My Shih Tzu - Sweet Samantha has passed

[MRR312]

Samantha, Shih Tzu, 12.5 years old, 22.5 lbs

Diagnosed with Cushings on 01/31/2013. Just recently found this site as I'm trying to make sense of the diagnosis and recommended treatment. I'll try and summarize Sam's history and recent tests/labs.

I'm hoping to get some input on other questions/information I should be pursuing before deciding on a treatment. I have a lot more of the site to explore but so far I've gotten comfortable that I should not rush into any treatment (was scheduled to start her on Trilosane 32mg/day this week) and if I do proceed with Trilosane, to start with a low dose.

Pre-Sept 2012
Good health except for some allergies and arthritis in one back hip.

She was on Rimadyl for about a year and a half which helped a lot but after her liver enzymes started going up, we discontinued use and they were coming back down.

She continues to be on Tramadol .5 50mg tablet once a day and a standard benedryl 1x/day for allergies.

Sept 2012
During routine urinalysis, calcium oxalate crystals were noted in her urine. Vet recommended that she start on Royal Canin SO prescription diet. Started this in late Oct. However, she resisted eating it so I kept her on half portion of her old food in the morning and half portion of SO in the evenings. I was also concerned that the prescription food was not very highly rated on some websites that evaluate ingredients.

1/28/2013
During pre-dental blood work, her liver enzymes were highly elevated:
ALKP 1469 ALT 173

She also had a Thyroid Screen (Total T4) Result: 1.6 ug/dL (within range .8 to 5.0)

I also noted that she had been drinking a lot more water in last few months and correspondingly, urinating a lot more. This seemed to roughly coincide with her starting the CO food but don't know if that could be related.

Additional testing recommended due to lab results.

1/31/2013
Bile Acid: Pre meal 29.0 umol/L, Post Meal 6.0 umol/L.
Diagnosis: Liver function ok

LDDS: Cortisol Sample 1: 5.0 ug/dL
Cortisol Sample 2 Dex: 2.1 ug/dL
Cortisol Sample 3 Dex: 2.1 ug/dL

Diagnosis: Suggestive of Cushings. No suppression of cortisol at 0, 4 and 8 hrs. Recommend Ultrasound to rule out adrenal tumor as well as assess liver health and bladder (CaOx crystals).

2/12/2013
Ultrasound done.

Results:
Liver mildly enlarged, homogeneous and normoechoic. A few hypoechoic nodules (7.1x8.7mm) throughout all lobes.
Both adrenal glands normal shape but enlarged. Left: 12.7mm caudal pole, Right: 10.4 mm caudal pole
Bladder had two small cystic calculi < 3 mm
Two enlarged lymph nodes near the liver
All other organs normal.

Vet stated enlarged adrenal glands confirmed PDH and felt liver and bladder issues were tied to Cushings diagnosis. Recommended treatment for PDH given clinical signs.

2/16/2013
Discussed treatment recommendation with primary vet. After consult with internist, the recommendation was made to start Samantha on a low dose (3mg/kg) of Trilosane and retest ACTH stimulation in 3 weeks to see if dosage needs adjustment. (After reading some posts on the forum, this does not seem like a low dose).

Thirst/urination seem to be the only typical Cushings signs present at this time. Her coat is fine, appetite hasn't changed but she has gained weight in her mid section over last two years but not sure I would classify as a pot belly.

I've seen several references to melatonin as an option for treating Cushings (both implant and pill form) and wondering if anybody has any experience with this. Seems like this would be a less drastic way to start treatment. A friend of mine has a Poodle/Terrier mix with Atypical Cushings and that is finally the treatment she landed on that is working for her dog.

[Squirt's Mom]

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[Squirt's Mom]

Hi and welcome to you and Samantha!


I've seen several references to melatonin as an option for treating Cushings (both implant and pill form) and wondering if anybody has any experience with this. Seems like this would be a less drastic way to start treatment. A friend of mine has a Poodle/Terrier mix with Atypical Cushings and that is finally the treatment she landed on that is working for her dog.

