take them. She ended up weighing around 60 lbs (just because she needed to lose some weight) when her time came to leave us.

It is funny how you are constantly watching them for any changes no matter what it is. I never really paid attention to changes before she had cushing's. Now with my new fur baby I watch her all the time and she should be healthy--I guess once you are use to the watching you never stop.

You are doing a great job!!!

[lauraperla]

Thank you Marie, the urine tip is useful I will watch that too. At the moment it's so dilute I think we could bottle it and sell it with no comeback!!!

[labblab]

Hi Laura, I hope you girls are having a good day!!

Just wanted to report back re: my contact with Dechra here in the U.S. I ended up talking to a technical rep by telephone, and even though I didn't get a set answer about a "wash-out" period, his response makes good sense to me. He advised that each dog's individual situation (and the specific reasons for the switch) should be taken into account when arriving at the treatment strategy. So there is no blanket "one size fits all" answer regarding timing or criteria. Dechra will be happy to talk with a vet about any individual case as it arises.

I know this doesn't offer you any concrete guidance. But my own thought is that it supports the notion that flexibility in applying the "wash-out" criteria can be warranted, depending upon individual circumstances.

Marianne

[lauraperla]

Thank you Marianne I do appreciate you taking the trouble to do that for us. Now that we are in loading I am happy we managed to have some wash out, we were a day shy of 3 weeks.

We're on day 3 of loading, I am twice a day dosing and following a strict regime around handling etc. I am just splitting one pill a day so it really isn't too hard. Her appetite and liquid intake are still both high and physically there's nothing of concern. If anything she seems to be feeling a lot better than at the start of the week when I was terribly concerned about her. Night times she has been much better too, I haven't had to get up with her. Gi-wise despite her best efforts, (chicken food, duck poop and horse foot trimmings have all been on the menu! ) all is fine.
I continue to watch her like a hawk for any signs.
Thank you for all your support and concern.

Laura and Saoirse xx

[lauraperla]

Just wanted to update you on the last few days.
Into day 3 of loading Saoirse's poop started to soften a little, no diarrhea and no change in frequency, just a little softer than expected. Her water intake was dropping by around 30ml/kg each day of loading.
On Saturday evening, at the end of day 4 of loading, I noticed a very slight hesitance around food, not refusal or inappetance, almost just a little pause as if she was thinking about what she was eating. Something so small, but worth noting and watching ever more closely.
Sunday morning there was no such hesitance but she seemed very stiff and sore with her arthritis. Then on Sunday at teatime, before her lysodren was due, I noticed the same slightest of hesitations before going on to eat normally. I had also noticed a decrease in her drinking frequency. Based on these two observations, we decided not to give her Lysodren. I worked out her water intake and she was down to 110ml/kg, from a starting point of 235ml/kg.
Onto Monday morning, she had a good night, I got up with her in the morning, let her out to pee. She came back in, had a drink, then threw up the water. Had another drink, threw up again, then had a final drink and threw up a third time. All in the space of about 20 minutes. After that she drank again and was fine. I did not feel she was in crisis territory but put a call into my gp vet. She called me back within an hour or so. Her assessment is that Saoirse has a gi problem caused by the Lysodren and may not be fully loaded, as her water intake is still above the sought after 60ml/kg. Her advice is that we pause and do not administer Lysodren for 2 days and then talk again on Wednesday once we have 2 more days' water results.
I gave her a can of Hill's critical care this morning, then a light lunch of rice and chicken. Her appetite is ok although definitely a reduction from ravenous! Her poop is back to normal. In herself she is quite bright. Fingers crossed we may be getting somewhere.
I have felt so many of you walking with me these last few days, your kind words wisdom and advice have given me, and so Saoirse, enormous strength.

Laura and Saoirse xx

[labblab]

Laura, since you are definitely seeing a reduction in appetite, have you and your vet discussed proceeding with an ACTH tomorrow as opposed to waiting to further assess her thirst? I do not have first-hand experience with Lysodren, but I know that several folks here have advised that thirst did not turn out for them to be the best indicator of a completed load.

I'd just hate for you to miss the mark if Saoirse is already loaded. Was her last dose Saturday night or Sunday morning? Hopefully some other Lysodren parents will also stop by with their thoughts.

Marianne

[Squirt's Mom]

Hi Laura,

I would recommend you schedule the ACTH now rather than wait for water consumption to drop more. The things you have mentioned with her eating have been more than enough to indicate she is loaded so I wouldn't wait and do not give any more of the Lyso until the ACTH is done.

Hugs,
Leslie and the gang

[lauraperla]

I had expected to acth sooner but on reflection I'm not too stressed about the 2 day pause, as it will also give me a chance to have a discussion with my IMS consultant who has been on holiday.

I agree completely about the thirst issue and have been reading up on that further, and it would seem it can take up to 35 days for the desirable 60ml/kg to be reached even when loading has been achieved far sooner. However I am pleased that we are seeing a good reduction and am sure that by the end of today we will see a further decrease.

[lauraperla]

Thank you Lesley. Those were my thoughts around the lyso its great to have that supported here. x

[labblab]

A 2 day pause before testing is actually good, because cortisol can continue to drop for 24-48 hours after dosing. So if you do proceed with testing after the pause, you can feel confident that you are catching Saorise at her low point.

