Attila-Calcinosis cutis, starting treatment w/ Lysodren..(Attila has passed on)

[Thirsty Frenchy]

My 8 yr. old French Bulldog, Attila, was diagnosed with Cushings over a month ago. (I do not have his blood levels, but we've done the ACTH stim test twice) I tried holistic meds for a month to no avail. In fact, his cortisol levels were higher in the ACTH stim test at the end of the month. My holistic vet insists Trilostane is safer, while my regular vet has been treating Cushings for 20 years with Lysodren (and warned me that there have been sudden death cases w/ Trilostane). After much research and a few sleepless nights, I realized they both have dangers and decided on Lysodren since my regular vet will be treating him. Attila's only health issue through his life has been severe skin allergies which have been periodically treated with steroids (which could be what caused the Cushings). Last month (before any holistic treatment) Attila had two bouts of a few days of bloody diarrhea :eek:for which he eventually had to be hospitalized for 2 nights. They couldn't find the cause, but he got back to normal with antibiotics and bland food.
I have some questions: 1) Has anyone's dog had irregular bowel movements since getting Cushings? 2) Is there food that will help Attila tolerate the Lysodren better? 3) I'm scare of destroying the boy's adrenals, so any support as I start the induction phase tomorrow is much appreciated. Grateful to have found such a knowledgeable and gracious group.

[Roxee's Dad]

Hi and welcome to you and Attila,

I have never worked with Lyso, but we have plenty here that have. Please let us know how much Attila weighs and the amount of lyso you are going to give for the induction phase.

Please also tell us what led the vet to test for cushings. Normally if a pup gets cushings from steroids, it is called iatrogenic cushings, and the cushings symptoms should go away after the pup is slowly weaned off the steroids.

Looking forward to hearing more about Attila.

[Thirsty Frenchy]

Thank you for responding. Attila is normally 26 pounds, but ballooned up to 34 lbs. with his swollen belly (he now looks like a pot bellied pig). I got him tested not only because of his weight gain, but he started to make little groans when any pressure was put around the belly when picked up. He started wanting water all the time and peeing much more which was clear color. He even had 2 accidents at work (he came to work with me to act as an unofficial therapy dog in the office). He had a bigger appetite and was panting more. He would only get steroids at most twice a year when his itching and red bumps got too severe.
I will be giving him 1/2 of a 500mg. tablet of Lysodren with his breakfast and dinner.

[Thirsty Frenchy]

At present he wants to drink constantly and can't make it too many hours without peeing.

[Roxee's Dad]

While we wait for some of the Lyso moms to check in, here is a link for Lysodren loading Instructions and related tips in our helpful resources section.

http://www.k9cushings.com/forum/showthread.php?t=181

[Trixie]

Welcome to the board. I can't help with the Lysodren as I'm using Vetoryl (Trilostane), but there are really knowledgeable people here who have experience with Lysodren and will help you through.
My dog started treatment last April and we're just now getting some good control. It is quite a relief when all that drinking starts to wane..it's taken awhile for us but finally the water dish is not constantly empty! My dog (age 9) is still active and getting better everyday.
She had a very bad gastro bout, including bloody diarrhea the summer of 2012. It turned out to be a clostridium overgrowth but they didn't find it for about 4 months. So it was off and on all that time. We didn't see Cushings symptoms until maybe Feb or March of this year. It could have been brewing before that but who knows?
Since Cushings she has had only a few bad poops, nothing like when she had the bacterial thing, but gastro upsets are common talk on this forum. Don't know if that's a Cushings thing or just a dog thing.

I'm sure others who know more will be posting soon to give you some good advice on the Lyso.
We all started here feeling terribly worried and upset but things really do get better! :)


Barbara

[frijole]

Hi I am a lysodren mom. My girl Haley used it for over 4 yrs with no problems. Key is to have an experienced vet and to follow dosing protocols and instructions carefully... keep an eye out for any changes whatsoever in eating/drinking.

Measure water intake BEFORE starting so you can tell if it is reduced.

I do want to question one thing about the dose - do you mean 1/2 of a pill in the am and 1/2 in the pm? Or do you mean 500 mg in am and 500 mg at night? (that's a pill each meal)

Trying to figure out if it's 500 or 1000 mgs a day. 500 mgs is within recommended dosing range but 1000 mgs would be too high. Max for your dog (starting dosage) is 772 mgs.

I think the dosage is ok but just want to double check.

Here is info that helped me. Read it over and over. Never give a pill if your dog is sick regardless - just wait. The drug continues to work for TWO days after the last pill so when in doubt withhold the dose ok? Always give the pill AFTER the dog has eaten so you can see if there was food left over or if the dog's eating pattern is slower. Any hesitation - just don't give it. You can always ask us and we'll give you our thoughts.

Give the drug wrapped in cream cheese - it's easy to hide the pill, dogs love it and the fat in the cheese helps coat the tummy and absorb the drug.

Don't change the diet during the load because signs of overdose are vomit and diarrhea and you won't know if it 's the new food/treat or the drug.

ARe you off of the steroids or not? This concerns me a bit if not. Tell us more about that. Also how long ago was the bloody diarrhea?

Start a diary as you watch for all signs of load and water intake so you can track changes. AGain watch your dog eat and drink PRIOR to loading so you can more easily spot changes while loading ok?

You will be fine. Oh and make sure your vet gives you prednisone to have on hand in case of emergency. Kim

http://www.k9cushings.com/forum/showthread.php?t=180
http://www.k9cushings.com/forum/showthread.php?t=181

[Karen_Izzy]

I can't help with the Lysodren either as my Isabel is on Vetoryl (Trilostane). But I wanted to say hello and tell you the support on this forum is wonderful. I think everyone started scared but with the info here and moral support (at all hours!!) will really help you. I am still at the beginning (only 13 days in) and I already feel better than I did on day one. My heart goes out to you..I know how you are feeling. You aren't alone!

Karen and Izzy

[Thirsty Frenchy]

Thank You for support. To Frijoles mom - I will be giving 250 mg (1/2 a pill)in the morning and 250 mg at night. His diarrhea ended a week and a half ago. He has not been on steroids for several months since his Cushings cleared up his skin. Thank you for the feeding and watering suggestions. My husband will be the one who will have the most time to monitor him so I will relay all this info. I must sound like a broken record to him, but he knows I've been worried and woken up very early every morning by Attila wanting more water..again, Thank you.

