13 y/o Pom (Vetoryl) - Shasta is at peace

[LtlBtyRam]

I'm new here. I have a 13 year old pom who got her confirmed Cushing diagnosis in December. We started Trilostane/Vetoryl. We were on 10mg/day for a bit then went to 10mg/twice a day. She seems to be doing fairly well but we retest in another 2 weeks.

[Roxee's Dad]

Hi and welcome to you and your pup :)

Please tell us more about the symptoms that led to the testing for cushings. If you have the test results, please do publish them here so we can have a look.

Cushings can be managed quite well and your pup can lead quite a normal and healthy life if managed properly.

You have come to a wonderful forum full of caring and knowledgeable members that will help in any way we can. We look forward to hearing more about her. :)

[molly muffin]

Hello and welcome to you and your little pom. Aren't they just so cute!
As John mentioned can you post the ACTH results you have already had? and tell us a little bit more about your baby.
John is also right that when controlled properly, your baby can have a full and regular life.

Sharlene and Molly Muffin

[LtlBtyRam]

Ok I kinda goofed. Call me a bad owner (no I don't really think this just joking) I was a little uneasy about everything going on. I also didn't feel comfortable posting much more without the labwork stuff. Shasta (my cush pup) has been going to the same vet's office since we got her at 6 weeks, although she has seen different doctors since they have several. We started seeing the same doctor for her Cushing's from the preliminary diagnosis up until she had to leave the practice at the end of May. One of the other doctors took over her case. The original doctor was very good about checking up on Shasta and monitoring her behaviors and making sure her ACTH stims were done when they needed to be, but didn't place a ton of emphasis on the numbers. We didn't really either (my personal outlook on stuff like exact numbers is they are a tool for measuring). Since she knew where we started and where we have traveled we just went with phrases like "significantly changed" or "on the high end or low end of the range" This was good enough for us, although I know several people here are all about the numbers. This made me feel conflicted about posting.

We were really pleased with her progress and a lot of her symptoms were going away, and according to her doctor she was coming down on her cortisol levels nicely. We wanted something a little more so we decided to start seeing a Holistic Chinese Medical Vet (this got started because we wanted to find out about Cushex and our medical vet was uncomfortable addressing our issues, so she gave us the name of someone to see who could answer our questions). We went and were started on Free & Easy Wanderer Teapill along with instructions to start Flax seed oil, and acupuncture treatments. The symptoms we were concerned about since they didn't seem to be improving very much were her skin and coat. Her skin was really dry and flaky. She has gotten a lion cut in the summer for a long time and last year's never grew back right (this has never been a problem before) and her pads were super super dry and so was her nose. After seeing the holistic vet we started to see improvement in her dry skin and coat although it took several weeks.

We also had an ACTH stim done then and it came out with "good results" and a recommendation to retest in 3 months. A couple of weeks before this next test was due she started becoming difficult to pill. We did an ACTH stim earlier than expected and got results of a significant decrease in cortisol levels. Around this time she went from being difficult to flat out refusal and we were having problems with vomiting and diarrhea as well. We took a few days of pred (which we had on hand from nearly the very beginning), went of all meds, and a bland diet. The bland diet took place for about a week and a half. We had a conversation with her attending vet and decided to start using Trilostane from a compounding pharmacy suspended as a liquid. We were informed this isn't the ideal way to take it, but we insisted as we would rather treat than not treat. We took it for 2 weeks exactly and got another ACTH stim. This last test was yesterday. I got a call today saying her cortisol levels were very borderline. This was not her attending doctor but one of the others and is leaving any decisions up to the attending. I'll know more Tuesday. I did ask about the numbers and got caught up in the fact that pre and post were the same and forgot them. I do have copies of her records since all of this started, but the full blood-work-ups are really hard to understand as they are hand written in her chart. I will see if they have printouts on Tuesday too. If not then I will post a super in-depth review of her case as best as I can read and make out the chart.

I know this is a long post. Thank you all for being so welcoming. This is an overview about what has taken place since the start of this. I have also kept a watch on her symptoms and behaviors and can post about those particulars if anyone is interested.

[mytil]

Hi and welcome to you and Shasta from me as well.

When you do post any lab values, post the results that were indicated as high.

You can also post the results of any diagnostic tests performed at the beginning - (LDDS - should be three numbers and letters after each numbers; an ACTH test - should be two numbers and letters after as well).

Here is a link to some great reading material on Trilostane/Vetoryl. http://www.k9cushings.com/forum/showthread.php?t=185

When the last ACTH monitoring was performed was it between 4-6 hours after the dose of Trilostane?

I am glad to hear her dry and flaky skin are starting to get better. One thing that may be happening as well is as the cortisol levels are brought back to normal, new skin and hair will start to grow and it causes the old damaged skin and fur to flake and fall off.

Keep us posted on the new ACTH results :)
Terry

[Harley PoMMom]

Hi and welcome to you and Shasta,

Sorry for the reasons that brought here but so glad you found us.

The drugs that are used to treat Cushing's are strong medications but are life savers for our dogs with Cushing's. Since the medications are not a cure for Cushing's but used to control the symptoms associated with Cushing's, I also lean towards how the dog is feeling/acting and do not go by just the "numbers." However, the ACTH stim numbers are a guide of how the medication is working and we have often seen that when a vet says a dog's results are within range that in fact they are not and that is why we ask to see those results. We will never judge any one, ok? ;) We are only here to help. :)

There have been instances when a dog's cortisol has dropped too low when they have been on Trilostane for an extended period of time, and this is another reason we like to see those ACTH stim results.

Here's a link from our Resource Thread that has informative information regarding Trilostane/Vetoryl: Trilostane/Vetoryl Information and Resources (http://www.k9cushings.com/forum/showthread.php?t=185) Please feel free to print anything out. ;)

Is Shasta on any other supplements or medications? How much does she weigh?

Please know we are here to help you and Shasta so do not hesitate to ask any and all questions.

Love and hugs, Lori

[LtlBtyRam]

Hi and welcome to you and Shasta from me as well. Here is a link to some great reading material on Trilostane/Vetoryl. http://www.k9cushings.com/forum/showthread.php?t=185

Thank you so much. I looked at a lot of that information when we started in December of 2012


When you do post any lab values, post the results that were indicated as high.

You can also post the results of any diagnostic tests performed at the beginning - (LDDS - should be three numbers and letters after each numbers; an ACTH test - should be two numbers and letters after as well).

I will do so when I can post the timeline in full, I'll be sure to look for the results as you described them. I'm hoping to do so on Tuesday.


When the last ACTH monitoring was performed was it between 4-6 hours after the dose of Trilostane?
Yes all of her ACTH's have been in the timeframe of 4-6 hours


I am glad to hear her dry and flaky skin are starting to get better. One thing that may be happening as well is as the cortisol levels are brought back to normal, new skin and hair will start to grow and it causes the old damaged skin and fur to flake and fall off.
Terry
I didn't know this.

[Simba's Mom]

Hello and welcome to you and Shasta, you have found a great family of cush pups and their families....lots of info and encouragement too, check out the many threads, lots to take in I know but knowledge is power, take care!!

[LtlBtyRam]

Hi and welcome to you and Shasta,

Sorry for the reasons that brought here but so glad you found us.
I can't say I'm happy about what brought me here either, but this community has helped me even before this, as I "lurked" a lot when this first started, but things just seem to not be quite right yet and I'm hoping this community can help us, our traditional vet, holistic vet, and the consulting doctor try to get better results.


The drugs that are used to treat Cushing's are strong medications but are life savers for our dogs with Cushing's. Since the medications are not a cure for Cushing's but used to control the symptoms associated with Cushing's, I also lean towards how the dog is feeling/acting and do not go by just the "numbers." However, the ACTH stim numbers are a guide of how the medication is working and we have often seen that when a vet says a dog's results are within range that in fact they are not and that is why we ask to see those results. We will never judge any one, ok? ;) We are only here to help. :)
Thank you. I'm sure when I get things posted in full we can all work together to get her health as best as possible. Her symptoms are definitely better on the Trilostane than off.


There have been instances when a dog's cortisol has dropped too low when they have been on Trilostane for an extended period of time, and this is another reason we like to see those ACTH stim results.
I think when she started refusing to take the Vetroyl pills her cortisol levels were a little too low for her, even though they were within the normal range. Again numbers to post soon. What are you considering as an extended period? She was on it for 7-8 months before she started refusing them. We were also informed by our vet that their levels can continue to drop for months, therefore the importance of continued testing.


Here's a link from our Resource Thread that has informative information regarding Trilostane/Vetoryl: Trilostane/Vetoryl Information and Resources (http://www.k9cushings.com/forum/showthread.php?t=185) Please feel free to print anything out. ;)
Really read a lot of this in depth when we got the preliminary and then the final diagnosis. It helped us a lot thank you so much for providing these links.


Is Shasta on any other supplements or medications? How much does she weigh?
She currently is only on Liquid Trilostane 1ml per day
and Metacam a fairly low dose I think as it is the 10 pound mark and I don't rid the syringe of the air bubble either

We have not reintroduced her Flax seed oil and will be advised about the Free & Easy Wanderer Teapill when we see the holistic vet on Tuesday These 2 things seem to be what helped her skin and hair so much, although even on these her pads and nose were pretty dry, but off of them they are really bad.

She weighs 13.89 pounds


Please know we are here to help you and Shasta so do not hesitate to ask any and all questions.
Love and hugs, Lori

Definitely not hesitating now, I hope to help others navigate this tumultuous journey as well.

[LtlBtyRam]

Hello and welcome to you and Shasta, you have found a great family of cush pups and their families....lots of info and encouragement too, check out the many threads, lots to take in I know but knowledge is power, take care!!

Thank you for the hello and the welcome. I have to say I'm really thankful for these boards. When we got the preliminary diagnosis I did what probably most of us do. I combed the internet for information and found these boards. I read quite a few of the threads in those early day, but have just now really felt comfortable posting and asking for help.

[Simba's Mom]

Yay, glad you feel comfortable, remember we are all in this boat together, no question is too big or too small...