Marianne

[Sabre's Mum]

Hi Laura

Just wanted to chime in as well ..... I would do an ACTH stim test. The ideal time is 48 hours after the last dose. Marianne is quite correct ... Lysodren still keeps on working (for want of a better phrase!) 24 to 48 hours after it is given. Once I became more educated on cushings, we always tested 48 hours after the last dose (except in cases of emergency when we though Sabre went too low).

Personally I would not concur with the vets thinking that Saorise has a GI upset caused by the Lysodren because she did not have any that day that she threw up the water ... her last dose was the previous morning.


All the best
Angela and Flynn

[Jenny & Judi in MN]

thank goodness you were so prepared. Can you imagine how sick she might have been if you hadn't stopped? Throwing up water was Jenny's sign she was loaded. Glad you caught it.

Judi

[frijole]

Hello! Lysodren user here - you did the right thing by stopping because even the slight change in appetite is enough to be significant. Schedule the acth test and get it done if you can 48 hrs from the last dose. Tell them you don't want to wait any longer than that because the cortisol will rise and your test results will be skewed.

I assume you have prednisone on hand in the event you see any signs of overload?

Keep us posted!
Kim

[lauraperla]

Thank you everyone!
Judi as soon as she threw up water I thought of your Jenny and knew!
Her water intake dropped to 88ml/kg yesterday which was exactly where it sat for the last 3 weeks that she was on Vetoryl.
Kim thank you I do have prednisone here in case I need to use it.
Marianne thank you and yes I agree it would be sensible to ACTH now, I will ask the vet to fit it in on Wednesday when I speak with her.
Saoirse had a good evening and night last night, I am sure we are beyond any danger zone as her last dose was Sunday morning. Interesting thing on the appetite, the desperation is gone, her appetite is good but when she eats she seems to be enjoying and actually tasting her food, she was licking her lips with pleasure after her dinner last night. I've not seen that in a very long time.

[lauraperla]

Angela I also do not agree with the gi theory for exactly that reason too.
I am quietly comfortable that she is loaded and will arrange the ACTH accordingly.
I'd be grateful for any views and advice on maintenance dosing. Her loading dosage was 1500mg daily and if indeed we have achieved loading, she did so in four and a half days. I'd like to split the dose maybe to twice a week and I am wondering whether based on a relatively fast loading, a 1500 weekly maintenance might be too high, perhaps we should settle on 1000, or 1250? I am sure my gp vet and IMS consultant will have views too, I'm learning more and more that I need to do my own research too!

[lauraperla]

One last, rather odd thing I wanted to share.
I've not slept well this past week, my sleep has been much like the kind you have when your baby is unwell, almost like a half trance resting consciousness.
Saoirse was asleep on her dog bed next to my side of the bed. It was 2am still very dark. I felt with complete certainty that our sweet angel Bracken was sitting on the dog bed next to her, exactly the way she used to go and sit with my daughters if they were sad, or ill. We always said she was the classic Nanny dog, straight out of Peter Pan. I felt so strongly that she was there that when I woke fully in the morning and realised she wasnt, and she couldnt possibly be, the grief of her loss hit me like a punch in the stomach.
And I truly believe that she was there, still is, watching over her little sister and willing her through this.

[frijole]

Angela I also do not agree with the gi theory for exactly that reason too.
I am quietly comfortable that she is loaded and will arrange the ACTH accordingly.
I'd be grateful for any views and advice on maintenance dosing. Her loading dosage was 1500mg daily and if indeed we have achieved loading, she did so in four and a half days. I'd like to split the dose maybe to twice a week and I am wondering whether based on a relatively fast loading, a 1500 weekly maintenance might be too high, perhaps we should settle on 1000, or 1250? I am sure my gp vet and IMS consultant will have views too, I'm learning more and more that I need to do my own research too!

Maintenance dosing is typically the daily dose during loading (in your case 1500) a WEEK vs a day. That amount is split into three, perhaps four so that it is spread out in order to maintain the load.

That said, the result of the acth test will determine if that amount should be lowered. If she is closer to a 1.0 vs a 5.0 then you might consider lowering it a bit. So get the test scheduled and I am also confident she's loaded.

Also note that usually the maintenance dose is not started for a full week after the last dose. Again, if she is on the low side they might have you wait a bit longer to start.

No doubt your IMS will help guide your vet thru the process. Congrats! Kim

[lauraperla]

Maintenance dosing is typically the daily dose during loading (in your case 1500) a WEEK vs a day. That amount is split into three, perhaps four so that it is spread out in order to maintain the load.

That said, the result of the acth test will determine if that amount should be lowered. If she is closer to a 1.0 vs a 5.0 then you might consider lowering it a bit. So get the test scheduled and I am also confident she's loaded.

Also note that usually the maintenance dose is not started for a full week after the last dose. Again, if she is on the low side they might have you wait a bit longer to start.

No doubt your IMS will help guide your vet thru the process. Congrats! Kim

Thanks Kim, as always very helpful, its much appreciated. In a preliminary discussion with my IMS he was intimating that once a week maintenance dosing should be fine, I would prefer for Saoirse's sake to spread the load throughout the week. Helps alot to have these things formulated in my mind before I step up for the next round of discussions!