This treatment approach only works in pups with Atypical Cushing's which is a form in which the cortisol is normal but one or more of the intermediate, or sex, hormones are elevated. The recommended treatment is melatonin in combination with flax ligans for Atypical.

However, in true Cushing's in which there is an elevation in the cortisol with or without elevations in the intermediate hormones this approach will have little to no effect. The two drugs shown to be the most effective are Lysodren and Vetoryl (Trilostane). Handled properly neither is riskier than the other; handled incorrectly, both have the exact same potential adverse effects. Both are life-saving drugs for our cush babies. ;)

I'm glad you found us and look forward to hearing much more as time passes.
Hugs,
Leslie and the gang

[lulusmom]

Hi and welcome to you and Samantha.

You did a great job of summarizing Samantha's recent history as it relates to the cushing's diagnosis but as usual, I still have more questions. :D Aside from identification of calcium oxalate crystals, what were the other results of the urine test(s)? I would particularly interested in the USG (urine specific gravity) and the PH. Was a culture done to rule out a urinary tract infection?

Yes, you do have time to learn a bit more about the disease and the treatment before starting the Trilostane. Since the dose is an odd one at 32mg, we have to assume it is a compounded med, right? Compounded drugs can save you lots of money which is great as long as the compound pharmacy has a good reputation.


Regardless of the LDDS and ultrasound, which is fairly consistent with cushing's, I am always wary of a diagnosis if the dog doesn't have overt symptoms. I realize that Samantha has been drinking and peeing more but as you said it could be the result of the diet change.
What other symptoms does Samantha have that has convinced your vet that she has cushing's that needs to be treated immediately?

I see that Samantha has been on arthritis meds for quite a while. Dogs with uncontrolled cushing's don't usually need medication for arthritis as they are self medicating with an abundance of cortisol, the body's natural steroidal anti-inflammatory. It's not until treatment brings cortisol levels down that the arthritis is usually unmasked, making treatment like Tramadol or Metacam necessasry. Are you sure Samantha is suffering from arthritis as opposed to muscle wasting weakness? Any coat and skin issues? Does she pant a lot and does she seek out cool places to lay on?

I'm very familiar with calcium oxalate stones. I had one dog with cushing's that had to have two surgeries before starting treatment with Lysodren and another non cushdog who also had surgery. I've read that mosts dogs who have had oxlates stones will have a recurrence within three years. That wasn't the case for my dogs. It seems the minute I took them off of kibble completely, a good number of their problems resolved and have never returned in the last seven years. I am not a fan of kibble, grain or no grain, especially for a dog with oxalate stones. Canned or home made wet food (with additional water or broth added) is best. I also add Potassium Citrate to their food to keep their PH balanced.

I'll be looking forward to hearing more about Samantha.

Glynda

[MRR312]

Hi, thanks for the warm welcome and the follow up questions.

Urinalysis Results
9/21/12
USG 1.053 Range (1.016 to 1.08)
PH 5.5 Range (5.0 to 7.5)
Urobilinogen 0.0 Range(0.0 - 2.0)
Glucose 0.0 Range (0.0-0.001)
Ketone 0.0 Range (0.0-0.001)
Billrubin Negative
Protein 1.0 Range (0.0-30.0)
Occult Blood Negative
WBC Negative
RBC Negative
Epithelial Cells Negative
Bacteria Negative
Crystals Positive (CaOx 21-50)
Casts Negative

12/28/12
USG 1.02 Range (1.016 to 1.08)
PH 5.5 Range (5.0 to 7.5)
Urobilinogen 0.0 Range(0.0 - 2.0)
Glucose 0.0 Range (0.0-0.001)
Ketone 0.0 Range (0.0-0.001)
Billrubin Negative
Protein 2.0 Range (0.0-30.0)
Occult Blood Negative
WBC Negative
RBC Negative
Epithelial Cells Negative
Bacteria Negative
Crystals Negative
Casts Positive

She also had abdominal x-rays on 9/21 which showed no stones and moderate degenerative changes Left Coxofemoral joint. After 12/28 test, a recommendation to consider a culture to check for a UTI was made depending on results of upcoming blood work. Wasn't pursued as we shifted focus to LDDS test and ultrasound. However, she was on an antibiotic for 7 days planning for the dental work.

