Pepper, 17 y/o (26lb terrier mix), Diagnosed w/Cushings yesterday

[Lisa Renee]

Good day to all! I'm so thankful to have found this forum. I'll try to keep the background info short...
Pepper is 17 (26lb terrier mix) this week and was diagnosed w/cushings yesterday. I thought she may have it due to increased appitite & water consumption, panting & pacing (only at night). But Pepper does NOT have a pot belly or hair loss. Saturday she had an epidsode w/nystagmus and I rushed her to emergency hospital. They suspected cushings (after blood test) and it was confirmed with test yesterday. She has since recovered from eye issue and is back to herself which includes hypothyroidism, arthritis & weakness in rear legs. Vet thinks its pituitary because her ultrasound last year showed nothing on adrenals. The only meds Pepper is on is for thyroid and, of course, heartworm. She hasn't been vacinated in 2 years due to her age. I try to keep her as med free as possible.

Vet wants to put her on Trilostane, I'm unsure about that drug. Also, has anyone had any luck with natural treatments?

Thank you in advance for any suggestions or information. I love my girl and I want to keep her as healthy and comfortable for as long as possible.

[Harley PoMMom]

Hi and welcome to you and Pepper,

So sorry for reasons that brought you here but glad you found us.

Cushing's is one of the most difficult diseases to get a confirmed diagnosis for because not one test is 100% accurate at diagnosing Cushing's and non-adrenal illnesses can create false positive results on all tests for Cushing's.

Could you round up copies of all tests that were done on Pepper and post any abnormalities that are listed along with the reference ranges and units of measurement...e.g. ALT 150U/L (5-100)....Thanks!

Has Pepper had her thyroid levels checked recently because Hyperthyroidism/Hypothyroidism share many of the same symptoms as Cushing's such as increased drinking/urination and hair/skin issues. What dose of thyroid medicine is Pepper taking and is it being given twice a day? It could be that her thyroid supplementation needs an dose adjustment.

I wish there were natural treatments for Cushing's but there are not, the two most rx'd drugs for Cushing's are Lysodren/Mitotane and Trilostane/Vetoryl. These are strong drugs but they are also a god send when given in the right dosage amount and with a vet following the correct treatment protocols.

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

Love and hugs,
Lori

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[labblab]

Dear Lisa,

Welcome to you and Pepper, and WOW you've done a great job of keeping your girl healthy and happy up to age 17! First off, even though folks here do give various supplements to support healthy body functioning, there are no nonprescription drugs that will address the root cause of Cushing's and lower cortisol sufficiently to control the disease. So it really will take treatment with either trilostane (or Lysodren, the other Rx option) to control the Cushing's, assuming it truly is the cause of her symptoms. Having said that, at age 17, you may want to consider pluses-and-minuses of Cushing's treatment before rushing in to treat Pepper.

Cushing's is typically a slowly progressive disease but it does have the potential to cause systemic damage over time (from high blood pressure, vulnerability to pancreatitis and infections, high cholesterol, kidney damage, liver inflammation, etc.). So for a younger dog, I'd certainly recommend effective treatment so as to eliminate some of these risks, improve longterm quality of life, and allow the dog to live out his/her normal lifespan. However, for a dog of Pepper's age, immediate quality of life issues seem of paramount importance to me. And there are some trade-offs to treatment, especially for an arthritic dog since the arthritis may actually worsen as the cortisol level drops, necessitating the introduction of additional drugs to better manage the discomfort. Also, especially at the beginning, there can be numerous vet visits and blood draws which can be less than pleasant for a dog who's nervous at the vet (and also hard on the owner's pocketbook :o).

I don't tell you any of this to dissuade you from treating if you and your vet agree this is the best path forward for Pepper. But I do think you are the best judge as to how uncomfortable her current symptoms are to you both, and if they are not bothering Pepper all that much -- as I say, you may want to hold off on treating for the time being.

First things first, though -- as Lori says, it'll be great if we can take a look at those test results.

Marianne

[SoggyDoggy]

Hi Lisa and welcome! First I have to say I'm Impressed! 17! Wow mum, you must be doing something great with Pepper! She's a lucky girl. Well, apart from a few medical issues that is :o I personally have 2 terrier mixes, 13 and 13.5, I just hope they too make it to 17!