[Jenny & Judi in MN]

you are so knowledgeable about this but I agree 100% on the maintenance dosing being more often than once a week. My vet had me try once a week since Jenny loaded so quickly and it was a huge fail.

the folks here had warned me but I went with his advice to start.

we now do 2 days on 1 day off of 1/4 of a pill. For loading we used 1/2 of a pill daily. Jenny was 8 pounds back then, 7 pounds now just to give you an idea. Judi

[labblab]

One last, rather odd thing I wanted to share.
I've not slept well this past week, my sleep has been much like the kind you have when your baby is unwell, almost like a half trance resting consciousness.
Saoirse was asleep on her dog bed next to my side of the bed. It was 2am still very dark. I felt with complete certainty that our sweet angel Bracken was sitting on the dog bed next to her, exactly the way she used to go and sit with my daughters if they were sad, or ill. We always said she was the classic Nanny dog, straight out of Peter Pan. I felt so strongly that she was there that when I woke fully in the morning and realised she wasnt, and she couldnt possibly be, the grief of her loss hit me like a punch in the stomach.
And I truly believe that she was there, still is, watching over her little sister and willing her through this.

Oh, what a sweet and poignant experience! The power of our relationships with our dogs transcends our logical minds and touches our very core. Your reunion with Bracken brings a tear to my eye and a lump to my throat. I do believe that the spirit is ever-present and the love is ever-lasting. Thank you so much for sharing this message of eternal loyalty and comfort. Hearing about sweet Bracken brings such comfort to me, too.

Marianne

[Squirt's Mom]

Dear Laura,

Tears also grace my eyes at the visit from Bracken. What a blessing indeed. I believe our babies never leave our side even when their bodies no longer walk this Earth. The love we share is one that cannot be broken, a bond that overcomes all. Thank you for sharing with us.

Hugs,
Leslie and the gang

[lauraperla]

Thank you Marianne, and Leslie. I truly believe that their spirit lives on.
With Bracken it didn't give me any 'get out of jail free' card though. She was such an attached dog that in the days after she passed I fretted that she'd be an unhappy spirit, sad at being on the other side from us. While I knew she was at last free of pain, i still worried.

We put her to rest in the garden not far from her favourite spot to sunbathe while I gardened. Its a spot I am looking at whenever I am in the utility doing prep of any sort, so many times a day. In the days after she died I started seeing rainbows in the sky above that spot. In the 2 years we'd lived here I had never seen a rainbow from that part of the house! Also kept happening even when it wasn't raining, when there wasn't even a cloud in the sky. Natural phenomenon, or the babblings of a lunatic hallucinating with grief? Many would explain it with either of those. I believe though my girly was sending me a message not to be sad, she was fine and still with us but happy to be released.

[lauraperla]

Back for a Saoirse update!
Water intake continues to fall, 88ml/kg on Monday, 66ml/kg yesterday. Appetite fine although her tummy is still a bit sore I feel (no evidence for that just a feeling) so we are on a soft food / invalid diet. I think she's enjoying being spoiled anyway!
One other interesting thing I witnessed yesterday was that she actually managed to use her tummy muscles! Her pot bellied pendulous abdomen has been swinging loose for some time now so it was quite a shock to see her stand up and tighten her tummy muscles.
I spoke with the vet, she is booked in for an acth tomorrow first thing. As we are likely to have a delay in result processing due to the easter break here, she'd like to start maintenance on Sunday with the 1500mg dose, so we'll be starting maintenance before we have an acth result as would think it would be the following thursday or friday before we have the info back from the lab. She is keen we administer the dosage in one day, albeit split into 3 small doses. I did discuss perhaps dosing across the week but she is keen we stick to the single day. Reflecting on that one, haven't made my mind up yet....
I am feeling that we are making good progress now.

[labblab]

Has your vet given a reason for wanting to confine the maintenance dosing to just one day each week?

Marianne

[lauraperla]

Hi Marianne,
Apparently it's the vet hospital protocol to maintenance dose once weekly and she doesn't want to deviate from that. She has recommended I split the dose into 3 smaller doses administered over the one day. Being terribly forgetful as I am, and often losing track of time, it may take me a little longer than a day to dose. ;-)

[lulusmom]

I like it...forgetfulness, yes I like it. Might I suggest that you try really, really hard to remember one pill on Mon, Wed and Friday?

[Jenny & Judi in MN]

I like it...forgetfulness, yes I like it. Might I suggest that you try really, really hard to remember one pill on Mon, Wed and Friday?

you guys crack me up

[lauraperla]

I like it...forgetfulness, yes I like it. Might I suggest that you try really, really hard to remember one pill on Mon, Wed and Friday?

It sounds about as much as I could manage. It's the plan for me ;-)

[lauraperla]

ACTH done this morning.
I took a urine sample in this morning, I could already see for myself that it was alot more concentrated, it had changed from Pinot grigio to Chardonnay. She had a trace amount of glucose, and a little blood in her urine. They've sent off the urine for culture. They also ran a set of bloods, there was no issue with glucose levels in her blood. (sorry this is a lot lower on the detail than i would like, I didn't see the vet at all today it was the nurse only). Tbh i'm not too worried, after all she's been through this week I'd expect a bit of collateral damage. I'll add some cranberry extract into her meals though as a precaution .

[Sabre's Mum]

I can't wait for the results. I absolutely agree with Glynda .... the maintenance dose three times a week sounds fabulous (and of course the forgetfulness).

Angela and Flynn

[lauraperla]

Thanks Angela, yes I am really looking forward to getting the results, it's going to be a frustrating wait though as the Easter weekend will extend the turnaround time of the lab.
My husband was away for 4 days this week and I didn't talk to him too much regarding the physical changes I am starting to see as I wanted him to evaluate her when he came back. He could see several changes in her particularly with the pot belly and her general conformation, also with her behaviour, she is a much happier, calmer, contented girl. Even with the arthritis still bring an issue, she is most definitely enjoying life a lot more. I'm getting quite choked up here even typing that, it seems like a miracle almost after the 2 years of misery that preceded it. I am very thankful .

