2 dogs w adrenal tumors, adrenal surgery and atypical (Darla has passed)

[sarahbera1]

I'm new here. I have two dogs with Atypical Cushings. Darla, 11 yr old Jack Russel Terrier, was diagnosed about a year ago. Was put on Lysodren and doing well. In early March of this year I noticed the typical Cushings signs start to come back. Went back to vet, more Lysodren (higher dose), didn't work. We tried it 2x. We decided to do an ultrasound the end of May. Turns out her left adrenal gland is big, right adrenal gland is growing into the vena cava artery, and liver has nodules on it. Surgery is not an option as she would bleed to death if she had it. They can't give her anything to make her feel more comfortable as the Lysodren we used stopped working. There was another medicine my doctor's colleague recommended, but my vet said it will effect her liver and it's already not functioning normally. We don't know if she has cancer on her liver unless we do a biopsy. Well, I'm not doing that because it will accomplish nothing as they can't do anything for her. My vet says she has maybe 1-2 months, or he could be wrong he said and maybe 4-5 months. He said when she has more bad days then good it is time to come back and see him.

My other dog, Rascal an 11 1/2 yr old Smooth Fox Terrier has Atypical Cushings Disease also. He was diagnosed earlier this year, only a few months ago. Originally brought him in because I thought he had a UTI. Anyway, he was tested and put on the same starter dose of Lysodren as Darla. I brought him in for follow up test. His levels were fine, but he was still drinking alot. Had ultrasound and the results were a huge left adrenal gland. Had more bloodwork done, this was sent out to the University of TN, came back abnormal for overactive sex hormones. I eventually decided that his best option was to have surgery to remove the tumor. He had surgery 2 weeks ago and is doing wonderfully. He is due back to the dr. Fri. for a follow up appt. The surgeon said he got it all, it was benign and he is "cured". Now we have to jump start his right adrenal gland. He is on Prednisone, at least until Fri, then he will have bloodwork and hopefully no more meds!

I just can't believe that not only do I have a dog w/Cushings Disease, I have 2 dogs with Cushings, and on top of that they both have Atypical Cushings. I don't know what the odds are, but it is unbelievable.

I'm just wondering if there is anyone in a similar situation, be it Darla's situation or Rascal's situation
Thanks for listening,
Sarah, Rascal & Darla

[frijole]

Sarah,

I hope it makes you feel better to know that we have seen quite a few with more than one cush dog. :( It isn't fun but at least you know what you are dealing with! And if you are looking for a place to find people who understand or to ask questions... you have found the best place. Welcome. Kim

[sarahbera1]

Kim,
Thanks. I'm glad I found this site. I will ask more questions when I have them.
Sarah

[Roxee's Dad]

Hi Sara,
I would also like to add my welcome too. I am so sorry about Darla's diagnosis, I know this must be very difficult time. Hopefully you can enjoy all the precious time you have left with her.

At the same time, I am happy that Rascal has been cured and hope you get her adrenal jumpstarted and it's smooth sailing from there.

We do have a few members with more than one diagnosed pup with cushings. I'm sure they will check in and be happy to share their experiences.

[Squirt's Mom]

Hey Sarah!

So glad you, Darla and Rascal made it! :) Welcome, welcome!

So glad to hear about Rascal's successful surgery! :D One of our members, Ken (Buffalo), has a pup who had an adrenalectomy 2 years ago and is doing wonderfully!

I am sorry, tho, to hear about Darla's situation. :( Did the docs mention trying Trilostane? We have had several folks here use that drug with adrenal tumors and it helped. You might mention this to see if it is an option for her, too.

You don't have to face any of this alone, Sarah. We are here and will help in any way we can, even if that is only to listen. Please keep us updated on your kids.

Hugs,
Leslie and the girls

[sarahbera1]

Leslie,
Thanks for the info on this site. I'm glad I'm here. My vet did mention Triolstane, but I guess it affects the liver and she already has some problems w/her liver know apparently (she has nodules on it). So he thinks it is not a good idea. What exactly does this drug do? I think I will call the vet and sit down w/him and discuss her care, as now the initial shock is wearing off and I am focused on trying to make her feel better during her last months w/us. I have more questions for my vet and I think now I can ask them as I was too upset last week to really say much to him. Thanks again and I'm glad I'm not alone with all of this.
Sarah

[Buffaloe]

Hi Sarah,

I am sorry you have had to deal with two dogs with adrenal tumors. You sure did a good job of getting them diagnosed.

I think virtually every, if not every dog with an adrenal tumor can also be said to have atypical cushing's disease. Invariably, adrenal tumors secrete excess intermediate (sex) hormones so I guess they could all be said to have have atypical cushing's. I think Rascal will be completely cured of any form of cushing's disease since his adrenalectomy. Congratulations on his successful surgery.

My Shiloh had a huge, malignant tumor in her left adrenal gland surgically removed in October, 2006. She is doing great today at 14 1/2. She took 20 mg. of pred. for the first week after surgery and then 10 mg. for the second week. Obviously, her right adrenal gland kicked in beautifully as I believe is very typical and will happen with Rascal. He is cured and can live for many years as a completely healthy and happy dog. I think you will see him continue to get healthier and healthier for many months.

I'm sure it is a real tricky surgery to remove Darla's right adrenal gland if it has in fact grown into the vena cava. I think only so much can be shown from an ultrasound. Shiloh's ultrasound showed the tumor was deviating the vena cava, compromising the blood flow and might be adhered; it was a huge tumor in her Lt. gland. After the adrenalectomy my surgeon blew it off like it was no big deal. He is awfully good. He has told me what one surgeon sees as inoperable, another sees as completely doable. He also said he doesn't care how many tumors there are, only their location and their involvement with area blood vessels. I know that successful adrenalectomies can be done when adrenal tumors have completely invaded the caudal vena cava although I'm sure they are more difficult and more risky. I can ask my surgeon about if you want me to. I'm just throwing this out; it is certainly understandable for you not to pursue a bilateral adrenalectomy where one of the tumors has invaded the cvc.

All the best to you, Darla and Rascal.

Ken

[sarahbera1]

Ken,
Thanks for the insight about the surgery. I have a appt. w/the ER vet (the dr. who saw Rascal before the surgery) in a couple of weeks for Darla. It's not w/the surgeon, just the board certified Dr. there (who initially saw Rascal and referred us to the surgeon). I will see what he says and take it from there. If nothing else we might be able to give her meds to make her feel better according the the dr. today. Oh, I brought Rascal in today for a follow-up after surgery and he is doing well and we are weaning him off the Prednisone. That's when I showed him Darla's ultrasound and he said he could help. We will see I guess. I'm so happy for Shiloh and glad she is doing well. It gives me hope!
Thanks
Sarah

[Buffaloe]

Hi Sarah,

I think you are right to have tons of hope. Your doctors sound wonderful and it sure sounds like Rascal is making a great recovery. That nasty tumor is history and there is no reason for him not to live out his whole lifespan as a very healthy, happy dog.

I've been thinking more about Darla. I guess I'm just saying, surgery is still a possibility although it would probably be a difficult one for any surgeon and pretty darn risky. If my dog had Darla's diagnosis, even with my having a surgeon who I believe in 100%, I don't know if I'd go for the surgery. I would have proceed exactly how my professionals advised me.

I hope they come up with a medication that helps Darla. You may have a bunch of quality time remaining with her. Nobody really knows. After Shiloh's adrenalectomy my surgeon said to me, "you can expect her to live about another year." Well, in a few months it will be three years and she's still a very happy, healthy piece of work. You are so right to have a tons of completely justified hope.

