Newly diagnosed 7 1/2 year old Boston Terrier - precious Harold has passed

[Carrie loves Harold]

Hi,
My sweet 7 1/2 year old Boston, Harold, was officially diagnosed yesterday with Cushing's Disease. I first noticed increased drinking and urination over the summer, however, we were dealing with other health issues with him (in July he lost his eye to glaucoma) and since it was summer (hotter weather), I didn't think much of the increased drinking. I finally got a full bloodwork panel done on him in the fall (don't have the results of that, but do remember that the thyroid level was low and the urine was very dilute). The vet wanted to do more bloodwork to rule out Cushing's, which the vet thought was unlikely since Harold did not look like the "traditional" Cushing's dog. Unfortunately at that time, Harold was on a prednisone drop for his eye, so we had to discontinue the drop and wait 6 weeks before we could run the test. Harold stayed with family for 6 weeks over the holidays due to personal circumstances and my traveling and when I came to pick him up he had gone way downhill. He was very lethargic, having accidents in the house (he was potty trained within 3 weeks of my getting him as a puppy and never had accidents in the house), and just wasn't my Harold. He also had blistering, peeling skin on his belly. I took him to the vet ASAP and we did the low-dose dexamethasone suppression test on 1/14/2014. The results were 2.9 at the start, 2.4 at about 5 hours, and 2.4 at about 8 hours. The vet wanted to have Harold come back in for an ultrasound to confirm the diagnosis, which he did yesterday. The ultrasound was consistent with a diagnosis of pituitary-dependent hyperadrenocorticism since his adrenal glands were enlarged, but with retention of normal shape (e.g., no indication of tumors on the adrenals). He also has some "mineral foci" in his kidneys and "small cystic calculi" in his bladder, which the vet said was likely secondary to the Cushing's disease.

Sorry for all of the info, but in the other posts I saw, people were always asking for the specific information related to the disease, so I figured I would post it proactively.

I started Harold on his first dose of Trilostane about 7 hours ago. He is getting a 30 mg capsule once a day and he weighs 24.3 lbs. (I am pretty nervous having him on the drug, but if it brings Harold back to me, it will be totally worth it!)

The couple of questions I have for the more experienced owners out there are:
1) On average, how long did it take before you saw an improvement after starting the Trilostane (specifically, how long did it take before they started acting like themselves and when did the increased urination stop)
2) Have you noticed tremors/shaking in your dogs? Harold has a pretty regular tremor even when he is not under stress. Is this common with Cushing's? The vet has mostly overlooked this concern when I have brought it up.
3) Have you heard of/had any experience with using melatonin in addition with/or as a substitution for the more traditional medications for Cushings?
4) Any dietary recommendations or other recommendations for taking care of a Cushing's dog?
5) Anything that I should be watching out for with the Trilostane?

Thank you for any feedback and advice you can give. I am pretty new to this diagnosis and want to provide the best care I can to my little pup, so any help from more experienced owners would be greatly appreciated.

Carrie P. and Harold

[doxiesrock912]

Welcome Carrie and Harold,

Cushings is really unique for each dog. Some see improvement within days, weeks, and even months.

If Harold becomes lethargic. has diarrhea and/or vomiting, eats less or not at all and the same with water intake - these are signs of Addison crisis which means that his Cortisol has dropped too low and that the prescription is too high. If any of this happens, stop giving the medicine immediately and call your vet.

In the beginning of treatment, monitoring is essential to be sure that you have the correct dosage. It could take several tries before finding the right one.

It is best to start low with Trilostane and work up from there. Many dogs do better with giving 1/2 of the recommended dosage twice a day, twelve hours apart with food. ALWAYS give it with a meal to ensure proper absorption.

Tremors are concerning, especially since you've just begun treatment and I would insist that your vet find the cause.

Educating yourself is key to this and I encourage you to read through the information in the "helpful resources" section on this forum.

If you post all of the results along with their normal ranges here, there are several people who are great at interpreting them for you here.

[Renee]

I'm definitely not one of the experts... but, I can answer your questions from my perspective.

I saw symptoms somewhat resolving within the first week, especially around the 10 day mark, I saw a big improvement in personality. Then, they kind of rebounded and came back somewhat. After a month on her initial dose, we increased by 10mg. I think the safest way to increase is in 10mg increments. We have done one increase so far, and plan to recheck in two weeks before considering another increase.