[Sabre's Mum]

It definitely is a wonderful feeling when you see your dog happier and back to the "old" self. Holidays are just not my favourite either with test results waiting!

Take care
Angela and Flynn

[lauraperla]

Hi again!
Just picked up a message on the phone from our vet, unfortunately I can't speak with her today due to her appointment schedule, so apologies I only have partial results to tell you.
Her ACTH post stim was 5.3. As the test was done on the Thursday after dosing stopped on the Sunday, so a 4 day lag, I' m pretty pleased with that as I'm sure there'll be a slight cortisol rebound. The IMS wanted us to ideally to be at 4 post loading, I am sure if the test had been taken on the Tuesday not the Thursday, that'd pretty much be exactly where we would be. Also she doesn't have a UTI. Tbh wasn't convinced that she had.
Good news.
Thank you thank you thank you xxx

[Squirt's Mom]

:D:D Woohoo!!! :D:D

[Sabre's Mum]

Fantastic news!

[lauraperla]

A bit more info here, again I'd welcome your thoughts.
The gp vet spoke with the IMS yesterday afternoon. He would like another urine sample to be tested this week just to check that the blood in urine problem is not persisting. Apparently there is a rare complication where she could have renal bleeding (this is also the reason why she's still not to be given metacam).
As she was slightly out with the desired range, and loading was achieved fairly quickly, the IMS would like her to have another ACTH next week to gage if there needs to be any further alteration to dosage of lysodren. I'm a little concerned that this is too soon but I'm prepared to go with it, albeit it will be towards the end of the week that I take her in.
I saw a slight increase in her water consumption for yesterday, a rise to 73ml/kg from 59 ml/kg. Will keep monitoring, hoping its just a one off.

[Sabre's Mum]

Generally an ACTH is done after a month of maintenance dosing BUT obviously if signs show that the dose is too high or too low then an ACTH can be done sooner.

If it puts your mind at rest that everything is OK ... and the money tree is there ... then do it. Saoirse is currently on 44mg/kg so she is near the higher dose so personally my concern would be that her cortisol levels would go too low as she loaded in 4 days.

For long term reference .... from personal experience with Sabre - a Hungarian Vizsla - he weighed 34kg when he started Lysodren and was on a similar dose .. he lost weight. I can't recall over how many months but he went down to about 25kg. So just keep this in the back of your mind (don't worry about it though!!!) in the future with her dosing.

Take care
Angela and Flynn

[lauraperla]

Week 2 of maintenance dosing, so far Saoirse seems to be coping well. Her drinking fell as low as 44ml/kg per day, I wondered if that was almost too low, but the last few days it's settled in the range of 70-90ml/kg.
I took a urine sample in last week and again as in the sample the week before she had some blood and glucose in the urine. The earlier sample came back from the lab as negative for UTIs, the second sample has been sent for analysis.
The gp vet is concerned that the Lysodren may have affected her kidneys and caused Fanconi's syndrome. I wondered if anyone here had heard of this happening? Saoirse is not at a level where I would consider that she has pu/ pd even though she is above the desired daily 60ml/kg. I also would have thought that the intensity of Lysodren loading could have some 'wear and tear ' effect on the organs?

[lauraperla]

Latest update, no UTI in the second screening. The IMS and vet hospital are now becoming increasingly concerned that Saoirse is showing signs of renal failure.
She had an ACTH scheduled tomorrow so there'll be some additional bloodwork to that. From there further tests will be determined.

[labblab]

I am so sorry to hear about this new concern! You two have been through so much, and things looked so promising with the successful Lysodren load. It is beyond unfair that you should have a new worry. :(

I'm afraid I know nothing about Fanconi's Syndrome. So I will wait anxiously to hear more from you as the diagnostics proceed.

Sending massive hugs to both you girls,
Marianne

[Squirt's Mom]

Hi Laura,

Like Marianne said (almost :D ) - daggum it! Just as it seems you and Saoirse are on the road to some peaceful days, this comes along so you have new worries on top of the old ones.

Even tho I don't know much about Fanconi's, I am slightly familiar with it as I have done some reading about it due to the chicken treat fiasco going on the last few years. Certain breeds are genetically predisposed to Fanconi's, Basenji's in particular, so much of the research has been on that breed.

Fanconi's has to do with the renal system improperly reabsorbing electrolytes and nutrients, causing them to be lost instead of used in the body as intended. Treatment is available but success varies depending on several factors so treatment is highly individualized.

That's about all I remember but here are some links that I have gathered on Fanconi's -

Fanconi’s Syndrome –
http://www.vet.uga.edu/vpp/clerk/davis/index.php

http://www.zandebasenjis.com/protocol.htm

http://www.carolonpets.com/blog/jerky-treats-causing-fanconi-syndrome-in-dogs/

http://www.caninegeneticdiseases.net/Fanconi/FANbasic.htm

http://www.petmd.com/dog/conditions/urinary/c_dg_fanconi_syndrome?page=2#.T5ALetWhtQM

Please let us know how things are going and anything else you learn.

