My mate tommy has cushings-sweet Tommy has passed

[Robert]

Hi all
I have a 14 year old maltese tommy and a 1 year old shi tzu Maltese cross chelle. Love em both to bits. Lost a 12 year old maltese tammy last year after a battle with cardiomyopathy so have had experience with dog illnesses before.
My little mate tommy has just been diagnosed with cushings and we are trying to get the tristolane dose right he started on 30 mg went to 60 and is now on 120. He didn't seem to have anything wrong with him before diagnosis other than high liver reading when he got his teeth cleaned over the last year or so. He is in his twilight years and has given me so much so the least I can do is look after him now.

[Roxee's Dad]

Welcome to you and Tommy,

Whoa... 120 mg of trilo for a maltese ???

How much does Tommy weigh? What symptoms of cushings does he have?

Can you post the results of his cushings test. Should be an ACTH and maybe an LDDS test.

Sorry for so many questions, but the more we know, the better we can understand and offer our experiences.

[Robert]

No drama re questions - want as much info as I can get especially from other pet owners.
Tommy is about 5.5 kilo which is around 12 lb or a bit more. He has had the ACTH test 3 times now. Once to confirm diagnosis the next where the readings dropped by half after 10 days on 30 mg but not enough for vet who doibled dose to 60 . then another 10 days later where it actually rose a little bit and he is now on the 120 mg and due for a test in a week. He had no symptoms per diagnosis that I noticed but he does seem a bit more alert and lively now. He is definitely drinking less. Right now he is chilling out on the bed which he jumped onto which isn't a bad effort for an old boy!!!!! I have read many posts here and he seems a lot luckier than many ie no back leg issues still has energy coat is fine etc
I was concerned re the big dose increase but my vet assures me it is ok. I don't have actual readings but will get them next time I go.

[Roxee's Dad]

Well that is great news, I am so glad Tommy is doing so well. The high dose really threw me off guard LOL. But if he is doing great, then we can't ask for more.

Little Tommy must be a pretty tough guy :) We look forward to seeing his test results. Give little Tommy a belly rub from me :)

[Robert]

Will do!! He is a tough little tyke but he is an old tough little tyke which is a worry but nothing to do about that.
Thanks for response.
Hope you and yours are well.

[Budsters Mom]

Hello and welcome from me too. :)
You have come to the right place! There are many K9Cushing's angels standing by to help and stay with you every step of the way. They love details, test results, any information you can get your hands on. The more the better. We will do all we can to help, but be ready for lots of questions! So again, welcome to you and Tommy.

Please post those ACTH results as soon as you have them. I am very concerned that a 12 pound dog would be on 120mg. Trilostane per day. The current starting recommendation is 1mg. Per pound to start. 120 mg. is an enormous amount for small dog. There is no drama here, just concern.:o We are just concerned about Tommy. We do ask lots of questions, to get as much information as possible. Please do not be offended by them, as we are only trying to help.

[Roxee's Dad]

Thanks, we are good, we have a a little Shih Tzu that just turned 18 last month, yeah she is a bit tired but still is enjoying life and actually has more energy than our 8ish year old pugle mix, so I know what you mean. ;) :)

[Robert]

Thank you for the welcome. Will get the test results and post next time I am at the vet. And 120 does sound a lot but the vet said there is a huge variance the way dogs react and the first signs of vomiting the runs or lethargy bring him in. Hecseems fine and I am keeping a close eye on him.
Cheers

[Robert]

John

Hope Tom gets to 18!!!! Look forward to talking more. Out of interest how big is the shi tzu . I have a 14 month old shi tzu Maltese cross who is all of 4 kg. tiny but full of beans
Cheers

[Budsters Mom]

I am glad that you're watching Tommy closely and that he's feeling well.:). We are worrywarts around here.;) We worry because we care. Give Tommy a belly rub for me.

[Robert]

Katy I can see people care here. Am looking forward to being part of that caring.
Lost a malt to cardiomyopathy last year and would have been good to talk to people who understand a dog isn't always just a dog.

[Budsters Mom]

Robert,
I lost my Buddy almost 6 weeks ago. The support and love freely given by this heavenly group of angels saved my sanity. They stayed with me 24/7 for several days talking me through my grief. We are truly a family here. Many of us have lost fur babies and none of us think a dog is just a dog. That remark makes me furious! :mad:I am sorry about the loss of your beloved Malt. You are now part of our family and we will do all we can to help you and Tommy.;):p

[Robert]

Hi sorry to hear about your loss pain must still be raw. Lost tAmmy one year ago and still think of her every day. Think of good things mostly now she was an amazing dog.

[Trish]

Hi Robert, welcome to the forum. Sorry I am not much help with the cushings, I am more an adrenal tumour person as that is what my dog Flynn has had, as well as liver cancer removed. That dose did prick my ears up though, whacking great dose for a little doggie but they are all so different aren't they! Hopefully you can get the tests the others have requested so they can have a good look over them for you. :)

[frijole]

Welcome from me too. Glad your boy is doing fine. Note that normal starting dose for a dog your size would be 10 mgs so 120 mgs is striking all of us. Also we have seen it happen many many times that it seems to 'kick in' after several weeks so we don't see dose changes quite so quickly. Just so I can sleep at night do you have a supply of prednisone to give in the event that that very high dose does kick in and the cortisol goes low? You might want to get some if you don't have it on hand. Just as a precaution. Thanks, Kim

[goldengirl88]

Robert:
OMG you are kidding us right?? 120mg for a maltese??? Is it mixed with German Shepherd or what? That is a dose for a very large dog. Firstly I forgot to welcome you I was so stunned by the dosage. Please get copies of all tests that you had done to confirm this diagnosis and post the results here. Also do you have prednisone on hand, as I think you are really going to need it. Your dog should have been started on the lowest dose of 10mg to start out. If she needed more than it could be adjusted. For a tiny Maltese 120mg is outrageous. Are you sure of the mgs? You need to get to a Vet that is experienced with Cushings, and you need to call Dechra the manufacturer of Vetoryl if that is what you are using and go over this with them. 866-933-2472 is the number. If you are truly giving that dosage to a maltese, I am stunned it survived . Please go to a Vet experienced with Cushings immediately or to an emergency facility, this dog needs help badly. I cannot stress this enough. What crazy vet would put a Maltese on 120mg???Please, please seek help now. Blessings
Patti

[Simba's Mom]

Hello and welcome to you and your furbaby, you have found the best place to be, it's like one big family here....I lost my Simba about a month ago, seems like yesterday....anyways, take care and get ready for lots of info and encouragement.....