[goldengirl88]

Just wanted to welcome you. I am not versed in Lysodren so I cannot help you with that. Please keep a doggie diary, you will use it many times to reference things. I write in mine first thing in the morning so I don't forget anything. Hope all goes well with the treatment. If you are vigilant about watching you dog will do fine. Blessings
Patti

[Junior's Mom]

Hi and welcome to the forum. You mentioned a bloated belly, which causes discomfort when pressure is exerted. Have you had an ultrasound done, to ensure there is nothing else going on with any organs? It is expensive, but definitely a good idea.
There are many knowledgable pet parents on here who will help you get through this.
Tracey

[grapey]

I understand what you're feeling. I'm about to start my Boston on Lysodren in two weeks, and I'm terrified. I keep thinking, what if I don't see the signs that she's had too much? What if I hurt her? I would never forgive myself. :(

But I know that many people here have gone through loading and done just fine, and my vet advocates a very conservative loading dose--about 125 mg per day for a 13 lb Boston.

Praying things go very, very smoothly for you.

[Thirsty Frenchy]

I have not done an ultrasound, but if it's necessary, I will, especially if its still sensitive after losing some bloat - funny, how after spending so much money on Attila up to now, spending more doesn't seem to matter as much. For Boston "grapey", I will keep a diary as suggested and keep you posted on Attila's progress w/Lysodren. He took his 1st dose and is still alive and well....oh, and I bought cream cheese for the pill.

[frijole]

Good girl. Its scary at first but trust me it will become a no brainer and you'll know it's saving her life. I'll be out of town tomorrow but will check in on Sunday morning. You will be fine. Kim

[molly muffin]

Day 1 success! :)

It'll get easier as time goes forward and you know how Atilia reacts to the drug, how fast the load goes and then we hope, smooth sailing on maintenance. :)

hugs,
Sharlene and Molly Muffin

[Thirsty Frenchy]

MISSION ABORTED: Attila woke me up twice in the middle of the night. He had peed and pooed (solid) indoors (on his paper) and needed to be let outside to go some more. About an hour later he scratched on my door and I found diarrhea (light in color) and he had vomited his undigested dinner. He drank lots after vomiting and vomited a little more. No energy change, but now he's sound asleep. I called the vet on duty and she said not to give him a prednisone tablet since this was probably not an Addison's reaction, but he is just not tolerating the Lysodren in his system. She did say to continue with Lysodren tomorrow as planned, but I am going to wait to speak with my prescribing vet before doing anything. FEEDBACK?

[Squirt's Mom]

Has anything changed other than starting the Lyso? New food, treats, bedding, cleaning products, yard sprays, etc?

[Thirsty Frenchy]

No, Nothing has changed. However, Im thinking I didn't give his gastro intestinal tract time enough to heal from his previous system upset 2 weeks ago.

[Thirsty Frenchy]

He stopped his holistic meds 2 days ago, but I've been told that should not adversely affect himAlso, he is still on a bland diet of sweet potato, oatmeal and whitefish (and fish oil). Maybe not enough fats to help with absorption of medication? Ill be at work today, but checking this thread periodically. Thanks

[Squirt's Mom]

Stopping the holistic meds may not have bothered him but the combination of stopping something the body is accustomed to and starting something new at the same time may have caused a problem. I'm just not sure. The fats in the feed are probably pretty low. It helps if you give the Lyso does in something like cream cheese or peanut butter. His system may not be quite up to par from his recent bout, like you say. AND your vet is right - there are pups who simply cannot handle one drug or the other and have to switch but I think it's too early and there are too many other possibilities to make that determination just yet.

If I were you, I would stop the Lyso for now and let his system settle really good. I would wait until he has solid stools for a day or so and his appetite is strong. If he is still nauseated or has diarrhea when you get home today, I think I would have him checked just to be sure the diarrhea isn't rearing it's head again or he doesn't have another infection of some sort. I would also talk to the Holistic vet and ask about this just to get their take on it.

[kaibosmom]

Hi and welcome. I guess I'm a Lysodren mom. My boy wasn't treated too long on it but I can tell you that the guidelines provided to you earlier were very helpful. It does seem really scary but after being on this forum for several months now I feel like I would choose Lysodren for my pup again if I had to. As for when you start treating him again, trust me you will know when he is loaded. You know your dog best and you will notice that slight change in water or eating that will signal you that the induction phase is over and it's time for an ACTH test. I had trouble keeping my dog in maintenance phase but when he was in control the change in him was amazing. It was so great to see all of the Cushing's symptoms subside. I'm not on here much anymore especially since I'm back to work after a nice summer break. If you ever have any questions feel free to intact me via private message. I can help with what I can. That being said, the support and knowledge on here is amazing. I couldn't have one though all I have without the support found here. Good luck.

[Thirsty Frenchy]

Thanks Kaibos Mom- I am stopped for now and giving him Flagyl to help with the diarrhea. The vet on duty said to give him 5mg. of Prednisolone too, but I dont see how 1 pill of Lysodren could lower his Cortisol that much, and my husband is hesitant to give him more drugs. Waiting for our Cushings vet to call back and direct me. Ohhh these sensitive Frenchies!

[grapey]

Poor guy! Hope he feels better soon.

[frijole]

It doesn't matter if the cortisol got too low after one pill or not - rule #1 is to never ever give lysodren to a sick dog. Vomit and diarrhea are signs of overloading so you have to get over both of those before you even think of restarting it. Otherwise you will not know for sure if it is the lysodren or not - not worth having an acth test (expensive) done after a single dose.

I don't know what supplements you were giving but it could also be that 2 days wasn't enough to cleanse them out of the system. Are there any other drugs you are giving? Just checking to be safe.

Tremendous job of keeping a close eye out. The other thing you have to make sure doesn't happen is pancreatitis. Cush dogs are prone to it. So you want the tummy to be able to digest food and for eating patterns to be normal.

Great job. Not impressed by whoever it was that told you to give the next dose - they obviously have never had to live thru the stress of loading. Glad you stopped and checked in. Keep up the good work. Kim

[Thirsty Frenchy]

Thank you Kim for the info. to look out for pancreatitis. Attila's not on any other meds, but I dont think his system got stabilized enough before we started Lyso. We have stopped it - I didnt listen to the doctor who told us to stay with it, I also only gave 1/2 5 mg. pill of prednisolone - I did not feel comfortable with it. Our treating vet has not called me back yet, so unless she's on vacation, it makes me lose faith since I think I should be able to contact her during the loading phase since she's the expert. We are giving Attila Flagyl right now for his diarrhea. Feeding bland food of oatmeal, sweet potato and a little white fish. He is eating and drinking up a storm with no vomiting and has good energy. My husband has reintroduced the holistics in the meantime. I will wait until his system is sound until we do anything.