[molly muffin]

Hello and welcome from me too. You've gotten some good feedback from the others already so I won't go over all that. Anything off in the tests, is what you want to post, high/low and any cushings specific test. Also, urinalysis if you have them too.

One thing is that metacam if the cortisol is not controlled can affect the liver and therefore the liver values. This was just confirmed by a specialist I see for another of our cush pups this week. They prefer something like tramadol for pain control. Just something you might want to speak with your vet about.
Numbers are important, but just as important is how the pup is doing. You also have to look at the entire picture. For instance, a dog that has arthritis or joint issues, might do a bit better if with a higher level of cortisol than a dog that doesn't have any joint issues. The higher level of cortisol helps to keep them feeling better, as long as the other symptoms are manageable.

We look forward to hearing more about Shasta and how she is doing.

Sharlene and Molly Muffin

[LtlBtyRam]

Hello and welcome from me too. You've gotten some good feedback from the others already so I won't go over all that. Anything off in the tests, is what you want to post, high/low and any cushings specific test. Also, urinalysis if you have them too.
Yes I have at least one UA


One thing is that metacam if the cortisol is not controlled can affect the liver and therefore the liver values. This was just confirmed by a specialist I see for another of our cush pups this week. They prefer something like tramadol for pain control. Just something you might want to speak with your vet about.
She was on tramadol then started refusing to take any pill. We had a little episode where we were around other dogs in uneven terrain and she stepped backwards apparently tweaking her back. Thus the Metacam came into the equation, but thank you for being aware of and pointing out the possible problems. I've already learned from reading other stories vets are all too human and make mistakes.


Numbers are important, but just as important is how the pup is doing. You also have to look at the entire picture. For instance, a dog that has arthritis or joint issues, might do a bit better if with a higher level of cortisol than a dog that doesn't have any joint issues. The higher level of cortisol helps to keep them feeling better, as long as the other symptoms are manageable.
Yes I think her cortisol levels will have to be a little on the high side she has arthritis, had both knees operated on for luxating pattellas at 9 months, and had one femur shaved for hip displaysia.


We look forward to hearing more about Shasta and how she is doing.

Sharlene and Molly Muffin
I'm sure you will get to know us well, as long as you want to anyway. :rolleyes:

[Roxee's Dad]

Hi and welcome back :D

I see you are getting plenty of help already :) I am happy that you are feeling more comfortable. I know many more will stop by to welcome you and Shasta. Holiday weekends can be kind of slow but looks like you are off to a wonderful start :)

[LtlBtyRam]

Hi and welcome back :D

I see you are getting plenty of help already :) I am happy that you are feeling more comfortable. I know many more will stop by to welcome you and Shasta. Holiday weekends can be kind of slow but looks like you are off to a wonderful start :)

Aww thanks.

We were really confident in our original attending vet and then adding the holistic vet just seemed to make things so much better. We were just in a really comfortable place, until we weren't. We are now back to being in a pretty comfortable place, but I have decided I want our experiences to benefit others, and maybe we can brainstorm on some of the things which haven't really added up. She is just so much better taking the meds than when she doesn't.

Now our attending doctor has changed, it isn't that we aren't as comfortable with her. She is the doctor at our vet office we would have gone with anyway had it just "not worked out that way" which of course it did. What the change in doctors did spur was a more hands on approach from me so I could follow things better, or explain them to someone new to her case better if I need to do so in the future.

[spdd]

Hi and welcome. I had my dog on Trilostane and Metacam at the same time. I was told in no uncertain terms that these two drugs should not be given together. I have taken my pup off Metacam entirely and only using Tramadol. NSAID's which Metacam can directly conflict with Trilostane and I believe my dogs enlarged liver is due to prolonged use of Metacam. He also would barf at times when on it.

If you read back somewhere in my thread, I think I gave the proper terminology as to what the two of them together create. I even had one vet tell me that other vets should know better then to prescribe the two of them together. Even though I decreased his dose of Metacam when I started Trilostane, I decided to take it out of the treatment plan entirely. I know what works for one dog may not work for another.

There is liquid Tramadol, however it is really bitter tasting to the dog (learned that the hard way) so I now get the pills, score them and cut them into quarters. Hiding in good cheese has worked so far, all be it though with my stubborn dog, the cheese now goes into his bowl as he refuses to take anything from my hand anymore - LOL

My dog has arthritis in his knees. We have done laser therapy, which in my case I don't believe helped, but I am pursuing hydrotherapy now as I'm lucky enough in this small town to have a dog pool for swimming. Warm salt water, it even helped me. I think swimming is great for muscle re-building and strenghthening.

I didn't mean to write a novel here, and I'm fairly new to this forum as well, but the knowledge here is incredible, really it is so Shasta and you will get the best advice.

P.S. I was just on FB after writing the above so I see you have read my thread.

[Harley PoMMom]

I think when she started refusing to take the Vetroyl pills her cortisol levels were a little too low for her, even though they were within the normal range. Again numbers to post soon. What are you considering as an extended period? She was on it for 7-8 months before she started refusing them. We were also informed by our vet that their levels can continue to drop for months, therefore the importance of continued testing.

We have a member whose dog, Princess, is currently on a Trilostane hiatus, for over a year now, and I believe it wasn't too long after treatment started that Princess' numbers went too low, here's a link to their thread: http://www.k9cushings.com/forum/showthread.php?t=1324



Really read a lot of this in depth when we got the preliminary and then the final diagnosis. It helped us a lot thank you so much for providing these links.

That is wonderful that you are educating yourself about Trilostane!!



She currently is only on Liquid Trilostane 1ml per day
and Metacam a fairly low dose I think as it is the 10 pound mark and I don't rid the syringe of the air bubble either

On your liquid Trilostane, there should be some indication as the concentration of Trilostane in the liquid. This might be something like 50 mg/ml. or 100 mg./ml. Could you post that specific amount for us?



We have not reintroduced her Flax seed oil and will be advised about the Free & Easy Wanderer Teapill when we see the holistic vet on Tuesday These 2 things seem to be what helped her skin and hair so much, although even on these her pads and nose were pretty dry, but off of them they are really bad.

Flax seed oil is usually not recommended because the lignan content is very low, and the flax oil can increase triglycerides. I would use either Flax hull (SDG) lignan, or HMR lignan. Link to information regarding lignans: http://www.vet.utk.edu/diagnostic/endocrinology/pdf/20120316-LIGNAN-Write-Up-Revision02.pdf

You're doing a great job!!

Love and hugs, Lori

[LtlBtyRam]

Hi and welcome. I had my dog on Trilostane and Metacam at the same time. I was told in no uncertain terms that these two drugs should not be given together. I have taken my pup off Metacam entirely and only using Tramadol. NSAID's which Metacam can directly conflict with Trilostane and I believe my dogs enlarged liver is due to prolonged use of Metacam. He also would barf at times when on it.

If you read back somewhere in my thread, I think I gave the proper terminology as to what the two of them together create. I even had one vet tell me that other vets should know better then to prescribe the two of them together. Even though I decreased his dose of Metacam when I started Trilostane, I decided to take it out of the treatment plan entirely. I know what works for one dog may not work for another.

There is liquid Tramadol, however it is really bitter tasting to the dog (learned that the hard way) so I now get the pills, score them and cut them into quarters. Hiding in good cheese has worked so far, all be it though with my stubborn dog, the cheese now goes into his bowl as he refuses to take anything from my hand anymore - LOL

My dog has arthritis in his knees. We have done laser therapy, which in my case I don't believe helped, but I am pursuing hydrotherapy now as I'm lucky enough in this small town to have a dog pool for swimming. Warm salt water, it even helped me. I think swimming is great for muscle re-building and strenghthening.

I didn't mean to write a novel here, and I'm fairly new to this forum as well, but the knowledge here is incredible, really it is so Shasta and you will get the best advice.

P.S. I was just on FB after writing the above so I see you have read my thread.

To our vet's credit the Metacam was given to her while we were on break from Trilo. We did something a little stupid. We went to a dog park (not a normal activity) we were going to leave her on leash, but another dog approached her and she quickly backed up on uneven terrain. Immediately she was having problems walking. We got very scared very quickly as we realized it was both rear legs she was having problems with. To the vet we went it was after hours, but our vet provides care from 6 am - 10 pm if emergencies arise outside of office hours (it used to be 24/7 but they got too busy drs were too tired). We found out it wasn't any knee or hip issues and there was a spot on her back she really balked at. So now we are thinking herniated disc (been down that road with a different dog). This is how the Metacam came to be prescribed. She actually hasn't had it for a couple of days. She is doing ok, but gets around much better with it.

We go see our herbalist vet on Tuesday (we haven't seen her since this happened). She will get a round of acupuncture then. I don't think the Metacam will be permanent. Thank you for showing your concern here on my thread. I haven't made it all the way through yours yet, but I will.

A little more history on Shasta. She had both knees operated on when she was 9 months old. One knee was low grade and not a big deal. The other knee was a high grade and was in a soft cast for two months. This was her rear right leg. This same leg a lot of years later presented problems again. We thought maybe the pins would need to come out after all which would have been really uncommon. After x-rays she was diagnosed with hip displaysia, but only in the right hip. Our vet said they have had good results in small dogs where they shave the top of the femur to provide relief. She has done really well with it since. I am convinced that leg didn't form very well while she was forming in the uterus.

[LtlBtyRam]

We have a member whose dog, Princess, is currently on a Trilostane hiatus, for over a year now, and I believe it wasn't too long after treatment started that Princess' numbers went too low, here's a link to their thread: http://www.k9cushings.com/forum/showthread.php?t=1324
I'll have to check that out.


That is wonderful that you are educating yourself about Trilostane!!
We actually provided some of the info to our vet as she had never used it and was super cautious and offered to refer us, but we said we'd start with them. After reading some other threads, even though they had no experience with the drug they have responded right on whenever we've had anything crop up. This gives me even more faith in them, but I will always educate myself about anything going on with my pups.