[Roxee's Dad]

John

Hope Tom gets to 18!!!! Look forward to talking more. Out of interest how big is the shi tzu . I have a 14 month old shi tzu Maltese cross who is all of 4 kg. tiny but full of beans
Cheers

At her overweight era, she was around 16 pounds (7.2 Kilo) In the last year or so, she has lost all her muscles and is down to 10 / 11 pounds (4.5 kilo) she has a lot of skeletal bones showing :( We have increased her feeding to 4 times a day just to maintain that weight. She can be a bit fussy about food in her old age, so we vary it a lot. Sometimes what is great for breakfast is not good enough for lunch. :rolleyes:

Your vet is right and we have said it many times here that each dog is different but lol, 120 mg for little Tommy does worry us. But he is doing well and we are all happy for both you and Tommy.


He had no symptoms per diagnosis that I noticed but he does seem a bit more alert and lively now. He is definitely drinking less.

While we are waiting for you to post his cushings diagnostic test results, can you tell us why the vet tested for cushings in the first place? When he had the blood panel before his dental (I assume) was his ALKP high? It would be very interesting for us to understand why the vet even did any cushings diagnostics given the lack of any outward symptoms.

[Robert]

Hi all
Thanks for all the responses. I too am worried about the dose but the vet is doing all the tests as per protocol and on both occasions has consulted with a specialist. I read a lot on the Internet and the dechra website. The dechra site says a practical starting point for a dog up to 10 kg is 30 mg and may need to be adjusted after testing Nd there is a wide response rate in dogs. I am keeping a close eye on him and am 5 minutes to my normal vet and 30 minutes to a 24 hour vet. I am just hoping and praying his next test is either in the mark or he reduces a bit. The reason he was tested was high liver reading - he had it the last 2 or 3 tillmes he had his teeth and the senior dog blood tests.
I will get the results of his tests and post them and ring my old vet for a chat re dosage. I am thinking he may be the opposite of my dog who passed tam who had N autoimmune disease went on pred was very sensitive to it and I believe that if it didn't cause her heart prob made it a lot worse.
Cheers

[Robert]

[QUOTE=Roxee's Dad;117541]At her overweight era, she was around 16 pounds (7.2 Kilo) In the last year or so, she has lost all her muscles and is down to 10 / 11 pounds (4.5 kilo) she has a lot of skeletal bones showing :( We have increased her feeding to 4 times a day just to maintain that weight. She can be a bit fussy about food in her old age, so we vary it a lot. Sometimes what is great for breakfast is not good enough for lunch. :rolleyes:



Little chelle I think runs around too much at this point to put on weight- she can be best described as a loveable idiot!!! Lol she also eats orctries to eat anything at this point including socks shoes etc

[molly muffin]

Hello and welcome from me too :)

Although it is not unheard of to have small dogs on large doses and big dogs on small doses, that often when it looks like the numbers aren't controlled at the dosage that you'd think they would be controlled at, then an ultrasound will be done to verify what anything that might be going on inside. Has an ultrasound been done on Tommy? If not, you might just want to think about that option and have a chat with your vet about that.

Welcome to the forum!
Sharlene and Molly Muffin

[Robert]

Hello and welcome from me too :)

Although it is not unheard of to have small dogs on large doses and big dogs on small doses, that often when it looks like the numbers aren't controlled at the dosage that you'd think they would be controlled at, then an ultrasound will be done to verify what anything that might be going on inside. Has an ultrasound been done on Tommy? If not, you might just want to think about that option and have a chat with your vet about that.

Welcome to the forum!
Sharlene and Molly Muffin

Thank you for the welcome. And if this dose isn't enough or even a bit too much will be asking vet lots of questions re further tests and if dogs can be just resistant to drug and discuss options
Didn't realise it was a big dose till advice from here.
Cheers

[Robert]

Been a hectic couple of weeks. Mum broke both shoulders - yes both and seems to be getting better. Spent heaps of time with her.
Also tommy had another ACTH test and I got to talk to specialist. His reading post injection started at 880 went to 408 first retest and is now 204. Needs to come down a bit more. Specialist wanted to go to 240 mg but I only agreed to 180. She has small dogs on the 240 twice a day. They were concerned re cost but at the moment can afford it. And Tom is 14 and a half so is in the twilight. As I told vet I want to keep him around as long as possible as healthy as possible.
Cheers

[labblab]

I am truly puzzled and worried as to why the specialist wanted to increase Tommy's dose at all. From what you have said, Tommy's only symptom has been an elevated liver on his bloodwork. We have been told that elevated liver enzymes may never return to normal levels in Cushpups no matter how long or well-controlled their cortisol levels may be. So you cannot base dosing increases solely on that criteria, and if Tommy has no outward symptoms of the disease, I do not understand why your vet wants to drop his cortisol even lower. Please take a look at this Vetoryl product insert:

http://www.dechra-us.com/files/dechraUSA/downloads/Product%20inserts/Vetoryl.pdf

And focus on these monitoring instructions:


5.4 to 9.1 ug/dl or
150 to 250 nmol/L
EITHER: Continue on current dose if clinical signs are well controlled
OR: Increase dose if clinical signs of hyperadrenocorticism are still evident*
(*Combinations of capsule sizes should be used to slowly increase the once daily dose.)

I am mortified that your specialist would have considered doubling Tommy's dose when his cortisol has already lowered to this level (7.4 ug/dl), he is exhibiting no outward symptoms, and he is taking such a massive dose already. 240 mg. would represent a dosing formula of 24 mg. per pound for him :eek:. Even the increase to 180 mg. is huge under these circumstances. To be honest, I have to question the validity of the Cushing's diagnosis in the first place if Tommy has had no overt symptoms of the disease and he is seemingly tolerating what would normally be a huge dose for a dog of his weight (there seems to be some evidence that dogs without Cushings can tolerate higher doses of the alternative drug, Lysodren, without exhibiting the same cortisol-lowering effect that would take place in Cushpups). But to continue massively increasing the dose at this stage (less than two months into treatment?) seems to me to be courting a life-threatening Addisonian crash and disaster... :(

Marianne

[Robert]

Yep Tom had no symptoms I noticed but he is drinking less and has heaps more energy-he actually did the malteses bolt yesterday - running like a lunatic for no reason.
And also if the levels are controlled then he may dodge the bad effects of the disease????? If not controlled he will surely be affected in a bad way soon???
Cheers

[labblab]

Can you tell us what tests were done to confirm Cushing's (and what the numerical results were)? Were there any other abnormalities in his blood and urine results that would be consistent with Cushing's? There are several alternative explanations for elevated liver enzymes which apparently were Tommy's only symptom. That's great that he's feeling well right now, but none of this may actually have anything to do with Cushing's.