Don't worry about keeping things short though, my first ever post here took up probably 5 times more space than yours did, and since then I've had posts double that even! Background is good! Lori mentioned trying to get copies of tests and posting the results. If possible, that is a great idea as it gives the folks here a clearer picture of what you are dealing with, and they will be able to offer more relevant advice for you. The wealth of experience here is just amazing and in the short time I've been here I've learnt so much!

My boy Fraser is on Trilostane. His cushings at the moment is really well controlled, and apart from taking the medications, he is his old normal self again! It can be tricky to get the balance right for some, but for us it's working great. Each dog will respond differently though, so that's why this place is here; to help us out learning all about issues that can arise - be it medication or even doggie apparel! (yes, it is discussed :D)

Anyway, I just wanted to stop by and welcome you, let you know that you are in the best of company and if you have any questions, feel free to post and ask away! Also, you will probably be bombarded with questions, it's all part of the process and as I said before, gives folks a clearer picture.

So good luck, other's will stop by shortly with more greetings and probably more questions for you. Take care and give Pepper a huge cuddle for us!

[Lisa Renee]

Hello and thank you so much for the welcome and the kudos. :) I've been very luck to have Pepper with me for 17yrs.

Called vet, waiting on copies of test results. In the mean time... her thyroid level was checked a few months ago and was good. She takes soloxine twice a day but I can't remember the dosage and I'm not at home at the moment. Right now pacing and panting seem to be the most bothersome symptoms. And these symptoms only occur at night, you can almost set your watch by it. Her increased appetite was welcome as she was not eating well before but she still isn't ravenous. She has a hard time getting up & standing still... her back legs give out. But up until now I always assumed that was arthritis. The vet seems to think the medication will not be a bother even with her advanced age. In fact, she ordered it and wants me to pick it up tomorrow & start giving it to Pepper. I'm very anxious about giving it to her. Its an ongoing struggle with me and any vet or medical doctor... I don't like having medication pushed on me... or my dog. I wonder if the natural remedies would ease symptoms just a bit even if they won't help her completely. (like to believe they would a least... does a placebo effect work even if its only fooling the pet owner?);)

I'll send the info from the reports soon.
Have a great day!!

[Squirt's Mom]

Hi Lisa,

Welcome to you and Pepper! :) 17! WOW! My Squirt will be 16 the 25th of Feb and I am like you - so blessed to have had her with me as long as I have. Of course, we would like another 16 or 17 years, huh? ;)

At the age of 17, it wouldn't be out of the question that what you are seeing is in part CCD, Canine Cognitive Dysfunction. The night time restlessness in particular could be attributed to this. The drug used to treat this was at one time thought to be the salvation for cush pups but it didn't pan out that way. It can help, tho. The drug is called Anipryl, generic is Selegiline. You might talk to your vet about this possibility and the Anipryl before you pay for and start using the Trilo.

I'm glad you found us and look forward to learning more about you and Pepper as time passes.

Hugs,
Leslie and the gang

[addy]

Hi and a big Welcome from and my pups,

Everyone has given really good input so far and I cant really anything to all the good advice. I will say, dont let any vet push you into treatment if you are not ready. I had one pushing me in the beginning based on a test that does not even confirm Cushings just advises further investigation.:eek::eek::eek:

You have done a wonderful job of taking care of Pepper and I have no doubt you will continue to do so, just dont let anyone try to strong arm you if you are not ready!!

I am so glad you found us.

[labblab]

Upon reading that your vet has already ordered the trilostane, one more word of advice even if you do decide you want to start treatment. Do not accept nor pay for a dose any larger than 30 mg. At a weight of 26 pounds, Pepper falls within a published dosage range that might lead your vet to prescribe as high as a 60 mg. capsule for her. However, as a result of recent research and clinical experience in the field, most specialists as well as Dechra (manufacturer of brandname Vetoryl) have revised and lowered their recommendations to an initial dosing formula of approx. 1 mg. per pound. Vetoryl comes in 10 mg. and 30 mg. capsules. So if your vet is prescribing the brandname product, Pepper could be started on a daily total of either 20 mg. or 30 mg. I encourage you NOT to begin with a dose or capsule size any larger than that.

Marianne

[lulusmom]

Hi and welcome to the forum.

Wow, congratulations to you for the superb job of caring for your precious Pepper. Wouldn't it be awesome if we could all keep them with us for that long and then some?