On your liquid Trilostane, there should be some indication as the concentration of Trilostane in the liquid. This might be something like 50 mg/ml. or 100 mg./ml. Could you post that specific amount for us?
Her bottle says "Trilostane 20mg veterinary suspension"


Flax seed oil is usually not recommended because the lignan content is very low, and the flax oil can increase triglycerides. I would use either Flax hull (SDG) lignan, or HMR lignan. Link to information regarding lignans: http://www.vet.utk.edu/diagnostic/endocrinology/pdf/20120316-LIGNAN-Write-Up-Revision02.pdf
As it was her holistic vet which told us to add the flax seed oil and we have an appointment this upcoming Tuesday I will bring up the concerns.

Thank you all for your input and support!
Angela

[LtlBtyRam]

I have a question. One thing I just haven't been able to decipher from everything I've read is about a compromised immune system. How does "uncontrolled" Cushing's make the immune compromised and if it is controlled it isn't as bad? I feel like I"m missing something basic here.

I'm asking this because we are trying to figure out about getting her Rabies booster shots. Our vet is pretty good about not "over vaccinating" and is also going to check with and IMS they have consulted before.

[mytil]

Hi again,

I have sec and wanted to answer your question.

Cortisol is a hormone that is essential for life. It maintains a normal blood glucose level, facilitates metabolism of fat, and supports the vascular and nervous systems. It affects the skeletal muscles, the red blood cell production system, the immune system, and the kidneys.

Too much of cortisol in the body suppresses the immune system and allows dogs with Cushing’s disease to get bacterial infections.

Whether to booster or not IMO depends upon the dog and extent of compromising conditions a dog is experiencing. There is a titer test that can be done to see if any boosters are needed. A Titer test will show the level of antibodies your dog has against the vaccine virus and will indicate if the boosters are needed.

Terry

[LtlBtyRam]

Hi again,

I have sec and wanted to answer your question.

Cortisol is a hormone that is essential for life. It maintains a normal blood glucose level, facilitates metabolism of fat, and supports the vascular and nervous systems. It affects the skeletal muscles, the red blood cell production system, the immune system, and the kidneys.

Too much of cortisol in the body suppresses the immune system and allows dogs with Cushing’s disease to get bacterial infections.

Whether to booster or not IMO depends upon the dog and extent of compromising conditions a dog is experiencing. There is a titer test that can be done to see if any boosters are needed. A Titer test will show the level of antibodies your dog has against the vaccine virus and will indicate if the boosters are needed.

Terry
Thank you for this info. We just brought up concerns with our regular attending vet on Friday and she was not really sure either. She said she would consult with an IMS. The main one I'm concerned with is the Rabies, just in case anything were to happen and it would become an issue.

She has not gotten any infections we are aware of. I don't know for sure how "early" we caught the Cushing's, but I think it was fairly early. From everything I have read there isn't really a progression for Cushing's so to speak as the symptoms are so varied and they don't seem to present in any specific order as all dogs are so unique in their case. Taking this into consideration is there any way to tell how early you caught the Cushing's?
Angela

[mytil]

...... Taking this into consideration is there any way to tell how early you caught the Cushing's?
Angela

The diagnostic tests will really help in determining "the stage" of Cushing's. The actual numbers tell a lot. I know when my Mytilda was just starting early on symptoms, her initial LDDS showed Baseline=2.1 ug/dl, 4 hour=1.4 ug/dl and 8 hour = 1.4 ug/dl so she was at that time considered borderline.

T.

[LtlBtyRam]

We've only had one LDDS test done. These numbers are on a copy I have of her hand written chart. I thought copies of labwork would be included when I requested copies of her chart, but I guess I have to specify those, as I'm sure they have actual reports from the lab.

Pre 18.2 (0-10)
4h 4.5 (actually done at 5hr)
8h 5.0 (0 - 1.4)

[LtlBtyRam]

NOT complete and ACTH stims as I can make out are as follows

Had ultrasound with a report of the findings as concurrent with a Cushing diagnosis, but no adrenal tumors.

12/14/12 ACTH stim Pre 16.3 (0-10) Post 35 (8-22)
Started 10 mg Trilo once per day. Initial reaction of not very much interest in food made us introduce more slowly at every other day.

12/21/12 electrolyte panel weight 13.12
Na 138 nmol/L 139-150
K 4.3 nmol/L
Cl 113 nmol/L
BUN 25 mg/dL
Glu 101 mg/dL
Hct 37 %PCV
Hb* 12.6 g/dL
*via Hct

1/4/13 electrolyte panel weight 13.5
Na 139 nmol/L 139-150
K 4.5 nmol/L
Cl 115 nmol/L
BUN 18 mg/dL
Glu 112 mg/dL
Hct 38 %PCV
Hb* 12.9 g/dL
*via Hct
ACTH stim pre 8.3 post 13.8

2/1/13 ACTH stim pre 16.3 post 23.6 weight 13.63

Went to 10 mg Trilo twice daily

2/21/13 had stressful episode with lots of panting advised by vet to give 1/8 of 5mg table of pred for a day or two-this took care of the episode

3/1/13 ACTH stim pre 10.6 post 11.2 weight 13.68

4/4/13 ACTH stim pre 10.3 post 16.3 weight 13.68
Alternate 30 mg and 20 mg for Trilo dosing worried 30 everyday may be too much and current 20 mg not enough

4/26/13 ACTH stim pre 2.4 post 6.1 weight 13.81 very stressful visit pred for the weekend

6/5/13 ACTH stim pre 2.3 post 3.8 weight 13.84


This next ACTH was prompted by her refusing her meds. We did get her to take them 4-6 hours before this next test or our vet wouldn't have done it
7/25/13 ACTH stim pre 0.9 post 2.9 weight 13.8 also had bloodwork, but unable to make out handwritten chart notes

Went off Trilo for 2 weeks went on liquid "20 mg veterinary suspension" Trilo for 2 weeks and got another ACTH stim on 8/30/13 but I don't have the numbers for it. I forgot what they said over the phone. The doctor who gave me the results wasn't the one on her case I do remember her saying they were very borderline and she would leave it up to Shasta's regular attending as to what to change if anything.

[Roxee's Dad]

7/25/13 ACTH stim pre 0.9 post 2.9 weight 13.8

That last ACTH is within the desired range 1.45-5.4 µg/dL as per the dechra protocol. have her symptoms subsided in that time period?

[LtlBtyRam]

That last ACTH is within the desired range 1.45-5.4 µg/dL as per the dechra protocol. have her symptoms subsided in that time period?

The ACTH you are referencing was barely able to be taken. We had been having a tough time getting her to take her meds that whole week. We talked with our vet and they really wanted an ACTH, we said we would try to get the Trilo in her, which we did since we had the test.

Up until then her symptoms had indeed gotten way way better. Water and outside visits went down almost immediately after starting Trilo. The last behavior symptoms we were rid of was the scavenging behavior.

The results were as you said were within the desired range, so we decided to not give any meds at all and see what happened. Within a week and a half we started seeing the water/pee increase and after 2 weeks back on Trilo (although now it is Trilo 20mg Vetrinary Suspension from a compounder) the symptoms have indeed gotten better again, although she is still trying to scavenge.

[Harley PoMMom]

This next ACTH was prompted by her refusing her meds. We did get her to take them 4-6 hours before this next test or our vet wouldn't have done it
7/25/13 ACTH stim pre 0.9 post 2.9 weight 13.8 also had bloodwork, but unable to make out handwritten chart notes



I believe Dechra is now recommending that the pre and post be between 1.45 ug/dl - 5.4 ug/dl. Although her post is within the therapeutic range her pre is not. So since her pre was too low the recommendation is to stop the Trilostane and restart at a lower dose.

Love and hugs, Lori

[LtlBtyRam]

I believe Dechra is now recommending that the pre and post be between 1.45 ug/dl - 5.4 ug/dl. Although her post is within the therapeutic range her pre is not. So since her pre was too low the recommendation is to stop the Trilostane and restart at a lower dose.

Love and hugs, Lori
Consequently that is what happened. That was her last dose of pill form Trilo. She just flat out refused to take it anymore so we went off totally.

When we started seeing symptoms show up again after about a week and a half we talked to the vet. They really really didn't want to do compounded liquid, but I got a tad forceful and said I would rather treat than not. We got the liquid took it for 14 days and got another ACTH on Fri. By the way her previous dose was 30mg one day then 20mg the next and back and forth. Our liquid states "Trilostane 20mg Veterinary Suspension" on the bottle and she is getting 1ml.

[Harley PoMMom]

I love your avatar!! Shasta sure is a cutie pie!!

Another thing I wanted to mention is that one of the side effects of Trilostane can be gastric upset. Many members give Pepcid AC 20-30 minutes before the dose of Trilostane, you may want to ask your vet about this and see what they have to say.

[LtlBtyRam]

ACTH stims as I can

12/14/12 ACTH stim Pre 16.3 (0-10) Post 35 (8-22) Started 10 mg Trilo once per day. Initial reaction of not very much interest in food made us introduce more slowly at every other day.

1/4/13 ACTH stim pre 8.3 post 13.8 weight 13.5

2/1/13 ACTH stim pre 16.3 post 23.6 weight 13.63 Went to 10 mg Trilo twice daily

2/21/13 had stressful episode with lots of panting advised by vet to give 1/8 of 5mg table of pred for a day or two-this took care of the episode

3/1/13 ACTH stim pre 10.6 post 11.2 weight 13.68

4/4/13 ACTH stim pre 10.3 post 16.3 weight 13.68

Alternate 30 mg and 20 mg for Trilo dosing worried 30 everyday may be too much and current 20 mg not enough

6/5/13 ACTH stim pre 2.3 post 3.8 weight 13.84

7/25/13 ACTH stim pre 0.9 post 2.9 weight 13.8

816/13 Started liquid "Trilostane 20mg veterinary suspension" 1 ml
8/31/13 ACTH stim pre 6.9 post 6.9

These are the latest numbers for Shasta. Not sure what to make of them both being the same.

Angela

[Harley PoMMom]

816/13 Started liquid "Trilostane 20mg veterinary suspension" 1 ml
8/31/13 ACTH stim pre 6.9 post 6.9

These are the latest numbers for Shasta. Not sure what to make of them both being the same.