And even if so, if he is doing this well at this stage, according to Dechra his level is sufficiently controlled and there would be no reason to increase his dose further.

[Robert]

He had a urine test and the ACTH tests and the urine was diluted and indicated issues and the only ACTH results I have we're posted earlier tonight.
The vet and specialist based on these results are sure of cushings.
Cheers

[frijole]

Robert, Please listen to Marianne. This is important. If a dog has too much of the drug the results can be fatal. She is right to question the dosage you are on. These things can happen very quickly. Please answer her questions. Thanks! Kim

[Robert]

The specialist wanted me to double from 120 mg and take rescue drug but because of situation with my mum wouldn't do that as I need to help her a lot. The spec . Has treated heaps of little dogs on more drug than he is on. The vet said she was initially surprised but is comfortable after discussion. He will get as close of an eye on him as I can and his 10 day tests.
Cheers

[FemaleK9]

Robert, I strongly urge you to heed the advice given to you here. These people know more about canine Cushing's that most vets. This isn't just a "support" group!

They will best be able to help you if they are given full information. Please get all the LDDS and ACTH test results for Tommy and post them here. They will also need to know what dosage Tommy was on prior to each test, how long it was from his last dose to the time of the test and whether the dose was given with food or if you were told to fast Tommy prior to the test (I was, and it is wrong, wrong wrong - it completely invalidates the test!).

I, too, have great faith in my vet, but I took the advice given to me here and it was the right thing to do. Armed with the information given to me here, I had an excellent discussion with my vet and the ACTH was done the right way. I not only saved my Rosie from a possible overdose, but I like to think I may have helped dogs that will be treated there in the future.

[Trixie]

Hi Robert,
I know you've probably heard it from too many here already, but I just have to add my own post because honestly that dose is shocking!
Obviously as of yet it has had no ill effects for Tommy and that too is amazing, but 180mg for a small dog just sounds so scary.
My dog- 15 pounds started at just 12mg. and gradually up to 28mg a day. Of course all are different and with different issues, but with lack of bad symptoms I don't know how the medication be dosed at this level.
Did you do a LDDS test when this all started for Tommy?

It also seems to me that although you want to have good control it should be on the lowest dose of the med possible...it's not like this medication is so good for a dog. I've been tweaking doses since April-- so almost 6 months. Seems you've gone from 0- 180 in a pretty short time. I hope Tommy continues to be just fine but be careful with this strong medication.

Barbara

[Budsters Mom]

Robert,
I am frightened for you and Tommy.:eek::eek: Such a high dosage for a little guy is terrifying me. Doubling it, makes my heart skip several beats.

I lost my little guy recently. His cortisol level dropped significantly more than 30 days after initiating treatment of Trilostane (Vetoryl) This is not uncommon.

Cushings in Tommy's case is suspect at best. He may not even have it. Vetoryl is used to control symptoms. It is NEVER increased in the absence of symptoms. It is a heavy duty drug, which needs to be monitored very closely. We care about you and Tommy. Losing a fur baby tears your heart out. Tommy is in danger. Please reconsider.

[Robert]

Robert,
I am frightened for you and Tommy.:eek::eek: Such a high dosage for a little guy is terrifying me. Doubling it, makes my heart skip several beats.

I lost my little guy recently. His cortisol level dropped significantly more than 30 days after initiating treatment of Trilostane (Vetoryl) This is not uncommon.

Cushings in Tommy's case is suspect at best. He may not even have it. Vetoryl is used to control symptoms. It is NEVER increased in the absence of symptoms. It is a heavy duty drug, which needs to be monitored very closely. We care about you and Tommy. Losing a fur baby tears your heart out. Tommy is in danger. Please reconsider.

Thank you and all for your concern. I must admit I am a tad confused as I am listening to what you guys say but on the other hand have my current vet my old vet and a specialist telling me all is ok with what is happening.
I know how it feels to lose a sick dog - tam left 12 months ago after a bout of Auto immune disease and then cardiomyopathy. I am wondering if Tom with this is the opposite to her with the autonmunevtreatmnt being steroids . She was very sensitive to them as she developed a skin reaction in a few months on a low dose that dogs usually only get after years on high doses. I am convinced the roids led to the heart issue but she had to have them.
I am keeping an extremely close eye on Tom and so far so good. His next ACTH test is next Wednesday.
I am so sorry for your loss and all others who have lost a pet they love. I still miss tam but know it would have only been for me to keep her alive she had had enough and all the fight had left her.

[Robert]

And the increase has been based on reaction to the drug.
And there in a few threads a suggestion that Tom may not have cushings. Noting that urine creatine indicated and 4 Ahct tests have been high what else could it be???
Appreciate everyone's concern but am now confused but feel I have to run with medicos

[labblab]

I am so sorry that we keep hammering away at you -- it must indeed be making you feel very confused and upset. And it is absolutely true that we are not vets, so we are not trying to substitute our recommendations for those of qualified professionals.

Everything else aside for the moment, though (the original diagnosis and the previous increases, which I do understand were based on ACTH results), I am still wondering why the Vetoryl dose is now being increased once again since Tommy's cortisol level is now within the range at which Dechra would recommend leaving "as is" since he is doing so well. Has your vet told you why he/she wants the cortisol level even lower than it already is? From what you are describing, there are no worrisome clinical symptoms that remain. Do you know what specific target it is it that your vet is currently shooting for? I do think that would be worth asking in view of Dechra's published monitoring recommendations that would be leaving well enough alone right now.

Marianne

[Budsters Mom]

Robert,
I am so sorry that I scared and confused you. I have felt exactly the way you are feeling a few times myself. Marianne is absolutely right. We are not medical professionals. I am extra sensitive right now. So many of our fur babies have crossed over the rainbow bridge this year, including mine. We are doing everything we can possibly do/say to save others the gut wrenching grief of losing their babies. I continue to feel concerned for you and Tommy, but will pull back and let others respond for now. I will continue to read about you journey and pray that all goes well for you both.