Please see my text in blue below:


Good day to all! I'm so thankful to have found this forum. I'll try to keep the background info short...
Pepper is 17 (26lb terrier mix) this week and was diagnosed w/cushings yesterday. I thought she may have it due to increased appitite & water consumption, panting & pacing (only at night). But Pepper does NOT have a pot belly or hair loss. Saturday she had an epidsode w/nystagmus and I rushed her to emergency hospital.
They suspected cushings (after blood test) and it was confirmed with test yesterday.

With respect to the nystagmus, Old Dog "Vestibular" Disease would have been my first suspect as it is not a symptom commonly associated with cushing's. There is also a condition called sundowners and that could explain why your dog only pants and paces in the evening. Elderly dogs, like elderly people, often times get very restless at night. Some bark for no reason, stare off into space, pace and whine. While some dogs with cushing's do seem to become more active at night, given your dog's age, again, I would not automatically assume those evening symptoms are associated with cushing's.

With respect to the increased drinking and peeing, did your vet do a urinalysis, including a culture. Dogs with cushing's drink more because they are peeing more because the kidneys are no longer concentrating the urine. If they don't keep up with the urinating, they will dehydrate rather quickly. Your vet should have done a standard urinalysis as well as culture because dilute urine will not always show the true extent of white blood cells. 40% to 50% of dogs with cushing's do have a urinary tract infection at time of diagnosis.

What exactly happened when you noticed her eyes darting back and forth? Did she stumble, appear to be having a seizure, acting out of it, lose her appetite? You mentioned in a subsequent post that your girl is having trouble getting up and standing still and that her appetite was off. Did these things happen after the nystagmus episode?


She has since recovered from eye issue and is back to herself which includes hypothyroidism, arthritis & weakness in rear legs.

So the testing for cushing's was done on the heels of the nastagmus episode? If so, even more reason to be concerned with the cushing's diagnosis. Any nonadrenal illness or serious stress can yield false positive results on all of the not so reliable diagnostic tests. A dog with nystagmus has something pretty stressful going on so......

Vet thinks its pituitary because her ultrasound last year showed nothing on adrenals.

This is a another red flag for me relative the diagnosis as normal adrenal glands were observed last year and apparently a new ultrasound was not done by your vet to differentiate between pituitary and adrenal dependent disease.

The only meds Pepper is on is for thyroid and, of course, heartworm. She hasn't been vacinated in 2 years due to her age. I try to keep her as med free as possible.

Vet wants to put her on Trilostane, I'm unsure about that drug. Also, has anyone had any luck with natural treatments?

Thank you in advance for any suggestions or information. I love my girl and I want to keep her as healthy and comfortable for as long as possible.

Please do not feel pressured by your vet to start treatment, especially until you are sure she has cushing's. I concur with Marianne's thoughts about weighing treatment for a very senior dog so please make sure you have read it. For what it's worth, based on what you have told us, if it were my dog, I'd probably not treat and I'm going to go way out on a limb here and say that if I could find something more benign to help improve the symptoms, I'd go for it. Anipryl is a drug that's a lot more benign than the other two and while it's efficacy for cushing's is pretty abysmal, it's proven effective for very senior dogs with canine cognitive problems. I'm not convinced that that is not what you are dealing with so what the heck, talk to your vet about it and give it a whirl?

[Lisa Renee]

Wow! You guys really are knowledgeable! Thank you for sharing your information with me. RE: nystagmus... Pepper was drinking water & I heard the familiar sound of her falling down by the bowl. She does that a lot. But she didn't try to get back up when I went over her eyes were darting back & forth but no stiffness or movement in her body and her breathing was normal. I have seizure and it didn't appear that she was having one but it freaked me out so I took her in. That vet listed these as possible reasons... seizure, tumor, blod clot, neurological even and vestibular event. Then a blood test for liver/kidney function, white blood cells, etc. Liver was high, white blood cell low. That is when that vet said, "possible cushings". Follow up w/regular clinic, they did ACHT (I think that is what it was called) and she said the second blood draw was off the charts. (still waiting for fax of test result)

The vet ordered the medication but I never agreed to give it to Pepper, I was still processing all of the info while she was talking. I was worried that it would cause other problems but now I'm concerned that she may not have it after all. In all reality everyday is a gift because who knows how much time she has... I'm not going to poison her body and shorten that time if I can help it.