Yes, the prescription being recommended for Samantha is a compounded med from Diamondback Pharmacy here in AZ (I'm lucky to live in the Phoenix area and I've seen they are highly recommended).

The recommendation to start Samantha on treatment was based on the results of the LDDS and ultrasound (enlarged liver, both adrenal glands enlarged, etc). My vet, the internist and vet doing the ultrasound all seem to be recommending treatment.

Regarding other symptoms, I'm becoming more aware of possible signs after reading more of others experiences on the site. She has been more active at night (won't settle down - pacing around, etc), recently seems to want more food late at night - will eat other dogs food that she wouldn't touch during the day. I think she has weak back leg strength that I attributed to the arthritis/age. She can't jump up on furniture, every so often back legs will go out from under her when she first gets up. So I think maybe a combination of arthritis/muscle weakness. She does not have hair loss or pant a lot. Given AZ, in hot weather she'll like to lie on the tile floor but right now likes to curl up in her bed or on my bed so don't think she is specifically seeking cool spots.

Regarding Samantha's arthritis and use of tramadol. If she has cushings, that could definitely be masking the need for tramadol. I've kept her on a maintenance dose as on and off she would start to limp if she had a lot of exercise. I guess I've kept her on it more out of habit and haven't thought to reduce or eliminate.

Any further advice/questions would be appreciated. I'm leaning toward having her start on Trilosane given the medical test results and behavior changes. But feel that 3mg/kg is a high dose to start on. I'm thinking a more conservative approach would be to start her on 2mg/kg (about 20mg) once a day and evaluate with the ACTH testing realizing it might take several adjustments to get the level right.

Regarding ACTH testing, is there a ball park range for the test that people have found to be reasonable. I haven't checked yet with my vet on the cost but obviously it has an impact on treatment.

Thanks again.

Mike

[addy]

http://www.k9cushings.com/forum/showthread.php?p=91363#post91363

This should give you some ideas of the ACTH cost ranges members have been paying.

Glad you found us!!

[molly muffin]

Hello and welcome Mike and Samantha :)

I tend to agree with starting on a lower dose of 20mg as compared to the 32, simply because you can always go up if needed, but you don't want to over do it and risk an Addison crisis.
Once you start treatment, then the first test should be within 12-14 days, and the next at the 30 day mark unless symptoms warrant a sooner test.

We will be with you ever step so any questions that come up or you are curious about just ask, someone will be around to try and answer.

Btw, love Samantha's picture, she is a cutie.

Sharlene and Molly Muffin

[MRR312]

Checking in again about Samantha.

The more I read and learn, I'm now having second thoughts on starting Samantha on Trilosane at this time. Aside from the LDDS test and ultrasound confirming PDH Cushings, she is not really showing severe symptoms. e.g., although she is drinking and urinating more, it's not to the point that she is having accidents in the house and most nights does not need to go out until morning. Also, the SO food package indicates it should result in increased urine volume.

While I know I have time as Cushings is slow progressing, I can't help but worry about:

1. What risks, if any, am I putting Samantha in by delaying?
2. What factors should determine when treatment should start? Not until external symptoms interfere with quality of life? (e.g., veroucious appitite, hair loss, excessive drinking, panting, ...)
3. If I delay treatment, should I be having any tests done periodically to make sure her internal health (organs, etc) are doing ok.

Any comments/input would be appreciated. Guess I'm going through a bit of information overload.

Finally, thinking I should set up a exam/consultation with her internist to go through current health and test results again. After her ultrasound, I had gone back to my primary vet and she did a phone consultation with the internist (to save me a long trip back to the Vet hospital) and together they recommended to start treatment.

So glad I found this site.

