Heavy Heart - Buddy not well (Buddy has passed)

[Coop]

Hi there

I am new to this forum and only found it when searching for calcinosis treatment and there was this site. I must admit it is hard to read some of the posts as I hear myself in the stories of others. Even writing now I feel quite emotional. Denial is a more comfortable place to be at this time. I'm still at the stage of wanting a miracle to happen where I wake up one morning and my boy will be back to his old self again.

My beloved Boxer, Buddy, aged 10.5, (his mum lived to 13 years) has always had excellent health until a year ago when he was diagnosed with hypothyroidism. Treatment has been successful though I still felt his fluid consumption was excessive. This began to increase – 3 litres plus a day - so back to the vet and he has now been diagnosed with probable adrenal-based hyperadrenocorticism. He had had the Urine Cortisol/Creatinine Ratio Test, Low Dose Dexamethasone Suppression Test and High Dose Dexamethasone Suppression Test plus ACTH Stimulation Test. My vet did do an ultrasound but said his expertise and with the limitations of his equipment he was unable to come up with anything conclusive, that’s why I say ‘probable’. There are no specialists I where I live, however, I do have faith in my vet.

So Buddy’s fluid consumption is of concern – we have gone from a water bowl to a water bucket - and he does have the classic muscle wastage around his back end, pot belly, a couple of sores that won’t heal but otherwise he’s quite a happy chappy. He has no hair loss, in fact he stopped moulting pre hypothyroidism, so doesn’t grow a coat at all. His coat remains healthy and quite thick. He was shaved for the ultrasound so is going to have a large bald patch from now on. Nor does Buddy pant, he has never done this so these two classic symptoms are absent. He still enjoys trotting around our paddocks and loves going for car rides though his energy levels are markedly lower than they used to be.

I have made a definite decision not to go with surgery and haven’t started Buddy on drugs. I feel reluctant to do so after all the research I’ve been doing. Trilostane is prohibitively expensive in New Zealand so that only leaves mitotane and the side effects worry me. I’m in a space where I want quality of life rather than risks I might regret. But lots of members on this site are saying the same thing so I won’t repeat what is common to these situations.

What I want to know is how you get past this apprehension?

Thank you for listening.
Forward Message Reply With Quote

[Sabre's Mum]

Hi Coop and Buddy,

Welcome from another Kiwi. As you can see from my location I live in Papamoa. Our handsome, now passed, Hungarian Vizsla Sabre was diagnosed with cushings and treated with Lysodren for two years.

At the time I did not look fully into treating with Trilostane but it was my understanding at that point in time (2008) that VSG (in Auckland) could import it in and I made the presumption that you had to be in their care ... and my understanding was that they were incredibily expensive. All presumptions on my behalf, but I now know of an owner who has taken their Vizsla to this specialist clinic and has spent a small fortune ... make that large fortune ... with IMHA issues.

So given the above we decided to go with Lysodren. From recollection we could get 20 tablets (500mg tablets) for just under $120. The best thing I could have done was find this site and research ... research and research. This allowed me to monitor Sabre more diligently and learn not to be fearful of his treatment. Treating Sabre with Lysodren actually gave him "Quality of Life" . He had massive hair loss and lots of calcinosis cutis which was only getting worse. With treatment his hair regrew and his calcinosis cutis resolved to the point of "being there" but not being an issue.

Do you have the results from the tests?

Did your vet ascertain that the skin infections were calcinosis cutis? In the initial stages three vets in the practice looked at Sabre and had no idea what his skin issues were. It was with a biopsy that we were abe to find out what they were. All three vets had never see a case of calcinosis cutis in their years in the industry ... two of which had also spent time in the UK.

If you have any queries please ask away.

Angela and Flynn (our rather needy Vizsla - in remission IMHA and SRMA)

[molly muffin]

Hi and welcome. I'm pretty much a newbie myself. :)

I can say, I went through anger and denial all probably right up till today when after the ultrasound, the diagnosis was confirmed and a plan that I was comfortable with was come up with.

I think that is the key, not exactly what test you get, or what medicine you decide to go with or not go with specifically. I think it is having a plan, knowing what you are going to do and feeling that whatever that is, it is what will be best for Buddy. Once you feel that, then it is easier to come to terms with what is and what will be and what everything means.

I hope that makes sense.

I don't know if the feeling will last. I hope so. I expect anxiety when we start meds, whenever that is for us and I expect I'll be right here through it all asking for advice, help and understanding. So maybe you'll have some up and down times still, I'm pretty sure you will, nothing seems to be easy with this thing, but at least there is some place with others who have all walked this same path.

HUGS to you and Buddy

[Coop]

Sorry, posted twice.

[Coop]

Thank you Angela and Molly for you words of reassurance. Angela, I am sad to hear your dear friend Sabre is no longer with you. I love the Hungarian Vizsla as a breed. Very handsome. I am from Dunedin.
I guess Molly, your words made an impact on me though I am still waiting for a direction (plan) to revel itself that feels like the right one for Buddy. I suppose I keep thinking that maybe it's not Cushing's but if it isn't there is something radically wrong or he wouldn't have all the symptoms he has. See, still in denial!!! I think I've done so much research - the good and the not so good - that I'm fearful of taking the drug option.
What I would like to know Angela is when you say Sabre's quality of life improved once on drugs what specifically did you observe apart from the coat regrowth and improvement in his calcinosis cutis? Does the muscle wasting improve, the pot belly, energy levels? Buddy's drinking worries me the most and I would assume that would be a significant improvement. If I'm going to come to a decision then I have to weigh up how he is now with how he would potentially be on drugs. Yes, that makes sense to me. Writing my thoughts down helps. But on the flip side I would like to know what could be the down side of Lysodren.
Angela, I don't have the results of his tests, only that the vet told me they were significant enough to indicate 'probable' Cushing's. I could ask for them if it was going to be helpful for comment. These are the costs I was quoted.
Cost of drugs: Mitotane, for the first month around $1100.00 then $230 per month. Trilostane, same cost ongoing $800 per month.
Kisses from Buddy

[Somesie]

The test results would undoubtedly be useful in order for some of our senior members to help you be more comfortable in the diagnosis, first and foremost. While I understand (and envy, a bit!) that you trust your vet, sometimes even the most well-meaning, ambitious of vets can get out of their depth with this disease. In this forum, there are people with far more knowledge and experience in this specialty than in probably all four of the vets I've seen, combined. So...get and post the test results - maybe that will move us to be able to help you toward the elusive plan! ;)

Past that, though, I notice that you say the excess drinking is your primary concern. Is he having accidents in the house? Because if he isn't, then the excess consumption is probably more a problem for you than for him, would be my guess. If he is, as you say, a 'happy chappy,' then you may not need to move forward with any medication at this time. Usually, the symptoms that move owners to investigate this mess is excess water consumption...that leads to household accidents...or excessive hunger (that is, I can tell you as the voice of painful experience, a horrible, horrible thing to witness and definitely diminishes the pup's quality of life). If there are no accidents, and he seems otherwise happy, that sounds like a pretty decent quality of life to me.

Now, that said, as a fellow Boxer owner/lover, I am also guessing that when you mention he's got a 'markedly lower energy level'...well, that in itself is a special problem for our boys, isn't it? Because they usually have such boundless energy and personality, it's hard to see them laying about. We are fairly certain that our boy has Atypical Cushing's, so I have had him on flax/melatonin for a little over two months now, and that has worked miracles on his ravenous appetite, which was always my primary concern. However, in recent weeks, he has been so withdrawn and lethargic that I felt compelled to seek out further medical options for him, because when I don't see that Boxer 'spark,' I just can't help but feel he's unhappy. That's going to be a decision that you will have to make...trying to find a balance between healthy, and actual happiness.

Right now, it sounds like you're doing a fine job. Based on what you've told us so far, if I were in your shoes, I don't think I'd be in a hurry to medicate him. But, in the same breath, I would encourage you not to be shy of the medications, because there are a lot of success stories with Lysodren (as well as Trilostane). I felt the exact same fear as you did, but in the past few months I've become fairly certain that once we are settled in our new home and are 100% sure of his diagnosis, we will end up medicating him, most likely with Lysodren as it is the drug appropriate to his case. I think the risk of giving him back his old self is worth it, and besides that...properly medicated and monitored, the risk is not all that great.

All this, I suppose, is a long-winded way of saying that my heart goes out to you, but that you are no longer alone in this diagnosis. This forum is an absolutely invaluable resource and support system....you'll see.

Big sloppy Boxer smooches from our house to yours,
Jenn & Co

[Sabre's Mum]

Hi

I spent 11 years of my life in Dunedin (school and uni) and have a soft spot for the city.


With regards to things I saw change ... before treatment Sabre was actually going downhill quite fast ... he got a sprung toe ... could barely walk, had a pot belly, muscle wasting (this was quite rapid), drunk a ton of water, always wanting food, huge weight gain (he was usually about 27kg and he went up to 34kg) was getting up every 2-3 hours every night along with a major case of pyoderma around his anus, his calcinosis cutis and hair loss. Without treatment we believe he would not have been around within a short time. He went from normal in Nov/Dec to this state by February. We saw everything turn around ... within 4 - 6 months. With water intake and food hunger taking the least time to remedy and the calcinosis cutis and hair loss the longest to remedy. He went from barely walking to being that usual 8/9 year old vizsla again ... we saw our handsome happy boy back again.

Being absoutely honest, and not trying to scare you, the downside to Lysodren is the dogs cortisol levels can go too low (you can do this with trilostane as well). BUT ..... if you educate yourself cushings and Lysodren use, use this forum (they will totally hold your hand from a cyber perspective) to help you a long the way this and watch Buddy .... this risk can be absolutely minimised. Some dogs get a maintenance dose easily that maintains a stable post ACTH stim test result ... others (like our dear Sabre) take some time getting this dose at the level that it is right.

So the downsides from treatment can be easily remedied with education ... arming yourself to be a great advocate for Buddy.

With regards to costs ... it really depends on the dose. Generally Lysodren is administered at 25 to 50mg/kg. Initially there is a loading phase whereby this dose is given daily (generally split and given am and pm) until the post stim ACTH is between 1-5ug/dl ( 30-110 nmol/L). Once this is achieved the maintenance dose is generally what you loaded at and split over the week. ACTH stim tests are done once loaded, then 30 days after going on the maintenance dose, then every 3 months after that. If any changes to dose are made you should retest after 30 days. The cost of the drug quoted by your vet seems a lot on the high side ... how much does Buddy weigh? I used to pay $180 for the ACTH stim test from recollection.

I would request the test results from your vet, post them online and place them in a file which you can update. Members can give you an idea of whether or not Buddy has cushings. Also help you interpret them as well.

Angela and Flynn

[Coop]

Wow, you wonderful people are so generous with your time and support. Hopefully, one day I will be in the same position to offer the same to others. Sometimes I feel like my life is consumed with trying to understand this disease that I knew nothing about until more recently.

Hi Jen, lovely to talk with another boxer enthusiast. We have had 4 boxers, Buddy is our third and we have a 6-year-old bitch, Yana. She is Buddy’s niece. We’re hooked on the breed. BTW, how do you add a photo next to your member name? I’d like to put Buddy there.

Yes, Buddy has had accidents inside but now we are on a regime of letting him out through the night so no more since then. I have noticed that just lately he does seem hungrier, reminiscent of when he was pre meds for his hypothyroidism.

The only way for me to be 100% sure of the diagnosis is to take a trip to Christchurch to the specialist there for an ultrasound since my own vet in Dunedin wasn’t successful with his equipment or expertise. Maybe I should be seriously considering this then I would know for sure what I am dealing with and the way forward will be clearer.

Is it unusual for a Cushing’s dog not to have hair loss? As I said, Buddy has a thick coat but doesn’t moult at all nor does he grow hair back like when he was shaved for the ultrasound.

I will contact the vet today and ask for his test results.

Angela, thanks so much for taking the time to answer my questions – it is really helpful. If Buddy were to regain more energy and had your result –“we saw our handsome happy boy back again” - I would be delighted. Buddy isn’t miserable or sleeping all day but it’s a while since I’ve seen him run.

Buddy’s normal weight was always around 30kgs but last time I weighed him he was up to 31 which isn’t too bad given his love of food lately.

Thanks again.
Buddy and Claire

[frijole]

Hi! No, not all cush dogs have hair loss. The most common symptoms are excessive thirst and/or hunger and hind leg weakness. Hope this helps. Kim

[Coop]

Thanks Kim. Yes, that does help as I hadn't read anywhere that hair loss doesn't always happen in all dogs. Buddy has all the other symptoms you mention though :( I'm still waiting for his test results so will post these when they arrive.
Claire

[Coop]

Repeat post.

[Coop]

Buddy’s test results. They don’t mean much to me but maybe others could comment.

Many thanks
Claire

12 June 2012
Urine Cortisol : Creat Ratio
Test type Result
UCORT 183
UCRE 4391
UCCR 41.7

13 June 2012
LDD Suppression test
0 hours 149
4 hours 129
8 hours 108

21 June 2012
HDD Suppression test
0 hours 173
3 hours 164
7 hours 93

[frijole]

Could you please edit the test results and add the units of measurement for each? They are different than what we typically see (USA) so we need to know how to convert them to answer your question. Thank you!!! :D Kim

[Coop]

Hi Kim

I couldn't find out how to edit so have to post again with the additional information. I hope this helps.

12 June 2012
Urine Cortisol : Creat Ratio
Test type Units Result
UCORT Ratio 183
UCRE Ratio 4391
UCCR Ratio 41.7

13 June 2012
LDD Suppression test
Animal Test type Units Results
0 hours CORT nmol/L 149
4 hours CORT nmol/L 129
8 hours CORT nmol/L 108

21 June 2012
HDD Suppression test
Animal Test type Units Results
0 hours CORT nmol/L 173
4 hours CORT nmol/L 164
8 hours CORT nmol/L 93

[Sabre's Mum]

Hi Marie

I will convert these to ug/dl so that those in the USA can understand the results:

Not so sure on the UCCR Ratio so here are the other two:

LDDS (in ug/dl)

0 hours 5.4
4 hours 4.67
8 hours 3.9


HDDS (in ug/dl)

0 hours 6.27
4 hours 5.94
8 hours 3.37


I will check out the flow charts later to check out the interpretation.