Angela

Are Shasta's symptoms controlled? If so, those are good numbers. Having the pre and the post being the same is ok too, they both have to be >1.45 ug/dl, which they are.

[addy]

Numbers are fine. We cant always go by numbers though. How is your pup feeling? Are symptoms controlled? Any side effects?

[LtlBtyRam]

Her symptoms aren't quite under control yet. She is still acting pretty hungry and goes around looking for food. Thanks for the reassurance.
Angela

[Harley PoMMom]

If symptoms are not controlled and/or bothersome to the pet or pet parent, then looking at Shasta's ACTH stim numbers there is some wiggle room. Since the Trilostane suspension was just started on 8/16, if this were me, I would wait for at least 30 days to see if symptoms abate more and if they don't you could raise her dose a bit.

[LtlBtyRam]

Our vet said her numbers were very border line. Is this indeed true? How are you folks converting the numbers? She used to be on the name brand with 30mg one day and 20mg the next. They also recommended we go to 1.25ml which would be equivalent to 25 mg and retest in 2 weeks. She doesn't seem to be suffering from any side effects. Was the pre of 0.9 on 7/25/13 too low? I'm sorry if I'm being pesky or overly cautious, it's just your folks knowledge is so awesome. It's also nice not to have to navigate this on my own.
Angela

[Harley PoMMom]

We've only had one LDDS test done. These numbers are on a copy I have of her hand written chart. I thought copies of labwork would be included when I requested copies of her chart, but I guess I have to specify those, as I'm sure they have actual reports from the lab.

Pre 18.2 (0-10)
4h 4.5 (actually done at 5hr)
8h 5.0 (0 - 1.4)




Had ultrasound with a report of the findings as concurrent with a Cushing diagnosis, but no adrenal tumors.

12/14/12 ACTH stim Pre 16.3 (0-10) Post 35 (8-22)


The LDDS test and the results from her diagnostic ACTH stimulation test are both indicative for Cushing's. The post of 35 from the ACTH is what I would consider high and not borderline, especially since no other non-adrenal illnesses were present.

[molly muffin]

I don't think 6.9 pre and post is bad. You might want it to come down a bit more, but probably not tons more, just to around 5.0 or just under and you might get there on the same dose.
Yea, 0.9 would be a bit low for me to feel comfortable with. Dechra likes 1.45 at least.

I'd keep a steady dose for each day, not up and down. That isn't a good way to get a balance in their system. It can continue to drop even for 30 days, so just hang in there. You're doing great.

Sharlene and Molly Muffin

[LtlBtyRam]

The LDDS test and the results from her diagnostic ACTH stimulation test are both indicative for Cushing's. The post of 35 from the ACTH is what I would consider high and not borderline, especially since no other non-adrenal illnesses were present.

The ACTH results that the vet was considering borderline where the last round on 8/30/13 where they were both 6.9, the first set she had last year they said were too high.

Yes the LDDS and her first ACTH plus her ultrasound is what got us to the Cushing's diagnosis, her blood work also supported the same diagnosis, but I don't have lab copies of those just handwritten chart notes which I can't read well enough to post.

[LtlBtyRam]

I'd keep a steady dose for each day, not up and down. That isn't a good way to get a balance in their system. It can continue to drop even for 30 days, so just hang in there. You're doing great.
Sharlene and Molly Muffin
We weren't crazy about alternating 30 mg and 20 mg, but we didn't feel we had a choice since at the time we were trying to use the name brand and there was no way to dose at 25 mg a day. The dose we really wanted was the 25 a day, but now we are using compounded we are going with the 25 mg a day dose. You can be sure we will definitely be watching for signs of a crash.

Have you heard about it dropping for several months when starting? Our vet said she read some comments on a vet board about how they can continue to drop well into begining treatment with Vetoryl/Trilostane.
Angela

[molly muffin]

We usually see up to and maybe just over 30, but again, it all depends on the dog and how they react to the drug. You can sort of get an idea if you see the numbers continue to decrease, say from your 12 day test after starting dose and on the same dose, still dropping at the 30 day test, then it is possible they could continue to go lower on the dose.

You're doing great!
hugs,
Sharlene and Molly Muffin

[Roxee's Dad]

Have you heard about it dropping for several months when starting? Our vet said she read some comments on a vet board about how they can continue to drop well into begining treatment with Vetoryl/Trilostane.

From my experience the answer is YES. Roxee continued to drop after a few months and at 1 point ended up just under the lower end of the recommended range. (0.9 post) It is important to have the ACTH done as per schedule. Or at the first sign of going too low.

[Harley PoMMom]

Have you heard about it dropping for several months when starting? Our vet said she read some comments on a vet board about how they can continue to drop well into begining treatment with Vetoryl/Trilostane.
Angela

Yes, we have seen it happen on the forum.

[LtlBtyRam]

These quotes are from another thread.

Not sure why these two are grouped together. Lignans are a fiber found in plants that often have estrogen properties, called phytoestrogens. Flax or spruce lignans are used in conjunction with melatonin to treat a form of Cushing's called Atypical in which the cortisol is normal but one or more of five intermediate, or sex, hormones are elevated.

Phosphatidylserine is a chemical, both natural and synthetic, used to treat issues like dementia, ADHD, Alzheimer's, depression and other things in humans. In dogs it is used in much the same way - but not to treat Cushing's. It has no properties that will benefit Cushing's. I gave PS100 to Squirt for a couple of years after reading an article in her IMS' office that talked about its protective properties for the older brain.

Neither one will control cortisol. ;)

As for the Hill's - that is one of the worst feeds on the market, prescription feeds included. I just looked at the ingredients in the hopes they were actually making improvements - but no. Still a corn and sodium based feed more suited to cows than carnivores with grape pumice added. Grapes are toxic to dogs and I wouldn't trust Hill's to process them correctly to prevent poisoning the dogs eating this feed. Sorry. I have absolutely no respect for this company nor its products. I ask our vet in TN once why her clinic stocked and sold Hill's. Her reply was that they (vet students) spent maybe one day in all her years of education on nutrition....and the ones to present the "lectures" included personnel from Hills. Then these representatives try to make contracts with the students that when they graduate that they agree to sell Hill's if at all possible. She told me that Hill's was as much a force in vet schools as lobbyists on Capitol Hill, that they literally hounded her for months prior to her graduation, dogged her until she found a clinic to work for, pressuring her to remember to promote their products in the business she ended up with. Our current vet told me basically the same thing when asked - because that's what they told him to sell in vet school. Hill's came out with another new form a year or so ago that they were touting as "natural". Doc tried to point to that feed to tell me how much they had improved their feed. When I had him compare the ingredients - they were basically the same, corn and salt in various forms. Hill's used to be an excellent feed when Dr. Morris, the vet who developed it, had control of the formula. But he sold it to Nestle' who took his formula and changed it, using much cheaper and lower quality ingredients which did nothing to improve the food or benefit the dogs eating it but sure did increase their profit margin. ;) I'm not saying don't feed it - just don't expect it to do what they claim it will.

Hugs,
Leslie and the gang
This was way before our Cushing's diagnosis, but has also cropped up after her Cushing's diagnosis. She had a skin issue of which we were advised to feed her Hills J/D. She has had skin issues crop up since her diagnosis now too. Our holistic vet (which is not the one to advise us to feed it) did look at some reference material and say the J/D had EPA or eicosapentaenoic acid and ALA alpha-linolenic acid, along with glucosamine and chondroitin. She said the EPA and ALA are what would help with her skin. How do we get these into her diet without the awful food. By the way, we were never crazy about feeding it to her, but it did help, so we went against our instincts.


Melatonin also has the ability to lower cortisol, but not enough to control the amounts released in Cushing's. This is the first I've heard of PS having the same ability so I would imagine it is also not as effective against the massive amounts caused by Cushing's but could be effective in cases of transient or acute elevations.
How much of an effect are we talking. We are trying to get Shasta stabilized and I fear 25 mg is going to be too much in the long run, but at the same time 20 mg doesn't quite seem to be cutting it either. Would either of these be an option if this indeed becomes the case?

I just want to do right by my girl, as I'm sure we all do. ;) There is just so much to navigate it can be daunting.:confused:

We have an appointment with our holistic Chinese Medical vet on Tues and I will print out the stuff on lignans and flax seed oils provided by HarleyPomMom as well.
Angela

[Squirt's Mom]

Hi Angela,

20mg of melatonin is a MASSIVE dose for a human and no way I would give that much to any dog of any size much less 25mg. Just to be sure we are talking about the same thing - melatonin is a supplement that can be purchased in the US without a prescription. It is used to help promote sleep and help with jet lag among other uses. The University of Tennessee in Knoxville, who is the only place to test for Atypical Cushing's that we know of, recommends a combination of melatonin and lignans to treat that form (Atypical) which does NOT involve elevated cortisol. So it is NOT used to control the cortisol but rather the intermediate hormones involved in Atypical. Even then, the dose is much lower that 20mg a day. ;)

ALA, EPA and DHA (Omega 3s) are considered essential fatty acids because the body requires these acids to function yet the body does not produce them so EFAs have to be ingested via food sources. The best sources of EPA and DHA are marine fish oils like salmon or krill which can be added to the feed if the amounts in the feed are not high enough. I look for feeds that list the highest levels of EPA and DHA in the nutrient analysis on the package. ALA is not typically the EFA that is focused on but rather the EPA and DHA. LA - linoleic acid, an Omega 6 - is often used for skin issues, tho. Sources of LA are sunflower oil, safflower oil, soybean oil, corn oil, evening primrose oil, broccoli, spinach, and other green leafy vegetables like collard greens or chard as well as animal tissue.