Hugs,
Leslie and the gang

[lauraperla]

The additional blood work showed an elevated red blood cell count. Other bloodwork ruled Fanconi's out but now we are facing a possible carcinoma in her kidney. She had an ultrasound today and there is an unusual area of concern in her left kidney, not enough to be recognised as a mass or tumour but enough to cause significant concern. Bloods being sent to a special lab who will screen to establish if this is a carcinoma. The only treatment option is removal of the kidney. In our view that's too much for the poor girl to go through.
Her ACTH wasn't great. Pre 7.0 and post 8.2. I wasnt surprised. I could see by watching her over the last week that her cortisol was rising. We're going to tweak her dosage rather than go through loading at this point in time.
I am heartsore for her. And me x

[labblab]

Laura, I am so sorry to hear this news. Please know that I am thinking of you both, and will be so anxious for your next report.

Sending my thoughts and prayers across the miles,
Marianne

[Squirt's Mom]

Hi Laura,

I hope this turns out to be nothing major after all, just a blip on the film. Prayers and healing white light are flying your way.

Hugs,
Leslie and the gang

[Sabre's Mum]

Hi Laura

Sorry to hear the latest. .... as others have said ... hopefully it is nothing.

Take care
Angela and Flynn

[Somesie]

Laura...just checking in on you. How's your girl? And you?? I will keep you in my thoughts, and Jordan sends two big sloppy kisses, one for each of you!

[lauraperla]

Thank you Jenn.
We are still waiting for the blood test results to determine whether the changes in her kidneys are malignant.
She's doing pretty good I am finding it hard to let myself hope that the lysodren is doing its job and worry instead that she's going out of range again and having a cortisol bounce!
We are due to take a week away with the family next week. My mum is looking after Saoirse at home. It's going to kill me to leave her even though I know she will be fine, thoroughly spoiled in fact!

[Somesie]

That's funny...I know exactly how you feel. When we went away recently for our second honeymoon (only four nights!), I was a wreck leaving them at camp. Mind you...this is a posh little place. They get their own room, with a heated floor, a window, and people furniture. When we got back, Jordan was in such good spirits, I thought maybe we should have left 'em there a little longer!!

Go enjoy your holiday and let her get spoiled by Grandma...that's what Grandmas do!!

Keep us posted!
Best,
Jenn

[lauraperla]

Back from our trip, much needed downtime for the family.
I've just picked up a message from the vet on our answering service and the blood test results were not good. It indicates that Saoirse does indeed have a cancerous growth in her kidney.
The vet wants to run yet more tests. She is now getting so stressed with vet visits that I am reluctant to keep going through all of these. She is fine regarding her cushings; my analysis would be that she is slightly higher than the desired range (I'd say her acth would come back somewhere in the range of 6 to 10) so the lysodren is exerting partial control. Having gone through the terminal cancer process with her sister just last year I am focused on Saoirse and the quality of life we can give her for the (I suspect little) time she has left. And multiple vet visits don't feature in that.
I honestly don't feel ready to be as brave as I need to be.

[Somesie]

Well, CRAP. (Which was not my first thought...but I figured I'd better keep it rated PG). I'm so, so sorry to hear this, Laura! Do you know what would be involved in further testing, and what they would be trying to find out? Basically...what's the end they're trying to accomplish?

As to your bravery, though...while I'm sure you're feeling spent by all of this, you know you'll be up to the tasks ahead, whatever they might be. That's what Moms do, and all indications are that you're indeed a very good one, so I have every confidence in you, even if your own confidence is lagging at the moment.

Is Saoirse doing OK right now? I mean...on just a normal day-to-day basis...is she her normal self and enjoying a decent quality of life, do you think? I'm sure once you speak with the doctor and know a little more, things will be more clear as to what your next steps should be. Maybe it's something that is slow-growing and you can spare her further vet visits just now. Let us know what you find out, OK?

Meanwhile, we'll keep you all in our thoughts. One day at a time, my friend....one day at a time.

Best,
Jenn

[lauraperla]

Thank you Jenn xx
'One day at a time' is how we walked our final 3 months with Bracken and when I reflect back on those months what I know most of all is that our dear sweet girl was surrounded by love and the family she cherished for all that time. We'll be sure that Saoirse gets the same deal.
As for the moment, she's doing ok. Her tramadol is giving her some pain control regarding the arthritis but she could do with a little more help. I'd really like to get her on something additional, her metacam has been off limits for several weeks now and she could do with it, or something to give her a bit more relief. She's not distressed although she's sticking to me like glue. She comes outside if I'm gardening and is happy to mooch around and be nosey, and steal the duck food. Her appetite is good, her thirst isn't abnormal and her body is functioning ok.
Unfortunately from what I've researched so far kidney cancer is a fast growing type which spreads swiftly to the lungs and the liver. However as this is so early - the tumour wasn't distinct yet on the last ultrasound, more a shadowy area/mass- I think her time will be framed in months rather than weeks.
The vet wants to run more bloods and urine, do another ultrasound. While I can understand the wish to monitor closely, when that monitoring isn't going to change what happens I think its unfair to put the dog through any more stress than is strictly necessary. If her kidneys start to fail we will see the signs and know its time. We're not going to start putting her through a regime of fluid injections and IVs. I'd like her care plan to now focus on being palliative and centred on her comfort and less about drug protocols and vets numbers. I'm happy to drop a urine sample in this week. I'll see how she is next week and if I feel she is doing ok we will maybe consider a general blood panel. Throwing acth monitoring out of the window for the moment.
The vet is calling me back later today I'll let you know how it goes.
laura & Saoirse xx

[Somesie]

Sounds like you're already feeling more brave than you'd thought! I admire and respect your approach...I hope I am able to be as strong when the time comes. Barkley and Jordan are the first dogs I've ever had (as an adult guardian, anyway); I have a hard time even thinking of such things, truth be told. Literally...I get all misty just thinking of it. This whole process with Jordan has been eye-opening in that regard, as they've both always been pretty healthy, then all of a sudden you start to realize...oh, wow, they're not always going to be with us. Bleh.