[frijole]

You are right to be upset that your vet has not contacted you yet. When a dog is loading access to a vet 24 x 7 is important. Especially when the back up or office tells you to give lysodren anyway... not good.

Glad things seem better today. I'd be cautious about adding a bunch of new things to the mix (holistic treatment) because any change in meds, food, treats etc will make you wonder what is causing the diarrhea, vomiting etc. I'd try to stick to as little change as possible so when you do start the lysodren again you have a very clean slate.

Keep us posted and you are doing the right thing by holding off. Kim

[Squirt's Mom]

I agree with Kim. Too many changes right now to add the Lyso to the mix until you see how the changes are going to work. Let him adjust to his regular feed and the Holistic meds before restarting the Lyso - then do not change one single thing during the load. ;)

[Thirsty Frenchy]

Hi - The vets office FINALLY called to check in - turns out the prescribing vet was never called by the office. They called her right away today and she wants Attila to get another ACTC stim test just for precaution and meet with us at the end of the week when she's back in the office. 1 pill of Lysodren doesn't seem to be enough to give an Addison's reaction and he's been showing no signs since early Saturday morning. His diarrhea is clearing up with Flagyl, and everything else is normal. I feel like this is a waste of money, and I am starting to look for other vets that have experience and can also be available more during the loading and maintenance phase of Lysodren. Anyway, the vet said they's be negligent if they didn't recommend an ACTH stim test.

[frijole]

If you only gave one pill and you haven't since and its been several days then the cortisol would have risen and the test wouldn't be valid anyway.... seriously don't do an acth test - too expensive to waste your money like that.

Get the tummy healed up and you can try again and if it repeats then you might have to try trilostane or start questioning the diagnosis.

Since you gave the pill has the water intake been the same? Is appetite back to normal? Kim

[Thirsty Frenchy]

That's what Im thinking about the ACTH test -but the vet has me a bit worried. I dont intend to start any meds until his tummy is regular. His water intake is the same (we are keeping track) and he's been eating voraciously like the piglet he is. Thanks Kim

[Squirt's Mom]

Nah, I wouldn't have the ACTH done either. If your boy was still showing signs his cortisol might be too low, then by all means have one but he isn't so don't waste the money nor put him through unnecessary stress. Tell your vet she hasn't been "negligent" and you have chosen to pass. :D

[Thirsty Frenchy]

Thank You oh Wise Ones! I will take your advice on not doing the ACTH test right now if you don't think any indication of a serious cortisol drop will show at this point (reaction happened early Saturday morning). I think the negligence was in my vet office not contacting my prescribing vet on time. Amazing that these decisions about Attila keep me up at night - but apparently you have all been through it...again, thank you for your guidance and support. Laura & Attila (the Hun)

[frijole]

:D:D:D No problem. Yes we have been there and seen that so many times it is pathetic. Keep us posted. Kim

[LtlBtyRam]

I'm a bit late to the party, but welcome to the forums. As you have already found out these folks are PAWSOME.
Angela

[Thirsty Frenchy]

We are back on here and under the care of a new doctor who specializes in Cushings Disease and is currently doing research on alternative treatments. Attila had a suppression test to determine whether pituitary or adrenal tumor that came up inconclusive, so he is having an ultrasound on Monday. I will report all info once I get it. In the meantime, I have not had a thorough sleep in several weeks since Attila scratches at my door to get water at least 3 times a night. He uses the pee pads well, but I also let him outside anyway and he goes again. I just bought an H2O self feeder so that he can drink whenever he wants, but I dont know if this is a good idea since I have heard dogs are not good at self monitoring. He seems to be able to take breaks from drinking today (I am testing it today). I know many of you are no longer dealing with the symptoms of extreme thirst & peeing, but if you have any suggestions so that I can sleep, please let me know. Also, if any of you like a mineral supplement during this time, I'd appreciate those suggestions. Thank You

[Harley PoMMom]

When a dog has or is suspected of having Cushing's retricting water can be detrimental. With Cushing's the increased amounts of cortisol make the kidneys work harder thus the dog pees more often and the dog HAS to drink more water to keep up with kidneys. :eek:

Giving Attila free access to water and then providing him with pee pads will hopefully curb him from keeping you awake.

Hugs, Lori

[Budsters Mom]

Hi Laura,
I think this is the first time I posted to your thread, so welcome from me too.:)

I totally understand the drinking and peeing thing. My Cush boy never used Pee pads before and was not about to start, no matter how hard I tried. He would hold it until he burst something before he would actually have an accident in the house. He could no longer get out his doggie door due his rear leg weakness. That made the potty issue a huge problem when I worked. Yes, it is a challenge, but please resist the urge to take Attila's water away. Cush pups need access to water 24/7. That could means getting up and pottying at all hours of the night. Do you have anyone who could take a shift or two, so you could get a better night's sleep? It normally get significantly better once the cortisol levels are controlled.

[Thirsty Frenchy]

Dear Lori & Kathy- Thank you so much for clarifying that!!! My husband was pushing the advice of one doctor to cut off water at 8PM, and I believed the other doctor who said he needed consistent H2O access. I will keep the self - drinker and maybe I'll get some sleep. (of course Attila loved the fact that I have been at his beck and call). As long as there are pee pads out, Attila will use them, although we'll see how flooded our bathroom is. I seem to be the only one who hears him at night, so unfortunately, my husband is of no help for shifts.

[frijole]

Wow - good thing you asked. The doc that said to withhold water after 8 pm is not who I would go to for cushing's help. The other one is the one I'd put my faith in. Seriously. Kim

[Thirsty Frenchy]

UPDATE: Hello Everyone who has been so helpful in checking in on this thread! Attila was tested and had an ultrasound which showed that Attila does not have an adrenal tumor. I found a vet who studies Cushings, Dr, Bruyette at VCA.(unfortunately, Attila did not qualify for his present study) Attila started Trilostane on Sunday October 12th. and got his ACTH Stim test this Monday the 20th. The levels indicate that his Cushings is under control so far. Yay! I requested all the results as everyone suggested so that I can track everything. He is drinking less, still very hungry, and still using the pee pads at night, but he has his old skip in his step, and he is trusting his hind legs more. I am very optimistic and will have him tested again in a month. I will keep reading this forum so that I'm as educated as possible, and maybe I'll eventually be able to help someone else. I especially want to find other ways to support aspects of his health that this disease may have compromised. I want to thank you all for being there when I needed the clear information and support.