Ken

[gpgscott]

Hi Sarah,

I am very glad Ken has found your thread.

You are going through a lot. And you are doing a great job. I am so glad that Racal is on the mend and I know you will find the best path for Darla.

I am very sad for you that you are having to deal with all of this at once.

Hugs and prayers. Scott

[sarahbera1]

Scott,
Thanks for the prayers. We will see what the dr. says on Friday about Darla.
Sarah

[Squirt's Mom]

Hi Sarah,

How are things going? Was just thinking of you today and here you are! :)

I hope Rascal continues to improve and that Darla isn't too uncomfortable. Do let us know what you learn on Fri about Darla.

Hugs,
Leslie and the girls

[sarahbera1]

Went to ER vet and they seem pretty optimistic that they can help her. At least treat her symptoms and make her feel better. Surgery could be a possibility, if I wanted to go that route, but I think not at this point as it is very risky to remove her right adrenal gland as it is invading the CVC. I just want her to get back to being a happy dog again! She started higher doses of Lysodren yesterday and will do until I see changes in drinking, appetite, etc. Hopefully we can get her on a good dose and she will start to become herself again. :) On another note...Rascal is doing great after his surgery:D

[Squirt's Mom]

Hi Sarah,

Good to hear from you again! Also good to hear that Rascal is doing so well! :D

I've got a few questions for you, if you don't mind. How much does Darah weigh? What mg of Lyso is she taking and how often? Did your vet tell you what to look for if the cortisol gets too low? Did you vet give you prednisone? If not, call today and insist they give you some. This is not an option when using Lyso, it is a necessity. Here is a link from the Resource section on using Lyso:

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

Hang in there! We are here with you to help in any way we can.

Hugs,
Leslie and the girls

[gpgscott]

Hi Sarah,

Glad Rascal is doing well and wishing you luck in finding a dose which helps Darla. Please keep us posted.

Scott

[sarahbera1]

Leslie,
Darla weighs 21 lbs. She is getting 250mg of Lysodren 1x day until I notice the typical changes (i.e., loss of thirst, appetite, vomiting, diarrhea, weakness). I have pred at home already. When I see these changes I will call vet and make appt. to get her tested. I am going to call vet 1x week to let him know how she is doing.

[Squirt's Mom]

Hi Sarah,

Thanks for the info! And sorry for the name screw-up for Darla. :o

I am glad you have the pred on hand but a word of caution - you don't want to let Darla get to the point of vomiting, diarrhea or weakness. If you see any of these signs, give the pred. Even with an adrenal tumor, you don't want the cortisol getting that low.

250mg/day is a conservative approach, which may be best for Darla. The usual dose of Lyso is 50mg/kg/day which for her would be 475mg/day. At 21lbs, her weight converts to 9.5kg (21lbs X 2.2 = 9.5kgs); 9.5 X 50= 475mg/day. BUT, that does not mean the dose is wrong, just conservative. Adrenal tumors are a bit different than pituitary tumors plus her current physical state, may be why the lower dose is what your vet decided to use.

Please keep us informed of Darla's progress. If you have any questions or just need to talk, we are here.

Hugs,
Leslie and the girls

[Buffaloe]

Hi Sarah,

We are delighted to hear that Rascal is doing so very well after his adrenalectomy. I expect you will continue to see him get healthier and healthier for a long time.

I also think Darla will respond favorably to the Lysodren treatment. Before Shiloh's surgery we loaded her with 1750 mg./day of Lysodren for 3.5 days. She weighs 75 pounds. The Lysodren brought her cortisol level down and clearly made her feel ALOT better. Just an FYI, dogs with adrenal tumors often require a higher dose of Lysodren than those with pituitary tumors. Darla is on a pretty conservative dose.

All the best to you, Darla and Rascal.

Ken

[sarahbera1]

Darla has been on Lysodren for 13 days @ 250 mg/day. No changes at all. Dr. says to call back in a couple days to see how she is. I really don't think anything will change by Friday.:confused: She is having more accidents in house, even after we just let her out:eek:
Sarah

[AlisonandMia]

Just thinking...you may want to get her electrolytes checked.

I would think that when treating an adrenal tumor, particularly if it has metastasized (ie you are trying to reduce the size and hormone-producing capacity of a lot of tissue) that there could be a theoretical risk that you could end up giving a dose of Lysodren that over time could be enough to effect aldosterone production (by the remaining normal adrenal tissue) and therefore have the situation where the cortisol (and sex hormone) production from the tumor is possibly still higher than you want while the aldosterone production has been lowered to the point that a dangerous electrolyte imbalance has occurred. (Aldosterone is the adrenal hormone that is responsible for maintaining the correct electrolyte balance in the body.)

Increased urination and resulting thirst can be a symptom of an electrolyte balance.

Alison

[Buffaloe]

Hi Sarah,

I think you are doing what you can for Darla. It must be difficult for you but you are doing everything you can do. Maybe your vet will give you the OK to try a higher dosage of Lysodren.

You know, Shiloh had a very large, malignant adrenal tumor which was causing her huge trouble. I would take her for short walks and shortly thereafter, dilute urine would just leak out of her when she was relaxing in the house. She had no idea it was even happening. But, when we loaded her with Lysodren (3 1/2 pills/day, 1750 mg.) it made her feel better. It probably also controlled her incontinence but I can't say that I remember. If I were in your shoes, I'd sure ask the vet about increasing the dose.

Hang in there and know, you are doing everything you can for Darla.

Ken

[Squirt's Mom]

Hi Sarah,

How are things going with Darla? and Rascal?

You might be able to use some of the meds that are for incontinence in pups to help with the urination urgency and accidents. For the life of me I can't remember any of the names of those meds. :rolleyes::o Others here have used them so hopefully they will be able to fill in my memory.

Another thought is Anipryl to help control the signs like the urination, panting, etc.

Then there are the doggy-diapers if she will tolerate them. ;)

Like Ken said, you are doing the best you can for Darla and I know she appreciates all you do for her. Be kind to yourself as you are to your babies and remember we are here for you.

Hugs,
Leslie and the girls

[sarahbera1]

Thanks to all. I left another message with the vet on Friday and no call back today. Thinking they might not have been around due to the 4th of July, although I know they were open as they are an ER vet and open 24/7 (plus I went by and saw a lot of cars). Will keep you updated as to what he says about Darla. As for Rascal, he is doing well. Still on 1/2 prednisone every 3 days. He is drinking 2 cups of water a day as compared to Darla's 7 cups. Also, he seems to be pretty frisky with Darla lately, and she wants nothing to do with it. They took the tumor out which was producing too much sex hormone, but he seems to be following Darla around all the time trying to "get" with her.
Thanks again,
Sarah and her 4 legged babies :p

[Buffaloe]

Hi Sarah,

I think Rascal is just feeling really, really good now with that tumor out of there. He will probably continue to improve and feel even better as the months go by.

I remember very well, during Shiloh's long diagnosis, getting frustrated when vets didn't call me back. But, they are busy and are seeing so many dogs with problems.

My hope is that you will be able to get Darla on a significantly higher dose of Lysodren...like 50 mg. per kg. of Darla's body weight per day. Or, at least something in that ballpark. Like Leslie said, be good to yourself, Sarah. You did an phenominal job for Rascal and are doing everything you can do for Darla.