[Robert]

Hi all
Just to clarify I am not upset or even mildly annoyed with anyone just not sure I am doing the right thing. I like to see all views so I canbaskbthe vet. I have asked all questions posed here and this site is the reason that although I have increased the dose it's not as much as they wanted me too. They have answered all questionscrecdosage etc to my satisfaction.
The second ahct reading tommy had last test was 204 and the test result form from the lab said the range should end at 100. So want to get closer to that 100 figure. I want to stop him getting bad symptoms before they happen and live out the twilight year or years of his life As healthy as possible. I love the little tyke.
And if I sounded short in previous responses apologies the written word does not Always reflect the intent of the writer. Please anyone who wants to comment pleas please do so it is a complicated matter and I have lots to learn.
Cheers

[Robert]

And I wish I had found a website like this for heart conditions and automune illnesses when my little tam was going through it last year.
Cheers

[Squirt's Mom]

Hi Robert,

You asked what else it could be with elevated cortisol on tests. Let me share our story with you.

My Squirt had the LDDS, HDDS, ACTH, UTK panel (full adrenal panel), and 2 ultrasounds before I ever started treatment...and she tested positive for the pituitary form of Cushing's on all six tests. HOWEVER, after the second ultrasound they told me about a tumor on her spleen. Once that tumor was removed her cortisol returned to normal and remained within normal range for several more years. Had I started treatment after the first positive test, she would not be here today. Her cortisol may have tested normal with treatment but the tumor would have ruptured regardless of treatment for the elevated cortisol. ;)

Cortisol is the body's natural response to stress of any kind, internal or external. That tumor was causing Squirt's cortisol to be elevated, not Cushing's. These tests cannot tell us why the cortisol is high, only that it is. For this reason, plus the fact that so many other things can cause elevated cortisol and cushing's signs, it is best to do as many tests as possible prior to starting treatment in order to rule out other possibilities like tumors, hypothyroidism, diabetes, liver or kidney disease and on and on. I always highly recommend the abdominal ultrasound if possible because that one test saved my Squirt's life. Had I started treatment like most folks were pushing me to after the positive LDDS (NOT on this forum), my Sweet Bebe would have suffered a terrible event most likely taking her life.

So to answer your question - elevated cortisol can mean many, many things that have absolutely nothing to do with Cushing's. ;) Please understand, I am not saying your sweet Tommy doesn't have Cushing's....just that there could be an additional reason his cortisol seems to be so difficult to bring into range without such a massive dose of this very powerful drug in his little body every day.

Hugs,
Leslie and the gang

[frijole]

My Annie had a rare adrenal tumor (non cushings) and she had 7 false positive cushings tests. Kim

[labblab]

Dear Robert,

You need not worry at all that you have offended us or seemed "short" in your replies. I totally understand that we are putting you in an awkward position vis-a-vis your vets. So do not apologize and do not worry -- you will never be rid of us this easily!!!! ;) :) :)

Marianne

[Robert]

To squirts mom and Annie's I will definetly be talking to vet and hopefully specialist about ultrasound. This site is absolutely a requirement for the I knowledgable like myself. Thank you both for your posts.
And marianne thank you again And looking forward to more advice.
Like I said in a post Tom is in his last year or so now and he has been an amazing dog and just want him around as long as possible as long as he is not suffering in any way.
Cheers

[Squirt's Mom]

I know that feeling well, Robert. Squirt was 15 in Feb. and every day is such a blessing!

[Robert]

I know that feeling well, Robert. Squirt was 15 in Feb. and every day is such a blessing!

Squirt is one lucky dog !!! And love the name

[lulusmom]

Hi Robert and a belated welcome to you and Tommy

I know that I'm late to the party but I wanted to share my thoughts and concerns about Tommy's diagnosis and treatment as well as provide you with some science based reference material that might help you understand why we have so many questions and concerns. It is my hope that this material will also help you ask meaningful and very direct questions of your vet and specialist. We aren't vets but we've followed more case studies than most vets will see in a lifetime and some of us are anal researchers who don't believe anything that isn't supported by science based evidence. I'm as anal as they come which is why this post is longer than most novels so please try to bear with me.


My little mate tommy has just been diagnosed with cushings and we are trying to get the tristolane dose right he started on 30 mg went to 60 and is now on 120.
I am assuming that the stim test results you posted after this post correlate with these. I’ve taken the liberty of combining them here but would appreciate it if you clarify if the 408 result was the first stim after starting treatment on 30mg or was that results after you increased the dose to 60mg. Could you also provide the dates or an approximately time span between each test.

Pre Treatment post stim result: 880 nmol (31.89 ug/dl)
First post treatment after starting 30mg or 60mg once daily: 408 nmol (14.78 ug/dl)
Second post treatment after increasing to 120mg once daily: 204 nmol (7.39 ug/dl)

He didn't seem to have anything wrong with him before diagnosis other than high liver reading when he got his teeth cleaned over the last year or so.
I just want to mention liver enzymes can be elevated by severe dental tartar and inflammation. Without any symptoms to suspect any other causes, most vets would have cleaned the teeth and rechecked liver enzymes in a few months to see if normalized. Did your vet do a bile acid test? This is another step a vet would take in cases in which only a single liver enzyme activity is increased and the increase is less than three times the upper reference range limit. I am assuming that the elevation was limited to the alkaline phosphatase isoenzyme, yes? How high was it? Were there any other abnormalities like high cholesterol, high triglycerides, high or low BUN?