[JackyB]

I am very, very new to this forum, but wanted to let you know that for years I have fed my boxers a raw diet. I stopped for the last few years because I got lazy. Working full time and being the taxi cab for my boys , was making it difficult to make the pick up times from my meat supplier. So I went to high quality grain free kibble. Since Barkley has been drinking and peeing so much( couldnt leave him alone for more than 2-3 hrs) I thought going back to a raw diet would be the best. I have to say that I am amazed at the decrease in his water consumption. It's almost back to normal, which means he doesnt have to go out side so often!

I know people have mixed feelings about a raw diet, but I have really found it helpful with my dogs. Either way, good luck with the lysodren. I will hopefully be starting on the same thing soon.

[Squirt's Mom]

Raw, wet (canned) and home cooked diets have a much higher moisture content than kibble (dry feed) so it is to be expected to see a rise in water consumption when going to kibble from any of those three type feeds. ;)

[Thirsty Frenchy]

Hi - I know this thread is old, but hopefully someone will get this. My French Bulldog, Attila has Cushings, has been on Vetoryl for a little over a month (under Dr. Bruyette's care) and has had the calcinosis for about a month. 2 days ago his hair started coming out in chunks on the back of his neck (w/ some blood from the skin attached). I have been cleaning the area daily, putting antibiotic ointment and have bandages and a t-shirt if we go out (as it looks pretty scary). It seems from the posts from Sabre's mom that it gets worse at first when meds are started but naturally clears up? Is there anything else I should be doing for him to help this heal? Can we expect the hair to ever grow back? I will consult with the vet, but I've found everyone on this forum to be the best consultants on the day to day issues in dealing with Cushings. Thanks for any input. Laura

[Squirt's Mom]

Hi Laura,

There has been no activity on Bruiser' thread for over 2 years so I moved you post to Attila's original thread in order to keep all responses and history concerning your baby's journey in one place. I will also change the title of this thread to reflect the CC so those who deal with this will know and be more apt to chat about it. ;)

Hugs,
Leslie and the gang

[Thirsty Frenchy]

Thank you so much Leslie - I couldn't figure out how to start a new thread with a new subject, so you have taken care of it all! Much appreciated.

[Arizona Boston]

Hi Laura,
My Boston has the dreaded CC. We tried a lot of things to help it, including over the counter ( human) antifungals and antibiotics, and various medicated shampoos.
I think what helped the most was an product called Dermarest, which is a (human) product for psoriasis that is 3% Salicylic acid that I got at the drugstore. It dries up the outer crusty shell part and just leaves a smoother bump.

I am following your thread because we are getting ready to start Lucy on Lysodren. Vetoryl did not work for her. She too has had issues with loose and or bloody stools in the past, so we are planning to give Pepcid before each dose.

Shelly and Lucy

[Thirsty Frenchy]

Thanks Shelly - I will look into Dermarest. I have looked at many of the posts on CC, but can't find too much advice on how to best care for it. I imagine antibiotics are good to keep on it to avoid infection? It would figure that Attila's American cousin (a Boston) would have similar GI issues. For us, Flagyl always seemed to work and we have only been feeding Attila sweet potatoes, oatmeal and white fish- very bland. Good luck with the Lysodren - Unfortunately, Attila's body rejected it, but there's good information on here about dosing and administration.

[Thirsty Frenchy]

Hello my fellow Cushings parents! Attila (9yr old Frenchie) has been on 30 mg. daily Vetoryl for over a year now. The results of his ACTH stimulation test last week were very good, however he has been drinking water excessively over the past month. He can hold his pee through the night, but he does pee more often in the day. His urine is sometimes yellow and sometimes clear. Has anyone had this happen?
Our vet (Dr Bruyette at VCA West LA) said that he could take an MRI to see if their is pressure on the "pituitary mass"(?). I said that before we go through that big procedure Id like to check his blood and organ function. He recommended a "plan panel" and urinalysis. As you can all probably understand, Id like to be proactive about this symptom in case it is linked to something more serious. Thank You for any input on this.

[Harley PoMMom]

It's been a while since we heard from you, welcome back! Over a year that Attila's been in treatment for Cushing's! Wow time goes by so fast!

I see that an urinalysis has been done, what were those findings? Did the results come back for the plan panel, and if so, could you post them? Diabetes can come on suddenly, has this been ruled out? Also, would you post those recent ACTH stimulation test results for us?

Hopefully the reason for Attila's increased water/urinating will be figured out soon, you're doing such a great job with dear Attila!

Hugs, Lori

[labblab]

Welcome back to you and Attila! I, too, am glad to hear that you have had a very good year, but sorry to read about this new issue. I know you are in very good hands with Dr. Bruyette, and I hope that you will soon get to the bottom of things. I do not know what a "plan panel" is, however. Is it some type of special blood panel?

Marianne

[Thirsty Frenchy]

Hi Lori and Marriane - (I guess the posts don't show up immediately in my email anymore) Thank you for responding. Yes, time has flown by! I am thankful that Attila has been stable during one of the busiest periods of my life this past year. I have never gotten the numbers from the ACTH stim tests, I have just trusted the doctors read on them because of his experience, but I can ask for them. We have not yet done the urinalysis or the blood "plan panel". I don't know what that is specifically, but thats the blood tests the doctor suggested in order to tell if anything is off. Good to know about the Diabetes. I would assume that would come up very quickly in any test. Its alarming that Im not alarmed at the $250 cost of the blood tests…at this point I say I could have sent Attila to college with all his vet bills. - I am probably in good company on here.