Mike

[frijole]

All the international experts in cushings now say don't treat unless there are symptoms. So I understand your thinking and there really is no rush to treat unless there are other issues. Just do blood panels periodically so you can check the liver enzymes. YOu might give some milk thistle or denamarin for the liver just to assist a bit. My 2 cents. Kim

[molly muffin]

Hi Mike,

You can go through our Resource site to read up on various articles about treating and testing for cushings, found here: http://www.k9cushings.com/forum/forumdisplay.php?f=10&order=desc

You might have already browsed through there. If so, one of the articles has to do with not treating for cushings and risks. http://www.k9cushings.com/forum/showthread.php?t=195

Basically if you have no symptoms by which to gauge how she is doing with treatment, it is often hard to tell if treatment is working, or if you are under dosing, until you have the ACTH test.

Myself, I am not treating yet, since I don't have a firm diagnosis. I have retested the LDDS test 3 times, I get liver function tests, ALT and ALP done every couple months and eventually I'll do another ultrasound to make sure nothing has changed internally. If you don't treat immediately and there is no rush to do so with cushings, then you still don't escape the ever blasted testing as it is just as important to know if things are progressing or not as it is to know how treatment is going once you do start. For instance, you'll have to watch for any increase in infections, keep an eye on the coat to make sure not skin issues are developing, and have blood tests done regularly, along with urine tests to see how that is going.

You know Samantha best, so only you can know how she is doing without treatment. I'd probably be leery of starting without symptoms.

With the SO food you will definitely see an increase in drinking and urinating and that is what you want to have happen. My Molly is also on SO. There is a definite decrease in water consumption and peeing, when she doesn't have it. (I tested just to be sure). You Want her to drink plenty and go to the bathroom often to keep the chances of any further crystals down. So that is off set by what is cushings related vs what is SO related.

As far as Oxalate crystals goes, Glynda, who answered you above, has had the best results with her means for controlling them of anyone that I know or have heard of and that includes my own vet people. So that is an option to check into too, which might in fact get Samantha off the SO food and give you a better idea of where she is at in regards to the food vs the cushings on water consumption. I'll let you two have a chat about that as there is nothing that I can offer that would compare to what Glynda knows. 6 years crystal free is pretty awesome recommendation.

Sharlene and Molly Muffin

[molly muffin]

Oh I had forgot that, Kim is right, you can give liver supplements. Molly is taking some and her numbers have come down on her liver a bit. Hopefully we'll see them come down more in the future.

Sharlene and Molly Muffin

[MRR312]

Update on Samatha

Thought we were doing ok until today. After a visit to the internist on 2/12 and an exam and review of all her tests, we decided to delay treatment with Trilostane. Since she was not showing many outward symptoms, we decided to wait until more symptoms appeared and/or blood work tells us there are issues with her internal organs.

So for the last 6 weeks, Samantha has been on liver supplements - vitamin E (400 IU per day), denamarin (90mg for small dogs once per day). She is also getting 3mg of Melatonin twice a day as the internist felt the liver damage noted on her ultrasound was most likely due to elevated sex hormones.

We also switched her from Royal Canin SO to Hills W/D as he felt that SO has too much fat and that Samantha should be on a low protein, low fat diet to raise the PH in her urine and control her weight. Unfortunately she resisted all attempts to get her to eat the dry or canned W/D. Her appetite has been very on/off over the last two weeks so I've been doing what I can to get her to eat. Rice, Chicken, back to her old kibble (Nutra Ultra) and mixing in Beneful Medley canned food which she has liked in the past.

We were scheduled for pre-dental blood work tomorrow, Monday, 4/1 where I planned to revisit her food with the vet as well as get a status on her internal organs.