Angela and Flynn

[Sabre's Mum]

Ok Marie .... checking the flowcharts which I will also link for you:

LDDS interpretation http://www.idexx.com/pubwebresources/pdf/en_us/smallanimal/snap/cortisol/cortisol-low-dose-dexamethasone-protocol.pdf

HDDS interpretation http://www.idexx.com/pubwebresources/pdf/en_us/smallanimal/snap/cortisol/cortisol-high-dose-dexamethasone-protocol.pdf

From this (if I have my brain switched on correctly tonight :) ) the LDDS shows that the results are consistent with cushings. The HDDS shows the results are unable to differentiate between PDH (pituitary) and ADH (adrenal).

So from my interpretation (please someone correct me if I am wrong) is that the results are consistent with cushings but are unable to differentiate between adrenal and pituitary.

Angela and Flynn

[Coop]

Angela, next to the UCCR Ratio it has the following ( 1 - 13 )

It also says below this, " ...raised UC-CR in dogs with appropriate clinical signs, raises the possibility of Cushings, but false positives can occur in dogs with non-adrenal illness. APL not terribly high. Other than PU/PD are there any other clinical signs that point to Cushings?"

But then of course this test was then followed with the LDDS and HDDS and the HDDS results say below the figures, " ...highly suggestive of functional adrenocortical neoplasia, however a tiny percentage of pituitary dependent hyperadrenoocorticism will have this picture, so ultrasound examination of the adrenal glands is recommended to confirm".

We did do an ultrasound but it was inconclusive.

Claire

[Coop]

I have made a decision to begin drug treatment for Buddy so that feels good. His fluid consumption is increasing so I can't sit back any longer and ignore this. Whether I go with Trilostane or Mitotane is yet to be decided but will I talk to the vet before making a final decision. The cost of Trilostane is horrendous in New Zealand - $800 a month and that doesn't include testing. Cushings is a very expensive illness. I'm not sure how his hypothyroidism and the medication he takes for that will be implicated in treatment. Anyhow, just thought I would share my decision.
Claire

[Sabre's Mum]

Hi Claire,

I have been really busy the past couple of days and have not had a chance to post (it always seems to take me so long!).

One thing that I may/may not have asked ... has Buddy's hypothyroidism been stable with treatment? ie are his thyroid test results where they should be but these symptoms have come about. The LDDS can give a false positive with the existence of other non-adrenal illnesses.

Another thing ... have any vet clinics in Dunedin have a high resolution ultrasound? (or was your ultrasound undertaken on a high resolution ultrasound machine?)

I was going to post that an ACTH stim test would be a great baseline to start treatment but I have reread and see that you have had one done. Did the vet give you these results ... there will be a pre and a post?

You will find that more vets in New Zealand will be more experienced with Lysodren .. obviously due to the expense of Trilostane. (Some also lack experience in using Lysodren as well!) As I said earlier ... I would double check the cost as what you were quoted does seem high. We paid just under $6 per tablet ... obviously the price varied due to the prescription fee of $15 so we always tried to get at least 20 tablets at a time.

Keep us up-dated ..... and ask any further questions if you need to.

Angela and Flynn

PS Hopefully that all makes sense ... darling lil Flynn was demanding my attention whilst I was trying to type! The ever helpful Vizsla ... NOT!

[Coop]

Hi Angela

I know what busy means. I think life has zapped us all into the fast lane!

Buddy's fairly recent thyroid test came back with good results so thankfully that is something that has settled with treatment. He is on Synthroid 6 x 2 a day.

I could ask my vet if anyone else locally has a high resolution ultrasound. I don't think his is but will check this out. I suspect only Vetspecs in Christchurch have such equipment. This is probably a really dumb questions but why, when the majority of the tests point to Cushings, is it still advisable to have an ultrasound. It seems to me that Buddy has enough symptoms to indicate he has Cushings so why not just proceed with drug treatment? Please forgive my lack ofe knowledge.

I thought we had an ACTH test but when I asked for all the results so I could post them this didn't come through so maybe I was wrong. Again, another thing to ask. The past weeks feel a bit of a blur.

The Lysodren was quoted at $1100 for the loading period and $230 a month so much cheaper than Trilostane but I could still be persuaded to go down the Trilostane track if I thought he would be better off with this drug though the longer term cost is scary.

Buddy has more sores down his spine now and they seem to be uncomfortable. I'm using Vitamin E oil to try and soothe them. Any suggestions for something better would be welcomed.

Snugly cuddles to Flynn from me and lickity licks from Buddy.
With warmest regards
Claire

[Steph n' Ella]

Ultra sound can help you determine if it is adrenal or pituitary cushings. High-res images of the adrenal glands would show if there is a tumor. If adrenals are clear then it is most likely a pituitary tumor.

[Sabre's Mum]

Hi Claire,

Cushings can be very difficult to diagnose and you can also have false positives. So, generally vets or specialists like to do ACTH stim, LDDS and an ultrasound. The ultrasound gives you the most "bang for your bucks" as you get to see all the other organs as well.

I will readily admit that in Sabre's case ... we only did an ACTH. We would have liked to do an ultrasound but had already spend $1700 on treating his pyoderma which was still in a terrible state. The ACTH, along with a biopsy which indicated calcinosis cutis, along with his symptoms is what lead us to us treating. We also made the decision that if it was adrenal cushings we would not undertake surgery so therefore our treatment plan would be the same.

Not sure if I asked but what was Buddy's ALP on his last test?

Angela and Flynn

[Coop]

Hi Angela

What still puzzles me, is that as I understand, effective drug treatment options for Cushings, whether adrenal or pituitary, are basically limited to Trilostane and Lysodren and both can be used for either though I understand there could be preferences here. Until Trilostane came along Lysodren seemed to be the preferred drug for either/or. So if there are sufficient symptoms, and other tests indicate probable Cushings, why isn't that enough to begin treatment without ultrasound diagnosis? I can understand an ultrasound is necessary if surgery is an option but if that has been discounted then I don't understand the need to keep testing. I know I'm really new to all this and trying to find my way through the haze of language, tests and their abbreviations, results and treatments etc, etc so please forgive my lack of knowledge. Like you Angela, we have spent a fortune already at the vet as along with Buddy's tests we have had a chronic eye ulcer with my other boxer. We're up to over $2,500 before even beginning Buddy's treatment so this has to be a consideration. If we go down the Trilostane pathway that's just the beginning of the financial outlay. How on earth do people afford to treat Cushings? It is such a difficult dilemma when you dearly love the one with it.

I know the vet said when he did the 'unsuccessful' ultrasound that he looked around at Buddy's other organs and they seemed fine.

I'm going to see the vet in the morning for my eye ulcer girl so will ask him the questions I have and I may decide then on the treatment plan. I feel as though I have to do something for my boy though I still wax and wane between what is the right plan. I am clear, however, that I no longer want to wait and see.

I don't know what an ALP test is but assume it's the hypothyroid test. All I recall is that the vet was happy with it.

And so it goes on. Worrying, wearying and stressful.

Thanks sooooooo much for your caring support Angela, it means a lot.

Warmest regards
Claire

[Somesie]

Claire,

You are correct in your assessment of the relative necessity (or not) of an ultrasound in your case. For some of us whose tests results are borderline or (like in my case) even negative, but the dog is symptomatic, the ultrasound becomes a very valuable tool. Additionally, there can be non-adrenal illnesses that will mimic Cushing's symptoms, so there is always some possibility of false positives where cortisol is elevated because of something else and in treating the cortisol elevation you're missing a bigger problem. That said, if you are comfortable with the test results and your baby is symptomatic, then you should feel comfortable in moving forward with medication.

At the risk of further confusing your decision making process, I am going to mention that Vetoryl and Lysodren are not actually the only drugs used to treat Cushing's. They are the most prevalent - and there's a reason for that, they work. Given that you mention cost as a factor, it might be prudent for you to discuss Anipryl (L-deprenyl) with your vet as a possible solution. The general consensus is that it is effective in far fewer dogs than the other two drugs, however it does have the benefit of having fewer potentially severe side effects, and it doesn't require periodic ACTH testing, either. So, if you happened to be one of the lucky ones for whom the drug works - you would at the least be saving money in ACTH stim tests, and then of course the drug may not be as expensive as the other two (of that...I have no idea). Like I said - I hate to confuse you, but this is an option and if it were me, I would want all the options on the table so that I could make the best decision that is available within my means.

There is one other drug, too, about which I know very little, I can't even recall the name but am fairly certain it starts with a K? Somebody else can probably chime in. Again...Vetoryl and Lysodren are the preferred medications, but they aren't the only ones. If something else is easier to budget and has a chance of working, it may be worth giving a try. We have actually done this with Jordan - we don't feel like it is time yet to put him on Lysodren, but we wanted to try something to improve his quality of life, so we are giving it a go. He was only on it for a few days before this kidney crisis we're dealing with now, but I have to say, I was encouraged by what I saw in those few days.

Sorry such a long message. I hope this helps you some. And I'm sorry your girl is suffering one of those nasty eye uclers. Our girl, Barkley, struggled with those on two occasions and it was horrible to see the discomfort she was in. I hope she's getting it cleared up and isn't in pain!

Sloppy Boxer kisses on you and yours...
Jenn

[Sabre's Mum]

Hi Marie

I can fully understand where you are coming from. Given your location, and the other reasons you have given ... I wouldn't bother with an ultrasound. I would personally do an ACTH stim test if this hasn't been done for a starting point though.

The ALP is a liver number and is generally quite elevated in cushings dogs.

Yes, cushings testing can be very expensive ... but once you start treatment things get easier. Lysodren is definitely the cheaper option .. particularly with the exorbitant cost of Trilostane in NZ.

Yes .. it can be a totally stressful time .... I fully understand.

Angela and Flynn

[Coop]

Hi there

I have taken some Cushing's free days spending quality time with my dear dogs and feel so much better. I can highly recommend it!! This disease can become all consuming so much so it feels like it takes over your life. So if any of you are feeling overwhelmed with the enormity of decisions and worry and don't know what to do next, time for you and your pooch works wonders. It doesn't mean that the enormity of the problem goes away but putting it aside for a while gives a different perspective. My advice to myself is, slow down - nothing disastrous is going to happen immediately and some space helps to give a better perspective.

Cheers
Claire

[Squirt's Mom]

Excellent advice, Clair! :) I'm glad you got some time to refresh and enjoy Coop!

Hugs,
Leslie and the gang

[addy]

off topic a bit- I know- but I saw you were dealing witha cornea ulcer too and just wondered how your vet was handling it. My Zoe's (Cush pup) has had one know for almost 4 weeks.

Thanks for any input.

[Coop]

Hi Addy

It's my other boxer, Yana, that has the corneal eye ulcer but I'm no stranger to treating ulcers since boxers are prone to them. We are into about our 8th or 9th week of treating Yana so it's been a stubborn one this time. I think finally we are coming out the other side but there's still a lot of scar tissue that will take longer to heal.

So the treatment regime has been:

Early stages - antibiotics, Rimadyl, Chlorafast 4 times a day, Conoptal 2 times a day.

Mid-stage: same as above but also serum.

Latter: Chlorafast and Conoptal.

In between all this the vet has been debriding regularly (using a cotton bud to remove the dead tissue) and on one occasion he sedated her and scarified the ulcer.

I am now only using Conoptal twice a day and beginning to feel optimistic.

I found a useful article on the Internet I sent to my vet.

http://veterinarymedicine.dvm360.com/vetmed/article/articleDetail.jsp?id=703805&sk=&date=&%0A%09%09%09&pageID=3

Hope this helps and good luck to you and Zoe.

Best wishes
Claire

[Coop]

Hi there

I would be very interested to hear if anyone has opted for adrenal surgery rather than drug treatment? If so would you make the same decision again if you could go back in time? I am also interested in recovery and how long this takes. I initially completely ruled out surgery but now thinking I want to explore every option.

Best wishes
Claire

[StarDeb55]

Claire, I have not posted to you previously, so here is a very late welcome. I have been following, though. I'm going to give you a link to Stormee's thread. Get your favorite beverage as the thread is rather long, but the good news is her little Min Pin has undergone a successful adrenalectomy.

http://www.k9cushings.com/forum/showthread.php?t=3674

We have also had several other members whose pups have had successful surgery, Kira is another one.

http://www.k9cushings.com/forum/showthread.php?t=2742

The one thing I will say is that an adrenalectomy is very delicate surgery depending on whether or not the tumor has invaded surrounding blood vessels. You want to make sure you get a board certified surgeon involved when opting for surgery & make sure they have plenty of experience with adrenalectomies.

Hope this helps.

Debbie

[Coop]

Hi Debbie

Okay, I'm away to brew a cuppa and will settle in for a long read. I do want all the information I can get so I truly thank you for taking the time to respond.

I have one more question to ask. Is there any advantage over HD ultrasound vs CT scan? Obviously, the purpose is to obtain a definitive diagnosis of which gland is the culprit plus checking the health of other organs to ascertain whether they are affected. Any opinions gladly received.

Best wishes
Claire

[Sabre's Mum]

Hi Claire,

Just wondering what you decided? Did you go for an ultrasound at Total Vets or the CT at the other specialist? As discussed with our phone conversation ... I thought that it depended what you are going to do with the information ie CT scan vs ultrasound. Hopefully you see this and can give us an update. Great to talk to you the other day ... sorry for my slight vagueness as I had just done an hour of Bokwa and driven 30 minutes back home!

Angela and Flynn

[Coop]

Hi Angela

We came back from Christchurch Tuesday this week all a bit wrung out from the trip but fine now. I was sooooo impressed with Total Vets, very thorough and this is the outcome.

Buddy had radiographs, chest and abdomen and he had an ultrasound plus bloods and urine test. Quoting from report.

Radiograph: - no calcified abdominal masses present and no evidence of tumour.

Ultrasound:
Spleen - normal echogeniciity and normal capsule.
Left and right kidneys - left has very slightly dilated pelvis on transverse view.
Left adrenal - appears enlarged. Plump peanut shaped gland appox. 1.2cm x 4cm.
Right adrenal - homogenous and approx 1.3cm x 3.5cm.

On the basis of radiography and ultrasound this is most likely PHD.

Then there are the CBC and urine results but this doesn't make much sense to me.

We decided not to go ahead with the CT scan on the basis of the above results. Personally, I feel a lot happier as I had convinced myself that he would have mets everywhere and this isn't the case.

So, we are going to begin treatment with Lysodren which is being ordered in right now. Feels scary but I'm ready now.

Cheers
Claire and Buddy

[Sabre's Mum]

Hi Claire

Fantastic news. Yes ... the boys breeder has only ever had glowing comments about Total Vets.

Glad everything went well. As I discussed with you, my opinion was that you would get what you needed from a HD ultrascan and queried why the specialist wanted to do a CT scan ... and the cost ... OUCH!