[Thirsty Frenchy]

Forgot to remind you of my name -"Laura"

[Squirt's Mom]

Good to hear from you again, Laura, and to know that Attila has been doing well the last couple of years. A thought on the urination, DI, a form of diabetes that has nothing to do with blood sugar but rather with how the body processes water. You might as Doc B if this is a possibility...and if he says yes, don't let him do the water deprivation test. It is risky. Most vets just start the med (an eyedrop) and if that works, there you have the diagnosis with minimal risk to the pup. ;)

Let us know and don't be a stranger!
Hugs,
Leslie and the gang

[Thirsty Frenchy]

Hi Leslie - I appreciate the heads up on the DI since I have never heard of it. I will definitely communicate with Dr. D regarding the potential water deprivation test. I will post the results of his tests - another medical mystery to be solved! Thank You once again for your wisdom. Staying in touch…Laura & Attila

[Thirsty Frenchy]

Hello - We did the blood tests and urinalysis with Dr. B. He described the blood test results as "boring" since nothing was out of the ordinary and the liver enzymes look good. The urine was diluted as expected. He is suggesting the option of getting an MRI to see if there is a pituitary tumor and if we will treat it with radiation or surgery. He says if not, we can use a medication called DDAVP which is a hormone to help with the excessive drinking and urination issues secondary to diabetes insipidus. MRI's are very pricey ($1600) as is surgery &/ or radiation ($8000 each). Ee gads! I already could have put Attila through college with what Ive spent on him. Anyone had an MRI? Ill wait to see the results of MRI before I ask about the options of surgery and/or radiation if they are needed. His symptoms are not severe right now, just thinking of taking proactive steps. Hopefully we are just looking at Diabetes Insipidus - good call Leslie! I know a few people wanted me to post blood results. I trust the doctor that they are normal, but do some of you still want me to get them? Thanks

[Squirt's Mom]

We definitely want to see the lab work. ;) I think I would try the eye drops first and see if they did the trick; if they helped I would take that to mean this is DI and not Cushing's. That would save you the money of an MRI right now and it may not be needed at all if the DDAVP works. :)

[molly muffin]

I second Leslie's thought of trying the eye drops for DI. On the off chance that is what it is, then you wouldn't have to fork out for the MRI.

[Thirsty Frenchy]

Dr. B did say we could start with the DDAVP which he uses an oral version as the eye drops can be irritating. However, he did say that if Attila responds to the medicine it would argue that he does have Diabetes Insipidus and probably a large pituitary tumor. Although I'd save money on the MRI, Id like your thoughts about how important it may be to visually see the size and location of his tumor at this point with an MRI? Thanks

[molly muffin]

Okay I have read back through the entire thread Laura, and I don't see anything that would make Dr. B suspect a large pituitary tumor. There doesn't appear to be any neurological issues. Is he thinking that the peeing is a neuro issue rather than DI? or that a larger pituitary tumor causes DI? I'm not sure I get his thinking on that. Did he expand at all?

I don't know if an MRI is going to show a large tumor or not. They are done, often when a larger tumor is suspected though. My specialist told me that at this point with my dog having no neuro systems (diva doesn't count) that the tumor could be so small that an MRI wouldn't show it and she has found that to happen several times. If you want to know though and if it will give you peace of mind and you can afford to do it, then it might be worth it. I don't know that it is imperative to have it done right away though, unless Dr. B is adamant that he thinks a large tumor is in play.

That's my two cents worth of layman thoughts. LOL :)

[Thirsty Frenchy]

Thanks Sharlene - Yes, Dr. B says that if the meds work for DI that there is likely to be a large pituitary tumor present. Even though Attila has no neurological issues at this time, Id like to get an MRI at some point to see what we are dealing with, as I don't want to be surprised. Dr. B said we can start the meds for now.

[Thirsty Frenchy]

He did not expand on his reasoning, but initially said a tumor could be pressing on the part of the brain that controls the processing of water.

[kaibosmom]

I'm curious about the Calcinosis cutis. Did it clear up on Vetoryl? If so, how long did it take? Did you try other treatments? If so, what? Kaibo has been diagnosed with Cushing's again and has CC. I would be thinking diabetes is happening, something Kaibo has as well. If you have questions about diabetes, just ask!

[Thirsty Frenchy]

Hi Kaibos's Mom! The only thing that worked in the end was the DMSO gel. …and boy does it stink! I tried bandaging his sores with antibacterial ointment and other natural salves, but nothing worked. He also has an extremely clean diet and Ive tried skin supplements. I don't think that the Vetoryl was effective with the CC as the timing didn't seem to correlate. I have included a previous post on this site from "Lulu's mom" from 2009 that discusses some findings by Attila's Cushings vet Dr. Bruyette which might be helpful. Also, Attila's hair has not grown back and its been 2 years. We are lucky its on his neck and he can't see it since he's a proud Frenchie!;)


I will be posting this on four members' threads, all of whom are dealing with calcinosis cutis. Kerry, Millie's Mama; Crystal, Annabelle's Mama; Shelly, Lucy's Mama and Pat, Peety's Mama.

I've seen too many dogs on Trilostane who have either had little to no effect on Calcinosis Cutis or a worsening effect while on the drug. Based on the frequency with which we've seen calcinosis cutis on this forum, there seems to be a correlation with the increased popularity of Trilostane for treatment of cushing's. I've had a gut feeling for a very long time that Trilostane is responsible for worsening calcinosis cutis due to it's effects on the sex hormones. Dr. Oliver, was the leading expert on adrenal steroids and he firmly believed that 11-deoxycortisol levels build-up in dogs being treated with Trilostane as did other intermediate steroid such as androstenedione, 17-hydroxyprogesterone, estradiol and progesterone. I've never been able to find anything in layman's terms that explains the affect, if any, these steroids have on calcium metabolism. While searching for that connection, I stumbled upon something even better. It was an abstract of a study entitled, "Canine hyperadrenocorticism: effects of trilostane on parathyroid hormone, calcium and phosphate concentrations". The last sentence of that abstract was eye opening.



It looks to me that cortisol isn't the only adrenal steroid that can cause elevations in blood calcium levels. Dr. David Bruyette, a renown endocrine expert, readily admits that he has had bad luck in resolving cc with trilostane. That's pretty telling coming from a high profile specialist who is a contributor to Dechra's continuing education program for veterinarians. This is not a new study. As a matter of fact, I believe it may have been published before Vetoryl was approved by the FDA.

You can find the complete abstract here: http://onlinelibrary.wiley.com/doi/10.1111/j.1748-5827.2005.tb00283.x/abstract

I'm just sharing my thoughts with those of you who may want to start asking more questions of your vets....or you may even consider calling Dechra, the manufacture of Vetoryl (Trilostane). I'd be very interested to hear what they have to say about this study.