I'm learning that many vets (and medical docs) just take educated guesses at what the problem may be and have a "here try this" plan for everything.

You guys are awesome, thank you again.
Lisa, Pepper and Reggie

[lulusmom]

It will be interesting to see the test results, especially what your vet thinks an off the chart post acth stimulated response is. Do you know if your vet did a urinalysis? If so, can you post the results here? If not, I highly recommend that you have one done. You can always start by doing a free catch at home and taking it directly to the vet, sparing your girl the stress of an office visit. If they see any blood in the urine and/or white blood cells, you can always start off with a round of Clavamox to see if whatever bacteria is involved will respond. If it doesn't, a culture should be done to identify the specific bacteria. If she does have a UTI, you may just solve the excessive peeing with antibiotitcs.

Glynda

[Lisa Renee]

:confused:

ACTH test results...

Pre ACTH cortisol 3.6
Post ACTH cortisol 24.2

Says "pre" should be 2 - 6
"Post" should be 6 - 18

It also says, "ACTH response test is only clearly positive (>22) in 30% of dogs w/hyperadrenocortiscism" . Does that mean that since Pepper came back 24.2 that there is a 30% chance she is positive for Cushings? I'll try to get the bloodwork resluts from the emergency hospital tomorrow.
Thanks again for any & all suggestions you guys have been SOOOO helpful. :D

[labblab]

What that means is that only 30% of dogs who truly have Cushing's will register a firm "positive" on the ACTH -- that particular test misses making the diagnosis and gives a "false negative" for a number of dogs even when they actually have the disease (although I don't think it is anywhere near as low as 30% so I question that statistic altogether :confused:).

But more importantly, a result of 24.2 is nowhere near "off the charts," especially if Pepper was under stress or suffering from another health issue at the time the test was performed. We have dogs here who register "post" results in the range of 30-50. So I would definitely put on the brakes as far as starting any treatment for the moment!

Marianne

[molly muffin]

Hi lisa and welcome to you and pepper and reggie. :)

Lets start where everyone else started, 17! Wow, what a gift! Good genes, good mom. :)

Next, my dog was diagnosed (high ACTH, high ALP and mildly high ALT) and my vet gave me the trilostane and I bought it and paid for it. But then I joined the forum, became much more knowledgeable, went to see an IMS specialist where we did ultrasound, which showed everything could be consistent with cushings, except, none of the symptoms. So ordered an LDDS and it was negative. She has now been through 3 LDDS tests, all of which are negative for cushngs. So, it's not a cut and dried area and vets aren't always correct.

You have to really investigate before you go down that road of dosing with the cushings medication and you want to be very sure that it is indeed cushings since these symptoms are mimic'd by so many other issues.

None of this is saying she doesn't have cushings, just that there are enough red flags that warrant further investigation.

How was her kidney function test?

Sharlene and Molly Muffin

[Lisa Renee]

Hi there. Thank you for the input and I've decided to not treat w/the med suggested by vet... at least not at this time.

Pepper's kidney results seem to be fine (from what I remember the vet saying). Her last UTI check was a couple of months ago and it was clear. She has been suffering from vaginitis for a few months. Ever since her bout of pancreatitis a few years ago antibiotics make her stop eating, for days at a time, so I have been hesitant to start up with a round of antibiotics. Is it possible the vaginitis could be causing some of her issues?

I am so appreciative of all the info you guys have given me. This is s beautiful place, with wonderful and informative people. You guys are awesome!

[frijole]

:D I'm so glad you are holding off... we get alot of dogs after they went ahead and started and were misdiagnosed and it is just so painful to deal with.. you are a wise woman.

This group is the best! We have members who thought their dogs had cushings but didn't that still hang around. Because cush dogs are older we have become geriatric 'experts' so to speak and learned all sorts of tricks from each other. So do keep us posted on Pepper. 17... so impressed! Kim

[Simba's Mom]

Welcome to the family, happy to have you here, sorry your pup is having some problems. Wow, 17 yrs, good job Mom and Pepper! This group of Cush parents is awesome, and the pups are pretty special too! We are here for you, some with info, some with hands to hold, it's a walk we can all do together, take care!