I have not noticed tremors, but you should definitely bring that up. I have not used melatonin either.

I think that diet is very specific to the dog, although lower fat food may be a good consideration because cushings dogs can get pancreatitis.

Did you have an ACTH done before starting the vetoryl? It is good to establish that baseline before starting the treatment phase.

[Harley PoMMom]

Hi Carrie,

Welcome to you and Harold! So sorry for the reasons that brought you here but glad you found us. Thank you for giving us such detailed information about your sweet boy. ;)



I started Harold on his first dose of Trilostane about 7 hours ago. He is getting a 30 mg capsule once a day and he weighs 24.3 lbs. (I am pretty nervous having him on the drug, but if it brings Harold back to me, it will be totally worth it!)

Although 30mg is a reasonable dose for Harold's weight of 24.3 lbs we have seen that dogs have the minimal side effects when started at the lower end of the dosage scale, say 1mg per pound. Did Harold's vet prescribe any prednisone to keep on hand in case of an emergency?


The couple of questions I have for the more experienced owners out there are:
1) On average, how long did it take before you saw an improvement after starting the Trilostane (specifically, how long did it take before they started acting like themselves and when did the increased urination stop)

The increase in drinking/urinating should abate within 2 weeks. Improvements to skin/hair issues can take much longer.


2) Have you noticed tremors/shaking in your dogs? Harold has a pretty regular tremor even when he is not under stress. Is this common with Cushing's? The vet has mostly overlooked this concern when I have brought it up.

We have occasionally seen tremors/shaking in dogs that are taking Trilostane. Trilostane is the active ingredient in Vetoryl, Dechra is the manufacturer of Vetoryl, and muscle tremors are listed as a side effect on Dechra's product insert. Link to the product insert: Dechra's U.S. Product Insert (http://www.dechra-us.com/files/dechraUSA/downloads/Product%20inserts/Vetoryl.pdf)

3) Have you heard of/had any experience with using melatonin in addition with/or as a substitution for the more traditional medications for Cushings?

Usually melatonin along with lignans are used for the treatment of Atypical Cushing's. Atypical Cushing's is when one or more of the adrenal sex hormones are elevated but the cortisol is not. Although melatonin and lignans do have cortisol lowering abilities they can not decrease a dog's elevated cortisol to within the therapeutic ranges.

4) Any dietary recommendations or other recommendations for taking care of a Cushing's dog?

Dogs with Cushing's can be predisposed to pancreatitis so a diet that has a high quality protein with moderate fiber and is low in fat may be better suited for a Cush dog. Also high blood pressure is common and should be checked for.

5) Anything that I should be watching out for with the Trilostane?

Hypoadrenocorticism (too low cortisol) can develop at any dose of Trilostane so the side effects need to be watched for. These side effects are but not limited to: lethargy, vomiting, diarrhea, or Harold just not acting himself. If any one of these are noticed a trip to the vets is needed.

It is very important that the Trilostane be given with food especially the day of any monitoring ACTH stimulation test. Also very important is that the ACTH stimulation test be performed 4-6 hours after the dose of Trilostane is given.

Thank you for any feedback and advice you can give. I am pretty new to this diagnosis and want to provide the best care I can to my little pup, so any help from more experienced owners would be greatly appreciated.

Carrie P. and Harold

We are here to help in any way we can so do not hesitate to ask any questions you have. Also, here's a handy link from our Resource Thread with info regarding Trilostane/Vetoryl: Trilostane/Vetoryl Information and Resources (http://www.k9cushings.com/forum/showthread.php?t=185)

Hugs, Lori

[Carrie loves Harold]

I did not have a baseline ACTH stim test done at the start because my vet did not recommend it.

The tremors/shaking have existed long before he was diagnosed with Cushings, so it isn't a side effect of the medication. I have noticed the shaking for a couple of years. It may be an anxiety thing because it usually resolves if you distract him or pet him? Not really sure though.