If your baby is doing well on the Hill's, I would switch it just now but rather wait until treatment has settled in. Here's why - sometimes switching feeds can cause digestive upsets like diarrhea or nausea. Diarrhea and nausea are signs of an overdose. So we don't want to confuse the picture if at all possible at the beginning of this journey. Once things are settled and you are more comfortable with things, then we can look at changing feeds if need be. ;)

Hope this helps!
Hugs,
Leslie and the gang

[LtlBtyRam]

Hi Angela,

20mg of melatonin is a MASSIVE dose for a human and no way I would give that much to any dog of any size much less 25mg. Just to be sure we are talking about the same thing - melatonin is a supplement that can be purchased in the US without a prescription. It is used to help promote sleep and help with jet lag among other uses. The University of Tennessee in Knoxville, who is the only place to test for Atypical Cushing's that we know of, recommends a combination of melatonin and lignans to treat that form (Atypical) which does NOT involve elevated cortisol. So it is NOT used to control the cortisol but rather the intermediate hormones involved in Atypical. Even then, the dose is much lower that 20mg a day. ;)
The reference to 20 mg was for how much Trilostane she is on. Her last ACTH was not quite where we want it so she is on 25 mg with another test in a week. My fear is over time the 25 mg of Trilostane is going to be too much and the 20 mg of it won't be quite enough. My question was if the melatonin might be enough to even her cortisol levels out.


ALA, EPA and DHA (Omega 3s) are considered essential fatty acids because the body requires these acids to function yet the body does not produce them so EFAs have to be ingested via food sources. The best sources of EPA and DHA are marine fish oils like salmon or krill which can be added to the feed if the amounts in the feed are not high enough. I look for feeds that list the highest levels of EPA and DHA in the nutrient analysis on the package. ALA is not typically the EFA that is focused on but rather the EPA and DHA. LA - linoleic acid, an Omega 6 - is often used for skin issues, tho. Sources of LA are sunflower oil, safflower oil, soybean oil, corn oil, evening primrose oil, broccoli, spinach, and other green leafy vegetables like collard greens or chard as well as animal tissue.
Thanks we will look at getting those things into her diet.


If your baby is doing well on the Hill's, I would switch it just now but rather wait until treatment has settled in. Here's why - sometimes switching feeds can cause digestive upsets like diarrhea or nausea. Diarrhea and nausea are signs of an overdose. So we don't want to confuse the picture if at all possible at the beginning of this journey. Once things are settled and you are more comfortable with things, then we can look at changing feeds if need be. ;)

Hope this helps!
Hugs,
Leslie and the gang
The main part of her diet is actually comprised of Fresh Pet Select which she really likes. We were giving her the Hills more as a supplement to get those items which were making her skin better. This info helps a lot. Thank you so much!
Angela

[molly muffin]

Hi Angela,

Wanted to check in and see how you and Shasta are doing :)

hugs,
Sharlene and Molly Muffin

[LtlBtyRam]

Hi everybody,
We have had a very busy past few weeks. Septic issues, car repair problems, acupuncture appointment and so on. Nothing overly alarming, but none the less annoying. Thanks for wondering Sharlene.

We have another ACTH due next week. I hope everyone else is doing well.
Angela

[LtlBtyRam]

ACTH results
pre 5.7
post 11.9

Does anybody have any reasons why her results seem to be up and down?

We went up to 1.5 ml per day. Her suspension is 20mg/ml so she is on the equivalent of 30mg every day. We will of course test again in 2 weeks and stop if she shows any signs of dropping cortisol. I am just very concerned the dose is too high.

I also know compounded can be quite different from the name brand. Just feeling anxious since upping the dose again. I can't get it out of my head it is too high. She still is acting hungry and ravenous, but the drinking has decreased quite a bit and the peeing is definitely way down. We were going out about every 2 hours and now it is more like every 4 hours now, so very happy about that.
Angela

[molly muffin]

Shasta certainly has been up and down with her numbers. It seems she goes lower when she is on the brand name vertroyl and up a bit with the suspension. It could be just the way it reacts in her system.
How are her symptoms? How are her legs?
Did you ever have an ultrasound done? Just curious and I don't see it mentioned.
I don't know if 30mg suspension, will have the same effect that 20 mg of vetroyl brand name did on her. Just keep a close eye and you know what to watch for already. It might be fine.
If if is a bit much, you can always go back down and leave it there and see how she does over time.

Hang in there. You really are doing great. It's natural to worry with each and every change. How is she doing over all?

hugs,
Sharlene and Molly Muffin

[LtlBtyRam]

Sharlene and Molly Muffin,
First thing, yes we had an ultrasound done last year. That was part of what was used to give her diagnosis. She showed an enlarged liver and adrenals. The person gave the report of her findings be supportive of the Cush diagnosis.

Next, her symptoms. They have been excessive thirst, peeing, ravenous, scavenging, pot belly, hair regrowth, back end problems. We have done much better on the thirst and the peeing has gotten much better from every 2 hours to every 3-4. She is still acting starved and scavenging, the back end is still having problems. I have noticed in the last few days her little legs look so little and you can see every tendon and bone :( . As per her chinese medical vet/acupuncturist her muscles under her pelvis have been super tight since the injury in August. This injury hasn't helped with the muscle atrophy which goes along with Cushing's as we have kept her pretty confined. Her potbelly is hard to tell as she has gotten a really fluffy belly. Next, hair regrowth issues. There has been a massive improvement on this over the course of the last year. While we took a month off of name brand Vetoryl her nose and pads got super dry again, but this too is starting to get better.

I think that covers all of your questions. Let me know if I need to clarify anything else.
Angela

[molly muffin]

Nope, I think you covered it all :) Thank you. I just couldn't remember about the ultrasound and I went through your thread, where I was rechecking the ACTH numbers and didn't see it, but that happens when I'm skimming too fast sometimes to find other things too. :)

The thing with Shasta, especially because of her previous leg problems, is that you aren't chasing numbers, other than as a guide to how the cortisol is doing, rather in her case and in most cases you are chasing the symptoms and as long as those are getting better, then even if the number goes up some, as long as the symptoms don't get worse, and things continue to improve, I think you are doing okay. She just seems to bounce alot and it might be the difference between compounded trilostane and vetroyl and the methose (suspension vs pill)

It's even harder when you have to consider those hind leg issues and be careful of them.

I was wondering how the coat was doing now. Fur belly sounds like it is doing very well indeed! Yay!
It sounds like the main thing now is that hunger issue and acting ravenous. Could some of that be habit do you think?

It would be great if that peeing could be gotten to a longer interval than 4 hours even, but I'm not sure how much better it will get and still maintain not having pain in her legs. arggghhh frustrating isn't it.

I still think you are doing really great. :)
Sharlene and Molly Muffin

[LtlBtyRam]

Well we were due for an ACTH last Thursday. Shasta's regular vet is on vacation. The vet who was going to do the test didn't realize there was a time schedule and decided not to risk iffy results and put it off. She will have it this upcoming Thursday.

I'm also going to try to get some pics of her little back legs posted. I know I won't have a problem getting a current pic of her coat which will show how much better filled in it is from the March pics.
Angela

[molly muffin]

Better to get it right than risk a wrong test time that wouldn't mean anything.

She is still doing good? Can't wait to see the new pics too. :)

hugs,
Sharlene and Molly Muffin

[molly muffin]

Angela I had to go to page 4 to find you!!!

Did Shasta have her ACTH test yet? What were the results?
I haven't seen you popping up on the threads lately, so you know, worrying here. :) Hope everything is okay.

Pop in and tell us whats going on when you have a moment. :)

hugs,
Sharlene and Molly Muffin

[molly muffin]

Hi, thought I'd see how you and Shasta are doing. Hope all is well.

hugs,
Sharlene and Molly Muffin

[LtlBtyRam]

We have been through quite a bit. Her original vet treating her left the practice. The vet who took over never seemed to make a decision without consulting the most local internal medicine specialist about half an hour north of where we live. We were uncomfortable with it so we started taking her directly there for her Cushing treatment. He was ok, but not our favorite doc in the world. Low and behold he left the hospital he was at to start his own practice somewhere. Another specialist took over. We love this vet. He has administered the proper tests at the right times, saved us some by citing some newer info where a resting cortisol level can be used instead of a full blown ACTH stim. We have done those too since he started treating her so nobody fret.

She is also getting acupuncture and 2 different tea pills and a hind quarter weakness supplement. This is just to support the western treatments. If anyone has any questions about these let me know.

We did have a scare last summer but we think it was due to running out of her tea pills. We found out just how fast the liver can change. Her symptoms sort of mimicked pancreatitis, but it just didn't totally fit. We make absolutely sure we don't run out now.

She is on a compounded form from a company in Arizona and taking it twice a day, but for now she is doing as good as we can hope for.

I apologize for not being around, I got scared I would jinx something. I have been keeping up with several threads through email updates.

I hope everybody out there is hanging in there too.

[molly muffin]

Angela! Sorry I'm not really here this week but a post from you and Shasta could not be left to later. Lol.

Okay tell me about these tea pills and what hind leg supplements do you have going on?

I'm glad you found a vet you like that works well with you. Yes I know in Europe they where and are using the resting cortisol as a gauge that they aren't going too low and then also doing the full ACTH test in between. It can work out to be a good monitoring system if you are stable withnp problems on the same dose.

Good to see you again. Belly rub for Shasta.

Hugs

[LtlBtyRam]

The hind quarter weakness is called just that, really fancy name I know. The company is Jing Tang.

The first tea pill she was put on was Free & Easy Wanderer. It is a supporter of the liver and endocrine system as a whole.

The tea pill we started about a month ago is Eight Flavor Rehmannia. This one helps with kidneys and liver.

When you can and have anymore questions let me know.

[molly muffin]

Those are very interesting. I haven't investigated any holistic vets, hmmm, sure they must have them up here. :) The tea pills sound very interesting and I'm wondering if you noticed a difference in her liver values and kidney values since Shasta started them?

[LtlBtyRam]

I can't really say. We haven't tested either values to see if the tea pills are specifically working. There is a bit of a story to go with this though.

We hadn't really had any blood work done outside of ACTH tests since diagnosis until the end of June last year. She had been on the Free & Easy Wanderer (mainly liver support) for over a year. We ran out and missed7 doses which comes out to 2.5 days. We had an episode of vomiting 4 times in a 6 hour period. I'm not talking just a little. I'm talking globs of partially digested food. We ended up at the emergency vet. She was kept overnight and given fluids because of dehydration. They did a complete blood panel and her liver values had to be diluted to be measured. It was bad and scary. We weren't sure she was going to come home. We never really did figure out what caused this episode. No change of food, no change in treats, nothing we could tell she had gotten unknowingly. Initially they were guessing pancreatitis, but it just didn't quite add up. The only thing we can attribute it too was running out of the tea pills. The emergency vet pretty much agreed with this too.