Today I had to take Samantha in to the vet as she has become severely bloated. This has taken place over the last 24-36 hours. She is peeing ok and this morning had a normal bowel movement. No vomiting or diarrhea. She does not seem to be in distress but is lethargic. Since it was Easter, my regular vet was closed but I got in at another nearby clinic. The vet recommended blood work and x-rays to determine if she had fluid building up in her abdomen. We started with blood work and the liver protein she was testing for (forgot the name) came back normal so she felt it was probably not liquid building up. But her ALKP enzymes were over 4000. They were 1400 back in January which triggered the cushings testing. The vet's thought was that this is all cushings related. Since Samantha was stable and not in distress, she felt I could wait till my appointment tomorrow to take things further (probably another ultrasound vs x-ray) as well as consult with the internist about starting Trilostane treatment.

So I will be going into my regular vet tomorrow and probably the internist as well. My head is spinning seeing Samantha so bloated and getting the test results on her liver. Any input/comments anyone has would be appreciated.

Thanks in advance.
Mike

[doxiesrock912]

Mike,
unless you feel that your regular vet is managing and has current up to date knowledge of Cushing's and updated dosage knowledge, I would go straight to an internist unless you need the referral from your GP vet.

I say this because Daisy's vet referred us to an internist right away and she really had much more knowledge than he did and he's considered one of the best in our area.

Daisy became bloated within the past two weeks, her liver and both adrenal glands are enlarged. Even though her hunger and thirst have lessoned, we're starting 10mg of Trilostane twice a day tomorrow.

Best of luck with Samantha:) She's adorable!

[Simba's Mom]

Welcome Mike and Samantha, what a cute fur baby you have..You have found a great place to be on this forum, lots of info and encouragement. take care!

[MRR312]

Thanks for the quick comments. Ended up back at Emergency Vet last night as Samantha's breathing was becoming labored. Had a great Vet and he did an emergency exam and determined that she does have fluid building up in her abdomen. But she was stable enough to take home and spend rest of night at home.

We are due to go back shortly this morning and she'll have an ultrasound to figure out what is going on and they will drain the fluid and do lab tests on that to diagnose as well.

Hopefully just a bump on the road and we'll have her back on track soon.

Mike

[Squirt's Mom]

Let us know what you learn, Mike! Prayers and healing white light go with you.

Hugs,
Leslie and the gang

[molly muffin]

Samantha is just adorable. I do hope that she is going to be okay. What did you learn today? Did they drain the fluid?

Sharlene and Molly Muffin

[jmac]

Just checking in on you and Samantha. I hope the appointment went well today, that you got some answers, and most importantly, that Samantha is feeling better.

Julie & Hannah

[doxiesrock912]

Mike,

that is so scary! I'm glad that Sam was well enough to go home. Regardless of the diagnosis, adding the stress if spending the night in a strange place won't help.

What did you find out today?

[MRR312]

Hi,

Been offline for a couple days and unfortunately not for good reasons. Samantha was admitted on Monday morning and they ran full blood panel, drained (about 16 ounces) the fluid from her abdomen, and got her started on IV/Antibiotics.

She's now been in the hospital for a full two days and not responding to treatment. Her white blood cell count was through the roof (24K), her liver enzymes 4000+, she has a UTI and not eating. She's been on an IV w/ antibiotics but it does not seem to be knocking down the infection. The fluid tested "normal" so they can't figure out what causing the build up. The vet has been great and I know Sam is getting great care. I can tell the doctor is frustrated that they can't get a handle on it.

This morning she continues to be very weak and tired. They added another antibiotic last night as well as got her to take some fluid food by syringe. However, she vomited twice overnight but doctor felt maybe more from stress than from the new antibiotic or food giving the timing wasn't correlated.

They are rerunning blood work and fluid tests today to see if anything is helping.

Will be going to visit her later today and get the results from the vet this evening. Depending on results, next steps would be more diagnostics on liver (biopsy, CT scan) to look for cancer and/or blood clots. If that is the recommendation I am going to have to make hardest decision yet on whether it's in Sam's best interest to keep on with all the tests if there is no good prognosis or if I need to let her go.

I was prepared for what lied ahead with starting treatment for Cushings but this has come so sudden and out of left field. Just last Friday she was her old self playing in the backyard and taking our daily walks. My heart is breaking as she's been my loyal companion since she was 8 weeks old and she'll be 13 in about 6 weeks.