There are fantastic Lysodren loading instructions on the site which I will give you a link to - http://www.k9cushings.com/forum/showthread.php?t=181

Generally, you have looking for the slightest change .... that hesitation when eating, when your dog would usually 'hoover' down their meal. Apetite is normally the first indicator as water consumption can be delayed but I would advise you also to measure Buddy's water consumption. In Sabre's case we saw his water consumption reduce a day or two after being loaded.
I had an excel chart set up with dosage of lysodren, water consumption and notes and kept this going for the whole duration Sabre was treated. I just found it easier to write down something I thought was a little strange with him .... and if it ended up that I had to take him to the vet I could rely on my short notes .... instead of my memory!

What dosage has your vet given you for Buddy? Are Total Vets overseeing his treatment or is your vet going to take care of it?

I trust the Buddy travelled OK up to Christchurch. For those of you who don't know NZ ... Claire and Buddy had to travel what is normally about a 6 - 6 1/2 hour journey without stops from Dunedin to Christchurch. The things we do for our dogs :).

Angela and Flynn

[Coop]

Hi Angela

Well, we have the Lysodren ready to begin treatment tomorrow. I'm not starting until then as the vet wants me to phone her on day 3 and I will be out of town on Monday for work and even though my partner will be home for observations he gets a bit lost in vet language so best I do it.

The vet said she is taking a more cautious approach with the loading and starting him on 392.5mg twice a day. Buddy weighs 31.7kgs.

So I feel prepared and very clear about what to watch out for and will document everything. We're lucky as our vet is 24/7 so the slightest concern and I will be in touch with them.

I can't really use Total vets for the oversight as they're too far away and not as available if I need them. Pity!!!

Will let you know how we go.

Cheers
Claire

[Coop]

Good news and I'm now a big advocate of a cautious approach to loading. Buddy is on half the recommended loading dosage and has reduced his fluid intake by a litre a day and we're just completing day 3. On day 1 of his Lysodren treatment he was drinking 6.5 litres in 24 hours; day 2 it was 5.5 and today I anticipate 4 maybe 4.5 tops once the 24 hours are up. He has shown no side effects at this stage. Appetite normal, no diarrhea or vomiting and no lethargy or wobbliness. Just his normal old self apart from a reduced water intake. I'm feeling cautiously optimistic. It's such a relief to see he is not constantly at the water bucket.

A happy
Claire

[Squirt's Mom]

Hi Claire,

You may want to contact the vet about an ACTH fairly soon based on Buddy's water intake. He may be loaded. ;) It seems that big dogs often load much sooner than the smaller ones so keep that in mind. ;) A decrease in water intake is one of the leading signs that the load has been achieved so I think I would call the vet today. And keep a very close eye for any signs that he is having problems just in case he IS loaded.

Hugs,
Leslie and the gang

[Steph n' Ella]

Yayayayay! So glad you have good news!

[Boriss McCall]

how awesome.. yay!! your dog is so gorgeous. Glad the big guy is responding so well.

Amy & Boriss

[Sabre's Mum]

Hi Claire,

I missed your post on Saturday ... busy weekend with the kids then it must have been off page one.

Great to hear about Buddy. I do have one query though. Usually Lysodren comes in 500mg tablets so what form of Lysodren is Buddy taking?

Angela and Flynn

[Coop]

Thanks everyone. Given I was soooooooooo fearful of this drug it is with enormous relief that nothing untoward has happened so far. Leslie, I spoke with the vet last night and she is excited too. I'm to speak to her again this afternoon but now that you have advised the ACTH stim test now I think I will talk to her earlier and suggest they consider doing it today and see what she says. His water intake in the past 24 hours was 4.5 so we're still going down a litre a day and of course I don't want that to drop to much.

I was going to say, "you have no idea how relieved I am" but of course this lovely group knows exactly how I feel!!!!

With a happy heart
Claire

[Coop]

Hi Angela

Just saw your post. Yes, you are right but because of Buddy's size and weight they said couldn't get one dose in one capsule so had to divide it between two. Of course you pay per capsule so my costs are double though the vet took $100 off the first order.

Buddy's dose is 392.5mg per capsule and he's taking two a day so very conservative but it's working so I'm fine with that and don't want to increase the dosage.

Warm wishes
Claire

[molly muffin]

Glad to hear that Buddy is doing okay!

hugs,
Sharlene

[Sabre's Mum]

Hi Claire ... sorry I am having a blonde moment (no offense blondies .. I am a brunette) .... so am right in guessing that you have the tablets especially made for Buddy? This may be the reason that initially you made the comment about the cost of your Lysodren. Sabre's Lysodren was about $5.80 per tablet if we ordered 20 tabs at a time. His were just the stock standard 500mg Lysodren tablets.

I would take a slightly different tact re the reduction in water ..... the Lysodren is having an effect BUT IMO Buddy is not loaded yet. The reason I say this is that yes .... some dogs are more likely to show that they are loaded through water reduction .... but the goal here is to get near 60ml per kg. From my experience though .... do not wait until this happens as there is a slight delay in this. In Sabre's case it was the following 24 hours after he hestitated with his food before his water went to 2L ... I do believe Buddy is pretty close though. Obviously you are still looking for the other indicators as well.

Hang in there .... I know how stressful it can be loading!

Angela and Flynn

[Coop]

Hi there

I phoned the vet today but she felt it was still too early for the ACTH test since Buddy had 4.5 litres yesterday. Of course I'm taking this consumption over a 24 hour period from 7am to 7am the following day as he drinks through the night. We are still having a daily 1 litre reduction in fluid consumption and this is day 4. I'm picking that by tomorrow we will be looking at test time. He has only had 2 litres in the past 11 hours (how wonderful) and I anticipate another 1 to a maximum of 1.5 through the night so I wouldn't like to go another day without testing since that would take him to maybe 2.5 by tomorrow. There is no reluctance with food. He waits for meal times with the same anticipation and eats the same quantity at the same rate and no hesitation. All other behaviours are still normal.

At this stage I don't feel at all stressed about the loading since we are being vigilant in our monitoring and very clear about what to watch out for and what action to take if in doubt. I still feel an enormous relief that the incessant drinking is coming under control.

Angela, I am going to inquire about cost of the drugs. From what I understand Buddy's were specially made for him based on his weight. Our 20 capsules at 392.5mg per capsule cost $357!!! I'm sure you will be shocked. I have never been told about a standard capsule. The impression I have is that they had to prepare the drug based on the dog's weight. How heavy was Sabre? Buddy is 31 kgs though I haven't weighed him lately and he looks slightly slimmer. I'll weigh him when we go in for testing. I like using the same scales for accuracy.

I'm not going to leave Buddy at the vet for the testing as he stresses being in their cage and the vet said the stress can impact on the test results. I certainly don't want that. So we will take him to be jabbed, go away for an hour and go back for the final stage. I will let you all know the results.

Best wishes
Claire

[Sabre's Mum]

WOOoOWWW! That is expensive! I am sure that Lysodren is available in tablet form still in NZ. It is also easier to change the dose. We had a pill cutter (which we designated for Lysodren use only) and could cut the tablets down to quarters easily. I will make a quick call to our vet tomorrow and ask ... we are "good" clients (ie added to their revenue stream considerably) so I am sure they will be able to oblige with an answer to availability.

Sabre started off at a very heavy and fat 34kgs and lost weight once on the Lysodren, which also made for dosage changes. He eventually settled at about 25kgs.

Angela and Flynn

[Sabre's Mum]

Forgot to say ... the best time for an ACTH is 48 hours after the last dose.

Angela and Flynn

[Coop]

Angela, you are a true gem. Thank you so much for all your advice and support. It is truly appreciated.

Buddy smooches and a Claire hug

[Coop]

So Anglea, since Buddy's dosage is twice a day 12 hours apart he shouldn't have any further meds for 48 hours and only then do the testing? I bet my vet doesn't know this. How do I convince her?

Claire

[Sabre's Mum]

So Anglea, since Buddy's dosage is twice a day 12 hours apart he shouldn't have any further meds for 48 hours and only then do the testing? I bet my vet doesn't know this. How do I convince her?

Claire

Yes, this is correct. Lysodren still works for up to 48 hours.

Angela and Flynn

PS ... I will see if there is an article reference with regards to testing timeframe. I found my vet (well she might have been bluffing me) was receptive to something I suggested it if I could back it up from someone reputable. :)

[Sabre's Mum]

Ok Claire ... the only article I found specifically stating the testing time frame was an Australian pathology newsletter. The link is http://www.qml.com.au/files/vet_nl_may08.pdf.

It states -


2. MONITORING TEST FOR THERAPEUTIC EFFICACY
a) Mitotane: test needs to be run 36 to 48 hours after any dose of mitotane.

Mitotane is another name for Lysodren.

Hope that helps. I have rung the vet ... didn't get the receptionist that usually would know straight away so am waiting for them to ring back with regards to Lysodren availability in NZ.

Angela and Flynn

[frijole]

Just chiming in regarding the 48 hr wait. It is protocol here in the US and the reasoning is simple - lysodren/mitotane continues to work for 48 hours after you give the dose. That is why if you notice changes in appetite and water intake you are told to stop immediately and have the testing done. (because it keeps on working)

Good luck, Kim

[Sabre's Mum]

OK Claire ... I have just got off the phone with the vet clinic. Apparently you can still get Lysodren in the standard 500mg tablets BUT last year the pharmaceutical companies doubled the price. The Practice Manager said that the supplier also required them to buy the full bottle of 100 tablets so the price was approximately $1100 as a cost to them then they put a mark-up of 10%. Because of the huge increase in price the vet clinics in Tauranga decided to co-share a bottle of Lysodren between them.

Maybe there are other vet clinics in Dunedin that have a stock of Lysodren that you could access making it cheaper for you and easier to manage any dosing changes.

Angela and Flynn

[Coop]

Thanks so much for the information Angela and Kim. I emailed your article to the vet and spoke to her today Angela. She said she hadn't heard of the 36 - 48 hour delay before testing and even phoned the drug company for verification and they supported her!!!! Maybe I should say it's standard practice in the US Kim!!! She hadn't read the article at the time I spoke to her so hopefully she might have by now. Buddy is still booked in for a test tomorrow morning at 10.15am with results due back on Saturday.

Buddy was trembling this morning and a bit lethargic so I passed this on to the vet and she advised not giving him his evening capsule and testing tomorrow so that's what we'll do unless I decide otherwise in the morning. I'll see how he goes overnight and how he is in the morning. So far today he has had 2 and a quarter litres of water in 13 hours and he lay out in the sun part of the day so likely he drank more because of this.

Angela, I really appreciate the information you found out about Trilostane and will discuss this with the vet. I wonder why they doubled the cost - interesting. It's a good idea of theirs to share the order around other vets. At least they're thinking of saving customers money if they can. Cushing's is so expensive.

Warmest wishes
Claire

[Squirt's Mom]

Angela, I really appreciate the information you found out about Trilostane and will discuss this with the vet. I wonder why they doubled the cost - interesting. It's a good idea of theirs to share the order around other vets. At least they're thinking of saving customers money if they can. Cushing's is so expensive.

Hi Claire,

I noticed you said "Trilostane" - is this what Buddy is taking and not Lysodren? If he is on the Trilostane (brand name Vetoryl) then the testing schedule is altogether different. Could you verify if he is on Trilo or Lyso?

Thanks!
Hugs,
Leslie and the gang

[Coop]

OMG of course I meant Mitotane!!!! So sorry for the confusion. The two drugs have gone around in my mind for so long they have become interchangeable and of course they're NOT!!! Definitely Mitotane!!!

For the first time since starting the treatment on Sunday Buddy's drinking hasn't reduced in the past 24 hours, in fact there has been a slight increase. He has had 4 litres in the past 24 hours and the day before it was 3.5 so he probably isn't loaded???? Not sure now whether to go ahead with the test.

Claire

[Sabre's Mum]

Claire ... I know it is a difficult one when loading and no full proof way to know unless you test. If Buddy was trembling and lethargic ... I would agree with the vets call. He might be loaded ... may not be quite there but it is always better to be safe. Although ... I know it's not great on the pocket.

With regards to the the test I know with Sabre we did his first test pretty much like you which would have been 24 hours. All his next tests were scheduled 48 hours after his last dose, at similar times with the exception when we believed him to be low and we would test straight away with a note in the back of our minds that he could be lower if his last dose was within the last 48 hours.

Take care
Angela and Flynn

[Coop]

Grrrrrrrrrrr!!!! My partner is down at the vet right now with Buddy for his ACTH test and they are asking if he has eaten this morning. Well, no one told me to fast him before the test so of course he has eaten!!!!! They phoned the lab who said if it wasn't a fatty meal they could still go ahead and try!!! I said that was an expensive experiment but they assured me I wouldn't be charged if it doesn't work. Honestly, sometimes these people expect pet owners to be mind readers. Can you see I'm a bit annoyed??? I'm not holding out much hope with the accuracy of the test results. Bugger!!!

Claire

[Harley PoMMom]

I never fasted Harley for his stim tests and I really don't think that this is a requirement. Although, if a dog is known to be prone to hyperlipidemia, then fasting may help.

[frijole]

You don't have to fast for the acth test so don't sweat it. Alot of vets get confused about that... it isn't a regular blood draw! :) You're ok. Kim

[Coop]

It would be interesting to hear if others have had to fast prior to the ACTH test. It might strengthen my argument. Our vet and the testing people were adamant that he should have been fasted. It's these inconsistencies I find sooooooooooo frustrating. I still haven't made progress with my vet re the wait for 48 hours post medication but will keep trying.

Claire

[Sabre's Mum]

You don't have to fast ... however we always fasted Sabre because we would take extra blood just in case we wanted to test his electrolytes or anything else. As I said earlier .... once you get onto maintenance YOU can determine when to have Buddy tested ... what she doesn't know won't hurt her.

Angela and Flynn

[Coop]

Woooooo hoooooo!!!!! Buddy is loaded after only 6 days on Lysodren and at the lower dosage. I am so excited!!!!! We now go on the maintenance regime of twice a week. Already he seems to be brighter and wanting to do more which is just lovely. We're going out to dinner tonight to celebrate!!! I'll have to bring home some leftovers so he has a treat too. Water intake is still over 3 litres but compared to less than a week ago when it was 6.5 we've made huge progress. I asked the vet to email me the test results but they haven't arrived yet so will post them when they do.