Ken

[sarahbera1]

So a vet tech called me back. Darla has been on the 250 mg 1x a day for 22 days as of today (Friday). Starting tomorrow I will up the dose to 750 mg 1x day and the dr. should call me Monday. Still no signs from Darla that anything is happening. Just a waiting game right now. Thanks for being a sounding board for me:D
Sarah, Darla and Rascal

[frijole]

Sarah,

Hi! I went back and saw that Darla is 21 lbs. The max recommended dosage is 50 mgs per kg of weight. You have been using 250 mgs with no luck and that is on the low side. I am curious why they decided on such a large jump. Have you had a recent acth test done to determine the cortisol level? If so, what is the current level?

21 lbs is 9.54 kgs. 9.54 x 50 mgs lysodren = 477 mgs lysodren. I could see them going to 500 mgs. since that is a pill and easy to administer... perhaps I am missing something. I know that it sometimes takes more lysodren with adrenal tumors... but having only been giving 250 I am concerned that tripling it is a huge leap.

I want to make sure that even though you have been giving lysodren for some time you are reminded of what to look for in terms of distress from getting too much just to be safe ok? (sorry but I am a worry wart!) First off - never give lysodren to a sick dog (vomit/diarrhea). Those are signs of overload. I'll put the link at the end of my message.

My dog has been using lysodren for 3 yrs now. She is 15 1/2! She did not respond quickly to lysodren and it took months and months of daily dosing and gradually increasing the amount to get her to load. She too is over the 50 mg amount but we did that because it took that strong of a dose. Because it was taking so long my vet too suggested I increase her to 750 mgs (from 500) and I just couldn't do it. I met him half way at 625 and she loaded at 1.8 if I recall not long after that. She has stayed at that level since then.

Even though you have given it to her for 2 months at 250 mgs that large of an increase could upset her stomach. I always waited to give lysodren to Haley after she had finished eating to make sure she was not loaded. I also gave it to her wrapped in cheese, cream cheese or in some peanutbutter. That helped with stomach upset from the drug itself.

Not that long ago I was out of peanut butter and she no longer takes it with cheese. I put some in a dollop of canned dog food alongside her kibbles. This worked well and it took me like 2 months to realise that she was vomiting after getting lysodren (later that day, sometimes the next). I went back to what I had always done for 3 yrs and she no longer is sick to her stomach. So even us "old timers" need reminding sometimes. :D Moral to story - always wait and give it after food and in cheese or something that coats the stomach.

Please watch like a hawk because I suspect that dosage will have an immediate effect. OK - here is the link.
http://www.k9cushings.com/forum/showthread.php?t=181

Kim

[frijole]

So a vet tech called me back. Darla has been on the 250 mg 1x a day for 22 days as of today (Friday). Starting tomorrow I will up the dose to 750 mg 1x day and the dr. should call me Monday. Still no signs from Darla that anything is happening. Just a waiting game right now. Thanks for being a sounding board for me:D
Sarah, Darla and Rascal

I just re-read this and realised you said a vet tech called you back with instructions to up dose to 750 mgs. Please call your vet and confirm that that is his/her recommended dosage and ask why the increase of 300%. We have seen before where vet techs make mistakes and I just want to be safe ok? Thanks!!!! Kim

[Buffaloe]

Hi Sarah,

I think it is good that you will be increasing Darla's dose of Lysodren. However, like Kim, I am worried that it may be too big of an increase. From all of my research, adrenal tumors sometimes need a higher dose of Lysodren than pituitary. I learned that the dose for adrenal tumors can be as much as 75 mg. of Lysodren per kg. of the dog's body weight. I checked Kim's math and it is exactly correct. If you dose Darla at 50 mg/kg, that would be 477 mg. of Lysodren per day.

This is just my opinion: I would much rather see you give Darla either 500 mg/day or 625 mg/day. You can always adjust it upward later (but I don't think you would have to.) I also think you should give it in two doses each day, morning and evening, definitely with food.

When I loaded Shi my vet wanted me to give her 2000 mg/day which was around 57 mg/kg. of her body weight. I was totally committed that there was absolutely no way I was going to give Shiloh too much Lysodren. I never told my vet but I just gave her 1750/day and she pretty much loaded in 3.5 days.

Again, just my opinion but I don't want you to give Darla more than 625 mg./day...maybe 3/4 pill in the morning and 1/2 a pill in the evening. Or, just give her 500 mg./day. Please talk with your vet about it. Bottom line, Darla is your dog and it is your decision. All the best to you, Darla and that Rascal boy.

Ken

[sarahbera1]

So a vet tech called me back. Darla has been on the 250 mg 1x a day for 22 days as of today (Friday). Starting tomorrow I will up the dose to 750 mg 1x day and the dr. should call me Monday. Still no signs from Darla that anything is happening. Just a waiting game right now. Thanks for being a sounding board for me:D
Sarah, Darla and Rascal
Sorry, my mistake the amount is 375 mg. Too much going on here :rolleyes: Anyway, the vet tech called me back after she talked to the vet and said up to 375 mg. My vet is at a conference until Monday, he will call me on Monday. I do give her meds in cheese and after she eats, no signs of distress as of yet.
Thanks,
Sarah

[lulusmom]

Hi Sarah,

Did your vet do an acth stim test before determining to up the dose or is he going by your reports of no changes in behavior? I ask because adrenal tumors are extremely resistant to lysodren and usually a vet will initiate treatment at no less than 50mg/kg and that dose is usually split into twice daily dosing. 375mg is 39mg/kg which is still below the normal 50mg/kg that is usually prescribed for a dog with PDH and I am not sure that loading won't continue to drag on at this low dose. Usually a stim test is done after 10 days and if very little to no change in the post stim number, then the dose is increased substantially. Again, if very little change after another 10 days, the dose is increased again. According to what I've read, some dogs have required between 100mg to 150mg which are some pretty scarey numbers but that's coming from experts like Dr. Edward Feldman and Dr. Johnny Hoskins. Without the benefit of a stim test at every 10 days, I am not sure how your vet is determining an appropriate change in dose. :confused: Perhaps I've missed something, which is entirely possible as I can be a putz sometimes.

Glynda

[sarahbera1]

No ACTH Stim test has been done. 22 days at 250 mg and 2 days at 375 mg. He will call me tomorrow when he is back from his conference. I will talk with him about everything then and we will decide what is next. Darla is still drinking, urinating and eating a lot. She might have slowed down a very very tiny bit in eating, but it is hard to tell. I will talk to vet and we might go ahead with the test. I'll keep you updated. Thanks.
Sarah and her 4 legged babies:D

[frijole]

Sarah, one of the reasons for doing the acth is to chart progress and determine changes in dosing. It helps you know where you are and you can better get a gut feel for how much longer. I would insist on one. Compare the number of this test to the number of the original test.

As Glynda said, since it is an adrenal tumor I am surprised the vet didn't up it to 500 mgs. However without a test I am glad he didn't. Better safe than sorry. Wishing you all the best.

Kim

[sarahbera1]

ACTH test on Friday, will update with results;)
Sarah

[frijole]

Cool and thanks. Good luck! Kim

[sarahbera1]

The ACTH test done a 1 1/2 weeks ago was still way out of whack. They upped Darla's dose to 500 mg 1x day. She has been on it for about a week. Yesterday she didn't eat all her food in the a.m. or p.m., but this a.m. she ate all her food. I called vet yesterday and a tech called me back today, she said keep on same dose and dr. will call tomorrow. She still doesn't look/act "normal" and she is having accidents in the house. I will see what the dr. says tomorrow.
Sarah and Darla :)
P.S. Rascal is doing great, still on Pred. (for at least another month or two)

[lulusmom]

Hi Sarah,

Can you please get the results of all acth stim tests done since Darla started taking Lysodren and post them here? Thanks.