Mike

[molly muffin]

I am so very sorry to hear that Samantha is having these problems. It knocks all of us for a loop when they can go from their normal happy little selves to being in such dire circumstances so quickly. I do hope that she can recover from this.
Sounds like a very bad infection with that high WBC count. What about e-coli? They can pick that up just about anywhere it seems and it is awful hard to get control of. Just a thought. I have heard of liver infection but I'm not sure what causes it, how you tell or how you treat it. Just something I heard about once. I assume the vets would be able to look into that.
I know I'm throwing straws out and hoping something can be done. It's very hard to look at those cute little adorable faces and realize that something is so seriously wrong. You just go into denial. Or I do.
Sincere big hugs to you, I know this is breaking your heart. We will continue to hope for the very best outcome.

hugs,
Sharlene and Molly Muffin

[Simba's Mom]

Sending healing hugs to Samantha, and encouraging hugs to you! I'm sure your world has turned upside down, it just plain sucks sometimes...knowing that Samantha is in good hands helps a little..so we will keep praying for positive reports!

[jmac]

Mike,

I am so very sorry to hear Samantha is not doing well. I can totally understand how horrible this must be for you. I have a 14 year-old Shih Tzu that is basically my baby, and she has had many issues over the past year. It has been agonizing for me and I've shed many tears, but I have luckily not had to deal with anything as difficult as this. I had tears rolling down my cheeks as I read your post.

It's the worst feeling when you don't know what is wrong or how to help, and I can imagine how devastating it is knowing that she is not responding to antibiotics. I'm glad you feel that she is getting good care and that the vet is determined to figure it out. I'm so sorry you may be faced with the difficult decision of whether or not it's time to let her go. Please know that I will be thinking of you and sending lots of positive thoughts and prayers your way. We are here for you whenever you need help or if you just want to come "talk." I'm hoping for the best for Samantha.

Julie & Hannah

[doxiesrock912]

Mike!

How scary and sad! It sounds like the vets are trying everything that they can think of. Keeping you all in our prayers!

[MRR312]

Hi all,

First I want to thank everyone for their kind words, prayers and positive energy.

A quick update while I have time. Got to visit Samantha yesterday twice. Late afternoon she was very tired and weak. Early evening she started to perk up a bit (would raise her head and look around, was able to sit up and even a short walk outside). But still not eating. However, met with vet and WBC count actually went up (34K from 24K) so antibiotics not working. He consulted with his colleagues including critical case vet and and everything is ambiguous as to what could be causing the infection/inflammation and fluid build-up (most likely liver related but can't be pinned down). So we have reached an impasse.

Discussed further diagnostic options (CT Scans, Liver Biopsy) and decided not to put Samantha through that given her age/condition and the prognosis if they find something (low probability of a good prognosis). Asked the doctor what he would do if it was his dog and he recommended leaving her one more night at the hospital to give the new antibiotics a second night to work as well as medication added to consolidate/expell liver toxins and a "water pill" to try and bring down fluid which continues to build up.

So going back today to bring my girl home. The doctor is very supportive of this. This way, I can spend time with her, continuing supportive/nursing care and meds. He thought good to give her a few more days and maybe the meds will win out. But if not, I have a few more days with her.

I have to thank all the doctors and staff here at VETMED in Phoenix as I think they have done everything possible and have showed great compassion through out.

I'll keep you posted.

Mike

[Mel-Tia]

Mike

So sorry to hear that things haven't improved.

Just wanted to send you some hugs and prayers, hoping upon hope that the antibiotic kicks in overnight and starts getting that infection under control

Paws up Samantha, keep fighting little girl.

Mel
Xxxxxx

[MRR312]

It's with heavy heart that I have to report that Samantha passed away late this morning.