The vet did not give me an emergency dose of prednisone/steroid, however, I live very close to his vet and also to two emergency vets, so I am not too concerned about getting him quick treatment if he starts having issues. One question I do have related to the potential drop in cortisol is how quickly these symptoms are typically noticed? I am currently in class from 8 AM to noon M-F and have to take the bus to class, so he is typically alone from 7 AM to 1 PM. My concern is if he starts having the symptoms while I am at class is it going to be life threatening to leave him alone or should he be okay as long as I get him to the vet as soon as possible after I return?

I am really glad I found this site! It's nice to know that despite the terrible circumstances that have brought us together, at least we are not going through it alone! Thanks for the warm welcomes so far. Harold and I both appreciate it!

[doxiesrock912]

Carrie,

Daisy has had a reaction a few times and it usually happens within the first few days or the first week.

[Harley PoMMom]

After giving the dose of Trilostane, peak concentrations are seen within 1.5 hours and it can take up to 18 hours for it to totally leave a dog's system. So usually, after Trilostane administration adverse side effects are seen within 2 hours.

Hypoadrenocorticism can be life threatening so it is imperative that when symptoms of too low cortisol are displayed that the dog be seen by a vet. Not only can the cortisol drop too low but sometimes the electrolytes can become imbalanced, principally aldosterone, in this case not only does the dog need some kind of supplemental steroid but also mineralocorticoid.

I really do not think that at 30mg of Trilostane that Harold will have an Addison's crisis, and it is not my intention to scare you. But like I mentioned before, Hypoadrenocorticism can happen at any dose of Trilostane so I just want you to be aware of this, ok?

Hugs, Lori

[Renee]

I stayed home from work for the first 10 days of vetoryl dosing. I am sure it was overkill on my part, and we started at 20mg per day for a 19 pound pug, which is at the low end. I am not saying you should stay home for that long, but I think staying for the first few days is not a bad idea.

Are you dosing in the morning with Harold's breakfast?

[Carrie loves Harold]

Thanks for all of the advice. I have actually been trying to give the dose around 1 PM when I get home from class so that I can be here with him for the rest of the night to watch him. I give him a smaller than normal breakfast and then give him more food at lunchtime when I give him his pill. I make sure that he eats the lunchtime food prior to giving his pill as I know it is supposed to be given with food. I know that you should give the pill in the morning, but the only way that I will be able to watch him after the dosing is giving it at 1 PM. Do you think this is a problem?

He did fine through the night after his first dose. Woke up this morning and his stool was normal, appetite was normal, etc. so I am staying positive!

Thanks for all the advice and encouragement!

[labblab]

Depending upon your vet's office hours, the 1:00 dosing could present a problem for the monitoring ACTH stimulation testing. It is very important that all subsequent monitoring tests be performed within the same time frame so that you are comparing "apples-to-apples" with the results.

Dechra, the manufacturer of brandname Vetoryl, recommends that the tests be performed 4-6 hours after dosing. Some specialists opt for an earlier time frame of 2-3 hours after dosing in the desire to catch the cortisol level at its very lowest after drug administration. Either way, you will want to establish a consistent schedule with your vet and continue to adhere to it. So if your normal pattern ultimately will be to dose earlier with breakfast, I'd probably go ahead establish that regimen now. It is really unlikely that your dog will have a reaction to the trilostane serious enough that you cannot wait to deal with it a few hours later when you arrive home after class.

Marianne

[Trixie]

Welcome Carrie and Harold!
I hope things go smoothly with Harold and his medication. I was so nervous giving the meds...it's stressful for sure. Now we are approaching a year since diagnosis and about 10 months on the medication.
It took us a very long time of dose tweaking. We started quite low and built up to the current dose of 28mg. We actually take 14mg twice a day. It was months before I noticed a decrease in the drinking, eating, panting...probably because we started with such a low dose. I expected immediate results but it didn't happen that way for my dog, though many people see results in just a few weeks.
Thankfully we had no bad side effects from the medication and my dog is doing very well now. Though it's finally coming down, she still has a high liver number, everything seems to take a long time with Trixie! I still watch her like a hawk and measure her drinking water everyday..guess it's a habit I just can't break myself of. Careful monitoring can't hurt but it can drive you a little crazy! ;)
Good luck with Harold. Everyone here is great, they all helped me through the worst of the worry and answered questions the vet couldn't!! :D

Barbara

[molly muffin]

Hello and welcome from me too.