Smiley Claire

[Sabre's Mum]

Hi Smiley Claire

We are smiling along with you! Go out and celebrate .... lucky you .... I miss those delicious Dunedin restaurants. Mind you most probably won't be around from my years in Dunedin.

And we would love to hear the results when you get them.

Angela and Flynn

[Coop]

Oh dear, I spoke too soon. Buddy is having a wee crash even though he had his last dose of Lysodren on Thursday morning. He was very ho hum about eating his tea tonight and it was his favourite meal - raw meat. Took him ages to eat it. He only went down in the past couple of hours and I just thought he was tired. Phoned the vet and we're going to hold back on the Prednisone unless there is wobbliness, trembling, vomiting or diarrhea. Is this the right thing to do?

No dining out tonight!!

Claire

[Sabre's Mum]

Hi Claire,

Great to talk to you! I think the vet has given you good advice. As explained Buddy is probably going through cortisol withdrawal ie he has come down from having high cortisol to coming to what you remembered to be about 2.8 (tested 24 hours after last dose). He would've come down lower but his cortisol is likely to increase from now on in. If he is "really" lethargic" there is probably no harm in giving a rescue dose of pred - which as explained is 0.25mg per kg so with Buddy's weight 10mg of pred as 5mg will probably not be enough.

The usual dosing protocol is to wait one week after dosing to give the next dose of lysodren. I am not a vet, but would not be wanting to give Buddy his next dose of lysodren on Sunday as your vet instructed but give his next dose on Thursday ... that is if Buddy is feeling better.

Hope you enjoyed your takeaways and wine. Happy to talk to you any time if you need to call.

Take care
Angela and Flynn

[Sabre's Mum]

How is Buddy this morning?

[Coop]

Good morning

We had a restless night right up until 2am. I made a bed on the floor in the room where the dogs sleep for myself and Buddy slept with me. He was very restless and couldn't seem to settle. Up and down all the time. Then he began trembling and by 2am I was worried enough about the restlessness, not drinking and trembling that I decided to give him half of a 20mg preds. About half an hour after that he finally fell asleep though the trembling took longer to stop. He did begin drinking a little about mid-night after not having any water since about 3pm yesterday and now he's back to big drinks though his total for the last 24 hour period was still only 2.5 litres.

So right now he's gone back to bed after having eaten his breakfast without hesitation. Not like he was at tea time last night. I will phone the vet a bit later and see what she says but like you Angela, I'm not at all keen to start him back on the Lysodren tonight. Mind you, the vet talked about the maintenance regime when he was doing well and hadn't crashed so I'll see what she says now.

We're a tired household after not having much sleep.

Warm wishes
Claire

[Sabre's Mum]

Hi Claire,

You made the right call with giving the pred.

As I said the usual protocol for Lysodren after loading is to wait one week before starting the maintenance dose. The vets advice, I realise this was before Buddy was not feeling good last night, was to start maintenance on Sunday this is too early and his earliest dose (if all is good) is actually Thursday.

Take care and hope you and Buddy rest well today.

Angela and Flynn

[Coop]

Hi there

The vet is now putting Buddy on a course of prednidone, retesting after this and then will determine the next course of action. Is this the normal procedure? He seems to be back to normal; appetite good, drinking a bit excessive and bright enough after catching up on some lost sleep so is this warranted? So far he has only had 20mg of pred over 2 doses in the past 17 hours. It feels like we're back to square one.

Claire

[Sabre's Mum]

Personally, I would say no. If your recollection was right that Buddy's post was 78 nmol/L I believe that Buddy was just going through cortisol withdrawal. I realise that he would have gone lower after this test but I believe it would probably not have placed him below 1.0 (a huge presumption on my behalf but one I have a gut feeling with).

What course of pred has she given Buddy? Personally I would take a different plan of action .... and actually not give him his next dose and see whether he is OK with it. If he is not, you can give him another dose of pred. If you only gave him 1/2 a tablet within 24 hours you only gave him a rescue dose so you it is easy just to stop the pred. The excessive drinking of water is the pred taking it's effect .... even at a low dose.

I really hate going against the vet's instructions but I really question her thinking in placing him on a course of pred.

So ... what was her course of pred ... given that she had previously told you to give 20mg of pred if symptoms of "going low" were indicated?

Call me if you want to chat

Angela and Flynn

[Sabre's Mum]

I see you just edited your post to the amount of pred given. So ... what pred course has she given you?

[Sabre's Mum]

I have sent you a PM.

Angela

[Coop]

I tried to reply to PM but not sure I did it right.

Buddy is fine this morning so didn't give pred. Will monitor him throughout the day reassess tonight.

Got the results for ACTH stim test when I got to work this morning.

Post 78 nmo1/L
Pre 44 nmo1/L

What does this mean?

Claire

[Sabre's Mum]

Yes .. you did well on the PM ... you must have done it twice but both came through. Sorry we had a major power cut this morning and my sister is having major issues with her dog ... lives in Sarawak so really hard for quality vet care and equipment. So have only just been able to get online now.

The results converted to ug/dl -

Pre 1.59
Post 2.82

So as discussed Buddy would have gone lower as the test was done 24 hours after the last dose of Lysodren. BUT these results are great ... your goal is to have the post number between 1 and 5 ug/dl (30 - 137nmol/L).

Angela and Flynn

[Coop]

Hi Angela

Sorry to hear about your sister's major problems with her dog. I hope together you can work though whatever the issues are. It is so worrisome when our fur friends are unwell.

Just thought I'd let you know that Buddy is doing well without any further pred. There is nothing that I would be concerned about and we have observed him closely. So far so good.

Warm wishes
Claire

PS it feels like just you and I are part of this discussion group. Is this normal?

[Squirt's Mom]

Hi Claire,

It kinda reads that way, too - as if you and Angela were the only ones in the room. ;):D But I assure you that is not the case. We are all here with you, listening and walking beside you.

It is always a little difficult to keep up with all that is happening when some of the info is passed via PMs and phone calls as the rest of us don't know what info has been shared. (NOT that this is "wrong" by any means! It is wonderful that you and Angela can converse in a more personal manner.) So we are relying on Angela and quietly fluttering around you and Buddy in case there is anything we can do to help. You are in good hands, I assure you, with Angela....and you are never alone. We are always by your side.

Hugs,
Leslie and the gang

[molly muffin]

hahahah Yep, we are all here, all reading and keeping up with what is going on. :)

Hugs,
Sharlene and molly muffing

[frijole]

I agree that those numbers are perfect and I would not think prednisone is necessary. That goal of loading is to lower cortisol to exactly where you have it so that is great.

Normally you would wait a week from the last dose and then start maintenance dosing. The weekly total dosage is what you were giving daily during the loading phase. Can you confirm what you were told to do next? Thanks. Kim

[Sabre's Mum]

Just so you know I have been generally summing up in my next post what Claire has said after any phone calls. Power was off til late yesterday. Claire gave me a phone call the other night after posting about the pred dosage and the reduction her vet wanted to do as she needed an answer immediately as his next dose was due (according to the vet). I gave her some options and the PM was just a quick note of a couple of options ... it was late at that stage and I needed to get to bed. I agree PM's are not a great way to do things and as I said I am trying to sum up the phone calls so others may assist where they can.

The other thing the vet wanted initially to start maintenance on Sunday .... which you would have seen in one of the posts further back which I have re-iterated what you said Kim ... to wait one week after the last loading dose to re-start the maintenance.

Claire will have to confirm but she did say on the phone that Buddy was going to get one tablet.

Great to hear that Buddy is doing well. I did forget to say Buddy's numbers were actually great and what he was going through, as discussed, was just cortisol withdrawal.

Angela and Flynn

[Sabre's Mum]

Yeah ... it's not so good for my sister. Her dog had a suspected fracture front leg ... no xray (well the vet was only just told here there is one 2 1/2 hours away) ... vet dug around, put a TIGHT bandage on it. Then it has swollen up to something HUGE. The things the vet is telling her is absolutely incredible ... ALP and urea is slightly elevated and say this indicates cancer ... he is saying it is osteosarcoma. He believes all the swelling is "bone" and it is the "bone cancer".

She has had a second opinion from a vet here in NZ who does consults for owners in the Pacific where there are no vets and everything I said he confirmed. The bloods are one of a dog which is fighting a massice infection. Wow having two very sick dogs has really expanded my knowledge!

Anyway ... she is now on track and has made an appointment with the vet 2 1/2 hours ago and has been instructed to re-start the antibiotics immediately. The dog is only 6 years old and is the pamper pooch!

Sorry to hijack your thread with my little ramble.

Angela and Flynn

[Coop]

Aw, thank you all for your lovely comments. I know you must all be very busy people and your support of everyone here is amazing. I sincerely hope I can do the same for others one day.

There's only been one PM between Angela and I and I have made a couple of phone calls when I was in a state of near panic and needed immediate support. She has been so generous and supportive and I can't thank her enough. I'm sure you've all been in that state at some stage where you just need instant support and advice that's not the vet.

I'm still feeling a little guilty at not following the vet's advice with the pred dosing so watching Buddy like a hawk for anything out of the ordinary. Water is down to a couple of litres a day; eating is normal and the other end is excreting normally. He was a bit pacy and unsettled in the early hours of this morning but seems to be fine since he had his breakfast.

Kim, the vet said to put Buddy on predisone when he crashed very suddenly on Saturday and the dose I've been given is 20mg. I only gave him half when he was at his worst in the middle of the night and it worked and he was fine the next day. But when I phoned her on Sunday she said to give him half twice a day for 3 days; half once a day for 3 days and half every other day for 3 days then retest him. I gave him another half after talking with her but since he had seemed fine I decided to stop and treat the two doses I gave him as rescue doses. My aim is to put him back on Lysodren on Thursday which is exactly a week since he had his last one but I'll talk to the vet first.

So that's where we're at. It's all day by day and wait and see!!!

Warmest wishes
Claire

[frijole]

OK.. so let's talk about the maintenance dose.

I just want to confirm it is the exact same dose that you were giving but only weekly vs daily?

Also it has been found that the most effective way to give the maintenance dose is NOT once a week but to split that dose into 3 or more equal doses. For example If the maintenance dose is one 500 mg pill rather than give that pill on Thursday you would cut it into 4 pieces and give 1/4 of a pill 4 days a week so it could be TH, SAT, MON, and TU. It keeps the dose more evenly distributed. Kim

[Sabre's Mum]

Ok Kim ..... I may have scared you by saying one tablet. Claire will be online later tonight NZ time hopefully but I should just put your mind at ease. Claire has compounded Lysodren in capsules ... Lysodren is now very expensive in NZ and from my discussions with my vet's practice manager, many vets do not want to have to pay the $1100 they have to to buy a bottle. I did suggest in an earlier post that Claire may want to see if another vet clinic in Dunedin as a stock which she may be able to utilise. I presume because of this upfront cost her vet chose to have the Lysodren compounded. (Even though overall it would be cheaper for Claire to have the usual Lysodren tablet).

Each capsule is 392.5gm and Buddy loaded on a twice daily dose of this.

Angela and Flynn

[frijole]

OK... I remember reading this now... I still want confirmation as to the dosage :) So does that mean two of these pills once a week (since that was the daily dose)? I am checking not to be a pain in the neck but to just make sure the maintenance dose is following protocol though I understand things might be different in New Zealand... better safe than sorry is all.

Thanks for the refresher Angela!

[molly muffin]

I think it is absolutely wonderful that you two can pick up the phone and have that instant contact, reassurance that is often so desperately needed! :) We all know that feeling to well.

I think the only thing really was to just make sure that in the thread everything medical is updated so anyone coming in reading it, whether to offer an opinion or in the case of someone else who has the same issues with their pup, looking for guidance, there is a record for everyone to follow.

gads, how horrible for that poor pup to have to go through such a thing. Hope there can be a road to recovery soon.

hugs,
Sharlene

[Coop]

Okay, it feels like we're all in the loop now and I have recorded everything here that I have spoken with Angela about on the phone. I have only contacted her in what felt like urgent situations for me.

Buddy loaded on 392.5mg twice a day for 6 days beginning from a Sunday and then the final dose was on the following Thursday morning when he showed signs of needing to stop. I had the tests done just under 24 hours after the last dose on the Friday and I have posted these results. Before he crashed on Saturday afternoon the vet had advised putting him on the same dose (392.5mg) twice a week on the next Sunday night and then on a Thursday night. She didn't make any mention of leaving it for one week so I am enormously grateful to learn this from you. So he is actually due to begin his maintenance this Thursday evening. I still want to talk to the vet before beginning. My only slight concern is that he very occasionally has mild trembles. Otherwise he's perky enough for him and no other concerns.

I hope this answers what you were asking.

Many thanks everyone
Claire
xoxoxo

[Coop]

Angela, I am so sorry to hear about your sister's awful situation. It must be horrible being so far away from a vet and then the tight bandage and subsequent swelling and frightening diagnosis. She must have been in such a state. Lucky she has such a knowledgeable and caring sister. My thoughts are with both of you.

Hugs
Claire

[Squirt's Mom]

Hi Claire,

It is my understanding that Lysodren reaches its peak at around 48 hours - ie, the pill keeps working for more than 2 days and is at its most potent around the 48 hour mark. This is why they say to test in the 36-48 hour range after the last dose when loading. So the ACTH done at 24 hours, would not have given a true picture of the cortisol level - it would have continued to fall over the next 24 hours. Angela is right on the maintenance dosing, too. Typically, we wait about a week to start that phase then the same amount that was given daily for the loading is used for maintenance, but the amount is spread out over a week in 2-4 smaller doses. ie, if a pup is getting 500mg a day for loading, they will get 500mg a week on maintenance.

With your situation on the availability of the drug only in capsule form - at an ASTRONOMICAL cost :eek: - it is going to be very difficult to keep Buddy on the schedule needed. One thought is if you have a pharmacy that would repackage the capsules into smaller doses for you. ie, break the 392.5mg capsule into 196.25mg (1/2) or 98.125mg (1/4) caps for you to use as the maintenance dose. Another thought - is it possible to get permission from whomever would give such so you could order the Lsyodren pills online and have them shipped to you there. I know we had to do something similar to get Vetoryl in the US before it was approved here. One final thought - is Vetoryl (Trilostane) available there? If so, it might be better to use this drug VS the Lysodren given it isn't available in the form needed.

Considering all you have working against you and Buddy, I think you are doing a fine job, Mom! Keep up the good work!

And I want to make sure you and Angela understand that I agree with Sharlene's statement 110% -


I think it is absolutely wonderful that you two can pick up the phone and have that instant contact, reassurance that is often so desperately needed! We all know that feeling to well.