Glynda

[Renee]

Not to hijack the thread, but just wanted to say I had a much different experience managing CC. I was able to resolve it with the use of vetoryl, and I had zero success with DMSO. But, as each dog reacts differently to things, I am sure that what works for some will not work for others.

[labblab]

Hi, just wanted to comment on that post of lulusmom (Glynda), because we actually subsequently started a whole thread on our Everything Else forum that offered some clarification to that post as well as additional case studies. Since the time that thread was started, we have seen several more dogs here who have had CC resolve while being treated with trilostane. That's why I think the picture is much more positive than at the time of Glynda's first post.

http://www.k9cushings.com/forum/showthread.php?t=5509

Marianne

[kaibosmom]

Thanks everyone! I will check that post out Marianne.

[Jed's Mom]

I also did not have any success with the DMSO and I could not get the smell out of the house for WEEKS! Jed had a pretty bad case, I have some pics in his album. I believe the only thing that helped was managing his cushings and at the time Jed was on vetoryl. Jed's hair did grow back and you would never know he had a skin issue. It just takes time.

[molly muffin]

CC can be the hardest thing to get rid of, but we have seen success with both lysodren and trilostane now. The key is getting the cortisol to a low point (post) that it stays controlled.
Any hard little deposits that are already there, will have to come out completely before it is all done with and have the cortisol low enough that no further ones develop.
It is well worth checking out the cc thread in Everything Else section that Marianne linked to.

[Thirsty Frenchy]

Here is the most recent ACTH Stim test results from 1/17/15: Let me know if you want to see other specific results of the blood panel which Dr. B said were all very normal
Cortisol Sample 1: <1.0 (Low) Reference Range: 1.0-5.0 ug/dL
Cortisol Sample 2: 3.4 (Low) Reference Range: 8.0-17.0 ug/dL

He started on the DDAVP about 5 days ago. Not seeing a change yet, but I don't know how long it takes…


We definitely want to see the lab work. ;) I think I would try the eye drops first and see if they did the trick; if they helped I would take that to mean this is DI and not Cushing's. That would save you the money of an MRI right now and it may not be needed at all if the DDAVP works. :)

[labblab]

Hi again Laura! I'm sorry you are not yet seeing any improvement in Atilla's drinking, but I really do not know how quickly the drops are supposed to help if they are going to do so.

Regarding Atilla's ACTH results: did Dr. Bruyette say anything at all about that low "pre" that was <1? Some specialists seem to be concerned about low "pre" numbers, but other specialists -- not so much. As a result, I have a hard time knowing how big an issue to make of it myself. Atilla's post of 3.4 was really perfect for a dog being treated for CC. So I don't know whether you want to risk increasing the "post" number by lowering the trilostane dose. Apparently Dr. B did not, but I am just wondering whether he discussed any concerns about the very low "pre." (By the way, the listed "post" norms are for a dog who does not have Cushing's at all. They are not relevant to a dog being treated with trilostane).

Marianne

[Thirsty Frenchy]

To: Marianne - Dr. B has not mentioned the low "pre" levels. He's been pleased with the past blood levels.
Update on possible Diabetes Insipidus:
We have been on the Desmopressin (DDAVP) for a month now and seeing some reduction in Attila's drinking and peeing, but we still have to provide a pee pad for him on the balcony since he may not be able to hold his urine until the next time we are able to take him out. So we are not out of the woods here. Dr. B is considering raising the dose. We are on .1 mg 2 x a day right now. Hmm...

[Thirsty Frenchy]

Hello Everyone - Attila started showing strange behavioral symptoms last night (i.e. barking, disorientation) and we rushed him to the ER. He got an MRI which indicates a large, aggressive tumor that started bleeding (which led to the sudden onset of symptoms). Dr. B says it is inoperable, but we can try radiation - 10 minutes a day for 16 days while pup under anesthesia. This may prolong his life for 9 mos.- 1year. We will see how he responds to his anti-swelling meds tomorrow morning which will indicate whether there has been any permanent damage. I will have to make a decision whether radiating is in his best interest. Has anyone gone through this?!

[Thirsty Frenchy]

having trouble finding old posts on radiating tumors...

[molly muffin]

Oh gosh. I am so sorry to hear this has happened to Attila.

I don't know that we have had one that has started bleeding. Maybe one the others will know about that. We have had several with macro tumors that have gotten radiation treatment.

It sounds like Attila's though has become unstable. So I think you have to rely a great deal on what they tell you about prognosis with the radiation if it is too late to be able to help him. The brain damage aspect. Can he go under anesthesia safely. Many factors to think about.

Do let us know how he is doing and we of course are hoping for the best but honestly I just don't know enough about what happens if they start to bleed into the brain to give you any real answers. Hopefully one of the others will know more.

Hugs

[molly muffin]

Look up radiation. Jed was our last one who went through radiation. The surgical knife one I think it was called.
http://www.k9cushings.com/forum/showthread.php?t=6383&highlight=radiation

Buttercup also http://www.k9cushings.com/forum/showthread.php?t=5850&highlight=Buttercup

Then we have the macro tumor thread. http://www.k9cushings.com/forum/showthread.php?t=3567&highlight=Macro+tumor

Hopefully these will help you

[Thirsty Frenchy]

Thank You Sharlene - Dr. B said Attila did well with the anesthesia during the MRI. He will be sedated through the night and they will gradually wake him tomorrow and see if he is back to being his alert self which would mean he responded well to the anti- swelling meds and doesn't have permanent brain damage. I keep thinking I should have done the MRI a few months ago, but I wanted to see if he'd respond to Desmopressin from his excessive drinking and peeing - who knew the tumor was so aggressive?

[molly muffin]

We have seen some pretty aggressive tumors lately. I don't know why that is but they can sometimes grow quickly if they are the type to do so.
That is good that he handled the anesthesia okay. That is always a worry too.
Hopefully there is no permanent damage. It is just all so very scary to know they are going through so much and not know what you can do to help them.

[Thirsty Frenchy]

I visited Attila at the vet tonight even though he was sedated. The doctor on duty showed me the MRI of the tumor. The largest point of the circumference is 2.3 cm (almost an inch!). For the tiny brain of a French Bulldog, this is a large tumor….and it bled. More to be revealed tomorrow morning as he comes out of sedation, then I will try to make the best decision possible based on a projected quality of life.