Please use the links directly below to learn more about the various diagnostic approaches to asymptomatic dogs with elevated liver enzymes. Like I mentioned before, none of us are vets but some of us keep up with the very latest studies, not just relative to cushing’s but the other endocrine disorders that are commonly associated with or often simmering before or become evident after a cushing’s diagnosis. Using link number 1, you will find information on all liver enzymes in a published article entitled “The diagnostic approach to asymptomatic dogs with elevated liver enzyme activities.” You will find Alkaline Phosphatase on page 2. The second link is to a pdf file for a recent paper by Dr. David C. Twedt published for the Western Veterinary Conference 2013. Dr. Twedt is considered a premier expert on the canine liver. I’ve listened to one of his audio lectures no less than 10 times and always get something new from it each time I listen. You’ll find the start of “Specific Evaluation of Increased ALP” on page two. You will note that he indicates a number of other conditions that are associated with increased Alkphos. Last but not least, I have included link number 3, to Dr. Mark Peterson’s blog on “Diagnosing Cushing’s Syndrome in Dogs: Which should I Test? What’s the Best Test to Use”. Dr. Peterson is a world renown endocrine expert who lectures worldwide, is highly published, has coauthored more than a few chapters of veterinary textbooks used in vet schools around the world and is a contributing expert on Dechra’s continuing education for veterinarians on their website. It’s a great read and his recommendations seem to be completely contrary to your vet’s diagnostic approach. The most germane excerpt that would apply to Tommy’s case as presented by you would be the following:


Testing for Cushing's syndrome is not recommended if the only abnormality is an increased serum alkaline phosphatase (SAP) activity on a serum chemistry panel, and the dog is otherwise apparently healthy. It is difficult enough to interpret endocrine tests in dogs with clinical signs of the disease; if they have no clinical signs, all of the endocrine tests may be difficult to interpret because of false-positive and false-negative results. The first step in workup in these dogs may include an abdominal ultrasound or bile acid testing.
One should not screen dogs for hyperadrenocorticism when the dog is sick with clinical signs that would not be related to Cushing's syndrome (e.g., vomiting, anorexia, weight loss). Many non-specific illnesses and other systemic diseases will produce false-positive results with the endocrine tests. Remember, hyperadrenocorticism is only slowly progressive, so hyperadrenocorticism is never an emergency diagnosis.
Before diagnostic testing is performed, it is therefore always good to ask oneself: if the test results would indicate hyperadrenocorticism, would I then feel confident to start treating with mitotane (Lysodren®) or trilostane (Vetoryl®) given the clinical picture of the patient? Would treatment help the dog's clinically signs? If either answer is "no," then it is probably best not to screen for hyperadrenocorticism in the first place.

1. http://veterinarymedicine.dvm360.com/vetmed/article/articleDetail.jsp?id=325515&sk=&date=&pageID=2

2. www.wvc.org/images/session_notes_2013/2013_SA127.pdf

3. http://endocrinevet.blogspot.com/2011/02/diagnosing-hyperadrenocorticism.html

Also tommy had another ACTH test and I got to talk to specialist. His reading post injection started at 880 went to 408 first retest and is now 204. Needs to come down a bit more. Specialist wanted to go to 240 mg but I only agreed to 180. She has small dogs on the 240 twice a day.
This is where I join the others in being completely taken aback by your specialist’s recommendation to double an already huge dose. If you read the various studies done by Dechra (link provided below) that were submitted as part of their packet to the FDA for approval, you’ll see a study that was done to evaluate the safety of trilostane in dogs. Groups of eight healthy dogs were given 1 to 5 times various large doses twice daily. In other words they were pounding these dogs with massive doses to see just how much they could withstand. Three out of eight dogs receiving 3 x (20.1mg/kg) twice daily died within 23 and 46 days on that dose. In Tommy’s case, that dose would equate to 331mg a day. If your vet has any dogs 5.5 kilos or under on 480mg per day, I’d say that’s worthy of sharing with the veterinary community at large because it’s a miracle those dogs have survived . We’ve seen hundred of case studies here and those doses are unfathomable. Are you sure those numbers are correct and are your vets making sure you are giving the drug with food. Taken on an empty stomach, absorption is greatly effected. If you are not giving with food, please don’t start now as doing so could really cause serious problems for Tommy.

www.fda.gov/OHRMS/DOCKETS/98fr/NADA-141-291-fois.pdf



They were concerned re cost but at the moment can afford it. And Tom is 14 and a half so is in the twilight. As I told vet I want to keep him around as long as possible as healthy as possible.

If your vet is using Cortrosyn as the stimulating agent for the acth stim test, s/he may not be aware that only a fraction of the cortrosyn is necessary for an accurate reading for small dogs. The remaining agent can be diluted and stored for future use for Tommy. This can be a huge savings as cortrosyn is the driving force behind the ridiculously high cost for the stim test. You should talk to your vet about this and be sure to print out Dr. Mark Peterson’s blog on the subject that instructs vets on how to dilute and store cortrosyn. I’ve included a link below:

http://endocrinevet.blogspot.com/2012/03/how-to-dilute-and-store-cortrosyn-for.html


Yep Tom had no symptoms I noticed but he is drinking less and has heaps more energy-he actually did the malteses bolt yesterday - running like a lunatic for no reason.

Do you think that perhaps Tommy had symptoms but you weren’t picking up on them? Your vet should have done a urinalysis as a routine screening for cushing’s to rule out a urinary tract infection as well as check urine specific gravity. Dogs with cushing’s who have progressed to the point of losing the ability to concentrate, they will urinate very large amounts and will drink buckets to stay hydrated. This is definitely not something a pet owner overlooks as once housebroken dogs start having frequent accidents in the house.


And also if the levels are controlled then he may dodge the bad effects of the disease????? If not controlled he will surely be affected in a bad way soon???

I have provided you with numerous reference that would make it very difficult to justify your rationale for treatment. The numerous references I have provided have the answers to those questions; however, I will add that the goal of treatment is to remedy symptoms and if Tommy has no symptoms, what are you treating? Based on what you have told us so far, it sounds to me that your vet is treating elevated liver enzymes. If that is the case, in the absence of symptoms associated with cushing’s and absent confirmation, via liver biopsy. that the liver enzymes were steroid induced, liver support like milk thistle and SAMe would have been a much better choice of treatment.

He had a urine test and the ACTH tests and the urine was diluted and indicated issues and the only ACTH results I have we're posted earlier tonight. The vet and specialist based on these results are sure of cushings.
Okay so even though urine was dilute, Tommy still had no symptoms??? He wasn’t drinking massive amounts and peeing massive amounts??? What were the issues with the urine? Was Tommy peeing all over the place and drinking tons of water? Was a culture done to rule out a UTI? If the answer to either of those questions is no, then I have no idea how both vets could possibly be so sure that Tommy has Cushing’s. They should have at least done additional testing to deternine which form of cushing’s he has. An abdominal ultrasound would have been a really good idea before starting treatment.

The specialist wanted me to double from 120 mg and take rescue drug but because of situation with my mum wouldn't do that as I need to help her a lot. The spec . Has treated heaps of little dogs on more drug than he is on.
Wow, that’s truly amazing? We’ve seen more case studies here than most vets will see in a lifetime and I can’t recall any case where a dog of Tommy’s size was getting a dose anywhere near that high. Others may remember but not me.