Glynda

[Squirt's Mom]

Hi Sarah,

The added meds may be making her feel ucky for now but if she continues to seem "off", do get in touch with your vet. I hope you will start to see some improvements with the increase.

Hugs,
Leslie and the girls

[Harley PoMMom]

Hi Sarah,

I can't help you with Darla's Lysodren, but concerning the accidents in the house, with Harley I use the puppy house-training pads. He's been doing pretty good here so far, but when he was having accidents in the house all the time, I would just lay them around, he would use them consistently.

So glad Rascal is doing great, and like Leslie said, I'm hoping too that you will soon see improvement with Darla.

Hugs to you all.
Lori

[sarahbera1]

So Darla went in for her ACTH Stim test on Fri. 7/31 & urine test. Will have results Monday. Vet thinks her urinating is a "behavioral" problem. I say no. It's the meds, but he is doing a urine test to see if it is really dilute or not. Things are getting frustrating with Darla. If her results are out of whack again, I don't know what I will do. I think they will be better though, if not right where they need to be. I'll keep you posted. Oh, by the way, she has had Low dose dex test and ACTH Stim tests done and I am a little confused as to what the difference is. My regular vet tried to explain it to me the other day. She had a low dose dex test done on 5/22 and that level was out of whack. The pre injection was 5, after 1st draw was 5 and after 2nd draw was 6, I guess they should have gone down. I don't know what "normal" is for that. Normal for ACTH according to the ER vet (who is treating Darla now) is between 5-20. So confusing.
Thanks for listening:confused:
Sarah & Darla

[Roxee's Dad]

Hi Sarah,


Oh, by the way, she has had Low dose dex test and ACTH Stim tests done and I am a little confused as to what the difference is. My regular vet tried to explain it to me the other day. She had a low dose dex test done on 5/22 and that level was out of whack. The pre injection was 5, after 1st draw was 5 and after 2nd draw was 6, I guess they should have gone down. I don't know what "normal" is for that. Normal for ACTH according to the ER vet (who is treating Darla now) is between 5-20. So confusing.



Many of us have been confused by all the different testing so try not to get too frustrated. There is a great link in our resources section that explains the different testing and desired results. ACTH, LDDS, UCCR etc...

Here's a quick link to it:

http://www.vin.com/proceedings/Proceedings.plx?CID=WSAVA2008&Category=3873&PID=23850&O=Generic

Still looking forward to you posting Darla's tests and results.

[sarahbera1]

I'm more confused than ever. Talked with vet tech and Darla's ACTH Stim test results are not good; Pre test was 7.1 and post was 16, on 7/17 she had an ACTH Stim done and results were about the same; Pre test was 8.2 and Post was 15. She has had 11 tests done (ACTH and Low Dose Dex) since 9/15/08. Vet suggested to keep her on the 500 mg and I can either do 1x day again or go every other day. I had her tested because she stopped eating all of her food, they think the high dose of the medicine might have irritated her GI track. So they suggested 1x every other day to see if she will eat normal while still on meds. How high of a dose can you go w/Lysodren? If and when she gets on a maintenance dose, does this stop the tumor from growing; or will it keep growing and just eliminate the symptoms? I guess these are the questions you have when you talk to the vet tech and not the vet. I know he is busy, but I seem to have more and more questions. I'm treading in new waters here and I don't feel very comfortable/confident with the decision(s) I'm making with the info I have. When do you say "enough is enough"? Vet tech said you will know when she is uncomfortable because "she won't participate in her normal activities". Well she is a Jack Russell, but very calm-she is a lap dog and doesn't do much anyway. I will call the Vet tomorrow and see if I can get a hold of him personally.:confused: So glad you guys are here. I'm just trying to make her feel as comfortable as possible, but I don't know if it will happen.
Thanks,
Sarah

[Gabrielle]

I'm so sorry to read about Darla's diagnosis, but so happy to read about Rascal! I know he will continue to improve month by month and soon be back to his healthy, happy self.

Good luck and God bless.

[Buffaloe]

Hi Sarah,

I'm sorry to hear that Darla's cortisol levels are not coming down with the higher dose of Lysodren. Adrenal tumors are just so difficult. There are at least 7-8 different kinds, each produces different patterns of hormones (aldosterone, progesterone, etc). Some produce lots of excess cortisol and some not so much. Some are malignant, some are benign. Sometimes Lysodren relieves the symptoms effectively. Unfortunately, some adrenal tumors tend to be resistant to medical therapy whether it be Lysodren, Trilostane or Ketoconazole.

Next time, instead of doing a regular stim test you could do an ACTH/full adrenal panel with the U. of Tennessee. You would get your cortisol readings but would also find out how much of the five hormones the tumor is producing. The more you know about the functioning of the tumor the better, I think.

Yes, I think you should try to speak with the veterinarian. Sarah, you're doing the best you can. So glad Rascal is doing so well and Darla is in my thoughts and prayers.

Ken

[ladysmom06]

Hi Sarah,

I'm sorry that the extra lysodren is not bringing Darla's levels down. I don't have any advise for you - we used trilostane - but I'm hoping you can talk to the vet and get some answers. Sending prayers and positive thoughts for Darla. Happy that Rascal continues to do well. Hugs to all of you.

[Roxee's Dad]

Hi Sarah,


She has had 11 tests done (ACTH and Low Dose Dex) since 9/15/08.

Of those 11 test, how many of those test were LDDS? Seems you would only need one of those as the LDDS is not used to evaluate response to therapy.

I really agree with the advice given previously to have a UTK panel performed as this is considered the gold standard for a proper and thorough diagnosis.

[sarahbera1]

I would have to look at all her medical records to see which ones were the Low Dose Dex vs. the ACTH Stim. I put Darla on the 500 mg of Lysodren 1x every other day (for about a week). I took her off the meds Tues because she still wasn't eating well. Still haven't spoken w/the Vet, so I decided to take her off the meds myself. Want to talk w/him about other drugs and many other things, so hopefully we can touch base today:) Meanwhile she doesn't look good, not the Darla I know. We will see what happens in the next week or two. I have a 8 and 9 year old running around the house and a baby who just started crawling, working full time and taking care of the house. It's hard to deal w/a Cushings dog, especially when she is not responding "like a typical Cushings dog" (she's not follwoing the rules...as the vet tech said). I think I'm going to have to put a time frame on this and see what happens or we might have to make a decision I'm not ready for.
Sarah & Darla

[Squirt's Mom]

Hi Sarah,

I am so sorry that Darla is having such a difficult time. I am also sorry that you are having to entertain these thoughts for her future. :( Please know we are here for you and will support you what ever the days ahead hold for you and Darla. Hold her close and love her dearly as long as you can.

Hugs,
Leslie and the girls

[lindyandkim]

Hi Sara,
I really feel for you with your full plate and it sounds like you are handling it beautifully, as well as can be.
For us, when Lindy got in bad shape, it helped both of us to lay low and not try to figure things out or fix it. Just give her as much love and massage and quiet rest as we could. My regular vet was good at stand by questions about hydration and food in just getting Lindy through those couple weeks.
Hugs and good thoughts to your pups.
Kim

[sarahbera1]

Finally s/w my vet Friday and he gave us a few options. 2 meds, Trilostane or Ketoconazole, do nothing, surgery, euthanasia now or percutaneous ethanol ablation. I am done with the medicines. Darla isn't doing well and I can't wait and see if this med. works, or that one or another one, all the while seeing her the way she is. She might not be in pain, but I now she is uncomfortable. Anyone hear of percutaneous ethanol ablation? Not me, but I have decided to opt for that one. Don't know really anything about it, except they inject ethanol in the tumor to stop it from secreting the hormones. Supposed to do the same thing the meds do. Scheduled for 8/28, so I have some time to do some research on it, and opt out if need be. If anyone out there has heard of this or has had it performed on their beloved one, I would love any input you have.
Thanks,
Sarah & Darla

[AlisonandMia]

Are they talking about doing this to the primary adrenal tumor or to the presumed secondaries in the liver - or both?