How are things going with the dosage? I agree, that normally from what we have seen is that 10 days you should notice some changes. That seems to be the average, but all dogs can respond differently.

I think you have asked all the pertinent questions and are you geared up for anything you'd need to keep an eye out for.

It's a lot more scary when you first start out and it's all the unknown. Knowledge though will always be your greatest asset with cushings. The more you know, the better advocate that you'll be.
How are Harold's other health issues doing now?

Again welcome to the forum
Sharlene and Molly Muffin

[goldengirl88]

Welcome to you both. I will post later but wanted to welcome you the forum and let you know this is the best place to come to help your dog. You can trust these people as they are extremely knowledgeable on this disease and will help and support you thru this journey. We all walk this path together. Blessings
Patti

[Arizona Boston]

Just a quick note to say hi!

My Boston Lucy is 17 lbs and started on 30mg Vetoryl with no ill effects, but of course each dog is different. You are smart to be vigilant in watching.

I wanted to comment on the tremors. Before we got Lucy, my step daughter had two Bostons. The little one was shaking like she was cold or scared, but I was told that was her way of begging for a treat. We have noticed our Lucy does that also and we still puzzle a little bit about it. We have tile floors that can be cold and maybe that contributes, but the time I really notice it is when she is in the kitchen while I am cooking and she is "anticipating".

Good luck for you and Harold…he is a young dog and should have many good years ahead of him.

Shelly and Lucy

[Carrie loves Harold]

So, I started my Boston, Harold, on vetoryl a little over 2 weeks ago. He went for his first stim test last Thursday, but the vet (unfortunately) took the blood draw too soon and so I had to bring him in for repeat testing today. Anyways, I am hoping to get the results back tomorrow so that I can see if the meds are doing what they are supposed to be doing and are at a safe dose.

In terms of any changes, I have not seen many in Harold yet. He may be a little "brighter," but he is still having accidents and needing to go out every couple of hours. Unfortunately, the excessive drinking/peeing/accidents are the symptom that I like the least about this disease. I love Harold, but I am so frustrated with having to get up every two- three hours to ensure he doesn't have an accident. I am just hoping that we find some relief from that particular symptom soon! Can anyone comment on their experience with the medication and how long it takes to start seeing a decrease in the polyuria? If the test results tomorrow indicate that the medication is doing its job, should I be concerned that something else is going on if the excessive peeing continues?

The ultrasound he had to confirm the diagnosis showed stones/calcifications in his bladder and kidneys, I am wondering if anyone has had any experience with this in relation to Cushings?

I'm just so tired of constantly cleaning/smelling pee. Cushing's is the worst!

Thanks for all your support!

[doxiesrock912]

Daisy had the same problem. Are you sure that Harold doesn't have a UTI? Cushings dogs can be prone to them. As for symptoms subsiding, each dog reacts differently. It could take another two weeks, or another month. Please be patient. Harold probably likes this less than you. Daisy thought that I was going to scold her when she had accidents. They don't understand that it's not their fault.

Please be sure that your vet has ruled out other problems though. Infections can interfere with test results.

Hugs.

[Carrie loves Harold]

Hi Valerie,

Thanks. I know that Harold feels terrible when he has accidents, as he gets the "I'm sorry" look on his face every time he does it. I do not blame him or scold him for the accidents, I know it has nothing to do with him and everything to do with Cushing's; it's just so frustrating! I guess I was hoping that once he got on medication it would be like a magic pill and everything would reverse in no time at all and I would have my Harold back. Maybe my newness to the diagnosis causes me to be a little naive.

As far as the UTI possibility, he had a UA and urine culture work up done a couple of weeks ago when he first got the initial bloodwork done, and it came back with no indication of an infection.

I just want Harold to start feeling better and have a good life.

[doxiesrock912]

I know Carrie, it will happen. Daisy got the same look.
What makes Cushings so hard to treat is that every case is unique. Therefore, treatment is complicated. It's a partnership between owner and vet which is immensely important with this disease.

Your best weapon is to educate yourself and use what you learn here. Too many of us have learned that vets don't know it all. Please look through the helpful resources section in the forum. There is a ton of great, up to date information.

Also, absolutely run questions and test results here. Some members can interpret them for you to help determine if your vet is on the right track with treatment.