Hugs,
Leslie and the gang

[Coop]

Hi Leslie

So are you saying giving Buddy a 392.5mg dose twice a week is too much and that it would be better to spread the total amount over 4 days of the week? If so this is going to be a major problem. The vet has already ordered in a quantity of this special dosage for Buddy and the place that compounded them charges per capsule and that's why they're so expensive. If I request that they be reduced by half they will still charge me $36 per capsule.

It's just not possible to import vet medicines into New Zealand. I tried to import Duralactin and they stopped it. Then the other option you suggested of Trilostane is just too expensive here. It was going to cost me $800 a month!!!!

I still have the option that Angela's vet uses which is to ask my vet if they would buy in the larger quantity of 500mg tabs and share with other practices. I haven't approach my vet about this one yet. But that still leaves the problem of my specially ordered batch sitting in their practice!!

In terms of the testing time for ACTH I did try to reason with my vet about this and she was adamant that the timing didn't matter. It's so hard when you meet this sort of resistance.

Oh well, I will keep battling on.

Warm wishes
Claire

[Sabre's Mum]

Hi Claire,

Yes, the Lysodren maintenance dose is generally split into 2-4 doses. As your vet has already obtained the capsules for you this is what I would suggest. Give his current maintenance dose split into twice a week eg. Thursday and Sunday - one capsule. In the mean time, ring other vets in Dunedin and see if anyone else has a stock of Lysodren - this will save your vet from having to fork out the cost for a start. See if they would be willing to allow your vet to access the supply for you. The vet clinic may also be able to do this for you?

I am not sure of the logistics, ie. whether they allow, but I do understand there is possibly one vet that still has stocks of Lysodren here in Tauranga. There is also an online Pet Pharmacy which is located in Whangamata. He is a brilliant vet and likes to keep medication costs low ... I will give him a call later in the morning and see if he has any.

Personally, I prefer the ease of a Lysodren tablet so that it makes it easier to adjust the dose.

So ... my calculation is that you have 11 capsules left so this leaves you 5 weeks to see if you can get an avenue to get some Lysodren tablets.

As I said earlier .... ignore the vet and just take the Buddy in 48 hours after his Lysodren when on maintenance for any ACTH stim tests. Obviously testing when he is not well is an other case altogether and I would test ASAP and just take into account in the back of your mind that he will most likely be lower.

Angela and Flynn

[Sabre's Mum]

Ok ... Stefan is away today so I will flick him an email.

Angela

[Squirt's Mom]

Hi Claire,

Since Buddy loaded on 392.5mg 2X a day, then his maintenance dose would be 785mg per week. As you have this already divided for you into the 392.5mg caps, you can simply give him one cap on Sun and one on Thurs - or which ever two days are easy for you to remember. So what you have should work fine for maintenance. I misunderstood his dosage - I had him taking only 392.5mg/day during the load. :o

Hugs,
Leslie and the gang

[Coop]

Angela, are you suggesting I have Buddy tested again before beginning the maintenance dosing? I was going to start this from tomorrow.

Better get back to my work.

Claire

[Sabre's Mum]

Hi Claire,

Sorry if my post wasn't clear ... no I wasn't suggesting this. Just in future for any ACTH stim tests ... just take in Buddy 48 hours after the last dose.

Others may chime in ... but if I recall we always dosed in the morning ... then were able to test 48 hours after then when doing stim tests.

Angela

[frijole]

Just letting you know you are doing great! Keep it up.

I am shocked at how hard it is for you to get drugs... and Duralactin - my God that is made of all natural ingredients and doesn't even require a prescription here... makes me sad and grateful.

I agree just give those special pills twice a week but it'd be so much easier and I'd think cheaper to use the regular 500 mgs ones and just give 3/4 of a pill which is 375 mgs. The thing is that over time you might have to tweek the dosage so being able to cut them and not having to worry about what to do with excess inventory of special compounded pills... you get the picture.

Anyway... keep us posted, fingers crossed! Kim

[Coop]

Okay, have just finished speaking with the vet where I had to fess up about not proceeding with the pred regime. She was fine about it - said she trusts me as I'm a vigilant owner - but she wants another ACTH test tomorrow before going on to the maintenance dose given Buddy had the wee crash on Saturday night. Besides, it will only put us one day behind the ideal for beginning maintenance by the time we get the results. I'm absolutely fine with this and would much rather be safe than sorry. The good thing is we don't have the 48 hour post meds complication since it's now a week tomorrow since he stopped the loading. I'm feeling like this is a great way forward. I will know for sure what his levels are and of course will let you all know.

Question - have any of you been instructed to fast your fur babies before the ACTH test? A locum at our vets said the dog should not have breakfast prior to the test but I've never read anything about this and nor has the vet I'm working with. She decided to go with the fasting to be on the safe side.

Angela, I also asked about the idea of sharing Mitotane tabs between clinics and she was certainly open to this and will investigate it so that's good news too.

Phew, that's it for now.

Thanks my wonderful cushy friends
Claire

[Coop]

PS My vet wanted to know the name of this site so I might be busted!!!!!

[labblab]

Claire, for your future reference, dogs do not need to be fasted before an ACTH test. For dogs taking trilostane which requires a daily dose even on the morning of the test, fasting actually invalidates the test results because the medication won't have been metabolized properly.

Per this "blog" by Dr. Mark Peterson, an endocrinology specialist here in the U.S., dogs taking Lysodren don't need to be fasted either, unless there will be additional bloodwork performed at the same time which WOULD be affected by having consumed a meal (such as choloesterol level check, etc.). Here's a link to Dr. Peterson's "blog" that discusses fasting and ACTH testing:

http://endocrinevet.blogspot.com/2011/03/whats-best-protocol-for-acth.html

You'll see that Lysodren does also need to be given with food, however, at the time of regular dosing. It requires some fat in order to be metabolized properly, too.

Marianne

[Sabre's Mum]

As said earlier you do not need to fast for an ACTH ... generally other blood tests do need the dog to be fasted. However, we did with Sabre because we, once he went low, alway drew another vial (well the vet) so that we had some blood that they could do other tests if required ... in particular Sabre's electrolytes.

Angela and Flynn

[Sabre's Mum]

PS My vet wanted to know the name of this site so I might be busted!!!!!

Mmmmm Claire ... it might be me who is busted!:)

[Sabre's Mum]

I know it is a costly expense the ACTH stim test, given his tremors occassionally still, the vets request for another ACTH stim before restarting is a safe option. My gut feeling is that he is just getting used to the Lysodren ..... but the only real way of knowing where he is is to test. One day is not going to make a difference to starting his maintenance.

Angela and Flynn

[Sabre's Mum]

Hi Claire

I have received a reply from My Vet (the online pet pharmacy). The vet suggested that your vet contacted Optimus, a compounding pharmacist in Auckland and they can make up the capsules. He believes this may be cheaper.

Obviously, from my point of view, Lysodren tablets would be the best option so that you can adjust the dose easily.

Angela and Flynn

[Coop]

Right, ACTH test has been done (and I didn't fast him) so tomorrow will reveal how Buddy is really doing. My gut feeling is that he is too low. He is less enthusiastic about his food and while he eats what I put down he takes longer which is unlike him. Water intake is still good, anything from 2 - 2.5 litres in 24 hours. I feel so much better about this.

I spotted a soft, substantial swelling at the top and back of his right front leg while at the vet. She examined it but decided not to aspirate and asked us to keep an eye on it. Another worrying sign we don't need at this time. Plus he has to go back on antibiotics for his calcinosis cutis as the sores on the back of his neck are infected again. Poor boy!

Angela, the capsules Buddy has were compounded by Optimus so no point in going back to them but thanks so, so much for trying. I have definitely got the vet interested in sharing an order between clinics.

Marianne, I was wrapping the Lysodren in soft cheese before giving them to Buddy so that it was fully enclosed. I read somewhere that giving it with fatty food was best and he loves cheese.

I think that's if for now and will let you know test results when I have them.

Thanks to all
Claire

[Sabre's Mum]

Looking forward to those test results!

Angela and Flynn

[Coop]

You will have to convert for me Angela. Results are:

Pre 29
Post 54

Last week it was 44 and 78 so quite a bit lower this time. Buddy's appetite isn't great either. We're not starting back on Lysodren yet.

Will write some more later since I'm still at work.

Claire

[Sabre's Mum]

Ok so converted to ug/dl these are :

Pre: 1.05
Post: 1.95

The post is within "treatment" range.

Maybe these results will convince your vet to test 48 hours after the last dose of Lysodren as the results are lower then Buddy's first ACTH test which was 24 hours after the last dose.

This is a hard one for maintenance ... most dogs who have just loaded and later through treatment will turn up their noses at food which they previously have eaten. So this just may be part of the parcel with Buddy having been on Lysodren. Usually this results would be fine to start maintenance. However the trembling is another thing in the equation.

Angela and Flynn

[frijole]

OK so you loaded in 6 days and the first test was like 2.8 and this one was done after being off the lysodren for a few days and after some prednisone treatment. And it is lower at 1.9

Yes, living proof that lysodren continued to work after the last dose.

My two cents - I would not start maintenance this week. I'd probably wait a week. The reason is because Buddy seems to be very sensitive to the lysodren and I think a week off might allow the cortisol to creep up a tad and that way when you start testing the maintenance dose to see if it is the right dose.. you have some wiggle room. By that I mean you don't have to worry about going too low (1.0 is too low and you are at 1.9 now)

That is another advantage of buying the whole pills and being able to cut them up... you can tweak the dose by simply cutting the pills in different dosages (downwards) if you need to. Compounding usually isn't done until after the dosage if finalyzed for exactly this reason.

Anyway... the load was successful which is great news. I just think giving Buddy a wee bit more cortisol might make him feel better and give you a little more protection against going too low. So that is why I'd wait another week before commencing the maintenance doses.

Kim

[Coop]

My sense is that it's too soon to begin maintenance and the vet agrees. She said to talk with her again early next week to see how Buddy is and I'm comfortable with this. If there's nothing to be lost in the delay (and in my limited knowledge I don't think there is?) then why rush into something that might have a negative effect.

It does seem that like you said Kim, Buddy is quite sensitive to the drug so I want to be cautious about this. I suppose there's no way of dividing up the contents of the capsule - maybe that's too risky since I have been wearing rubber gloves as advised when handling them. Then there would be the problem of dividing the dose accurately. Sorry, I'm thinking out loud.

Buddy's appetite was slightly better tonight so I'm encouraged about this and water intake is still in a satisfactory range so I'll go with the status quo for now.

I must discuss further with the vet the 48 hour wait before ACTH testing as you are right, this is sound evidence. But give her her due, she did consult on a list of endocrinologists and she said they didn't support the 48 hour wait. Again, conflicting opinions but it's too important to get it wrong. But like you say Angela, when he's on maintenance I can chose the timing.

Warmest wishes
Claire

[Sabre's Mum]

Hi Claire,

I agree with Kim ... Buddy does appear sensitive to Lysodren. Generally you want to get straight into maintenance one week after loading to that the numbers don't get away on you ie cortisol levels. But I think in Buddy's case you are going to just have to watch him and seen when he is ready before you start his maintenance.

Splitting the capsule up is not advisable ... they should be done at the compounding pharmacy.

Have a fabulous weekend ... hopefully you have better weather than we have forecast for day and we have two hockey games!

Angela and Flynn

[Coop]

I didn't spot your post until now Angela as it was on a new page. I have been concerned about Buddy over the past few days and have a call into the vet. He has almost no appetite and I have to persuade him to eat anything. I have been tempting him with his favourite foods without a lot of success. He also goes through restless periods where it’s like he doesn’t know quite what to do with himself and paces a lot. This sometimes happens through the night. The other worrying observation is that his skin, especially where it was shaved for the ultrasound, has blackish spots all over it and they’re getting worse quite quickly. Is this what they call bruising? The only encouraging signs are that his fluid consumption is within a normal range and his peeing and pooing is still normal and no vomiting. There is no way he’s well enough to go back on to Lysodren at this time. He just isn’t himself so I’ve worried over the weekend. I plan to take him to the vet this afternoon for a thorough check over.
Claire

[frijole]

I'm glad you posted - no lysodren for sure. You never give it to a dog that isnt eating or that is sick (even if unrelated to loading). Do you have prednisone on hand just in case? It might provide a bit of relief. Glad you contacted the vet.

Re the black spots - are they like bruises or like sores? Bruises could be from handling during the ultrasound but if they are sores I'd be more concerned. Angela can coach you on skin issues as she went thru them with her dog.

Best of luck! Kim

[Coop]

I have pred on hand so will discuss this with the vet when I go to see her in an hour.

The skin on his belly looks splotchy like small black (like bruising) spots of colouring under the skin and they are spreading and getting larger. Definitely not sores, he has calcinosis cutis so I'm familiar with that. All rather puzzling. Hopefully the vet can tell me more. If she can't I'll try taking a photo and see how I can make it available to the members to see what others think.

Claire

[frijole]

Good luck at the vets!!!!

[Coop]

Back from the vet. She was puzzled about the skin condition that my partner describes as a mouldy belly and that's exactly what it looks like. She gave Buddy a good check over and was concerned about some abnormal heart beats so did an ECG which has shown up that there are some arythms and something else that I can't remember. The vet is going to have a closer look at the test results tonight and let me know tomorrow. She also wondered about a urinary infection though all the symptoms of that are the same as cushing's symptoms so a bit hard to tell. How have others known their pooches have had a urinary tract infection? I left a urine sample for testing and we've put him on penicillin. Other than that she's puzzled about his lethargy and lack of appetite since it's now 11 days since he had any Lysodren.

Cheers
Claire

PS Despite Buddy's reduced food intake (about half what he normally has) he is putting on weight. Very strange!!!

[Sabre's Mum]

Hi Claire

I am sorry to hear that Buddy is not feeling well. I have not had a dog with a UTI but many here have. Care of Mr "Google" I see that lethargy is also one of the symptoms. Many here have the main symptom of accidents and increase in urinating.

Some dogs do get hit hard with the loading phase and I do believe that Buddy's body is sensitive to Lysodren. Sabre used to have what I would call the "Lysodren blues" ie. for about 24 hours after a dose he wasn't that energetic and would just want to rest and sleep. He was a dog who became sensitive to Lysodren (he was good at 50mg/kg at one stage) and when we finally got him stable on maintenance he was on about 20mg/kg.

The putting on weight with reduced apetite is VERY strange!

I think I said earlier that some dogs do become very finicky eaters and what once was food they eat becomes something they don't like at all.