The vet said she was initially surprised but is comfortable after discussion. He will get as close of an eye on him as I can and his 10 day tests.
I wish I could say the same thing. I am anything but comfortable with the diagnosis or treatment.

Thank you and all for your concern. I must admit I am a tad confused as I am listening to what you guys say but on the other hand have my current vet my old vet and a specialist telling me all is ok with what is happening.
The feeling is mutual because I don’t think I’d be alone if I told you that I am more than confused by 1) your vet and your specialists lack of appropriate testing; 2) their comfort with prescribing treatment to a dog with few to no symptoms and 3) their comfort with prescribing an increase in dose despite the fact that the manufacturer's recommendations dictate otherwise. Tommy has no symptoms and the post stimulated cortisol is within an acceptable therapeutic range. Why in the world would they increase the dose to an even more staggering mg? I can understand a general practitioner vet being so uninformed but not a specialist. I think we must be missing some pieces of the puzzle or perhaps we’re misunderstanding the facts as you’ve presented them to us. :confused:

Glynda

[Robert]

Ok I am a bit annoyed now. All previous posts by you guys and the vast majority of the post in question have been useful informative and got me thinking.
But if you are going to use studies as a reference point please make sure they are relevant. I guess the point was too much of the drug is dangerous but I fail to see the connection between giving massive amounts of the drug to 6 month old dogs who don't have a cortisol issue to Tom who cortisol reading wS 880 at the start andis being monitored every week or so. I also note that the young dogs were in one of the studies showed severe signs 4-15 days before they passed. Tom would be at the vet in half an hour from noticing any issue.

[Squirt's Mom]

But if you are going to use studies as a reference point please make sure they are relevant.

Hi Robert,

I just wanted to let you know that Glynda probably knows more about Cushing's and the treatments for it, as well as associated endocrine issues, than any vet out there, including IMS' (Specialists). She attends veterinary conferences, listens to taped recordings of lectures and other veterinary conferences from around the world constantly, talks with vets personally, and reads heavy duty veterinary manuals instead of curling up with a good mystery. For over 8 years she has lived, breathed and bled canine Cushing's. She understands the often complex language used in these studies and she KNOWS their relevance to any given situation...or she would not post them in an effort to help us. Glynda has been solely responsible for saving the lives of countless pups here and elsewhere by talking with vets who were on the wrong track and teaching them what needed to be done and how.

Consider those younger bodies compared to older bodies like your Tommy and my Squirt. Their older bodies are already wearing down and simply due to the aging process, not necessarily a disease process, these older bodies will have an even harder time dealing with those massive doses. Those younger bodies would have been better equipped to cope with those doses than an older body would - an older body already ravaged by age. Those younger pups had healthy kidneys and livers and gall bladders and brains and adrenal glands, etc while our old buddies already have decreased function in ALL their organs. And we would add a huge dose of any drug to these old organs?

You would have Tommy at the vet if you saw signs he was in trouble - of that we have no doubt. What I don't think you understand is that with such a massive dose if things do go bad, they are going to go very, very bad very quickly and there may be nothing that can be done regardless of how quickly you get him to the vet. The fact he is still with us is an apparent miracle. That is indisputable based on our understanding of his diagnosis and dosing.

I would also like to call your attention to the final comment Glynda made -


I think we must be missing some pieces of the puzzle or perhaps we’re misunderstanding the facts as you’ve presented them to us.

This huge, MASSIVE dose Tommy is taking has us all terrified for him and for you. The fact that his ACTHs seem to support the control of the cortisol (even tho there is apparently no proof he ever had elevated cortisol to start with :eek:) and that he is not having problems indicate some vital part of this story is missing or misunderstood. The doses your vet claims to use in her clients would set the veterinary world on it's ears in awe that her patients are not all dead within days and the whole community will want to know her secrets. The company who makes the drug Tommy is on, Dechra, would want to study her cases and her cases would start to fill those manuals Glynda reads. So something is off somewhere - either that or your vet is selfishly holding on to secrets that would benefit every cush pup out here OR Tommy is simply one in 500,000,000 - an anomaly in canine Cushing's, which would also put him in the Endocrine manuals.

But after all this chatting the bottom line is this - Tommy in YOUR baby and the decisions concerning his care are all yours and yours alone to make. You came to us with concerns about getting his dose right and we are simply reacting to the dose he is currently taking which is way, way, way out of the norm plus the fact that your vet apparently did no testing to even confirm that he does actually have Cushing's. We have seen too many deaths resulting from doses that were too high, deaths resulting from vets who were flying by the seat of their pants - and we do NOT want to have to add Tommy to that list. We care about you and about Tommy and want the very best for the both of you for each and every day that is to come. That is the source of our passion - we care. That is why Glynda devotes so much of her life to Canine Cushing's - she cares.

Hugs,
Leslie and the gang

[addy]

I have resisted posting as I dont want you to feel like we are all ganging up on you but I have to second Leslie's post. We must surmise we are indeed missing huge pieces of the puzzle as an explanation for the medical treatment Tommy is getting.:confused:

I understand it is hard to write everything down here especially when we feel like we have to write a book;)

Our own IMS we used when my pup started her journey is well respected by all the vets in our community. I cant begin to tell you how many misconceptions she has had about treating with Vetoryl.
It is okay and sometimes very necessary to disagree with a vet or at least have an explanation given to you regarding your dog. You are the only advocate Tommy has, so you must be his voice.

Please think back and see if perhaps you can fill in the blanks for us. We would all feel so much better as we are all very concerned and worried about Tommy and you. Please know that each post you read here comes from our hearts.

[doxiesrock912]

Robert,
without the advice that I have received on this forum, I firmly believe that our Daisy Mae wouldn't be here with us now and certainly she wouldn't be doing as well as she is.

Treating Cushings is complex and each dog reacts differently to the medications. There are suggested guidelines from the manufacturer based on the dog's weight but starting lower than those and working up to an ideal dose has worked well for the majority of us.

Daisy did start at the suggested dose and it was immediately obvious that this was too high for her. We lowered the dosage considerably and over time her body has acclimated and we are now at the original dosage without the side affects that she experienced in the beginning. Daisy is 9 years old and weighs 11lbs. She's on 10mg of Vetyrol twice a day as close to 12 hours apart as possible.