Anyway, on a happier note...here's a funny little visual for you, which you made me think of with the reference to arthritis meds. I've just started Barkley on a glucosamine supplement for some mild arthritis in her back legs, and they are capsules that I empty into her food. I wasn't sure if I should mix it in or just leave it in a pile on top, so this morning I was experimenting a little bit, and I'll be darned if she didn't look up at me after her first few bites, with two distinct lines of white powder coming down from each nostril! I almost spit out my coffee laughing at her, standing there looking like she's partying with illegal substances!! Too funny!

Please do let us know how it goes with the vet this afternoon. Maybe it's not as bad as you think, and you'll have many months, rather than a few. I sure hope so. Keep me posted!

Jenn

[labblab]

Dear Laura,

I had so hoped to hear different news about the kidney. It has to be so very hard for you to gird yourself for the future, after traveling down the same path with Bracken. But I know, without any doubt, that Saoirsie will be cradled with love during every moment that you will be able to spend together.

For what it may be worth, I share your philosophy regarding palliative care. For her, the beauty is that she does not have a clue as to the diagnosis. So every moment of life that remains "dog-worthy" for her is one that she will savor. Without poking, without prodding. Surrounded by her loving family.

Please do keep us updated. As Jenn says, hopefully there will be much more time left than you may now imagine. But regardless, we'll be with you every step of the way.

Sending many hugs,
Marianne

[Jenny & Judi in MN]

I am so sorry to read this about your beautiful girl. I hope you and she can enjoy as much time as you have. hugs, Judi

[mytil]

Hi Laura,

I am so very sorry to read this. I had not posted in your thread but have been following. My heart is with you and your girl.

Terry

[lauraperla]

Thank you Jenn for making me smile on a dark day :)
Marianne yes it is indeed a blessing that she is oblivious to the diagnosis and today we have had a good day together in the house with lots of treats and cuddles.
Judi and Terry thank you for your thoughts and kind words.

[Sabre's Mum]

Laura

I am so sorry to hear the latest results of the latest diagnostics. Saoirse will surely be enjoying tose cuddles.

Hugs from me to you (you can give some to Saoirse as well ... GSPs give cuddles just like Vizslas...)
Angela and Flynn

[Squirt's Mom]

Hi Laura,

I am so sorry to hear the report on Saoirse's kidneys. :(

But this knowledge, tho a heavy burden to bear, can be a blessing and it sounds as if you intend to make it be so for all. We never know what the next minute will bring and someone we love so dearly can suddenly be gone with no warning, no chance for those special moments or conversations, no magical days of making memories to cherish - they are simply gone in the blink of an eye. So enjoy each minute you can with no thought of the next minute.

Hugs,
Leslie and the gang

[Somesie]

G'mornin' Laura. How's everyone feeling today? Any more detail from the vet? Just wanted you to know I'm thinking of you.

Jenn

[lauraperla]

Good morning Jenn. Thank you for thinking of me. We're doing ok, I wobble a bit but its, as Leslie says, cherishing the time left that is the crucial thing.
I spoke to the vet late Tuesday. She mentioned once again that removal of the kidney is an option but I am not prepared to put our poor girl through that. Lurking in my mind is that I suspect the kidney is not the primary cancer site and what's going on is that the disease is spreading from elsewhere; when she had her MRI scan at the end of February they said she had a suspicious looking cyst on one of her ovaries but they would disregard that for the moment. I wonder if that was indeed a ticking time bomb.
I explained to the vet that my sole priority was keeping Saoirse comfortable and happy for the little time she has left. To that end I have requested that she now goes back onto metacam and I've started that, thankfully so far with little effect - I know the risk that carries but I would prefer she is as comfortable as possible, even if that gives her less time. I said that I did not intend to put her through any rigorous testing regime. I've said I'll drop a urine sample in this week, I'll do that tomorrow. The vet would like to do an acth and draw bloods next week. I said I'd get back to her next week about scheduling it, mainly because I wanted to talk to my husband about how we manage Saoirse. I do not intend to allow the testing or bloods to go ahead. With everything else going on I cannot see how you could accept any acth result as a true result of her Cushings.
I know we are in the final days with her, and I will, as Marianne alluded to, take this day by day. With Bracken I frequently referred to a veterinarian end of life / quality of life assessment and that kept me aware, when the balance tipped for her, I knew it was time. For Saoirse I have a slightly different lens. She already has so much discomfort, through Cushings, and arthritis, that I won't sit back and wait til the cancer spreads and she's put through more distress. If I can give her a last couple of weeks of being spoiled at home, nosing round the garden, sharing cuddles and being loved without any distress from vets trips then I will be, in as much as I ever will be, feeling that I have done the right thing for her.
In terms of Lysodren monitoring and dosage, I'm using water consumption, appetite and behaviour monitoring to ascertain the level of control.
My Mum bless her offered to be the one to support Saoirse at the end. I don't need her to do that for me, I know that being there for Bracken (and her being at home) made the end incredibly peaceful, and I will do the same for Saoirse. I was incredibly touched by my Mum's thoughtfulness though.
I haven't told my daughters yet. I'll start introducing the idea over the next few days when I feel I am a bit steadier and can answer any questions they have without faltering.
Angela - yes GSPs and Viszlas have much in common! A long time ago someone explained to me that GSPs don't sit with you, they sit ON you. Its been true with both our girls. I have a good friend who got a Viszla pup as her first ever dog (think its rather like having a Ferrari as your first car!) and I was happy to be able to keep her steady through a whirlwind of a puppyhood.
Finally thank you so much to everybody for your support and understanding. Having somewhere to come where people truly understand not just what you're going through, but also the intensity and complexity of the bond you have with your pet is so comforting.
love and hugs,
Laura and Saoirse xx