[molly muffin]

What was used or is being used to treat the vaginitis?
Any kind of problem within the body Can cause high cortisol levels. That is the problem with using say only one test like the ACTH to diagnose cushings. It's just almost impossible to say that is definitely what is occurring with one test.
Cortisol is a funny thing, it has highs and lows throughout the day, it spikes in response to certain stimuli, such as thunderstorms, vet visits, etc, and it is the response for many disease's or problems to protect the animal. It masks many things too, such as the arthritic problems that most with older dogs have and is revealed even more once the cortisol is lowered.

Sharlene and Molly Muffin

[Harley PoMMom]

If the restlessness is bothersome melatonin may help with that. Melatonin seems to act as a calming agent especially when a dog is acting stressed. One can use a dosage of 3 to 6 mg given twice a day.

[Lisa Renee]

What was used or is being used to treat the vaginitis?


Good day everyone! I've only been treating Pepper's vaginitis by cleaning the area 2-4 times a day.

Thank you for the melatonin tip... I've been giving her that at night, it does help a bit.

Pepper's water consumption has increased over the past few days, and every day she has thrown up water & a tiny bit of food. She doesn't gag first, it just comes rushing out. Maybe from drinking too much at one time? Her urine out put is still only 2-3 times a day.

Hope everyone & the pups have a great day!:D

[SoggyDoggy]

Hi Lisa, you are right, this is an amazing group of people! I have learnt so much in such a short amount of time it's just amazing! And I sure wouldn't have the confidence in treating my baby boy if it wasn't for the support of this place. :)

I have to say, I'm glad you have decided not to treat at this stage, it really doesn't sound like a cut and dried case, and any vet who orders and pushes a drug as strong as this while the pet owner is not comfortable should be discarded in my opinion. I had a bad experience with the vet that diagnosed my dog. Despite frequent questioning on my part, he was put on 60mg Trilostane, weighing just 22 pounds. Within the space of 3 weeks, his cortisol dropped dangerously low and we only just avoided a cortisol crash - yet the vet was still trying to tell me he was good. I finally told her I wanted a referral to an IMS and got the answers I needed (which were the same as what I was being told here FYI - that the dose was way too high and his test results were indeed too low). As a result, I can't speak highly enough of going to see an IMS in the early stages and getting a straight answer right from the start. Especially if there is some question as to what is really going on.

Reading your posts, it sounds like you are dealing with your regular vet? If this is the case, I would urge you to consider an IMS consult if you wish to pursue this further, and particularly if the vomiting continues. Reading the advice here, I too would be highly suspicious that Pepper is in need of a cushing's drug, and wouldn't feel comfortable giving it without further investigation. It is very strong and can cause great problems if given to a dog that doesn't actually need it. As you know though, cushing's is not something you have to rush to treat, so you have time.

This is just my opinion, though I truly think there are a couple (or more) members here who are actually Vet's themselves. And if not formally, well then they should be!

Good luck and do keep us posted. I'm still so impressed with the 17 years! I soooooo hope my boys make it that far!

[Lisa Renee]

Thanks Naomi! Am I right in thinking an IMS is Internal Medicine Specialist? The original idea of Cushings came from the vet in the internal medicine ICU at Gulf Coast Animal Hospital. They wanted me to come back and to the ACHT test there but it was $100 more than my regular vet. The regular clinic I go to has 2 vets one in her late 40's and one in her late 20's/early 30's and they have a very different approach to treatments. I see the older vet and she knows my aversion to "just trying anything" to see if it works. But as luck would have it she was on vacation this week. Pepper threw up water & a little food 2 times last night and seems depressed this morning but maybe she is just tired. Keeping an eye on her.

[SoggyDoggy]

Yep, IMS = Internal Med Specialist. If they wanted you to have the test done, you should still be able to go back to them with the results in hand I would think and say "What next?" Again, if you can round up copies of all tests done so far and have your regular vet sent them to the Animal Hospital for review prior to appointment, you will be able to discuss the big picture and see if you can get a straight answer. It's like you going to a GP doctor for major surgery, why would you? If there's a specialist around who understands the finer workings and nuances of our babies, then why should we play guessing games with our babies? Also, if you can get your regular vet talking to the IMS and working as a team, then you have a better picture. Though make sure they include you in that loop!