Until I found this forum, I trusted what the vets were saying. Since receiving an education here, we have "fired" two vets that clearly didn't have the experience needed with Cushings. Thankfully, the third vet has been working in conjunction with our IMS specialist who does have experience.

The bottom line is that treatment for Cushings is as individualized as each of our dogs. There is no "one size fits all". Starting lower allows the dog's body to adjust and this is imperative and keeps the dog from life threatening complications from too high a dose. Each dog bring a whole new learning curve for you and the vet.

[molly muffin]

Hi Robert, gosh, just read through your thread, sorry to hear about your mom. Both shoulders!!!! That is awful. Hope she is doing okay and recovering from that.
I think your plan to talk to the vets, see what they say, express any concerns you have, either in your own mind or raised here on the forum and pursue the ultrasound is a good one.
I like the ultrasound if it is an option financially as it can tell you much about what might be really going on inside of their small little bodies and either confirm the treatment you are on, or present alternatives that you might not have known need to be addressed. It's a sound plan in my head anyway.

Hope you had a good day.
Sharlene and Molly Muffin

[Robert]

Hi Robert, gosh, just read through your thread, sorry to hear about your mom. Both shoulders!!!! That is awful. Hope she is doing okay and recovering from that.
I think your plan to talk to the vets, see what they say, express any concerns you have, either in your own mind or raised here on the forum and pursue the ultrasound is a good one.
I like the ultrasound if it is an option financially as it can tell you much about what might be really going on inside of their small little bodies and either confirm the treatment you are on, or present alternatives that you might not have known need to be addressed. It's a sound plan in my head anyway.

Hope you had a good day.
Sharlene and Molly Muffin

Thank you re both mum and Tom. Mum will be in hospital at least another week and then go to respite care for a month or so. The health system here has been so good both to her and us since this happened. Then my dad starts radiotherapy for 9 weeks it never rains but it pours.
I will ask about ultrasound for Tom but after advice her Tom will at most be staying on current dose assuming levels come down a bit more. Have lots of questions for vet - they will hate me lol.
Thank you for your post. Hope you Nd yours are all well.
Cheers

[FemaleK9]

So glad you will be talking to your vet - this might be a good time to ask for copies of all the tests done so far on Tommy. After all, you've paid for them and you're entitled to a copy. Without seeing my Rosie's test results I would't have understood what's happening with her nearly so well.

And your vet shouldn't mind; you're just asking questions because you want to understand everything you can about what's going on with your little Tommy - as we do.

[Robert]

Tommy is in a lot of trouble. He has not been well all week and vet was focusing on too much trilostane. Ultrasound though has found big and numerous cysts on kidneys and blood test elevated kidney readings. They are going to rehydrate him over the next day but if still sick I will have to let him go. If ok he will need to go on special diet.
I am so upset. Please pray for tommy

[FemaleK9]

Oh, dear, I was afraid after your last posts that we weren't hearing from you because things weren't going well for your Mum or Dad or Tommy. I'm so sorry poor Tommy is so sick. We will be hoping and praying for him to pull through.

[doxiesrock912]

Praying that all goes well for Tommy!

[Little Britches]

Awe, bless poor little Tommy, sending lots of hugs and get well wishes from here. Keeping him in my thoughts and prayers - c'mon lil guy, we're all rooting for you. x

Freda

[Robert]

Thanks guys thoughts are appreciated. Just left vets- even so sick tail wagged and he licked me when he saw me. Made me cry.
Vets say Saturday which is 2 days not 1 will probably be the day we know the outcome. They say toxins have built up and they will flush them away and is prob 60 40 he will get through this. His pancreas didn't look great on the ultrasound either- could have a bit of pancreatis on top.
And they think the reason he needs such a big dose of trilostane is the size of his adrenals- they haven't seen them so big in such a little body b4. They are both like that and are the right shape so his cushings is pituarity based.
I love this dog so much

[Squirt's Mom]

Hoping your sweet boy is back home as soon as possible. Let us know how things are going.

Hugs,
Leslie and the gang

[goldengirl88]

I am praying for you and you precious baby, hoping all goes well and he pulls through this. Blessings
Patti

[Budsters Mom]

Hi Robert,
I am so sorry to hear about your sweet Tommy. I have worried about both of you for some time. I know how much you love him and how hard it is to let our babies go. Praying that it doesn't come to that, but if does we are here for you as always.

[molly muffin]

Hoping that Tommy makes a full recovery and is home with you where he needs to be soon. 60/40 is better than 50/50, so I am going to choose to be optimistic :)

hugs,
Sharlene and Molly Muffin

[Trixie]

Hoping Tommy gets through with flying colors. Sending positive thoughts for a full recovery.

Barbara

[Robert]

Tommy was just too sick and he was helped on his way to heaven and tammy about 4 hours ago. He died the way he lived - quietly and dignified.
Every day I have been home for the last 14 and a half years other than last night he has greeted me at the door by barking running in circles and then finding a soft toy and running up the hallway. No more. I miss him so bad already.
RIP tommy

[Budsters Mom]

Robert, I am so sorry to hear this very sad news. I know that your heart is broken. I hope you will return and talk with us when you feel up to it. Tommy has been greeted at the Rainbow bridge by many of our Cush angels who have passed before him, including mine. They've got his back now and we've got yours. Sending you many loving hugs.

[Little Britches]

Oh Robert, I'm so very sorry that you have lost your dear Tommy, please remember at this sad time that you gave him a wonderful life and also that he passed peacefully with the dignity he deserved. So terribly hard when we have to bid farewell to our babies. He'll be there waiting at the bridge one sweet day to greet you, so its farewell and not goodbye. Hugs from here. xx

Run free at the beautiful bridge sweet Tommy, forever young and playing with your new found friends. xx

[LtlBtyRam]

Tears for you and Tommy. I'm so sorry for your loss. Prayers for you.
Angela

[Squirt's Mom]

Dear Robert,

I am so sorry to hear that Tommy lost this fight. I know your heart is broken into a million pieces. You are a good dad and gave all you had to Tommy so that he could have the best life possible and when no more could be done, you gave him the greatest gift of all - freedom from a failing vessel. Today, Tommy is whole and strong once again, running in the Rainbow Fields with Tammy and many new friends from here who were also there to greet him. Tommy and Tammy will be watching over you and Chelle with much love and pride. And one day, when your job here is done, you will hold them again, covering their faces with kisses.