[Somesie]

You sound so grounded and...I don't know...'together.' It seems like being so secure in (or maybe 'resigned to'?) your plans for her must provide some level of comfort in an otherwise awful situation. I hope I'm able to be as clear-headed and strong when the time comes. I'm so sorry you and your family are having to go through this.

Do you have any stories about her that you'd like to share? I don't really know how to help in a situation like this...not sure what you need. I guess, just know that I'll keep you all in my thoughts and will continue to check in on you. Don't feel obliged to respond, but if you feel like sharing - silliness or sadness - I'm happy to lend an ear...or keyboard, I guess.

We were out walking this morning and I had an overwhelming "enjoy the little things" moment, blowing apart dandelions gone-to-seed and watching Barkley and Jordan both go crazy chasing the fuzzy bits into the wind. Each moment is precious...no matter how many you have left. Enjoy yours, my friend!!

Best,
Jenn

[lauraperla]

Hello again,
I've been thinking often over the last few days that I must come by and update you all on Saoirse.
Since we had the news of her kidney tumour I've gone to ground while I figured out how we were going to get through this new situation. With both of us anxious and worn out by endless vets tests and visits, I decided to invoke a moratorium on all that, give us a chance to breathe. I spoke to the vet about this but while I think she got the general gist, she finished our conversation by requesting that I take Saoirse in for an acth the following week. Well I didn't. Instead after much reflection I decided to go with my gut, and manage her by what I was seeing from her.
The vet advised that she'd like Saoirse's maintenance dose of lysodren to be 150g twice a week. I felt that was too much so I decided to proceed on 150g once a week and monitor her on appetite and water consumption, keeping an eye on urine concentration too. Having had two years of limited control on vetoryl and the recent tranistion onto lysodren I feel confident I have a handle on this although I would not recommend this approach at all to anyone who is new to Cushing's or has a recently diagnosed dog. For her arthritis I'm giving her metacam and tramadol but I've cut her daily tramadol, she was on 150mg a day and I now give her 50 to 100.
She's holding her own. Still nosey, stuck firmly by my side wherever I am in the house (bit disconcerting when I am in the shower). I have no idea how long we will sit in this phase but I do know that the removal of the continual veterinary procedures has removed a big area of stress from her life and I feel that its giving her the best possible quality of life.
I know that this approach is a little unconventional and carries its risks. I also know that without the knowledge this site gave me, and the realisation from reading here that I am the best advocate for my dog, I would not be confident enough to have got to this point.
So thank you all xxxx

Laura & Saoirse xxxx

[Squirt's Mom]

Dear Laura,

I, for one, think you are doing both you and Saoirse a favor. For me, there reaches a point in which we have to weigh the continued vet visits, meds, tests and so on against the happiness and peace so badly needed.

I have a friend who's baby is dying from cancer - he has only a few weeks left. Her vets are pushing her to have him seen by all sorts of specialists and treat many things that in a short while will have no bearing whatsoever - there is no cure, the cancer treatment is simply buying them some tiny bit of time. Her baby is traumatized by seeing the vet so their time has been full of stress, frustration, arguments, and wasted time and money...on top of the unbearable sadness knowing his days are truly numbered. She has reached the point of "no more!" and is doing what you are doing - taking care of the immediate needs as best she can and devoting her time and love solely to him. In my heart, they will both benefit from this as opposed to running all over the state trying to fix things that can never be fixed.

If I learned something serious was going on with Squirt, I would not spend her days putting her through surgeries, treatments, and repeated vet visits - she is 14 and has been through enough. I would do all I could to keep her comfortable and happy for as long as possible. In the end, it would mean more to remember a few weeks or months of a happy Squirt than to remember months and months of a miserable Squirt. I feel I owe her this, at the very least - she saved my life after all.

We are here anytime you wish to talk. Know you are not alone - you and your sweet girl are always with us and we with you.

Hugs,
Leslie and the gang

[lauraperla]

Hi everyone,
I have some sad news about Saoirse. She deteriorated over the weekend, a combination of kidney and heart issues.
We organised a home visit from the vet and she was put to sleep yesterday afternoon. I held her through, and beyond her last moments. It was peaceful and dignified, a good ending to a life lived well. We have buried her here at home, in the paddock next to her big sister.
We managed to give her a last few weeks of happiness and love and without stress.
I am and will ever be grateful for the blessing of 11 years with my beloved girl. I miss her terribly but I am consoled by her struggle being over. She will be in my heart always.
Thank you, all my friends here for walking this path with me. Your kindness and support helped us live her life well through to the end.
Laura xx

[jmac]

Laura,

I am so sorry to hear you lost Saoirse, but I am so glad you feel the way you do. That is exactly what I hope I can say when I have to make that decision. It is incredibly hard for us, but we need to make the decisions for them, to ease their pain and suffering. I am so glad to hear she went peacefully at home, and it is priceless for you to know you did the right thing and feel good about it. It sounds like you made exactly the right choices for her in her last weeks. You're in my thoughts...