Received a call from the vet right before I was leaving to bring her home and was told that as they went to get her ready for discharge, they noticed that she had stopped breathing and had no heartbeat. From what they could tell, she went peacefully in her sleep and most likely her heart just gave out as she was very quiet all morning.

So had to make the trip for different reasons but got to spend time with her to say a final goodbye. saw that looked very peaceful and I know now in a better place.

Still in shock but wanted to thank everyone again for all the support.

Mike

[addy]

Mike, I am so sorry to hear this. That had to be a really hard phone call to receive.

Rest peacefully sweet girl.

[jmac]

Mike,

I am so terribly sorry. What a horrible call to receive. I'm glad you were able to say goodbye for your own peace of mind. And as difficult as it must be, I'm glad she went peacefully. You're in my thoughts.

Julie & Hannah

[Bo's Mom]

Oh, I am so sorry. I am at a loss of words...but please know we will say prayers for you and your dear Samantha. She is now an Angel running free.

[molly muffin]

Oh Mike I am so very sorry that this happened. :( Samantha will always be with you in the most important place of all, your heart.

My sincerest condolences
Sharlene

[doxiesrock912]

Mike,
I am so very sorry! You are right about Samantha being in a better place. Animals are so sweet; loving, and unselfish - how could there not be a special place in Heaven for them.

Lots of hugs!

[Simba's Mom]

So sorry to hear about Samantha, you did everything you could for her, your a good daddy forsure.. I cried when I read she passed, so many pups are leaving us way to soon....but i'm glad that she is running free now...with no pain...take care, sending hugs and prayers!

[Roxee's Dad]

I am so very sorry for your loss Mike, Rest in Peace sweet girl, Tonight you are our newest and brightest star in the sky.......

[Tina]

Dear Mike,
I am heartbroken to read about Samantha and am so sorry for your loss. You are in my thoughts and prayers.

Tina

[Squirt's Mom]

Dear Mike,

I am so sorry to hear about Samantha. I know your heart is shattered but your sweet girl is no longer in pain; she is whole once again, strong as she was in her youth. Samantha carried your love with her and will keep it safe until you meet again.

Please know we are here anytime you wish to talk.

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


A Simple Message From Your Pet
by Ken D. Conover

To have loved and then said farewell is better than to have never loved at all.
For all of the times that you stooped and touched my head, fed me my favorite treat and
returned the love that I so unconditionally gave to you. For the care that you gave to me
so unselfishly. For all of these things I am grateful and thankful. I ask that you grieve
not for the loss but rejoice in the fact that we lived, loved and touched each other's lives.
My life was fuller because you were there, not as owner, but as my friend. Today, I am
as I was in my youth. The grass is always green, butterflies flit among the flowers and
the sun shines gently down upon all of God's creatures. I can run, jump and play
and do all of the things that I did in my youth. There is no sickness, no aching joints
and no regrets and no aging. We await the arrival of our lifelong companions and know
that togetherness is forever. You live in our hearts as we do in yours. Companions such
as you are very rare and unique. Don't hold the love that you have within yourself.
Give it to another like me and then I will live forever. For love never really dies,
and you are loved and missed as surely as we are.

Your pet in heaven.

[labblab]

Dear Mike,

I join our other members in telling you how deeply sorry I am about Samantha's passing. I am also so sorry that this is my first post to you. I so wish I could be writing under different circumstances. But I am very grateful that you did find us, and that you have had the chance to tell us what has happened. Because in this way, we can join you in honoring your sweet Samantha and all that she has meant to you. Her name has now been entered on our special memorial thread of honor:

http://www.k9cushings.com/forum/showthread.php?t=4794

And I will soon be contacting you to see whether you might wish us to link a special photo to her memorial line. But in the meantime, please know that both you and Samantha will always remain members of our family, and that we will welcome you back at any time to tell us more about your lives together and to let us know how you are getting along after this sudden and tragic shock.

Sending many hugs to you today, in loving memory of your beautiful little girl.
Marianne

[Boriss McCall]

MIke,
I am so sorry for your loss. I know it is hard. You are in my thoughts.

hugs
amy