I must go ... hope this makes sense as our darling Flynn will not stop whining as he wants me to play with him and his toy .... now barking!

Angela and naughty Flynn

[Sabre's Mum]

Forgot about the black spots .... could you post a pic?

Angela

[Sabre's Mum]

Has your vet tested Buddy's thyroid level? As I was googling options for black spots I found some info. Hypothyroidism occurs when the thyroid gland doesn't secrete enough of the hormones that control the metabolic rate of the dog. When an insufficiency occurs, the dog will often gain weight and become less active. There will often be a darkening of skin pigmentation while it also becomes scaly.

Angela and Flynn

[Coop]

I asked the vet to do a blood test for his thyroid as it must be about due and I keep wondering if maybe this might be part of what's going down with him. I have to wait for results. She did another blood test for potassium and sodium levels (I think) and that came back normal.

I am now waiting for Buddy to stretch out so I can get some good shots of his mouldy tummy!!!

Claire

[Coop]

Photos are up now and keep in mind he used to have a lovely pink tummy.

Claire

[Steph n' Ella]

Would you describe the skin as thin, flakey, and/or delicate? Does it feel waxy or oily to the touch?

[Steph n' Ella]

There was a recent thread that described similar skin problems in which the owner had skin "punches" examined. Ella has bad skin issues too. Balding, black heads, possible calcifications/plaque. Check out this link...

http://www.k9cushings.com/forum/showthread.php?p=81040#post81040

Addy has come good pics of zoe's skin problems...

http://www.k9cushings.com/forum/album.php?albumid=433

Some people have treated with dimethyl sulfoxide (DMSO) gel. It is only availble in some countries. Not sure about NZ

[Steph n' Ella]

I have had some success re-growing hair when I could treat the area reqularly and give her 1 to 2 baths a week. Then when she had her spay surgery everything went to hell :( No bath for 10 days and a shaved tummy and I feel like I am at square one.

You should be able to get similar products in NZ...I treat the area with a cotton ball soaked alternatively in a topical antiseptic wash and a mild astringent.

http://www.cleanandclear.com/product/astringents-toners/essentials-deep-cleaning-toner-sensitive-skin

http://www.cvs.com/shop/product-detail/CVS-Antiseptic-Wash?skuId=209921

[Sabre's Mum]

Claire I have just looked at the pics. I am not sure what it is .... it does not look like comedomes (black heads). I think, can't say for absolute sure, Sabre had these as he aged. I would just keep an eye on it ... not sure whether it is something to worry about.

Others may have some ideas.

Angela and Flynn

[Coop]

Thanks so much for the helpful information. Buddy's skin isn't flaky or oily, nor does it appear to be thin and fragile. He definitely doesn't have 'blackheads'. I would love to try the regular bathing but at over 30kgs he's rather heavy to lift in and out of the bath and he hates them so I don't want to stress him. Besides, with the calcinosis cutis all over his neck and back I would have to be very careful not to make this worse. He doesn't like the sores being touched so that would be tricky. Maybe I could try just hand applying the topical solutions. I did look on the Internet for DMSO but it's not obtainable in New Zealand!!

Anyhow, thanks again.

Cheers
Claire

[Sabre's Mum]

Yeah no DSMO in NZ ... my vet looked at me rather strangely when I asked her about DSMO when we were trying to sort out Sabre's calcinosis cutis. She said it was used on horses YEARS ago in NZ.

Sorry my last post wasn't very self explanatory ... the black spots that you posted ... I recall that Sabre had some of these on his skin as well. It never seemed to be an issue ... so I do not think that they are something to be worried about ???

We tried oatmeal shampoos ... but found that in the end they did not do a lot. We found that with the Lysodren, and keeping on top of any infections, that eventually the calcinosis cutis sorted itself out. For Sabre, it was always "there" but never became infected again and all of the scabs healed.

Angela and Flynn

[Squirt's Mom]

Hi Claire,

Cush pups get hyperpigmentation, a darkening of the skin. It is hard to tell in pictures if the dark spots on Buddy's belly are raised or not. The cushing's hyperpigmentation looks more like bruising than anything else. And there really isn't much that can be done for it. Is this area raised, or smooth and bruised looking?

I hope Buddy is doing well today.
Hugs,
Leslie and the gang

[Coop]

Your information is helpful Leslie. I looked it up on the Internet and it seems there's nothing much to worry about. There is nothing raised but has a bruised appearance though it doesn't bother him at all.

The past few days have been more worrying on a couple of levels. I took Buddy back to the vet for a more comprehensive checkup since his lack of appetite and lethargy was becoming concerning. I think I said this earlier.

Angela, the thyroid check I asked for came back with a result that isn't flash - 19 and his last check in May was 29. He's just below the lowest of the normal range. Vet said if a dog's system is compromised in other ways thyroid levels can be affected. Good to have this information though.

She is still most disturbed by the checks on his heart and has consulted specialists especially at Massey University (a vet training institution in NZ) and doing her own research. Most evidence for the symptoms so far is inconclusive so treatment options vague. The one thing they came up with as an intermediary measure was to increase his cortisol level slightly to take some pressure off his system even though his ACTH levels were okay. So we gave him 20mg of prednisone last night and again this morning. It hasn't changed the lack of appetite though he is eating enough that he's not going to starve. There's been a slight increase in water intake so I will monitor this carefully. We then took him back again today for blood pressure checks. She wants to do an x-ray of his heart and spleen tomorrow.

The other stress is my partner. He is getting really worried by everything Buddy is being put through and thinks we should just leave him be to live out his life however long that may be. I know he is unhappy with the way we just keep going back and back to the vet and all the ensuing costs that are really substantial now. He thinks the vets should be able to diagnose and treat without all this endless testing. Of course he hasn't done all the research I have so really doesn't have any understanding of the complexities of cushings other than what I explain in simple terms. This is an additional stress I could well do without but then I guess he's coping in his own way as he does love Buddy and just wants him to get better while I know it's not that simple.

So we're still betwixt and between not knowing what's going on in that loveable body of our precious boy.

Claire

[Sabre's Mum]

I am sorry to hear that things aren't going so well. Be re-assured that you are doing the right thing. The only way that calcinosis cutis can be managed is by way of treatment for cushings. Otherwise, it continues to develop with nasty infections which may become unmanageable. It is hard getting the OH to understand sometimes ... particularly when you are the one that puts in most of the research. I have been lucky ... my husband is a former RN and he is now shocked that I can now interpret blood results and then rattle off a heap of info that I have found out. He told me the yesterday that I should actually be a vet!

With his thyroid does Buddy need his meds to be increased? Maybe he needs to be at a higher level to feel "normal". Note .... I have never had a dog with hypothroidism ... but am just thinking out loud.

Just take care at these levels of pred, Buddy will need to have a tapering programme.

I forgot about your post about Buddy's heart. Sabre had a heart murmur but I know with Lysodren treatment .... and particulary when he was low or on the low side of treatment, he had a slow heart beat .... slower than a normal dog.

All the best for tomorrow.

Hugs
Angela and Flynn

[Coop]

Angela, the vet never mentioned a tapering programme. Buddy only had the 2 preds, one last night and one this morning - 20mg dosage. How should I taper?

Claire

PS His water has definitely increased today:-(

[frijole]

I'm not quite sure I followed the thyroid testing that was done but if it is hypothyroidism in the US it is treated with totally different meds than cushings - cush meds are NOT adjusted up. Here we use thyroxine meds. They are inexpensive and it's very easy to treat. It is common for cush dogs to have hypothyroidism - my Haley did.

Kim

[Sabre's Mum]

Sorry Kim and Claire if my post wasn't written to explanatory enough. I meant his thyroid meds NOT his lysodren. (Buddy is currently on thyroid medication).

If it was 20mg each dose I would taper ... if it was 20mg over two doses then it should be OK to stop. I will be the pred that is having an effect on the water consumption increase .... wait till you have (NO you don't want it) a dog on 4mg/kg of pred then you see the effects!

Angela and Flynn

[Coop]

Sorry Kim, I should have made myself clearer. Buddy also has hypothyroidism (diagnosed early 2011) and is on Synthroid for this. He has 6 monthly blood tests to monitor the thyroid and I asked for an earlier test since he didn't seem all that well. This is the test that came back lower than I would have liked and it may be that I need to increase his Synthroid.

Buddy is currently not on any cushing's medication since he hasn't been all that well since loading.

Angela, Buddy had two doses of 20mg pred one evening and one next morning (yesterday) so I should taper?

Claire

[Squirt's Mom]

Hi Claire,

There have been some recalls on Levothyroxin but I'm not sure if that would affect Buddy but wanted you to be aware just in case as there are three manufacturers involved to date.

http://www.lifewithdogs.tv/2012/09/thyroid-medication-recall2/

Hugs,
Leslie and the gang

[Sabre's Mum]

Yes Claire ... since he has taken 40mg of pred within 24 hours I would taper. The dose which was given in the last 24 hours is 4 x a rescue dose so really needs to be tapered so that Buddy feels OK with the eventual removal of the pred. I would give the vet a call so that you can get the right reduction regime for him,

Angela and Flynn

[Coop]

Hi all

I've been a bit quiet lately so here is an update though there's not a lot to report. Buddy is probably brighter and eating is sometimes improved and other times still patchy. Drinking, once he was off prednisone, is back to 2 - 2.5 litres a day and I'm happy with this. So without any further Mitotate treatment, apart from the loading, he's still holding his own. His energy levels appear slightly better too.

We are back to the vet tomorrow to check out the arrhythmia and my normal vet is back from 6 weeks leave so I will fill him in on everything that has transpired over the past few weeks.

It's quite a nice feeling to say there's not a lot of news.

Warmest wishes
Claire

[Sabre's Mum]

Claire we like to hear "not much news". All the best for your visit to your vet tomorrow, I am sure he will be quite impressed by your cushings knowledge!

Angela and Flynn

[Coop]

Buddy had an echo ultrasound today and was diagnosed with ARVC which is a very common heart condition well known to Boxers so is now on medication for it. Our tally as of today is hypothyroidism, cushings and now ARVC. It's hard to believe he has so many complex conditions. But since he still has enough quality of life and isn't miserable we will keep moving forward with him. Our fur family are so worth it.

I asked the vet about Buddy's cushings since he isn't on Mitotane since loading and the vet said that when his water consumption reaches 3 litres it will be time to go on to maintenance. So far we're not exceeding 2.5 so it's a wait and see on that front.

I am hoping we don't have to visit the vet again for a while. It's beginning to feel like our second home!!!

Warmest wishes
Claire

[lulusmom]

If our vet did not prescribe Pimobendan (Vetmedin) as one of the heart meds, you should ask your vet for a prescription. I have two boys on heart meds for congestive heart failure and Vetmedin has made a big difference. I'm convinced that drug is the only reason one of my boys is still alive.

[Coop]

Thanks so much for your suggestion. It's really great that we can pass on our experiences. Buddy doesn't have congestive heart failure so I don't think this is the right medication for him. For AVRC the medication is beta blockers and Sotalol is one of those and used for Buddy's condition so I think we're doing the right thing. He's very sleepy today so I've been a bit worried but he doesn't seem distressed in any way. I will continue to monitor him closely.

Best wishes
Claire

[Sabre's Mum]

Hi Claire

Sorry for my belated reply .... read your post but haven't had the time in the last couple of days with everything going on around here! Not great news to hear you are also dealing with AVRC but good that you are now addressing it. Hopefully dear Buddy will get back on track soon.

Angela and Flynn

[Coop]

Hi there

Again I've been a bit quiet for a while so here's a check in. Buddy is now adjusting to his heart medication. I had to reduce it as it was making him sleepy and I've gradually increased it to the right dosage and he seems to be fine. In fact, he seems to be a happier chappy overall. A lot more interested in life and wanting to do more than he has in a long time. Less sleeping and more activity. Water consumption is still consistently less than 2 litres a day usually between 1.25 and 1.5 over a 24 hour period so that's good. Some of the scabs from his calcinosis cutis are starting to come off and I think there's a hint of his shaved areas beginning to grow hair. The only issue of late is red and hot paw pads. From what I've read it suggest an allergy so I tried aloe vera without success and then gave him an antihistamine for a couple of days to see if this made any difference and the redness has definitely subsided so now is the long haul of finding out what he's allergic to.

So, in terms of his cushings has anyone ever heard of or had the experience of only doing the loading and not having to go on to maintenance? At this stage Buddy has only had 4.5 days of loading with Lysodren a month ago and no further medication since, mostly because he wasn't well but he's doing everything pretty normally now so I am not even considering maintenance until/if he increases his water consumption. I am back in my faze of hoping we have a miracle though reality says it's only a matter of time.

So that's us enjoying the positives of our fur babies.

Warmest wishes
Claire

[Sabre's Mum]

Hi Claire,

Great to hear the latest news on Buddy with his heart meds at the right level and that you have an antihistamine that works for him.

We have had dogs in the past which have overloaded and not been on treatment for a long time. I am not sure whether we have had any dogs like Buddy. I know with Sabre, when he was on a Lysodren holiday it took a couple of months to go from about 1.9 to about 2.6 (totally from recollection as I no longer have his data).

Generally, when dogs are within range after loading, maintenance is started after a week so in most cases this is what has happened.

Angela and Flynn

[Coop]

Hi there

I have been absent from this forum for such a long time now and while I feel significant guilt, in my own mind I can justify it. Buddy has continued without any cushing’s symptoms – that is without any medication since loading and it’s been 3 months now - and his health and well-being just keep getting better. It has been such a relief and joy after all the stresses that I have just wanted to enjoy and focus on health and put illness and worries to one side. I am so enjoying having my old boy enjoying his life again.
This is the progress Buddy has made.
• He has moulted for the first time in 2 years. Oh, the joy of dog hair around the house. I never thought I would ever say that!!!

• He is growing a new coat and the shaved area from the ultrasound prep, that stayed bare for so long, now has soft new regrowth.

• The white on his front legs had turned a dirty brown from constant licking is now clean and snowy white again.

• His calcinosis cutis has cleared so that there are no scabs any longer though there are still remnants of where the sores have been under his coat.

• His appetite and weight are normal for him.

• Water intake fluctuates from a minimum of half a litre to a maximum of just over a litre a day. There has been a slight increase lately but nothing I’m concerned about at this stage though I’m closely monitoring this.

• Just had his T4 levels checked for his hypothyroidism and it is 27 so that’s great as it did go down to 21 when he was unwell post loading.

• He is alert (not sleeping all the time) and wants to exercise
within his elderly limitations.