[Squirt's Mom]

Our thoughts and prayers are with you hoping for the best possible outcome.

[Jed's Mom]

Just read through your thread. Gosh our dogs are lucky we love them like our kids. That is a large tumor for your little guy. Please keep us posted. Your guy is much like my Jed I think...hard time handling the cushings meds, the CC and now the large tumor and they are about the same age. It's so hard to watch them suffer through all of this...

xoxo
Lisa and Jed

[Jed's Mom]

a couple of videos about cyber knife

https://www.youtube.com/watch?v=g0goPNHp6H0

https://www.youtube.com/watch?v=SrbWZ0_wNE4

[molly muffin]

checking in on you and Attlia. How did this morning go?

hugs

[Thirsty Frenchy]

My sweet baby boy passed on this morning. This came on suddenly the night before last when Attila started yelping in his sleep. I thought he was having a running or barking dream, but it kept going, and I saw that he was disoriented. My husband and I rushed him to the emergency room where he was put on anti-swelling meds and sedated for the night. Our trusted vet took an MRI which showed the huge (2.3 cm) brain tumor I mentioned in my previous post that had started bleeding, hence the sudden onset of symptoms. We were hoping the brain swelling would go down and we could radiate that damned tumor down to size this morning. I got a call from the vet at 5AM this morning saying that Attila was having problems breathing and his blood pressure was low and he may not have much time left. At 6AM we made the decision to set Attila free of his struggle to breathe. My husband and I were with him - he knew we were there and that he was surrounded by love. I kissed that fuzzy muzzle, and I had my hand on his heart as he passed.
I know we all ask ourselves - should I have done anything different? Our vet said that even if we decided a few months ago to get the MRI and do radiation, there were chances that it might have side effects on the rest of the brain because the tumor was so large in proportion to his little Frenchie brain. I have to trust that this was the best way for him to go.
Attila went to work with me twice this past week and made quick fans of everyone. He was happiest being around his humans. He was his usual alert, energetic, stubborn, playful, silly, sassy, loving, empathic, gentle self up to his last day.
I have never experienced grief, but it physically hurts. Attila opened my heart and he kept it massaged. He amazed me every day with his innate gifts. How lucky I was to fall in love each and every day. Although I have not been a consistent member to this forum, I can't tell you how much I have appreciated everyone being here for me and each other. It takes a village to raise our canine children, and you are all part of that village. Thank You, Laura

[mytil]

Laura,

I am very sorry to read about your little Attila!!! Yes the grief hurts very deep and will continue to and know we are all here for you.

To second guess is something we all have gone through, but know you did your very best for him! And he knows this! Please be kind to yourself.

(((hugs)))
Terry

[Jed's Mom]

Laura, my heart breaks for you. My thoughts and prayers are with you and your husband.

-Lisa

[judymaggie]

Laura--my heartfelt condolences to you and your husband. Your love for Attila was obvious to all of us and all of your decisions were based on that love.

[molly muffin]

Oh Laura, so very sorry to hear that Attila passed. I'm glad he knew you were there with him.

My sincerest condolences.

[Harley PoMMom]

Oh Laura,

I am so terribly sorry for the loss of your sweet Attila, you are in my thoughts and prayers.

With Heartfelt Sympathy, Lori

[budindian]

I am so very sorry for your loss.

[Squirt's Mom]

Dear Laura,

My heart just shattered reading about your sweet baby boy. You gave Attila a wonderful life and fought with him for as long as possible. I know he is watching over you with all the love in his heart.

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



I Haven't Left At All

I saw you gently weeping as you looked through photographs
You paused for just a moment at one that made you laugh.

But as you turned more pages the tears began to flow
You whispered that you missed me but I want you to know;
I softly licked those stinging tears that down your cheeks did fall
I want to help you understand I haven’t left at all.

On those days that you are overcome with sorrow, pain and grief
I rest my head upon your leg to offer some relief.
When you take our walking path I’ve seen you turn around
Because I know you surely heard my paws upon the ground.

At night while you are sleeping I snuggle at your side
You stroke my fur as you touch that place where I used to lie.
You said it’s just your heart playing tricks upon your mind
But rest assured I’m really there, my spirit’s left behind.

I know your heart is hurting; it’s like an open sore
You think my life has ended and you won’t see me anymore.
But for those of us bound tight by love, death is not the curtain call;
It’s really the eternal beginning that waits for us all.

So, dear Master, as you live your life I patiently await
For us to be together when you pass through Heaven’s gate

[Thirsty Frenchy]

Leslie - This poem is beautiful, along with the two quotes below. I need to know he is with me somewhere. The last quote really helps me with a new perspective.

Dear Laura,

My heart just shattered reading about your sweet baby boy. You gave Attila a wonderful life and fought with him for as long as possible. I know he is watching over you with all the love in his heart.

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



I Haven't Left At All

I saw you gently weeping as you looked through photographs
You paused for just a moment at one that made you laugh.

But as you turned more pages the tears began to flow
You whispered that you missed me but I want you to know;
I softly licked those stinging tears that down your cheeks did fall
I want to help you understand I haven’t left at all.

On those days that you are overcome with sorrow, pain and grief
I rest my head upon your leg to offer some relief.
When you take our walking path I’ve seen you turn around
Because I know you surely heard my paws upon the ground.

At night while you are sleeping I snuggle at your side
You stroke my fur as you touch that place where I used to lie.
You said it’s just your heart playing tricks upon your mind
But rest assured I’m really there, my spirit’s left behind.

I know your heart is hurting; it’s like an open sore
You think my life has ended and you won’t see me anymore.
But for those of us bound tight by love, death is not the curtain call;
It’s really the eternal beginning that waits for us all.

So, dear Master, as you live your life I patiently await
For us to be together when you pass through Heaven’s gate

[Thirsty Frenchy]

To those of you who have reached out to me and my husband - Lori, Bandits mom,Leslie, Sharlene, Judy, Lisa and Terry and all your fur children: Feeling connected with you all with your empathy makes the pain more bearable. Thank You. This grief thing is new to me and more difficult than anything Ive felt. I am relieved to know that many of you have made it through, and that it can be an expanding experience (at some point soon I hope!).

[Harley PoMMom]

Dear Laura,

Many people in this world have no idea that it is possible to feel this close and this connected to one's furbaby, but we do, and it is so hard losing them, please know that we are here for you and your husband always.

(((HUGS))) Lori

[molly muffin]

Big Hugs Laura.