The other tea pill she has only been on for about 2 months. Her Chinese/holistic vet added it because she is having fur problems and she thought it would help. We have started seeing some hair regrowth so we are happy with the results.

She has always had really dry skin. I'm talking it looks like dandruff dry. I mentioned earlier we had her on Science Diet for it, but decided to get the ingredients another way. She is picky and doesn't like any kind of oils on her food, so we had to find something else. Probably not ideal, but we are using a supplement from the GNC Pet line. She takes it and it has what she needs so we use it. (what we don't do for these guys huh :rolleyes:) She also gets something from this line for joints.

Its kinda of funny none of her vets obsess about numbers. It more of how is she doing, has any behaviors changed, is she eating/drinking ok, etc.

She sees her Chinese/holistic vet every 2 weeks to get acupuncture. I know others have not had good results, but it makes a huge difference for her. I don't think I'd still have her if not for Dr. Sperlich. She gets weighed at those visits too, so it helps monitoring too.

If for some reason she doesn't eat her food with the supplements on she doesn't get around as well. The gabapentin is put on part of her food, so she always gets it. The tea pills and hindquarter weakness goes on the other part. She doesn't always eat that part and we can really tell.

I hope this helps you or someone else, and as always if you want any more info let me know.
Angela & Shasta

[molly muffin]

Thanks, yes it does help. Interesting that she might have reacted to missing her tea pill. Hmmm..was it yellow throw up like bile? which could be liver, which is what her pills where for.

Judy is getting acupuncture for her Abbie and it along with the adequan shots seem to really be helping her. She is on lysodren treatment for her cushings.

[LtlBtyRam]

Thanks, yes it does help. Interesting that she might have reacted to missing her tea pill. Hmmm..was it yellow throw up like bile? which could be liver, which is what her pills where for.
No it wasn't yellowish by any means. Sometimes she will spit up a little bile (this has been pretty much a normal occurance even way before the Cushing dx) and since the thing last year has been on 5 mg of Pepcid a day and it seems to really keep it at bay. It was a heaping pile of partially digested food (sorry for the yucky mental image) and after several of these is what prompted us to take her in.


Judy is getting acupuncture for her Abbie and it along with the adequan shots seem to really be helping her. She is on lysodren treatment for her cushings.
I'm glad to hear others getting good results too. I think if I had it to do over again I might go the Lysodren route, we have really had some ups and downs with Trilostane, but thankfully we are doing really well at the moment. Knock on wood.
Angela & Shasta & Family

[judymaggie]

Angela--if it makes you feel any better with your decision to go with trilostane, we have had a lot of difficulty getting Abbie on a good Lysodren dose. Her ACTH numbers have been all over the place. The only reason I went with Lysodren is that our vet has no experience with trilostane. I have expressed a willingness to share info and learn along with him but, so far, he hasn't bitten. He has taken wonderful care of my first Cush beagle, Maggie, and has brought Abbie through some tough surgeries so I am not willing to find another vet.

[LtlBtyRam]

Angela--if it makes you feel any better with your decision to go with trilostane, we have had a lot of difficulty getting Abbie on a good Lysodren dose. Her ACTH numbers have been all over the place.
I did not realize lyso could be so difficult to stabilize. I have not researched it as much as the trilo so maybe it wouldn't have been any easier.

The only reason I went with Lysodren is that our vet has no experience with trilostane. I have expressed a willingness to share info and learn along with him but, so far, he hasn't bitten. He has taken wonderful care of my first Cush beagle, Maggie, and has brought Abbie through some tough surgeries so I am not willing to find another vet.
I got super lucky at initial diagnosis. One of the vets at our regular hospital was very interested in these types of diseases and disorders. She had not treated with trilo either, but offered to learn as we went. We started with daily communication with the vet or a vet tech at least. Then it went to 2xweekly then 1xweekly then down from there until we contacted them with any questions or changes. I am very thankful for her attentiveness. Even though she didn't know anything about the drug she must have done her homework as she did everything per all the protocols preached here. We started trilo in Dec 2012 she left the practice May of 2013, it sent us spinning. When we started having problems in late July 2013 our vet hospital gave us good care, but wouldn't do anything without consulting the IMS which is about half an hour away. Any time we had a question they fielded it to him then got back to us. We ended up just going to the 24 hour emergency hospital he practiced out of. He was good, but not my favorite doctor I've had the pleasure of dealing with. He too ended up leaving and now the IMS we have is not only good, but I actually like him. :) She also has a Chinese/holistic vet she gets acupuncture and herb supplements from. We are very blessed to be getting the care we are.

[LtlBtyRam]

Went to get acupuncture today. She is doing pretty well. Resting now, but it is par for the course. She usually is quite calm and relaxed the evening of her appointment. Also had to pick up more of the Free & Easy Wanderer tea pills. No weight loss, so I'm happy with that too.

[Harley PoMMom]

Glad to hear that Shasta is doing well!!!

[molly muffin]

Sounds like Shasta continues to do very well. Such great news to hear. I love it when they are doing well.

[LtlBtyRam]

Thanks to both of you. I am thankful for every day I have her and even more thankful for every good day we have. She will have a rough day tomorrow since she is being groomed. We keep these to a minimum amount, but sometimes she needs a professional's attention. She has been seeing the same groomer for a long time and they work with us on trying to do it on a slower day and work on her straight through to reduce the stress to get her home as soon as possible.

Even though her last set of tests came back with good numbers and she seems to be doing well with all the Cush behaviors her hair still isn't quite right. I've kinda let go of it because I don't know why and don't want to spend more money on more tests which may or may not be of help. Both her IMS vet and Chinese vet are aware of the situation and seem to be okay with things.

I thought I saw a reply somewhere mention something about fat deposits around the tail, but can't find it now. Does anyone have any information regarding this. She used to have the typical Pom tail curled over her back. She no longer carries is so and it just kind of hangs down unless she is actively wagging it or is excited and has it up for a few seconds. Again her IMS has seen this and examined it. He said he didn't see any clinical reason for it, but did notice a little fat at the base. He didn't seem to think it should keep her from having it up.

Does anyone have any ideas about this or should I be looking into something else for either the hair or tail?

[Harley PoMMom]

When dogs have elevated cortisol over a period of time it does damage to the hair follicles, my pomboy, Harley, developed a "rat tail." Hair follicles have to go through a cycle so they die off and then regrow and that can take a while. We have had some dogs on the forum that when their new hair grew in it was totally a different texture/color. I found this post from Addy, no mention of fat deposits tho.


My Zoe continued to lose hair and it had a pattern to it too and my IMS said she did not have yeast on her skin and she developed it in her ears despit using a probiotic. A second IMS agreed with me to be proactive and treat her skin. Her hair got worse before it got better and had I not insisted, I don't know where it would have all gone.

Every dog is different and certainly my Zozo had many other issues. But I can clearly say, the Ketoc Chlor flushed out her follicles, which by the way, have a cycle all their own of about three months.

And I faithfully cleaned her ears with an ear wash and wiped them with medicated pads.

Zoe chewed her paws for a very long time, once her cortisol was in the right place for her, she stopped licking and chewing.
We went through the whole allergy thing, the cone, all of it, Benadeyl, foot washes, antibiotic and cortisone spray.

I hope I don't sound like a broken record.

[LtlBtyRam]

Thanks PomMom. She used to get a lion cut every summer and never had problems with hair regrowth. The year she got diagnosed (2012) it took a really long time to grow back in, to be honest it wasn't until after starting the trilostane when it did grow back.

She had gotten trimmed in 2013 and had no problems with it growing back. She ended up matted last fall and had to be cut fairly short (not quite puppy cut short) and it hasn't grown back right since. We did start a second tea pill for it about 2 months ago and it seems to be starting to grow back in. She also had an ACTH about 2 months ago as well so we know her trilo is at a good dose. It gives me some relief to have you mention how long it can take.

Her nose has also been dry and crusty on and off since diagnosis. This too is getting better again.

[molly muffin]

They are so precious aren't they. I have noticed that quite a few of the poms have fur issues with Cushing's. It could be that their hair cycles are sensitive to the cortisol levels.
Gingers mum mentioned the fat deposit on tail are but that isn't something I have heard of really. Neck areas being fatty or large are more common I think.
The tail is such a distinguishing factor with dogs. If she holds it up when she is happy then it makes me think thee might not be a physical reason so much as a behaviour reason for it. Since the tail is a part of the spine if she doesn't seem to be able to hold it up then it could be an issue with her back perhaps. It is so hard to know for sure.

[LtlBtyRam]

Just thought I'd pop on and give an update. Shasta is still doing pretty good. We had to switch to liquid trilo about 3 months ago. She isn't quite as controlled as far as cortisol levels, but we are ok since all of the other clinical symptoms seem to be ok. We are due for another acth in about 3 weeks.

I have discussed it with her IMS vet and we may keep her closer to cortisol levels closer to 10 than the 1-5 range. She seems to have so much more energy and enjoys life more at the higher level, and as long as it doesn't get any higher I really think it's a good number for her. Does anyone else have any experience with keeping cortisol a little higher for pet comfort.

She does have a few other minor things going on and we are considering doing a teeth cleaning which concerns me, but her teeth really need to be cleaned.

I hope others are hanging in there.

Angela & Shasta & Ginger & the rest of the human family

[Squirt's Mom]

It is so good to hear that Shasta is doing well! I would talk to the vet and see if they feel she's ok to go under for a dental....or if they can offer a cleaning that doesn't require going under. Mine can't have dentals due to health issues so they take Clindamycin every month to help with plaque and tartar build up. They all still have horrid teeth and breath most of the month but I can tell their teeth are improving a tad bit with this approach.

[Harley PoMMom]

I am so glad that Shasta is doing well. With Trilostane the therapeutic ranges are 1.45 ug/dl - 5.4 ug/dl, and a post can be as high as 9.1 if clinical symptoms are controlled.