Just did a little Googling and found this: http://www.ajronline.org/cgi/content/full/174/4/1031. It is a human case, concerning an adrenal tumor in a 78yo woman and it also gives some background on the procedure.

Have they given you an idea of the risks -v- benefits? I've never seen a case here where it has been done but it does sound like a good option in Darla's case.

Good luck and keep us posted.

Alison

[sarahbera1]

Has anynone used Cushex Drops, a natural remedy? Thinking of this instead of the injection.
Thanks,
Sarah & Darla

[muskyhusky]

Has anynone used Cushex Drops, a natural remedy? Thinking of this instead of the injection.
Thanks,
Sarah & Darla

No, I've seen them advertised on the internet though, I was always afraid that it would make things worse instead of better.

[Roxee's Dad]

Hi Sarah,
Regarding Cushex drops, I have inserted a quote from Glynda. Nobody is against natural remedies but most of us would like to see proven results. There have been a few that went the natural route but have not or will not have any test (ACTH) to prove that it has lowered the cortisol levels.


Hi Felice,

I am the member that wrote to PetAlive, as well as other companies claiming to have natural remedies that are effective in treating cushing's. None of these companies have done any testing to prove their claims. PetAlive ignored my very direct question about testing and provided a list of wonderful things their natural remedy would do for my dogs. They also mentioned that it is safe to use with conventional treatment. Well duh, the point of my email to them was to ask them to provide supporting documentation that their product's efficacy would allow a pet owner to avoid conventional treatment. It is pretty disturbing that these people get away with such blatant fraudulent advertising.

Pet owners with cushdogs, especially those new to the disease, are overwhelmed and very vulnerable which makes them huge targets for these unscrupulous companies. I would suggest that any member that is contemplating treating with anything other than conventional treatment, to do their own research and ask questions of any company that claims to have an effective treatment for cushing's. It is only effective if clinical trials have been done to prove its effiicacy by way of acth stimulation tests, low dose dexamethasone suppression test, urine cortisol:creatinine ratio, etc.

Glynda

[labblab]

Dear Sarah,

I know you are faced with some tough decisions right now, and my heart goes out to you as you weigh your alternatives. However, I just wanted to point you in the direction of this recent conversation here re: Cushex drops. As you will see, it is not a positive endorsement.

http://www.k9cushings.com/forum/showthread.php?p=4711&highlight=Cushex#post4711

I do hope that you will be able to arrive at a treatment decision that you feel comfortable about.

Marianne

P.S. I see that John and I were posting at the same time, and that he has given you a quote from the link that I included above. Sorry for the duplication of effort!

[Buffaloe]

Hi Mary,

I sure don't understand why the Lysodren is not lowering Darla's cortisol level. Personally, I would not even consider the cushex drops. I think that trying Trilostane would be a viable option, it works in a completely different way than Lysodren. The injections really do sound pretty promising but I don't know hardly anything about them.

I don't know what % of functional adrenal tumors secrete excessive amounts of aldosterone...way less than half, I'm sure. But if, by chance, Darla's tumor is producing lots of aldosterone (symptoms would be hypertension and low potassium/high sodium) there's a medicine to effectively counter-act the effects of the elevated aldosterone. I recently posted to Nellie's mom about this. If Darla is not suffering from high blood pressure/electrolyte imbalances, then her aldosterone levels are probably fine.

I would hope that I have the courage to follow this course of action with Shiloh near the end: If she still seems to be enjoying being alive I'll keep her going. Even if she's somewhat uncomfortable and in a little pain, if she is still finding some joy in life I will definitely keep her going. If I'm not sure, I'll keep her going. But if she's definitely uncomfortable, in pain, not happy, and not showing me she finds some joy in life then I gotta have the courage to let her go. If in doubt I'll keep her going. But I'm committed to never letting Shi suffer very much. I know, talk's cheap but that is my gameplan.

All the best to you, Darla and Rascal.

Ken

[Squirt's Mom]

Hi Sarah,

How is Darla today?

Hugs,
Leslie and the girls

[gpgscott]

Hi Sarah,

I have no personal experience with the ethanol ablation but I am familiar with other forms of ablation. I have done some quick research on the ethanol ablation.

It sounds like a very good procedure. There may be less chance for a total disabling of the tumor vs. surgery but the costs and risks also seem to be reduced, and I think greatly based on my limited research.

The questions I would want answered is how far does the ethanol migrate upon injection and what range of tissue outside of the injection site is damaged. How do you protect the major blood networks in the immediate area from damage by the ethanol.

This seems to be a very good alternative to surgery. I will be very interested to learn more.

Best to you all. Scott

[sarahbera1]

Spoke with Vet Tech the other day and she explained most of the procedure to me. I am definately going forward with the procdure. Dr. will call me next week after his vacation to discuss my other questions. Bottom line, will have almost same results as surgery, with out the cost or invasive procedure. 8/28 is the date and I'll update you all how it goes.
Thanks,
Sarah & Darla

[sunimist]

Hi Sarah,

My heart goes out to you and sweet Darla. I pray the procedure you have chosen works for Darla. I know very little about this procedure, but I must say that all I have read and heard (which isn't a lot), the ethanol ablation sounds very promising for conditions such as Darla's. We will be following very closely and rooting for you. :)

Best of luck for complete success and lots of hugs to you and Darla.

Shelba and Suni

[sarahbera1]

Thank you!
Sarah & Darla :D

[Roxee's Dad]

We will be following very closely and rooting for you

Me too.

Keeping both you and Darla in our thoughts and prayers.

[sarahbera1]

Hey, thanks. The big day is tomorrow. Didn't talk w/the vet again, but tech left me a message and we will talk tomorrow a.m. before the procedure. Everything sounds good though, vet isn't worried about side effects, really the only one would be intoxication.... ha ha!!!, which would need IV fluids to counteract. I 'll keep you posted.:)
Sarah & Darla:D

[Squirt's Mom]

Hi Sarah,

Waiting on pins and needles for the report on Darla today!

Sending prayers and healing thoughts your way,
Leslie and the girls

[SaxLady]

Hi Sarah,
How is Darla? We hope all went well and will send healing and prayers.
Candy

[sarahbera1]

Hello everyone,
Darla did very well and is home. We will hopefully see good results w/in a week. Meaning....less drinking=less accidents, & decrease in food consumption. I do have to watch out for bad results, she might start to exhibit signs of an Addisonian dog. I will watch closely for that. The vet gave me Prednisone to counter act that. Will call the vet in a week with an update and we will decide what the next step is, what tests to do, etc. Thanks for all the prayers!!
Sarah & Darla :D

[frijole]

Wonderful news. Thanks for the update. Hugs to you both! Kim

[Squirt's Mom]

Hey Sarah,

I am so glad to hear that Darla is home and the procedure went well. This is very interesting to me as I had never heard of it before. So I am learning from you and Darla - and I love to learn! That's why I can't seem to stop taking courses of one kind or the other....I have become a professional student. :p And I get to look to you and Darla to instruct me this time. :)

I know you will keep a good eye on her and will take the appropriate action if needed. It is good to know your vet sent you home with pred! I am impressed!