• And a biggie for me that won’t seem much to others; he can jump into the car again. Because of his rear end weakness we’ve been lifting him in for a long time.

• He’s still on heart meds and will be for the rest of his days but adjusted well to this.

So that’s just a quick overview of how things are going and we’re making the most of this special time with our Buddy.
I will post a couple of before and after photos so you can see the difference in him. I think the before photos show in his eyes and expression how miserable he was then whereas the after photos he has his spark back.
None of this may last but I feel like a miracle has come our way. Whatever happens from here I will always be indebted to this forum and all you wonderful people. You helped me through some very dark days. If I were half as knowledgeable as you I would be trying to help others.

Thank you from the bottom of my heart and I will pop back again I promise.

Our best wishes to everyone
Buddy and Claire

[addy]

Clarie just keep on loving it and enjoying. I am so happy for you and Buddy.:D:D:D:D

Wonderful news!!

[Bo's Mom]

That is awesome news Buddy!!! Keep giving your family great reasons to post. We want to all hear about you continuing to do well.

[molly muffin]

Buddy looks fabulous! I commented on his pictures. It really is a big difference. I say, enjoy it! I hope it last for a very, very long time.
It's okay to just check in once in awhile and say things are still awesome. We love to hear that you know!

Hugs,
Sharlene

[Sabre's Mum]

Claire ... what a fantastic update. I was wondering how you two were going ... I presumed that everything was OK ... no posts, no phone calls but that update is brilliant.

The photos show a remarkable difference before and after. Thanks for posting these as it may help others who may be hesitating to treat ... he just looks such a happy handsome chap.

Angela and Flynn

[Coop]

Your lovely replies have made me smile inside and outside. Thank you so much for your understanding and encouragement. Life is good at this time and sharing it has been such a good thing to do. I promise to check in again.

Warmest wishes
Claire

[frijole]

:) Wonderful. I think we should edit your title! What do you want it to say? :D Kim

[Coop]

I agree. What about Happy heart?
Claire

[Coop]

I am going to post my most recent experience with Buddy simply because it may be helpful to other members though this has nothing to do with his Cushings.

Buddy came down VERY suddenly and dramatically with Canine Vestibular Disease though I’d never heard of it until it was diagnosed. It is one of the scariest things I have seen and experienced with my dogs. He went from being relatively normal in the morning to vomiting, unable to stand, drooling, head tilt, eyes flickering and frightening unwell all within an hour. We rushed him to the vet and he stayed there for the day.

The vet diagnosed him very quickly and explained the disease and all the symptoms that go with it. I’ve copied this from the Internet rather than repeat what I now know.

Introduction
Idiopathic vestibular disease (IVD) means that the vestibular system in a dog has gone awry for no known reason. The vestibular system is what gives people, and dogs, their balance, coordination and equilibrium. When dogs develop IVD, their equilibrium becomes disrupted suddenly, dramatically and without warning. The profound symptoms of this disorder can incapacitate the dogs and are frightening for owners, as well.
Symptoms of Idiopathic Vestibular Disease
Dogs with idiopathic vestibular disease suffer an extremely sudden onset of one or more of the following symptoms:
• Dizziness (labrynthitis)
• Loss of balance
• Disorientation
• Loss of coordination (ataxia)
• Reluctance to rise or stand
• Inability to rise or stand (recumbency)
• Nausea (recurrent bouts)
• Vomiting (sudden onset; recurrent bouts; may last for days)
• Loss of appetite (inappetence; anorexia)
• Loss of thirst
• Dehydration
• Falling
• Stumbling; staggering
• Circling
• Rapid irregular eye movements (nystagmus)
• Head tilt (mild to marked)
Dogs with IVD appear to be in considerable distress and discomfort, and the symptoms can quickly become debilitating. Most symptoms peak in about 24 to 36 hours, but varying degrees of incoordination and balance abnormalities can continue for a number of weeks. Despite the startlingly acute onset of IVD, almost all affected animals recover spontaneously, without extensive medical treatment. Occasionally, a dog will have a lingering head tilt.
http://www.petwave.com/Dogs/Dog-Health-Center/Ear-and-Eye-Disorders/Idiopathic-Vestibular-Disease.aspx


We nursed Buddy by keeping him quiet and hydrated with fluid. He refused to eat or drink from his bowl so I was thankful I’d taught him a long time ago to drink from a squirty drink bottle. He accepted this so getting fluid into him wasn’t too difficult. Gradually I introduced liquid food as he wouldn’t eat at all, in fact the first week he only had liquid food. His only medication was anti-nausea injections that I administered. We had to carry him outside to toilet as he couldn’t take many steps before falling over. By day three there wasn’t a lot of improvement and the vet was beginning to talk about making a ‘hard’ decision. By some strange turn of fate I lifted his left earflap and found a discharge coming out of his ear. As it turned out he had a middle ear infection and likely a burst eardrum. No wonder he couldn’t stand. I was excited by this discovery as it told us why he had the disease and was treatable with antibiotics.

So gradually he improved and at three weeks now he’s back to almost normal though still has a slight head tilt sometimes and still a little wobbly at times.

If anyone experiences this disease with their older dogs I can assure you it’s frightening but the prognosis is good. There is a lot of useful information on the Internet to support you through to recovery.
An interesting aside from the vestibular disease is that just before Buddy came down with it his fluid intake had increased to 2 litres a day. The vet was talking about loading him again with Mitotane which scared me given his first experience but since this episode his water consumption has gone back to normal. All very odd but I’m happy.

Best wishes
Claire

[frijole]

Done and with pleasure. What a wonderful story and thanks for sharing it. So many dogs are misdiagnosed and cush dogs tend to be older and prone to other diseases so I am sure this will be helpful to someone in the future.

Meanwhile sending hugs to you both! Kim

[Coop]

Thanks Kim. After Buddy's experience I am now convinced that a previous boxer we owned had the same disease at 10 years of age and was put down on the advice of the vet. She had all the same sudden symptoms and had I insisted on giving it more time she could have lived a lot longer. It looks so much like a stroke so I urge dog owners to make sure they have an accurate diagnosis before making any drastic decisions. I am going to post a photo that the vet nurse took of him while he was with them on the first day. They said he was 'settled' but you can clearly see the terror in his eyes. His world was spinning out of control poor boy.

BTW, in terms of your comment of misdiagnosis Kim, my vet got so focused on what he thought could be an enlarged pituitary tumour he didn't check his ears carefully enough. Very often vestibular is idiopathic (no identifiable cause) so he made his diagnosis based on the cushings. Good learning here all round. He admitted his mistake to me and apologised.

I don't know if this is permitted but if anyone wants to see more of Buddy I have heaps on my Facebook page. If it's not permitted then please delete this.

Buddy's page link (http://www.facebook.com/claire.perry.9085)

Best wishes
Claire and Buddy

[Boriss McCall]

Claire,
Thanks for the info about Buddy. That sounds very scary! So, glad you discovered the ear infection.

[addy]

I am so glad you posted about Buddy. We have had a few members suffer through the same problem and it is good to spell out the symptoms as you did for everyone's furture reference.

You are doing a great job, Claire.


Give Buddy some belly rubs from all of us, poor pup.

[molly muffin]

Yay Buddy!

Terrifying. I can't even imagine going through that with not one but two of your dogs in a life time. It is definitely going to be helpful to someone going forward too. I am very grateful that you posted about it and that Buddy is well on the road to recovery. So often, the not known, leads to being in a place where you feel you have to make those really hard decisions, when you shouldn't be in that place at all. I'm glad that y you checked his ears and discovered what was Really going on.
Love the new title!
hugs,
Sharlene and Molly Muffin

[Coop]

Thank you Amy and Addy. I LOVE the way you both express your love for your dogs below your signatures - very touching.

I would encourage every dog owner to teach their pets to drink out of a squirty drink bottle. If I hadn't taught Buddy he would have been in dire straights as he refused to drink out of a bowl. I think his licking reflexes were affected and besides he couldn't even turn himself on his beanbag at the beginning much less lift his head. I just squirted water and then liquid food slowly into the side of his mouth and he would swallow most of it though I did use towels to catch the spill over. We then progressed to hand feeding as again he wouldn't eat out of his bowl. It took some time to wean him off hand feeding - he rather liked all the attention from Mum.

His appetite is almost normal now but last night he fell over while eating his tea and was soooooo embarrassed. He still gets the wobbles and it's a long way down for a big dog to reach floor level so I invented a solution. I used an old plastic bowl (about 15cms tall) half filled with water to weight it down and placed his food bowl in the top of that and placed it on a non-slip cloth - problem solved!!! Now he doesn't have to bend down so far and is steadier while eating. I'll post a photo to demonstrate.

I have learned so many valuable lessons and would be happy to support any other members going through vestibular disorder.

Best wishes
Claire

[Coop]

Sharlene, when I was despairing about how ill Buddy was and thinking this was going to be the end, a colleague at work reminded me to hang in there as he was a determined old boy and his resilience had pulled him through lots of other tough times and how right she was. It was a good reminder to never give up hope. She was a wonderfully encouraging support. People, near and far, are amazing especially in times of trouble.
C

[Tina]

Hi Claire,

I have been following Buddy's thread since way back and am so happy to read that he has been doing so well overall, minus this latest setback. How scary. Thank you so much for posting your experience and all of that information. It seems there have been a couple of other instances of this illness on the forum in the past few months or so, not many. I had not heard of it before then. I think I learn something valuable on this forum most every day. And I am going to take your suggestion about teaching my pups to drink out of a squirty bottle. You never know when it may be needed. Thanks again for posting all of the information, and I hope Buddy continues to improve and feel better.

Hugs,

Tina and Jasper

[Megan]

Please ignoremy post... stupidly read the first page and replied, not realising there was a billionty posts since then and things have progressed... oops :D

[molly muffin]

:D:D That happens to all of us! No worries.

Sharlene and Molly Muffin

[Sabre's Mum]

Hi Claire

Thanks for the great info on vestibular disease ... there have been a few dogs here that have had it and it will be useful info for others.

How are you are you all in sunny Dunedin .... I hope you and Buddy are coped with the other day at ... what was it ... 34 degrees! We are in for a 30 degree scorcher today!

Just a note for when, and if, you start the lysodren reloading ... make sure you get an ACTH stim first - don't just rely on the water consumption.

All the best
Angela and Flynn

[Coop]

The main focus of this site is the welfare and wellbeing of our beloved pets so I am going to post this warning regarding dog treats made in China. I came very close to losing my boxer Yana after feeding her Waggin' Train treats. The issue has been in the media since 2007 and yet again it has hit the headlines again. Please follow this link and whatever you do DON"T feed your pets ANY treat Made In China.

Dogs have been getting very ill and/or dying from this brand for many years. It horrifies me that the brand is still in shops all over the world!

This article mentions yet another recall, but the brand keeps coming back with problems!
http://www.poisonedpets.com/nestle-purina-claims-illegal-drugs-found-in-waggin-train-chicken-jerky-pet-treats-not-a-problem/

[labblab]

Thanks so much for this warning. Just want to alert you and all our members that we have a special subforum here that is devoted to highlighting product recalls. So if anybody becomes aware of recalls that they'd like to broadcast to the membership, you can post them here:

http://www.k9cushings.com/forum/forumdisplay.php?f=31

Also, the American Veterinary Medical Association (AVMA) hosts a twitter feed with up-to-the-moment announcements:

https://mobile.twitter.com/avmarecallwatch

Marianne

[molly muffin]

You're right, stay away from those nasty chinese made dog treats! Just isn't safe.

Sharlene and Molly Muffin

[Coop]

I am again back to having a 'heavy heart'! Buddy is coming to the end of his life. We got through the vestibular disease with some lingering effects but he then developed other worrying symptoms and today he was diagnosed with Canine Pericardial Disease - fluid around his heart plus a tumour at the base of his heart. He has had four collapses in the past 24 hours; very laboured breathing, almost no eating and drinking huge quantities of water. He has just started to cough up bloody mucus. We have decided not to put him through any further procedures or medications. In the past two years he has been tested, diagnosed and treated for hypothyroidism, Cushings, ARVC, vestibular and now this. It's time to just let him be.

We'll probably take him on his final car ride tomorrow to the vet depending on how he is but if not then it will be in the next couple of days. We are adamant we're not going to keep him with us if he's suffering. This is about him not us. He could of course have a much more severe collapse in the next hours and the decision is then taken out of our hands.

The sad thing is I can't even really spoil him in his last wee while with us. He doesn't want to eat so it can't food. He's too unsteady on his feet so can't go any special places and there's the risk of more collapses so I'm trying to keep him calm. Oh well, lots of cuddles and snuggles are in order for our darling boy. I'm trying so hard to be brave around him - I don't want him to see my breaking heart.

Claire

[frijole]

Dear sweet Claire, I am so sorry to hear this update. That said - dear Buddy is going to leave this place with a happy heart - because you have been such a loving mom through all of this. While it would be great to give him an awesome meal and treats - without a doubt your love is the best possible gift. I will hold you both in prayer tonight and send strength and comfort. My heart breaks along with yours. You have done everything and more for your baby. Please know that. Love, Kim

[NoonelovesmelikeNorman]

I am sorry Claire, my thoughts and prayers will be with you and your family throughout the days and weeks. Peace be with Buddy. With heartfelt sympathy. (((hugs))) Sharon

[Tina]

Oh Claire, I am so sad to read this news about Buddy. You both have been through so much, and you have been the best Mom. Know that you and Buddy are in my prayers.

Love and hugs,
Tina

[molly muffin]

Oh Claire. I am very sorry to hear this. I don't really think I can anything better than what Kim wrote. You are buddy's special treat. You love and cuddles are what he loves most.
Sending lots of love and strength your way.
Love
Sharlene

[gummysmurf]

So so sorry to hear about Buddy. I went through the same thing a week ago, and I know oh so well the bittersweet way you are spending the time. If you are like me you are fluctuating between bouts of disbelief and the deepest sorrow - know that Buddy knows how very much he is loved.

You and Buddy are in my thoughts and my heart aches for you. When Buddy passes no doubt he will be met by my goofball boxer Baxter and Irena's sweet boy Maximus. They will be youthful and spry and sniff each other's smelly parts in greeting. Then they will no doubt touch noses and discuss us in their boxer way before scampering off in complete joy. Because isn't that the way of it with boxers? Complete unabashed joy. No doubt he is completely and utterly content simply being in your presence, the best gift of all.

[k9diabetes]

I know that Buddy can feel, down into his bones, your love and devotion all around him and that's the most wonderful gift you can give him, have given him throughout his life with you.