I also believe that those ACTH stimulation numbers should not be the only guide when deciding an adjustment in dosage, how the dog is feeling/acting has to be taken in consideration too. So, if Shasta does seem to do better with her post running higher, than so be it. ;)

Hugs, Lori

[molly muffin]

I like molly at a bit higher of cortisol too and really don't want her down too low as it makes her luxating patella's bother her more.
It's a bit of a balancing act sometimes getting the dose that helps them the most but gives them a good quality of life too. I think that is important also and you know how Shasta feels at lower levels vs high, so I think you can use that as a determining factor as long as everything else is good too.

Great to see you again.

[LtlBtyRam]

Hi all,
I wish I was just updating we are doing fine. Yesterday we went into the vet's because Shasta couldn't stop coughing. They took an x-ray. The news is bad, but we don't know how bad yet. Her spleen was really bad. We leave for an ultrasound in about 20 minutes. According to what the vet said last night she has a tumor, most likely cancerous. If it hasn't spread to her heart then she might be able to have her spleen removed. I don't have a lot of info yet. If you see this post soon please keep thoughts of a perfect heart in your minds and prayers. If you see this later then please just keep us in your thoughts and prayers.

Angela, Shasta, Ginger, & the rest of the human family

[labblab]

Oh Angela, I am surely wishing dear Shasta the best possible news from the ultrasound. Most definitely, I am holding you both in my thoughts and heart!!

Marianne

[LtlBtyRam]

Thanks Marianne. We are leaving now. Perfect heart, perfect heart, perfect heart.

[lulusmom]

Angela, my thoughts and prayers are with you and Shasta and will be looking forward to your update.

Glynda

[Renee]

Perfect heart prayers!

[molly muffin]

Angela, I am so sorry to read this. Hoping for good news in there somewhere and that the spleen could be removed. Leslie's baby had to have her spleen removed due to tumor, and went on for many years afterwards, so I'm hoping this is the case with Shasta.
Let us know okay!

[LtlBtyRam]

Well we are all home again. No problems with heart, lungs, or spleen. What seemed like a mass on the spleen is actually a large mass on the liver, there are also smaller nodules they can't say are or are not related to the large one. They say most likely the awful c word although there is not evidence of spreading to any other organ, as of yet. Really no idea what to do now. I may consult with the surgeon. I just don't really know what to do next. Thanks for the support.

Angela, Shasta, Ginger, and the rest of the human family

[LtlBtyRam]

I was hoping for the same news, now not sure what to do. I just really wish I knew about the spread part. Knowing that would make the decision so much easier.


Angela, I am so sorry to read this. Hoping for good news in there somewhere and that the spleen could be removed. Leslie's baby had to have her spleen removed due to tumor, and went on for many years afterwards, so I'm hoping this is the case with Shasta.
Let us know okay!

Angela, Shasta, Ginger, and the human family

[lulusmom]

I am sorry that you didn't get better news and I bet you are on total overload right now. I totally understand that feeling. I believe the only way to know for sure what you are dealing with is to biopsy the liver, which is not without risk. I think discussing the matter with an internal medicine specialist and/or a board certified surgeon would be a good next step. No matter what decision you make, we're here for both of you.

Hugs,
Glynda

[LtlBtyRam]

From what the ultrasound Dr. said the only thing we could biopsy was the large mass. I don't see where getting the large mass biopsy would be helpful. Where I'm at is if it has spread I don't want to put her through surgery. If there is a chance it can 1.) be taken out 2.) hasn't spread, then surgery could be an option. I just really really wish I knew if this has spread or not.
I just didn't see this coming. Saw a lot of other possibilities, just not this.
I think a consult with the surgeon might very well happen. The ultrasound was taken in the same practice where her IMS is at and he will get a full copy of the ultrasound & results.
Thanks to all

Angela, Shasta, Ginger, and the rest of the human family

[Budsters Mom]

I was so hoping for better news too.:o I know that overload feeling oh so well. :o

Continuing to hold you both close within our family here.

Hugs,
Kathy

[LtlBtyRam]

I know this is a huge wall of text, but I got the ultrasound results. They are as follows.

Requesting Veterinarian: Dr. Williams of Mtn View AH / Dr. Walton of BPVP Tacoma
Study Date: November 24, 2015
__________________________________________________ __________________________________________________ __________________________________________________ __________________________________
Ultrasonographic Findings
Abdominal study.
Arising from the mid dorsal slightly to the right of midline aspect of the liver was a very large rounded lobular-marginated mixed echogenic mass which occupied the majority of the cranial and mid abdomen. Exact measurement of the size of this mass was difficult but was at least 11 cm in dimension. This mass was mostly heterogeneously hyperechoic but mixed echogenic throughout with a few small anechoic through transmitting cystic regions, central hyperechoic shadowing mineralization, and was markedly irregular in internal architecture. Doppler blood flow was detected throughout the mass, moreso peripherally, via Color Doppler interrogation. This mass was not encompassing but adjacent to the hepatic hilar vessels when imaged from the right intercostal window. Throughout the remainder of the liver were numerous round well-defined slightly hypoechoic fairly homogenous in echotexture nodules measuring up to 2.1 cm in dimension. The gallbladder contained a small amount of echogenic luminal debris. No intrahepatic or common bile duct distention or obvious hepatic lymphadenopathy identified. Both adrenal glands were hypoechoic and generally enlarged measuring 1.16 cm in thickness on the right and 1.26 cm on the left at their respective caudal poles. The spleen, kidneys, urinary bladder, and gastrointestinal tract were unremarkable. No free effusion identified.

Ultrasonographic Impressions/Recommendations
- Pedunculated single large liver mass is most consistent with benign or malignant primary hepatic neoplasia (i.e. hepatocellular carcinoma/adenoma, neuroendocrine/carcinoid, sarcoma, other). Although considered less likely, a large regenerative/hyperplastic liver nodule cannot be excluded and biopsy is needed for definitive diagnosis. Aspirates were declined at this time, but US-guided FNA or Tru-Cut biopsy on this mass is considered feasible with patient heavily sedated/anesthetized for prognostication purposes if clinically indicated. Few additional liver nodules are not outwardly cavitary or otherwise definitively sinister in appearance, but differentials must include both metastatic neoplasia in addition to benign change such as hyperplasia/regeneration. No evidence of free effusion/hemorrhage at this time. Recommend consultation with a veterinary surgeon.
- Bilateral marked adrenomegaly is expected given historically diagnosed Cushing's disease and concurrent Trilostane therapy.

[molly muffin]

Dang. :( Well it doesn't sound like they know for sure if it is benign or malignant. It doesn't appear that they think the other nodules are sinister, so that is a good thing at least.

I would have the consult with the surgeon and at least see what he thinks.
We have a questionaire that was made up by Trish, whose dog Flynn has been through liver surgery and removal of a pheo adrenal tumor.
It might help you at least


Part I - Questions to ask when considering if surgery is an option for your dog’s adrenal tumour:
1. What type of tumour do you suspect, ?functional, ?non-functional, pheochromocytoma, benign, metastatic
2. Expected life span for my dog in a normal situation. If your dog is close to, at or past his expected lifespan for his breed is surgery going to be of any benefit?
3. Prognosis for my dog if we treated medically i.e. with Cushings medications. AND if we do not proceed with surgery how long do you think it would be before the tumour started adversely affecting his quality of life?
4. If he is miserable now, does the benefit of potentially risky surgery outweigh his current quality of life?
5. Are there any other health problems that could impact on a positive surgical outcome, for example: if your dog is overweight or has heart, BP, liver, kidney or lung conditions
6. Is there any sign of tumour spread – imaging should be done, including ultrasound and on advice of specialists either CT or MRI to check whether there is local invasion around the tumour, into blood vessels including vena cava or spread further away in the body to lungs etc
7. Surgeon recommendations – would he/she do it for their own dog?
8. Psychological impact for the owner: It is important to understand this is risky surgery, sadly current guidelines indicate 1:5 dogs do not make it, and some recommendations are not even that high. Can you accept it if your dogs dies during or in the postoperative recovery period surgery? This is where it is important to weigh up whether the benefit of your dog being fully cured is worth the risk of possibly losing him.
9. Financially – can you afford it? Find out estimate of costs.
10. Hopefully this will not happen, but if your dog collapses, e.g his heart stops either during his surgery or afterwards what emergency measures should be undertaken, do you want your dog to have CPR, how far are you (the owner) willing to go for your dog to be saved in such circumstances

Part II - Surgery has been recommended as treatment for your dogs adrenal tumour, here are a few suggestions on what questions you should ask your surgeon:
1. Are you board certified? How many operations of this type have you done? What complications have you experienced? What were the outcomes?
2. Please explain to me how you will do the surgery, which part would likely give you the most trouble? Will you be doing the actual surgery or a resident in a teaching situation? If so, is their close supervision?
3. Will there be a specialist anaesthetist available for the surgery?
4. If it hasn’t been done, do we need a CT/MRI scan to look at the tumour more closely to check for vena cava involvement or any other tumour spread?
5. What are the risks associated with this surgery, including
• Bleeding (including trauma to blood vessels or other organs during surgery)
• clots
• Blood pressure or heart problems such as arrhythmias
• pancreatitis
• pneumonia
• kidney failure
• infection
• wound problems
• bowel problems
• anaesthetic risks
• adrenal insufficiency or electrolyte abnormalities
• death (sorry but you have to ask that risk too)
6. If we proceed with surgery does my dog need preoperative treatment with Cushing’s meds, antihypertensive if high blood pressure is a problem – phenoxybenzamine recommended preoperatively for dogs with pheochromocytoma, anticoagulants or anything else?
7. How will you treat to prevent clots postoperatively?
8. What would you do if you found anything else during the surgery i.e. nodules in other organs e.g. spleen, opposite adrenal, liver, kidney. Would you remove them and what are the risks associated when doing additional abdominal surgery together with adrenalectomy
9. How long will it take and when will you contact me so I know all is OK, when can I visit after surgery?
10. How will the postoperative period go, how long would you anticipate he would need to stay in hospital? How will we manage pain?
11. What monitoring would be needed, e.g. heart monitoring, oxygen levels in the postoperative period
12. If your dog has an adrenocortical tumour affecting cortisol production will he need to be on steroids following surgery and for how long?
13. If there are problems when I take him home, who do I contact? Hopefully the surgical team until all is stable. with some questions to ask the surgeon:



They won't all pertain to the liver surgery but still some good ones to discuss with the doctor.