Prayers and positive thoughts continue,
Hugs,
Leslie and the girls

[nelliesmom]

Hi Sarah, I'm Mary. My Nellie has an adrenal tumor also. I am very interested to learn more about the procedure you had done. She has done well on trilostane for the last 2 1/2 weeks (appetite, thirst & urination) but now seems to be having some side effects. One of the reasons I am not inclined to do surgery is the cost involved. Please let me know more about how your pup is doing since the procedure.

[sarahbera1]

O.k., so Darla is still the same, but it has only been 4 days. Still drinking like crazy and eating like there is no tomorrow. She was eating moths lastnight outside. More accidents in the house. Will call vet Fri. to update him. On the other hand, Rascal has 8 more doses of Pred then he is done. He is doing great after his surgery.

Mary,
Rascal, my other dog w/Cushings, had a left adrenal tumor and had surgery a few months ago. He is doing great. We are just waiting for his right adrenal gland to kick in and then he will be "cured." Like I said only a few more doses of prednisone left than we will have his levels tested and hopefully they will be normal. The surgery was quite expensive, and there is no guarantees, as you know. Hope this helps you.

Sarah, Darla & Rascal

[Buffaloe]

Hi Sarah,

I did quite a bit of reading about the ethanol ablation procedure and it does sound very promising. It makes alot of sense. It sounds like it may take around a week to start seeing the positive signs. You and Darla are in my prayers; it is time you both caught a break. I'm hoping Darla's moth eating days are over in a few more days and she starts feeling a whole lot better.

Ken

[gpgscott]

Hello everyone,
Darla did very well and is home. We will hopefully see good results w/in a week. Meaning....less drinking=less accidents, & decrease in food consumption. I do have to watch out for bad results, she might start to exhibit signs of an Addisonian dog. I will watch closely for that. The vet gave me Prednisone to counter act that. Will call the vet in a week with an update and we will decide what the next step is, what tests to do, etc. Thanks for all the prayers!!
Sarah & Darla :D

Sarah,

Very sorry to have missed this post and hoping my late response finds both you and Darla well.

I would be very interested in everyting you can tell us about this procedure. I am sure you know it is not commonly done, you are the first member who has been through it.

Very best to you all. Scott

[sarahbera1]

It doesn't look like the injection procedure worked for Darla. Called the vet and he left me a message about my options....surgery, Triolstane and another drug (which escapes my memory at the moment). Anyhow, I called him and am waiting for a call back. Doesn't look good at this point. I already said no surgery and I don't want to give her anymore meds as it really doesn't seem like a good idea in my eyes. She has already been through so much and I just can't put her through major surgery knowing she doesn't have a good chance (and knowing that the tumor is growing, not rapidly, but still growing). As far as the meds go, I don't even know if they will work and I can't see myself putting her through dose after dose to find the right dose and the right med, and there is no guarantee that we will find it. Hopefully I will talk to the vet this week and see..... I already have given myself a time table with this and it is fast approaching and really looks bleak.

By the way, Rascal has I think 4 more doses of Pred left than he is done. I guess the next step is to get his levels checked. He is doing really great!

Thanks for being a sounding board
Sarah, Darla & Rascal

[Buffaloe]

Sarah,

I am so dissappointed the ablation procedure didn't seem to help Darla. I do think Trilostane has a possibility of helping Darla as it works in a completely different way than Lysodren or Ketoconazole.

Please hear me out on this one. I didn't see that you ever had the Tennessee adrenal panel done on Darla although I may be mistaken. One of the 5 sex hormones is aldosterone. If Darla's tumor(s) are producing excessive amounts of aldosterone, she would be suffering from hypertension. She would also likely have low levels of potassium which is a serious problem, sometimes life-threatening. Lysodren has very little chance of lowering aldosterone because it is produced in the inner part of the adrenal glands. I don't think any drug will effectively lower aldosterone levels but spironolactone will very effectively counter-act the bad effects of high aldosterone. I think spironolactone is a pretty innocuous drug and it is cheap. There is a very reasonable chance that Darla is suffering from high levels of aldosterone. Shiloh's adrenal tumor (surgically removed in 2006) produced very high amounts of aldosterone. If I would have treated it medically I would have positively put her on spironolactone.

I hope you will discuss putting Darla on spironolactone, IMO even without an adrenal panel. I don't think there is any reason for any dog with an aldosterone producing adrenal tumor to suffer from the terrible effects of high aldosterone. Dr. Oliver (Tennessee) and my surgeon both spoke with me about the neccessity of using spironolactone if we decided to treat Shi's tumor medically.

I hope Darla is hanging in there and at least feeling OK.

Ken

[gpgscott]

Sarah,

I am very dissapointed also to learn that the ablation treatment seems to be ineffective in Darla's case.

Ken makes some very good points and Dr. Oliver is very responsive to email, maybe your Dr. would be interested in hearing his view. Joliver@utk.edu.

Thanks for the Rascal update and hope the testing supports his behavior.

Best wishes. Scott

[Harley PoMMom]

Hi Sarah,

I too am sorry that Darla is not improving with the ablation treatment.

Altho I have no words of wisdom to share with you, I did want to reconfirm what Scott has said about Dr. Oliver. Harley's vet has talked with him and I must of emailed him...well alot of emails...and he is very prompt and very courteous...such a wonderful man. I do hope your vet decides to communicate with Dr. Oliver.

So glad Rascal's doing so well.

Best of luck to you, Darla and Rascal.

Love and hugs.
Lori

[sarahbera1]

I spoke w/both vets today and have decided to euthanize Darla on Th. 9/24, that was the earliest appt. at my personal vet. I know in my head it is right but my heart is telling me something different. Everyone says I'm doing the right thing but I feel like I'm letting her down and giving up on her. I'm very upset about the whole thing and am in tears whenever I think about it or see her. She had a good life.
Sarah, Darla and Rascal

[Harley PoMMom]

Sarah,

This is one of the hardest decsions, and the one we most dread making for our furbabies that we love so very much. But we know there may come a time when we will have to make this choice so our furbaby can be free of the pain and suffering that this terrible disease has inflicted upon them. You are not giving up on Darla, you, my dear are setting her free. You have done everything humanly possible for her.

My heart goes out to you at this very difficult time, and please know that I understand how you feel.

Love and many hugs.
Lori

[BestBuddy]

Sarah,
Sometimes the hardest choices are the right ones. Give Darla some extra special loving.I will be thinking of you.
Jenny

[MiniSchnauzerMom]

Sarah,

I'm sorry that Darla did not improve with the treatment she received. I know all too well about that conflict of head and heart....it's a tough place to be in. Your decision is neither "letting her down" or "giving up" on your girl. This is a decision that evokes a multitude of overwhelming feelings and it is not an easy one, but it is definitely a decision that is made out of love for your Darla. This may sound strange....but hug her, love her and tell her how you feel, it will help.

Holding you and Darla in my thoughts.

Louise

[Buffaloe]

Hi Sarah,

What a difficult decision you have had to make. When we make the decision to get one of these wonderful creatures, we know at some point we're going to have to deal with this, one way or another. It is hard to imagine when they are so young and wild. If and when I get to the pearly gates, I think I'll have to ask God why he gave us these amazing companions but with such short lifespans. Then again, I suspect we'll understand when we get there.

You have gone way, way, way beyond the call of duty in taking great care of Darla. She is a lucky girl and I know she has lived a great life. You are not the only one in tears about this. I am so glad you still have several days with sweet Darla and I'm thankful that you have Rascal. I'm sure he will help you alot during these rough times. Darla knows she has always been deeply, deeply loved.