Natalie

[Sabre's Mum]

Hi Claire

I am so sorry to hear the latest news on Buddy ... I was just looking at the handsome boy on facebook the other day. My thoughts are with you and Buddy.

Take care and enjoy the cuddles
Angela and Flynn

[Coop]

I knew if I posted Buddy's ordeal you would all be so understanding and kind I would weep all over the place and I have. Thank you all for your comforting words of support. Right now they make me cry but when I read back in time I will feel the comfort of your love and support. I'm still trying so hard not to let Buddy see how deeply I am hurting and grieving.

It seems as though the boxer clan are calling from the other side. Buddy's sister died in mid-December and now Baxter and Max have gone over to join them. There will be boxer high jinks I know. I will try to remember to smile through my tears as I imagine the greetings.

Like all of us here that have known the grief of losing our beloved pets I can't comprehend life without Buddy. His constancy in my daily life for 11 years is going to leave a huge gaping hole. Already his niece, Yana, knows that something is up. She is sooooooooo quiet for her and sometimes snuggles beside him which she doesn't normally do. For a boisterous boxer I love the quiet way she comforts him. I am doing as she does. They teach us so much.

So at this time I am on high alert for any changes in Buddy waiting in case it's the major collapse. He's sleeping most of the time so I reach down and touch his warm body all the time trying to overdose on velvet ears and his soft warm coat. Oh, to bottle that feeling and take a dose when comfort is needed.

I began thinking about the many words of wisdom I've read on this site and the one that is vivid is that very often cush pups don't die of cushings, rather other age related illnesses. I think for me I got so absorbed in cushings (and other illness management) it becames a distraction from the natural aging and I lost sight of the inevitable. We battle so hard to give them a better quality of life and other things sneak up on us. Well, that's what happened with us. While I was rejoicing that we'd got the better of cushings(!) everything came crashing down with the vestibular and now this. It's come as quite a shock.

But my focus must be this time I have so off I am to snuggle and cuddle my precious boy.

Claire
xoxo

[Sabre's Mum]

Hi Claire

Yes ... it is so lovely that Yana is behaving like she is with Buddy. Dogs just seem to pick up when their best buddies are ill.

Take care and enjoy the cuddles
Angela and Flynn

[gummysmurf]

I love this:
He's sleeping most of the time so I reach down and touch his warm body all the time trying to overdose on velvet ears and his soft warm coat. Oh, to bottle that feeling and take a dose when comfort is needed.

And I know what you mean about getting so caught up in Cushings that you don't see the forest for the trees. I was thinking about this just this morning - how Baxter had been slowing down and changing so much these past 6 months and I completely missed it.

You are so good to try and be so strong. I wish I had done a better job of managing my tears and sorrow in front of Baxter. You are a wondeful, caring mom, and buddy knows in his heart of hearts that he is loved and surrounded by the people (and boxers) that he loves most in the world.

[Squirt's Mom]

Dear Claire,

Those loving touches, gentle words, and the love pouring from your heart to Buddy's means more than the tastiest treat ever could to your sweet boy. They give him a comfort and remind him that you will always be with him, just as he will always be with you. You could give him nothing better in the time ahead, nothing.

Our thoughts and prayers are with you,
Leslie and the gang

[addy]

Oh Claire,

We do forget in our battle with Cushings becuase it is such a war that something else may come along.

I may not have posted much but I did follow Buddy's journey. I am so sorry your heart is breaking into a million pieces. We are here for you now and always.

((((((((((((((((((((((hugs))))))))))))))))))))

[Coop]

Thank you so much to everyone for your kind words of care and support. I haven't been able to visit this site in the past couple of days - it hurts too much and I am numb. But you can never know how comforting it is to have people from around this world giving so much of themselves. You are such and amazing group. I would like to share a little of the past couple of days and I will post some of Buddy's last photos.

Buddy, Apex Red Ribbon 28.12.2001 – 15.01.2013

Love – what is love? A great and aching heart;
Wrung hands; and silence; and a long despair
Robert Louis Stevenson

Monday 14 January 2013

Today the bottom of our world dropped out – you have a heart condition we cannot treat. No wonder you struggle with your breathing and don’t want to eat. Always, I’ve helped you to get better but this time I can’t.

Our darling Buddy – 11 years and 17 days old today. For all of this time you have been a constant joy in our lives – loving you and being loved, feeding you, playing with you, laughing at you, caring for you and tending to you. But now we have to accept the time has come to say our final goodbyes until we meet again.

God, how hard this is. Letting go of a huge and precious part of your daily life that has loved without condition, greeted you with such joy even if the absence was only minutes, found fun in every little thing you’ve done, rejoiced in the smallest things that life brings your way and made you smile every day for all these years. It is incomprehensible that you won’t be here the next day, the next week, the next month and the next year.

My head and heart are in a vicious battle. The rationale part of me sees your laboured breathing from your damaged heart, the frightening collapses as it misses too many beats, your lack of appetite and unquenchable thirst, the effort to walk too much and how tired this makes you. But most of all my head tells my heart, “you cannot ignore his ills and aching body and the sadness in his eyes”. I struggle to admit you look so tired Buddy.

For the past two years you and I have battled with your health issues. As one was brought under control and we enjoyed the respite the next would descend. Oh, the endless visits to the vet, the observing, assessing and monitoring your symptoms and behaviour, always on alert to any changes. I became so tuned in to you and your wellbeing. There were the hours and hours of researching your illnesses on the Internet to find ways to make you better again. And each time we succeeded; that is until this time. This one has beaten us Buddy and I struggle to accept defeat. We have no choice this time but to let you go. “I can’t, I won’t, I have to, there is no choice!”. When? tomorrow, the next day? Let’s wait and see.

Tuesday 15th January

I slept beside you all night so that you wouldn’t be alone. Yana joined us and slept next to you. Your breathing was so rapid and I hate to see how unwell you are. You don’t want breakfast – just rest. But you did wander a little way into the paddock this morning and I annoyed you by clicking away with my camera. You hate the camera as many of your photos show. But you indulged me today dear boy. I need to make all the memories I can in this short time we still have.

Dad and I talk and decide another day or two isn’t going to make this easier and you might have more collapses that frighten you so in the morning we make a time with the vet for your final car ride - 2pm today. You mustn’t see my shattered heart nor the sobs and tears that fall for you. This is your time to be cherished, petted and loved and my time to grieve will come later.

My heart aches at the thought of letting you go and my eyes feast on you, my body hugs and touches and kisses you trying to absorb every morsel that is the essence of you. I am desperate to store you up so I can take comfort in the soft feel of you, the adoring eyes, and the love that has no limits, your bravery and courage, when you are no longer here. Futile I know, but the enormity of letting you go is indescribable.

Time was our enemy. We try to behave normally so that all that is familiar comforts you. How hard this is.

So hour-by-hour then minute by minute we measure the time we still have with you. What an agony. Then it is time to go. The rest I don’t want words to remind me other than to say you left this world with the grace and dignity that was always you my beloved boy. I will love you for eternity. Until we meet again!


As a very special light went out in our world today; another was lit and glows brightly in doggy heaven. It is called Buddy!

[frijole]

My heart just broke. That was so touching and your love just jumped off the screen as I read it. What a wonderful love you shared with our friend Buddy. Thanks for sharing him with us. We all grew to love him and he will be missed. What you did was the right and unselfish thing but oh how I know it hurts to the core of your being. Only time will heal but you know that.

I'm heading to bed and promise to include you and yours in my prayers tonight. Meanwhile I know our newest angel will be looking over us all. RIP dearest angel Buddy. Run wild and carefree - free of pain. With love, Kim

[molly muffin]

{{{HUGS}}} I wish I could just give you endless hugs and make the pain all go away. You performed the final act of love, selfless and heartbreaking. I'm going to go look at Buddy's pictures.

love,
Sharlene and Molly Muffin

[SoggyDoggy]

Claire, I am so very sorry. Buddy was an amazing character, so strong to battle everything he did with such grace. I know it is so very hard to make that decision and he will be missed greatly, but the love will never stop.

Hugs and cuddles to you and Yana both.

Naomi.

[Trish]

Oh my, such a beautiful boy. I am so sorry for your loss. You write so well, he sure must have felt your love as I can feel it in your words all the way up here in the North Island :) Take Care
Trish xx

[Squirt's Mom]

Dear Claire,

Your love for Buddy and his for you has been evident from your first post. You have stood by his side and fought with him every step of the way. And when there was nothing left that could be conquered, you gave him the greatest gift of all - freedom from a failing vessel. It is both the hardest and the kindest thing we can do for our babies, to give them every minute we can yet have the courage to send them on when we can do no more. Buddy was sent on his way fueled by a lifetime of your love, knowing that would never change, knowing that one day he will be with his mom for all eternity.

We will be here anytime you wish to talk. We know what you are going through and our shoulders are safe and soft, our arms strong, our hearts aching with yours.

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


May I Go

Do you think the time is right?
May I say goodbye to pain filled days and endless lonely nights?
I've lived my life and done my best, an example tried to be.
So can I take that step beyond, and set my Spirit free?
I didn't want to go at first, I fought with all my might.
But something seems to draw me now to a warm and living Light.
I want to go, I really do; it's difficult to stay.
But I will try as best I can to live just one more day.
To give you time to care for me and share your love and fears.
I know you're sad and afraid, because I see your tears.
I'll not be far, I promise that, and hope you'll always know,
That my Spirit will be close to you wherever you may go.
Thank you so for loving me. You know I love you too,
And that's why it's hard to say goodbye and end this life with you.
So hold me now just one more time and let me hear you say,
Because you care so much for me, you'll let me go today.

by Susan A. Jackson

[Jenny & Judi in MN]

I am so so sorry. hugs, Judi

[Boriss McCall]

I am so sorry for you loss. Buddy was a sweet pup.
REst in Peace Buddy

Hugs!

[Sabre's Mum]

Claire,

What you have written is truly beautiful ... it has really touched my heart ... and now I am writing through a stream of tears. I am so sorry for your loss.

Angela and Flynn

[addy]

You tried so hard but some things we cant fix. Your words are beautiful and I now Buddy left this world feeling your love without a doubt.

I am so very sorry.

[Coop]

Thank you yet again for your comforting words that make me cry every time but in a healthy way. I love the poem Leslie - thank you. I wish I could feel Buddy's spirit but I just can't. Only the emptiness and sadness.

Anyhow, I wanted to ask if there is anything I could be doing for Yana, Buddy's niece? She is almost 7 and has only ever known life with her Uncle Buddy and she's very lost and sad right now. There must be many of you that have been through this with the dogs left behind and I would really appreciate any suggestions. Part of me thinks, keep her busy, then the other part says, she's entitled to her sadness and loss and I should just let her be and manage it in her own way. I am making sure she gets lots of attention and reassurance but I don't want her to become too dependent on me as I go back to work in a week. She will never be on her own for long periods of time as my partner works shift work and he's mostly home through the day but she is more attached to me.

I would love to hear from you and thanks again for being there. It means so much to me cush family.

Claire
xoxox

PS It's funny not signing off Claire and Buddy!!

[Squirt's Mom]

Some links that may offer suggestions to help Yana -

Grieving dogs – how to help -

http://www.veterinarypartner.com/Content.plx?A=1400

http://www.petplace.com/dogs/grief-in-dogs/page1.aspx

http://dogblog.dogster.com/2010/08/23/when-a-dog-loses-a-loved-one-an-interview-with-dr-michael-w-fox-2/

http://dogs.about.com/od/petloss/a/dogs-and-grief-over-death-of-another-dog.htm

[Simba's Mom]

So sorry to hear about your sweetie, sending prayers and hugs!

[Boriss McCall]

: ( YOu can still sign off Claire & Buddy.. Buddy is still & will always be a part of your heart.

We went thru this during the summer. Boriss grew up with our dog Cleo she was 3 when we got him & she passed away last year at 1 month before she turned 12.

Boriss was really lost without her. I could tell he was grieving. But, he was distracted by vet visits almost immediately. we found out he had cushings about 3 weeks after she died. I tired to give him as much love as possible.

I remember his first car ride after she had been gone a few days he totally FREAKED out. He loves riding in the car. But, that time he cried & was going spastic the entire time. It made me sad wondering if he thought when Cleo left that I just took her somewhere & she never came back.

It will get easier. But, just like for you it takes them time to grieve & adjust to the change.

I am so sorry you are going thru this. It breaks me heart for you.

hugs..

[Coop]

Thank you. I will look up the links. I should have thought to do a search myself but the old brain isn't functioning all that well.

Amy, firstly I am so sorry you lost your dear Cleo then so soon after Boriss was diagnosed with cushings. How devastating. Life deals some cruel blows sometimes.

Boriss's reaction to going out in the car after Cleo passed is so, so sad. I wish we could know what goes on in their minds. We actually had the opposite to you. The next time we went out Yana was desperate to get in the car. I think she thought we were going to bring Buddy home. So sad.

No mater how much we rationalise that death is part of life it is still such a shock and a huge adjustment for those left behind.
xox

[Boriss McCall]

You are right.. You can never be prepared for the pain & grief. Last year was hard on everyone in my house. but, thankfully time does heal the heart.
At first it seems impossible & then you go thru the guilt stage for feeling better. :(

Yana is definitely grieving. Glad she has parents like ya'll to help pull her through the sad times.

big hugs..

[Bo's Mom]

Dear Buddy,
Fly free and make your paw prints all over Heaven. Watch upon your loved ones and let them know you are with them wherever they go. Send your doggy messages to your niece who still looks for you and will grieve because of your absence. You will be missed, but know you were loved.

Love,
Your Friends

[scoora]

Claire-I am so, so sorry to hear of your loss of your sweet boy Buddy. I can feel your love for Buddy in your writing. My thoughts and prayers are with you.

[Tina]

Dear Claire,
I am so so sorry to read about Buddy. Your words about your special boy are beautiful. I know you don't feel it now, but his spirit is with you and it always will be. You just don't think it is now because of the enormous raw pain that is so overwhelming. I can remember the feeling so well from when I lost my beloved lab Dakota. As time fades the searing pain, you will realize that his spirit has always been right by your side, as well as living within your heart. You are in my prayers.

Love and hugs,
Tina and Jasper

[bgdavis]

I'm very sorry for your loss of Buddy. Poor boy had so many problems, but now he is at peace.

Bonnie and Angel Criss Ann

[gummysmurf]

Just read what you wrote about your remaining time with Buddy. He was so very very loved. I think he lived a life we'd all like to achieve, whether animal or human. To be so cherished and adored, and to give so much joy to others.