Tommy's name has been added to the In Loving Memory thread for 2013 where he will always be remembered as a member of our family here.

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

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


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

[goldengirl88]

So sorry about Tommy, I know how heartbreaking this is for you and will pray for you and your sweet baby. Blessings
Patti

[FemaleK9]

So sorry, Robert! You and Tommy reached the day we all dread; you made the hard decision and freed Tommy from suffering. You gave him a good, long happy life, and he will live on in your heart and in your memories.

[Robert]

Thanks to everyone for their kind thoughts. Can't believe he has gone but can't stop crying.
He was a great little dog and will never be forgotten. He gave so much even the last few days. When tam passed August last year I asked him for at least 12 months after she went and he gave me 13 months. Tommy I love you

[doxiesrock912]

Oh Robert!

I am so sorry to hear this news!
Rest in peace Tommy. There are many angels waiting to greet him.

[Harley PoMMom]

Dear Robert,

I am so terribly sorry for your loss of sweet Tommy and my heart goes out to you in this most difficult time. We are here for you and sure do understand your pain.

Godspeed sweet Tommy

With Heartfelt Sympathy,
Lori

[mcdavis]

I'm so very sorry to hear about Tommy. It sounds like you did everything you possibly could to give him a wonderful life and I'm sure that you have many happy memories of the all too short time you had together.

[mypuppy]

dear Robert,
I am feeling your great loss for your precious Tommy as I mourn my sweet girl. it is a terribly, empty, unnatural feeling, and life seems without purpose without them.

I am deeply and truly saddened for you and your boy. May God give you (us) the strength to carry on without their presence--we always want the tangibles--we want our babies here and now. It hurts!

God Bless you and Tommy.

tight hugs. jeanette

[Trish]

So sorry about the loss of Tommy, sad times for you. My condolences x

[molly muffin]

Robert,
I am so sorry that Tommy lost the battle. I really was being optimistic. We understand the pain so very well. Our shoulders are broad and if there any time at you want to have a chat, or anything, we are here for you.
Tommy will always live in your heart. What a great guy he was. Tail wagging at the door for you. There isn't much better.
My sincerest condolences.
Sharlene and Molly Muffin

[Robert]

Thank you all again. Everyone but especially those people going through the same at this time.
Tommy was the most gentle dog and so sweet. You can see both in his photo in the furbabes lost area. My heart is broken but I know I did the right thing for him. I miss him so bad

[spdd]

I haven't been on in a few days. I'm so very sorry to hear about Tommy. You did everything you could. My condolences.

[Trixie]

Dear Robert,
I'm so very sorry to see the sad news about Tommy. It's so hard to get through such a loss. Tommy had a great life with you! You did the right thing, he couldn't suffer through anymore.
Barbara

[apollo6]

I am so sorry for the loss of your sweet Tommy. Know that he loved you to the end. It is never easy to loss our babies.
Hugs Sonja and Angel Apollo

[Roxee's Dad]

Dear Robert,
I am so very sorry for your loss of Tommy.

Rest in Peace sweet boy... you are one of our newest and brightest stars in the sky.....

[Robert]

I feel like my heart has been ripped out.
Been thinking so much about tommy and want to say something in
I can only say here. About 3 months ago Tom stopped doing something he had the previous 14 years - sleeping on my bed at night. Thought it might have cause him and chelle had the odd fight up there but they did on the couch and it never stopped him getting up there. He jumped on things till the last week with no dramas so it wasn't that either. He was also spending more time outside than usual. I'm wondering if this was instinct in trying to get me used to him not being here if somehow he knew our time was coming to an end. He was the same in every other way always greeted me and was close. If this was the reason it didn't work can't say how much I'd give just to take him for one more walk or give him a treat. But he's gone

[doxiesrock912]

Robert,
One of the first things that Daisy stopped doing was jumping up or off of furniture. This happens to a lot of Cushpups.

[molly muffin]

Hi Robert, it could be that he knew his time was getting shorter. Animals are pack animals and their favorite place is going to be where the pack is. (you) When something isn't right, they know. So who knows for sure, maybe that was his way of telling you.
It isn't easy, it won't ever feel "right" that he isn't with you any more. They leave a huge hole in our lives when they are no longer there.
Sending you hugs hugs,
Sharlene and Molly Muffin

[Trixie]

Robert,
The schnauzer I had growing up did the exact same thing before she died years ago. Always slept in my bed, and when I went to college she slept in my parents room. A few months before she died she wouldn't sleep in my bed anymore when I was home,(that was so sad for me), then when she was sick she wouldn't sleep by my mother either...we wondered the same thing as you..did she do this on purpose, her instinct that she was ready to leave and began to separate? We think it was...but who really knows. It's just so sad to lose them...just writing about my childhood dog Misty makes me feel a sad and she's been gone for over 30 years!

Barbara

[Budsters Mom]

Hi Robert,
I know those feelings well. I lost my Buddy a few months ago. I would give anything to be greeted by his beautiful smile one more time. :o
Your feelings are completely normal and natural. We love our babies so much that losing them tears us to shreds inside. Know that Tommy is now pain free and surrounded by many fur baby angels. He is fine now. Time will heal your sorrow little by little as it is doing for me. Keep sharing your feelings. It does help. Xxxxx

[scoora]

Robert, I'm so sorry to hear about the loss of your sweet boy Tommy.
My thoughts and prayers are with you.

[Bo's Mom]

Robert,
I am so sorry to read about your angel boy Tommy. The pain runs deep because we love these fur babies with the core of our soul. It will take time and there will be days where it still seems like yesterday and the pain is still raw. Please stick around as we love to hear stories and just comfort those who need it.

[Robert]

Tommys ashes can come home tomorrow. Cried when got the call he really is gone. God I miss him

[goldengirl88]

It's gonna be a tough day for sure, and I will say a prayer for you. Blessings
Patti

[molly muffin]

It will be good to have him home.

hugs,
Sharlene and Molly Muffin

[Robert]

Tommy is home. Can't believe he is in that little box but he is. He is now next to Tam here as well as above.

[goldengirl88]

God Bless you both
Patti

[spdd]

I can't imagine how you are feeling, someday I'm sure I will. Thinking about you.

[Cooper is missed]

I'm so sorry for your loss. My Cooper has been gone a month today. It's still tough, some days are better than others. I know how you feel when you say you'd like to give him one more treat. I'd give anything to hold my baby again. It's really hard but time will heal, I'm sure of it.