Julie & Hannah

[Jenny & Judi in MN]

so sorry and so glad she got to go in your arms at home. hugs, Judi

[Sabre's Mum]

Laura

I am so sorry to hear the news on Saoirse. I am sure you treasure those last few weeks with her.

Take care
Angela and Flynn

[Bo's Mom]

I am so sorry to hear about Saoirse. Please know that you are in our thoughts and prayers.

[Spiceysmum]

Laura,

I am so sorry to hear about Saoirse. I am glad she enjoyed the last few weeks with you with no stress but lots of love.

Linda

[mytil]

Laura,

I am so very sorry. Your girl is still with you for sure and now she is completely pain free and healthy again with her sister. Please do stay with us - we all have big shoulders here.

Deep peace of the quiet earth to you . . .
Terry

[frijole]

I am so sorry to hear this news. You and yours are in my prayers. Kim

[addy]

Laura, the absolute love and devotion you gave Saorise is so admirable. Your strength and courage right up through her final days is an inspriation to us all.

I am so sorry you lost your girl but I know she is forever in your heart.

[bgdavis]

Laura,

I'm so sorry to read of your recent loss of Saoirse. She will remain with you always.

Bonnie and Angel Criss Ann

[Nika'sMom]

I am so sorry for your loss..you are an amazingly strong person and you Saoirse was so lucky to have you for her furmom...love and hugs coming to you..Lynda

[k9diabetes]

I am so sorry to know that Saoirse has passed. I didn't get a chance to get to know the two of you so I went back to the first few pages of your thread and I knew as soon as I read this:


I have had considerable problems obtaining copies of any test results from my vets. They have advised me that it is not normal practice to give owners copies of results. However I stamped my feet and caused a scene in their reception last week saying that I had to have them prior to my trip to the veterinary hospital. They gave me copies of the last 3 acth results and the last set of bloods.

that Saoirse was a beloved member of your family who could not have asked for better care.

The hardest part about loving a dog is that you ache and mourn their loss to the same degree that you loved them....

Natalie

[lauraperla]

Thank you everyone for your kind words of sympathy, they mean so much to me as you all truly understand the amazing bond we have with our furbabies.
Natalie the point about the amount you love them and the amount you grieve them is incredibly true.
Saoirse was with me all the time these last few months. Never left my side - even on her very last day she insisted on lying on the lawn while I mowed it (resulted in a very crazy pattern). Not having her in 'my space' feels incredibly weird. Its also the first time in 14 years that we are a dog free household, and the first time in both my daughters lives that they have not had a tail wagging at them every day. I don't like it at all.
I certainly don't intend to disappear from the forum, I hope I can manage to help others the way others have helped me. While I'm no whizz on the numbers and labs, the years with a cushdog have hopefully given me some experience I can use to help others on their journey.
laura x

[lulusmom]

Laura,

I am just now trying to catch up with everybody and see that you lost your precious Saoirse. I would like to extend my deepest sympathies to you and your family and let you know that you and yours are in my thoughts and prayers.

Jojo was an anti-social old fart so I hope your party girl can show him how to have a good time. I'd love to see him play with wild abandon when we meet again.

(((Huge Consoling Hugs)))
Glynda

[lauraperla]

Oh dear Glynda. Anyone who didn't fall for any of Saoirse's multiple party tricks ended up just getting sat on by her! At least she will give Jojo something to be a grumpy old fart about!

[Tuffy]

Laura:

I am sorry you lost Saoirse but I am glad that she went at home and with you where she was happy and secure. I am still new here and still learning my way around this site. Like you, I have a dog that is failing aside from the Cushings. This isn't coming out well but I wanted you to know that I think the happiest way to go is in a loved one's arms where you are not alone and your with someone who loves you. You gave that to Saoirse and I can't think of a better way to leave.

Fawni,
Tuffy's mom

[Altira]

I hope you aren't dog free for too long. That's just as heart breaking to me. I can't live without them.

[molly muffin]

It is always so heart breaking to lose ones best friend and companion. The gift is that they were a part of your life and you a part of theirs.

[lauraperla]

End of one chapter, start of another.
Way back in January we contacted our girls breeder to order another girl to follow Bracken and join us and Saoirse.
The pups were ready last weekend. My husband and I drove the 7 hours to have a look... and came home with a little sweetie that my girls have named Jessy.
She's a black and white Gsp so looks very different from our 2 liver girls. For me that's a good thing. If I'm honest for me it feels too early and my heart if anything is heavier, it makes the loss of Saoirse even more acute, but for the family it's absolutely the right thing.
And the house feels 'right' again now we have a dog in it again.

[Squirt's Mom]

Oh, Laura,

I hope this little soul will help heal your heart in time. I am sure Jessy will bring much joy and activity to your home. :)

We need pics, ya know!

Hugs,
Leslie and the gang

[lauraperla]

Thank you Leslie, and yes pics on the way! Biggest problem I'm having is trying to get her to stay still, impossible!

[Sabre's Mum]

Ooooohhhh! Puppy in the house! I truly can understand that standing still for photographs thingy!!!! We still can't get Flynn to stay still and he turned 3 years last month. Whereas our darling ole Sabre would "pose" in front of the camera.

If you manage to get that "still moment" (maybe sleeping?) we would love to see a pic.

Angela and Flynn