Ken

[labblab]

Dear Sarah,

Although I have not posted to you before, I have been following your journey and had high hopes for Darla's treatment. I am terribly sorry that it has not turned out to be the solution that you had so wished for. I can only imagine how painful these next few days will be for you, but I am hoping that you will somehow find peace in your decision and be able to fill these final hours with love.

We are here with you now, and we will stay here with you. Please come back at any time over these next few days, and beyond. I will be thinking of you and your sweet Darla especially on the 24th. May you find comfort in knowing that you will be releasing Darla's spirit from a body that is failing her. Your loving connection with one another will change, but it will never end.

Many (((hugs))) of strength and comfort to you, and to Darla and to Rascal as well~
Marianne

[sarahbera1]

Had a heart to heart with Darla on Sat. I think it helped me...she just sat there as I talked. Awful place to be in and I know many of you have been there. I'm glad I found this site, it has helped me tremendously. At least she will be out of pain and able to run and roll around w/out hurt. I will always remember her sunbathing, laying like a sprawled out frog in the grass :) Thanks for your kind words it does help as the time draws near :(

[MiniSchnauzerMom]

Sarah,

I'm so glad you had the heart-to-heart with Darla, I knew it would help. I know you're in a very painful place and surely do wish I could help relieve that pain but also know it just doesn't work that way. Grief takes it's own time. I will, however, "be here" with my cyber ear to listen and my cyber shoulder for crying on.

Take care, Sarah and could you tell Darla that Louise is sending some extra love and kisses for her.

Louise

[labblab]

Dear Sarah,

I want you to know that I am holding both you and Darla in my heart today. May Darla's release be calm and peaceful. Without a doubt, she will know how much she has been, and always will be, loved. I wish you strength and comfort on this most bittersweet day. Sarah, please return to us whenever you are ready and able, so that we can join you in honoring Darla and all that she has meant to you.

With (((hugs))) of comfort and peace to you and your sweet girl,
Marianne

[mytil]

I too wanted to let you know we are all here for you. We have been through the same decisions and it is not an easy one to make on one hand, but it is the promise we make our furbabies.

My heart is with you today and the coming weeks and months. Please do stay with us.
((((hugs))))
Terry

[Harley PoMMom]

I, too, wanted to let you know that you and Darla are in my thoughts and prayers today...and always.

Love and (((many hugs)))
Lori

[Squirt's Mom]

Dear Sarah,

My thoughts and prayers are with you, Darla and Rascal today as you fulfill the most difficult of promises to keep.

Hugs and tears,
Leslie and the girls

[frijole]

I too am thinking of you and sending out hugs. Kim

[Roxee's Dad]

Keeping you and Darla in my thoughts and prayers today. My heart hurts for you today.

[sarahbera1]

Darla has passed on. Thank you for your kind words. It was a very difficult decision to make, but none the less the right one. Although it doesn't make it any easier. I sit here alone in my basement trying to come to grips with this, all the while typing and the tears are flowing. Somehow I thought it would be easier than it is, I guess I was delusional. I miss her terribly, even though I know in my mind she is in a better place and not in pain. I just feel like I gave up on her and keep wondering, "what if"...what if I did this, what if I tried that. I hope she knows I love her and I only wanted what was best for her and didn't want her to suffer any more. I told my girls on Thursday. I debated if I should or not, they are 7 and 9. I did as I thought they could say goodbye to her that day before we took her to the vet. We have decided to have a memorial service for her next weekend. My girls wanted a funeral, but we don't have her body nor do we have her ashes. I could not bring myself to take her body home to bury it. I wasn't sure about getting her ashes, but we decided not to. I clipped some of her fur and will make a memorial plaque with the fur and pics of her and the kids. We will place it out at the end of her run she was always on. They need some sort of closure and I guess I do to. Rascal seems ok now, although it has only been a couple of days. I know he will miss his sister and is wondering now where she is. I'm trying to really make an effort to be with him and spend time with him. I posted new pictures on my profile, please take a look at them. She was a sweet dog and I will miss her. As time goes on I'm sure it will get easier to grieve, but for now it is still very fresh. I try not to think about it, but that never works. I am trying to be strong for my girls, they seem to be doing fine (kids are resilient), better than me. I will post more when I am able. Thank you all for being there for me.
Sarah, Rascal and Darla in spirit

[Tamarah]

Sarah -

I'm so sorry for your loss. It's always seems hardest on the ones they leave behind. Don't ever doubt that Darla knew how much you loved her. My thoughts and prayers are with you! Extra special hugs and belly rubs to Rascal too.

Tammy, Crash, and Darby

[Squirt's Mom]

Dear Sarah,

My heart aches for you. I can imagine the pain you are feeling but please do not let yourself take on any guilt. You did all you could for Darla and she knows that, honey. You went looking for help when you knew what she was facing, you have taken every step you could to give her the comfort in life she deserved, and when those steps failed you kept your promise and set her free from her suffering. Someone here once said that we take on this pain so our babies no longer have to hurt. What greater act of love can there be?

Darla is carefree, happy and whole once again...just as she was always meant to be. She knows how much you love her and will be watching over you as you watched over her.

Please know we are here for you anytime. Darla's name has been added to those here who have gone before this year where she can always be remembered and honored by her K9C family.

Our deepest sympathies,
Leslie, Squirt, Ruby, Goldie and Crystal

[labblab]

Dear Sarah,

My heart aches upon reading your post. Your words take me right back to the first days after my husband and I released our cushpup, Barkis. Like you, I had hoped and prayed that I would feel some peace upon keeping him from suffering any further. But instead, my pain only shifted and deepened. I missed him more than I could have imagined, and there was no peace. Only self-doubt and questioning. Had I done the right thing? Should I have done more? With time, the pain eased. And finally, the peace did come. But it is not easy, and the peace will only arrive in its own time.

I tell you this in the hope that you will not feel alone. Without a crystal ball, we can never know how things might have turned out differently. But I will tell you what my family kept telling me. You made your decision because you did not want Darla to suffer. You did the best you could with what you knew and with what you felt in your heart. And you made your decision out of love for Darla. I am certan that she knew how much you loved her. And now, even though you are in pain, she is at peace and will never suffer again.

I am so glad you've posted your new photos of Darla and Rascal. What sweet babies, the both of them. This way we can help you honor and celebrate them both.

Many (((hugs))) to you, Sarah. Please stay with us and continue to tell us how you are doing. This is such a tough time. Hopefully we can help a bit by being here to walk alongside you.

Marianne (forever Barkis' and Peg's and Luna's mom)

[nikkismom]

Sarah, I'm sorry I have just caught up with your story of Darla, but my Nikki died September 8 and things are not normal yet and won't be for a while. But I do want to say how sorry I am for your loss of Darla. You did as much as you could. Sometimes, there's nothing else we can do but end their suffering. Although I know I did the right thing, I still walk around in a daze sometimes and feel so lost. Nikki was diagnosed in October and I can't really say she got alot better. But I don't regret anything because I did the best I could and so did you. Hang in there, it will get better. My thoughts are with you. Sharon

[BestBuddy]

Sarah,

There are no words to make you feel better it will just take time. Darla is now free from pain and illness. Remember the good times.

Godspeed Darla.

Jenny

[sunimist]

Dear Sarah,

My thoughts and prayers are with you for peace and understanding as you fight the guilt you are feeling. I honestly think we all have to deal with a fair amount of guilt with the "what ifs" and "maybes" before we can move on to find the peace we so desperately crave. I know I did.