And I am going to sound ageist here, but see the older vet! The one that screwed my boy up was young and inexperienced, as soon as I spoke to the practice manager who has an additional 15 or so years experience, she was horrified at what I was telling her that had gone on (including misinterpretation of results) Also the IMS that I saw at a specialist practice was very experienced and knowledgable. It makes so much difference, talking to someone who actually has a detailed understanding (IMS), or even experience (older GP vet) and if the young vet is the one pushing the meds on you, avoid her. I have made it clear at the practice I go to that that particular vet will never see either of my dogs again, not even for nail clips or anal glands! She did her dash and that's it!

Now to be fair, there are some young vets out there that are just fantastic, but imagine how much more fantastic they will be with 10 years experience behind them. Sorry, in my book experience wins every time (and I admit, still relatively young myself, but old enough to know what I was like fresh from Uni/College) Tertiary education is great, but when you add on the job training on top of it, that's when you get excellent. Some things need to be learnt hands on, not just out of a text book, and I think this type of situation is one of them, (not to mention people skills :o)

Anyway, please do keep an eye on Pepper, the chuck-ups don't sound great. Is it only night time that she throws up or does she do it during the day too? Just make sure she doesn't get dehydrated in the meantime, but if it continues, I would be seeking further advice.

Let us know how she goes. I must go to bed now, nearly midnight for me so hope to check on you tomorrow. Take care.

[Trish]

Hi Lisa
My dog is a terrier mix too, I love hearing about other dogs like Flynn that have had such a good life with their families, well done you! I so hope you get to the bottom of Pepper's problems and she does well with whatever treatment you decide is appropriate. Hope she stops feeling so ill, sounds like all that water is filling up her little tummy till it can hold no more, poor girl.

I will be keeping an eye on your progress and wishing you all the best.

Trish xxxx

[molly muffin]

Hmm, the throwing up is a bit worrying here, not normal for cushings diagnosis. More like something else intestinal or stomach. Any yellow bile in it?
Yes, Naomi is correct, the vet does the test because, yep, it's cheaper usually to get them to do it, but then they should send that to the IMS who is now your consult specialist and you should be able to make an appointment to see your IMS when you want to. This is another reason that it is very important to keep your own file of test results. I always go with file in hand. :)

Sharlene and Molly Muffin

[Lisa Renee]

Good day all and again thank for all of the kind words! :) I am very happy to report that Pepper has not thrown up since my last post a couple of days ago. To answer the question... it was just water and a tiny bit of digested food but not bile, thankfully. Pepper has been doing remarkably well... while she is still pacing at night it isn't for nearly as long. She is able to get by herself most of the time and we even went to the park yesterday. I wanted to show her that not all car rides end at the vet. lol Thank you for all of your help, I knew deep down inside, that I shouldn't give her the meds but what I learned from you guys helped me feel more comfortable. If she remains like this I will not even pursue any further testing because at this stage in the game I don't want to put her through any further testing, too much stress on her. I will continue to update and throw in my support to those in need.
Have a beautiful day!!
Lisa

[molly muffin]

Hi Lisa,
Yay! So glad to hear that Pepper hasn't had any more throwing up issues. If that starts again, you might try going to a very bland, chicken/rice diet for a bit and nothing harsh into the stomach and see if that helps to calm it down.
Glad that you will be sticking around. Do give us updates and let us know how you and Pepper are doing. We love to keep track of our family. :)

Sharlene and Molly Muffin

[addy]

If she remains like this I will not even pursue any further testing because at this stage in the game I don't want to put her through any further testing, too much stress on her. I will continue to update and throw in my support to those in need.



aww Lisa, way to go!!!:):):):):):)

[SoggyDoggy]

Hey Lisa,

So glad Pepper has picked up and stopped throwing up, also glad to hear she got a fun car ride! Do keep us posted, a champion like her inspires us all.

[Trish]

I second what Naomi said! Pepper is a role model for us all for a healthy long life! Happy to hear she had fun in the park! Let us know how she is doing, you are part of the family now :D
Trish xxxxxxxxxxxx

[NoonelovesmelikeNorman]

Hi Lisa, So happy Pepper is doing so well. Love the idea of an enjoyable car ride with a happy destination - the park.:D

You are so blessed to have had Pepper for 17 years and she is so blessed to have you...You're a great Mama. Thanks for sharing the good news.

Love and Hugs,

Sharon and Norman