Maybe it is benign and that would be great. The liver can be mighty recuperative.

Still I am so sorry, as this it is just shocking to ever find a large mass when it isn't expected :(

[LtlBtyRam]

Thank you so much Sharlene. I appreciate the help. The doc who did the ultrasound doesn't think it is benign. I don't know if a fine needle aspiration will really help, as either way I think surgery would probably be a good option. At this point it seems to be affecting the liver only. The big shocker is she has seemed to be doing so well over the past few months. I am doing my best to keep a good outlook on this all. I will take the questionnaire an tailor it to our situation, then have it with me for the consult. I just can't reconcile how good she seems with this latest news. Her cough is just about under control, we aren't giving her the suppressant but maybe once a day down from 3 times. Coughing is what led us to find this. She was having a tough time. We took her to our regular vet who did x-rays saying it was a spleen tumor. The next day at the ultrasound we found out it wasn't. I will be calling for the surgeon's consult tomorrow. Thank you again Sharlene. The last week has been incredibly hard.


Dang. :( Well it doesn't sound like they know for sure if it is benign or malignant. It doesn't appear that they think the other nodules are sinister, so that is a good thing at least.

I would have the consult with the surgeon and at least see what he thinks.
We have a questionaire that was made up by Trish, whose dog Flynn has been through liver surgery and removal of a pheo adrenal tumor.
It might help you at least



They won't all pertain to the liver surgery but still some good ones to discuss with the doctor.

Maybe it is benign and that would be great. The liver can be mighty recuperative.

Still I am so sorry, as this it is just shocking to ever find a large mass when it isn't expected :(

[molly muffin]

Just checking in to see how you and Shasta are doing? I hope she is doing okay.

[LtlBtyRam]

We are doing as good as we can. We had the surgeon consult on Monday. Per the ultrasound the surgeon said she isn't a very good candidate for surgery. As far as can be seen the tumor is on the right side of the liver which means it is near the two major blood vessels supplying the abdomen and the back of the body. It is also near the base of the liver. Not the news I was hoping for. If it were the type of malignancy they think it would not be a good candidate for chemo either, so I don't think we will even bother finding out.

At this point I'm pretty bummed out. The western medicine world has really failed me. This is the first time I've had this experience. I've got to say this really sucks. We don't really have any options except watching her waste away.

Her acupuncturist says there is a tea pill formula that can help slow tumor growth. We are starting it today. I'm really sad and don't relish going through this.

Angela, Shasta, Ginger, and the rest of the human family

[molly muffin]

One of our members, has both of her beagles on a chinese (not sure if it is a tea pill, but that does sound familiar) Anyway, they have been on it, or at least Snuggs has for over a year and I think doing well. I don't think their adrenal tumors have increase.
This is not to give you any kind of false hope, but from what it sounds like, there are few options available surgically or chemo wise to help Shasta, so the best thing is to make sure that her life, however long is left is the best possible and I don't think a tea pill at this point would be harmful. She is in good spirits currently and enjoying life and that is what counts.

Big hugs. I'm sorry it wasn't better news

[LtlBtyRam]

Thanks for the hugs and empathy. I too am sorry about the news. I wish we caught it before it got to the size it is. 11 cm is about 5 inches and in her that is really big, and that is just one dimension. We have no real idea how deep it is. I feel I failed her, which is the hardest part. Yes the main thing now is the quality she has left. Thanks for the hope too, although it is really hard to keep it in sight right now.
Angela, Shasta, Ginger, and the rest of the human family

[molly muffin]

Hi Angela, I just wanted to check in on your and Shasta and see how you are both doing. I know this can't be an easy time for you.

[LtlBtyRam]

Well all. I thank you for everything. She has been fighting for a long time now. I know I only post when something bad happens. She is still with us, although I think we are nearing the end of the good fight. She is hardly eating. I will be back tomorrow.

[DoxieMama]

Hi Angela,

I have only joined recently but went back through your thread to read the history of your Shasta. I am so sorry to hear about the tumor. Did the cough resolve? Is she still taking trilostane or other meds/supplements?

Many hugs for you, and belly rubs for Shasta.
Shana

[molly muffin]

Hi Angela, oh little Shasta definitely has been fighting a good fight alright.
Poor little dear. I'm sure that you are both exhausted much of the time.
Have you tried the Royal Canine appetite stimulating small can food? Sometimes it works to get them to eat a little bit.

[LtlBtyRam]

Hi Angela,

I have only joined recently but went back through your thread to read the history of your Shasta. I am so sorry to hear about the tumor. Did the cough resolve? Is she still taking trilostane or other meds/supplements?

Many hugs for you, and belly rubs for Shasta.
Shana

The cough pretty much did resolve it took some suppressants, but it got better. She has not gotten her trilostane or any supplements for several days now. She isn't eating hardly a thing, just this evening she has not drunk in several hours. Her time is very near.
Thank you for your post
Angela

[LtlBtyRam]

Hi Angela, oh little Shasta definitely has been fighting a good fight alright.
Poor little dear. I'm sure that you are both exhausted much of the time.
Have you tried the Royal Canine appetite stimulating small can food? Sometimes it works to get them to eat a little bit.

I have not tried the Royal Canine we had been trying to appeal to her with her favorite foods, but now that isn't even working. She hasn't eaten since this morning and it is nearing midnight. She hasn't had anything to drink since before dinner. Her time is very very near. We are looking into options to assist her here at home. It is very hard and I love her so much, but watching her struggle is even harder. My heart is breaking. I know the rest of the family feels as I do. Thank you for your kind thoughts.
Angela

[LtlBtyRam]

Her fight is over.

[labblab]

Fare thee well, sweet little girl, now that you are released from any pain or suffering. Your spirit is free, as it will forever remain.

Your K9C Family joins in celebrating your life and honoring your memory...

Sending so many hugs this morning to all who love you so dearly, and who already miss you so deeply ~
Marianne

[Squirt's Mom]

My heart is broken to hear this news but I know you and Shasta fought the good fight and when no more battles could be won, you gave her freedom. Today she is once again strong in herself, as she was as a pup, no illness, no pain, no fear. One day you will hold your sweet girl again. Til then, she will watch over you with all the love and tenderness you gave to her.

Our deepest sympathies,
Leslie, Trinket, Brick, Sophie, Fox and all our Angels



A Special Gift

They're a very special gift, to be cherished and loved;
You're chosen for each other by God Himself above.
It's a match made in heaven so it can't be wrong;
You're tied together by a bond that's oh so strong.

All they'll ever ask from you is to be loved and fed,
And at night make sure they have fresh water and a bed.
In return, for so little, the rewards are so great!
You'll get a companion for life with some very special traits.

When you are lost and the end seems so far away
They'll walk by your side, they'll help you find your way.
When life gets you down they can put a smile on your face
As they run you in circles with their fast pace.

You'll share the good with the bad, you'll be happy and sad;
And through it all you have a friend, the best you ever had.
You're time together will be special and unique;
It will be as priceless to you as a rare antique.

Then, before you know it, the day will arrive
When suddenly your life takes a steep dive.
The furry friend who's been with you for all of these years
Has now passed on and left you in tears.

As you sit and wonder what did I do?
Why is this all happening to you?
Into each of our lives a little rain must fall,
And you must be strong to answer the call.

Your little one's spirit has flown home on the wings of a dove,
To a special place that awaits them in heaven above.
St. Francis will meet them; when they get home
He will take them to a meadow where they're free to roam.

There in the meadows, down by the pond,
Your furry friend will remember his loving bond.
He'll look into the water, then you appear;
He can see you're frightened, he can feel your fear.

Through the bond that still ties you from heaven above
He looks down upon you, he sends you his love.
Because you loved him and because you care
Whenever you need him, he'll always be there.

There, in the meadows, they patiently wait for the day
When you will celebrate your life together, each and every day.
Waiting for that day; when you come walking back home
When together for an eternity through the meadows you'll roam.

Author Unknown

[Joan2517]

I am so sorry for your loss.

[DoxieMama]

I'm sorry for your loss. Please be gentle with yourself while you grieve.

Run free, sweet Shasta!

[judymaggie]

My heart goes out to you at the loss of your dear Shasta. Please take some solace in knowing that she is at peace and pain free.

[budindian]

I'm so sorry for your loss. She fought a good fight and so did you, you didn't let her down. We do the best we can with what we have.
My heart breaks for you and your family, its not easy losing a loved one.

[molly muffin]

Oh Angela, I am so sorry for the lost of precious Shasta.
She really did fight a good fight. Remember when you first came here, years ago and now it seems that what was going on them was so much simpler than the past year has been.
You both fought on, no matter how tough it was and I know it wasn't easy at all.
My heart just breaks for you and your family.
Sending you my heart felt condolences and big hugs.

[LtlBtyRam]

Thank you all for the kind words. The hardest part is knowing all the moments I'll never have again. No more sweet baby girl kisses, no more holding her and going "Who is cuter? Shasta!" no more making sure the water bowl is fresh before bed. I will miss it all, even the times it was at the worst and we were going outside every 2 hours around the clock and all the fuss to get her to take her meds. Our family had another dog before Shasta and he passed in 2010, but he was bonded most to another household member. Shasta was really my first bonded pet and was my heart dog. I know every one here has had heartache thank you for keeping us in your thoughts and prayers through this difficult time.

[LtlBtyRam]

I can't believe how quiet the house is without her. She didn't bark much, but it goes beyond any physical noises. She was just such a big presence. I knew she was, just not quite how much.
Angela

[Joan2517]

Yes...it's been two months without Lena and the silence is still overwhelming even with four other dogs. I still listen for her...

[molly muffin]

Amazing how much of a presence they have isn't it.
They just really do project so much life and energy that it's really hard to not have it.