I count it a blessing to have known your precious Darla but I know she is at peace now. Her sweet spirit will always be your shining light.

Be kind to yourself, and I hope you continue to check in with us.

(((HUGS)))

Shelba and Suni

[MiniSchnauzerMom]

Sarah,

I am sorry for your loss. You have lifted the weight of illness and suffering from your sweet Darla, this was not giving up...this was love.

Peace sweet Darla,

With sincere sympathy,
Louise

[Dollydog]

Hello Sarah,
I'm sorry to hear of your loss. I've just been checking out your thread this morning after reading of Darla's passing. There are so few words to help with what you're feeling now.
I let Lady go on Sept. 9/09....life had become such a burden to her. There was some initial relief and now there's just the grieving. I have guilt for carrying on too long and guilt for letting go too soon. :confused: And there's the terrible feeling of loss....
Please be kind to yourself and I'm glad that you have so many other beings in your life that need you now...they will help with the passage of time,
Jo-Ann & my Dollydog angel :)

[SaxLady]

Sarah,
I am so sorry for your loss of sweet Darla. Perhaps my little Katrina was there to meet her as she crossed the bridge.
Candy

[k9diabetes]

I am sorry to read of Darla's passing. I know even when it is the right thing to do it is never the easy thing to do and that doesn't even get to the going on without them.

Natalie

[Barney's Mom]

Sarah, I am so sorry to hear of Darla's passing. It saddens me to know how much your heart is breaking and I hope you are able to find peace soon. You and your family are in my prayers and in my heart.

Cheryl

[frijole]

Sarah, I join the others in sending my sympathy to you and the family. You have been thru a great deal with 2 sick dogs. Hang in there. Hugs, Kim

[John II]

Dear Sarah,

My thoughts and prayers are with you.

[Buffaloe]

Hi Sarah,

I thought if I waited a few days to write this I'd be able to do it without tears but I was wrong. Thank you for the pictures of Darla. She is one of God's precious creatures, her spirit will live forever and I have no doubt that you will be with her again.

I think it is pretty clear that Darla had a bad adrenal tumor or tumors. That was my opinion way back in June. The Lysodren worked well for quite a while, then it just wouldn't do the job. Even the ablation procedure didn't help and surgery was not an option. You did everything you could possibly do for Darla. We feel so totally responsible for our dog's well-being...we always feel some guilt at the end. We think we should have done something sooner or something different. You did everything you could have possibly done for Darla.

The pain is probably going to go on for a while. But what a gigantic blessing it is that you have Rascal and he is a cured boy. I hope you will always keep that in mind. Be good to yourself.

Ken

[corgipallie]

Sarah,
I don't think I've posted on your thread but I just saw about Darla's passing. I'm so sorry. I wish I could offer you more comfort. We are all here for you.
l lost my Pallie 7 1/2 weeks ago. I hope you can find comfort in knowing you did all you could for her and that you had the opportunity to say goodbye.

((((((((hugs))))))

Steph, Apollo and Pallie from heaven

[sarahbera1]

I have to thank you all for your thoughtfulness and kind words. It really helps knowing that you all understand what I have gone through with 2 Cushings dogs and what I'm going through now with the loss of Darla. I have to say that it took about a week before I could almost read all the posts here without crying. One day at a time I say. My kids seem to be doing fine, I'm the one that is a mess. I can't believe that she was with us for 10 years, than one day she is gone forever (although she will live in my heart always). The memorial service for her is Sunday afternoon. It might sound weird but it it's something I need to do. So, Rascal seems to be doing o.k. I know he is wondering where his sister is. They were together 24/7 for the past 10 years, and then for her to be gone one day must be surreal. He was having some eating issues, but I think it is a little bit of depression and being picky as I gave them both dry kibble and moist food the last 3 nights before Darla passed. I think he might be holding out for that. He eventually eats, but I have to stand there over him and make him eat. I still have to watch out for signs of an Addisonian dog as he stopped his pred. last Friday. But it was such a low dose, that I and the vet don't think it will be a problem. Other than that, he is doing fine. Now we all have to adjust to life without our sweet Darla. Thank you so much for being there for me to talk to and ask all kinds of questions. I'm so glad I made it to this site. When I went to the memorial page and saw all the dogs who have passed in 2009, my heart just sank. I know they are all playing together, pain free and happy as can be :)
Sarah, Rascal and Darla in spirit

[labblab]

Dear Sarah,

I will be thinking of you all on Sunday afternoon! I believe the memorial service is such a good idea. Nothing changes the pain, but I do think that there is a comfort that comes from rituals such as these, for they give us the chance to honor how much our pups meant to us, and always will. It marks an unbroken circle of love and remembrance.

I am so glad that you have come back to check in with us once again. I am hoping that you will continue to stay with us, Sarah.

Many (((hugs))) in honor of Darla and her service on Sunday,
Marianne

[Dollydog]

Hi Sarah,
There is nothing weird about the memorial service or your need to do it. With all the little things I'm doing in the last 3 weeks, I get a little bit more closure and a little more peace.
I still have problems with our beloved ones being here one moment and then gone the next. Lady was with me for 13 years....:confused: She's pain free and now I need to work on me being like that!!

The memorial service will be a great way for your kids to see how the grieving process can be handled with dignity and compassion for themselves and others.
Jo-Ann & my Dollydog Angel :)

[labblab]

Dear Sarah,

Thinking of you and your family today as you honor Darla with your memorial ceremony...

Many (((hugs))) to you all, and both a smile and a tear at the thought of Darla joining my beloved Barkis at the Bridge...
Marianne

[Harley PoMMom]

Dear Sarah,

I am, also, keeping you and your family in my thoughts and prayers today as you honor Darla with your memorial service.

Love and many hugs.
Lori

[sarahbera1]

Thank you all. The service was nice. I went tearied eyed when I was reading a poem and had to have someone else read it. Miss her terriably (more than I thought). I know she is happy and pain free. Like someone posted here said "I am taking on her pain now so she can be pain free". You all have been so kind. I will check in every now and then and update you on my Rascal boy. He is eating better now, but he seems lonely (or am I reading too much into his behavior). Well wishes for all the Cush pups out there and their families :)

Sarah, Rascal and Darla in spirit

[gpgscott]

Hi Sarah,

I am sure Racal is still remembering his companion. I am sorry I missed your earlier posts and am just reading this morning about the last couple of weeks.

Making the decision to help one on in the end of their journey is probably the toughest one any of us have to make.

Best to you and your family.

Scott

[labblab]

Dear Sarah,

I'm so glad to hear that you plan to keep checking in here with us. I also want to invite you to please feel free to start a new thread for yourself on our forum, "In Loving Memory (http://www.k9cushings.com/forum/forumdisplay.php?f=8)." This is a special place where members come to post tributes. But it is also a special place where you can come to talk about your feelings and your memories. You do not need to have any kind of "formal" tribute in mind at all -- you can just start a thread to tell us how things are going for you and Rascal and your family. If you are like me, there will be many steps both forward and backward in the coming weeks. But for me, it helped so much just to have someplace to come and talk. If you think that might be a help to you, as well, PLEASE do start a new thread. Anything and everything that comes to your mind is OK. It does not matter whether it is even written out in complete sentences!! All of us who have shared in sorrow will understand, and we will be here to listen to whatever you may care to tell us, at any time.

Many (((hugs))) to you, in continuing memory of your sweet Darla.
Marianne

[ladysmom06]

Sarah,

I know there is nothing I can say to ease the pain and deep sense of loss you are feeling but wanted to tell you how very sorry I am for your loss of Darla. Keeping you in my thoughts and prayers.