Grief is a rollercoaster. One moment you are fine and then something will touch that memory, emotion inside and you just lose it. At least that is how it is for me.
I think everyone experiences it in a way unique to them, even within the same household.

We're here, any time you need us.

hugs

[Thirsty Frenchy]

I needed your messages today Lori and Sharlene - Thank you! One week ago today is when he passed on. I awoke out of the blue at 520AM this morning - the same time when I saw Attila last Tuesday morning at the hospital. The subconscious is a surprising thing. It has been a very teary day and night, spurred on by calling the vet to let them know the cremation company hadn't called yet. I don't want to say goodbye to his body either. Thankfully many people around me at work understand the connection, especially since they knew my furry son. Yes, a roller coaster is!

[spdd]

Just want you to know that I know exactly how you are feeling. It was only me and "mah boy" and I lost him suddenly in November at 15. To this day when I go to the memorial candle page, I weep, sometimes uncontrollably as he was almost the most cherished thing I had. It is still very difficult, but I want you to know that the stomach turning, gut wrenching grief you are feeling, will subside. That doesn't mean though you will miss them any less, you are just able to cope with it better. Even today, something will set me off so unexpectedly, and bring me to tears, but I am able to manage better and so will you. I didn't want to say goodbye to his body either, he was beautiful even in death, but I somehow have come to a semblance or acceptance, even though the pain remains. I can function a little better then I could before when absolutely nothing mattered.
I didn't even want to look at other dogs walking down the street or watch how happy other people were with their dogs, but I can cope with that now and even have the odd time gone and pet someone else's dog. I call it my therapy... it works even though I still long for me beloved boy.
This was my first time losing a pet, and I can't imagine ever going through it again, and yet once in a blue moon lately I have wondered if I will ever get one again.... a few months ago it wouldn't have even crossed my mind.
So.... after my rambling, although I was completely shattered and just never thought I could cope without Keesh, you will in time feel a bit better. Grief is so different for so many. Keeping you in my thoughts as you travel this sad journey.

[Thirsty Frenchy]

Thank you for reaching out Judi. I think because we have such a chemical reaction to our dogs (endorphins, oxytocin) we feel that loss of their bodies so much more. I will feel like Im losing him all over again once I know he is cremated this week. The man from the cremation company finally called this evening and I asked if I could call him back when I didn't have to work because I knew I wouldn't be able to hold it together. You helped in building my faith that this will get easier, or at least Ill be able to cope better once the shock to the system wears off a bit. Love to you and your boy Keesh.

[Bonnie0420]

Laura, I'm so sorry about your sweet baby Attila, it's so hard, we too just lost our baby girl Aggie the 27th of April. It's a roller coaster ride for sure. We do well for a while and the craziest things will set you off. Won't bore you with lots of details but I had a Dr appt on tues, had to have an IV thing put in my arm and I lost it, all I could see was the one in Aggies paw, heard I song I sang to her, I lost it.
A storm (she hated them), the squirrels she won't chase again, it's all the first and as everyone had been so supportive of me saying things, they all assure me it's hard it is natural and above all ITS OK!!
We too had Aggie cremated, and the raw emotions started all over yesterday when we got her ashes back. BUT, this morning when I came down the steps, I said Hi to her, told her I missed her but I was so glad she wasn't in pain and struggling. (She is in our China cabinet). Tomorrow I might not react the same way, but I'm learning that no matter what it's OK...
They are our babies, gave us the most unconditional love ever and will always have a special place in our hearts, but...it hurts like HELL. I hope I'm not over stepping my bounds by sharing what we have been going through
I wish for you peace and comfort

[Thirsty Frenchy]

HI Bonnie - Overstepping? Absolutely not!!! I need you to share your experience since we are going through a parallel process, and I am brand new to this as well. I started following your thread on April 27th when Attila went into the hospital. I posted to you and I was trying to get as much solace as possible from the posts from the community. Today I finally spoke with the cremation people. It felt like it was happening all over again for me too. We get the ashes on Monday with a paw print and fur. I don't have a china cabinet, but Ill have to make a special alter. Im glad to hear you had a good morning with her. Aggie has soulful eyes, she looks like a very caring dog. Attila has the independent bulldog spirit, so when he gets to doggy Heaven, he'll be adventuring around without a care in the world, knowing Ill always be there for him. If Aggie is a big dog, he'll probably find her since he thinks he's a big dog and he likes pretty girls…This waking up at the same hour I got to the hospital for Attila that last night has got to stop. Im looking and feeling a little haggard by now! Please reach out anytime, it will be a surprising process for sure, but like you said, its all OK. Keeping you, your husband and Aggie in my thoughts.

[Bonnie0420]

Ah Laura, it's tough and just plane sucks. Last night thought I was having a good night, got in bed and just lost it. Laid there and held in the tears as I didn't want Joe to know, I cry he cries he cries, I cry, but it subsided.
Just prepare yourself for Monday, it's going to be so hard and will bring it all up again, at least it did for us. Now with her ashes at home, I tell her how much we miss her, how hard we tried and how so unfair it was that she had to go through this, but (and I hate it when people, other then our community heresay it, but) I tell her how she isn't suffering now, how she can breath better, not have to potty every 15 mins, not just always think she is hungry, the diease was awful and we saw what it was doing to her.
You will say to yourself wow, I didn't cry today, the you will think, don't I care, what's wrong with me, you do care you do miss your baby, your just having a peaceful day, I say to myself it's Aggie sending me good vibes telling me she is ok.
When you talk to Attila, tell him Aggie is really nice, just a tad stand off-ish, she is "British" you know LOL. She wasn't your typical Lab, she HATED water, she wouldn't retrieve worth a darn, you throw a ball or stick and she would look at you like um, YOU threw it, YOU go get it..she was a trip.
Write me messages anytime you want, tell me more about Attila. For me, it helps to share. you will cry as you write, you will have to stop and re-group but it's OK.
I'm a talker as you can see, or should say a writer..I just put it down as I'm feeling it....it does help, today so far has been a pretty good day, tough but good...it's one day at a time...xoxo
I'm here anytime and do my best to respond, I just won't do it at work...my co-workers all know but I'm trying to just stay focused at work and get throught the days....
But again....whatever you are feeling, whenever you want to cry, scream or whatever, DO IT, only YOU can take charge of your life and do this and cope how YOU need to do it.

Much love and hugs