[addy]

Hi and Welcome,

Lets wait to get the results back as it may be the numbers are still too high. Sometimes these things take awhile to work out.

Have you tried pee pads or a belly band for Harold in the meantime?

My Zoe was diagnosed almost 4 years ago and started treatment with Vetoryl in June 2010. We are currently on a Vetoryl holiday and I have been putting a pee pad right in front of the door which has cut down on cleaning up messes and washing rug runners considerably. She sometimes has a hard time holding it all night and cant make it out the door, or if she has been sleeping for 3 hours while we are at work she cant quite hold it until she get gets outside any more.

I am so glad you found us.

[Renee]

If Harold has stones in his bladder, then he could develop an infection at any time. So, even though he had a culture a few weeks ago, this does not mean he would not or could not have an infection now. In addition, a UA is a complete waste of time. They are often wrong, especially with cushings dogs. Lots of false negatives.

Is there a reason you have not had the bladder stones removed? Has he been passing them? As long as there are stones in his bladder, he will be even more prone to infection, especially if the stones are struvites, as the crystals just keep growing and growing.

When my pug started the vetoryl, it took probably 3 weeks for the peeing/water drinking to subside noticeably. She still has peak times of water drinking, and lately she's been having accidents in the house again at night, but we just upped her vetoryl dose in the evening, so I hope we can get better control of that.

[Carrie loves Harold]

Renee:
The reason we have not worked up the stones yet is I was still under a bit of a sticker price shock after the ultrasound and initial blood work costs came back. I plan to get an xray to look into the stones as soon as I have recovered from the first round of bills, then we will figure out what to do with the stones (e.g., whether it is likely he will pass them on his own or whether he will need some kind of medical intervention).

Addy:
I tried the belly band, but he peed right through it. So I bought human nighttime incontinence pads to put in the band, but then it wouldn't fit around his waist. I have tried about every iteration of diaper/belly band combo that I can think of to no avail. For the time being, I am keeping him in a crate while I am at class. At least that way if he has an accident, it is a little easier to clean up and isn't ruining the carpet in the room I rent! When I am home, I can take him out every couple of hours, so its not that big of a deal (aside from the number it is doing on my sleep cycle). Harold is totally worth it though!

[molly muffin]

Try diapers with onsies maybe. I've heard of others on here using that combination.
It rather depends on how the vetroyl is working if the cortisol is coming down enough (Usually) as to how quickly the symptoms of drinking/peeing go away.
Some never do, but most will eventually as the cortisol becomes in range.

Hang in there. :)
I agree, cushings definitely comes with sticker shock. Hopefully the stones are small enough they can be passed. My molly has a problem with crystals and she had a couple very small stones that the IMS said she should pass and they aren' t big enough to cause a blockage. You want to know that though for sure.

Sharlene and Molly Muffin

[Renee]

Belly bands are definitely designed to be used with incontinence pads. Try the medium absorbancy, cheap, generic brand. If the belly band won't fit around him when you use the pads, then get the next size up on the band. I use belly bands for my boy pug that likes to mark.

I totally understand sticker shock. Tobey had to have stones removed last year, and it was about $1250, just for the surgery. It has really helped cut down on her UTI's though.

[goldengirl88]

I just wanted to post and tell you that my Tipper has terrible tremors and I believe it is a side effect of her Vetoryl. Blessings
Patti

[Carrie loves Harold]

Hi All,
Its been a while, just wanted to give a heads up on Harold and see if I can get some more advice.

So Harold is into his 3rd month of Vetoryl tx (about 65 days of tx to be exact). Both of the blood checks since starting tx have shown that his cortisol levels are in the normal range (e.g., the medication seems to be doing what it is supposed to be doing). The problem is, the polyuria/polydipsia has continued, and if anything, it seems like he might be drinking more. He had a UA done about two weeks ago that gave no indication of crystals, infection, or diabetes.

For others who have had Cushings dogs with crystals, have you changed their diet? I know there is a special prescription diet specific for urinary issues, I am wondering if there is any contraindication for using this type of food with a Cushings dog.

Also, does anyone have a recommendation for a Vet with experience in Cushings disease treatment in Portland, OR? I have started to have doubts about Harold's current vet, as he does not seem to concerned about the issues that I continue to bring up (e.g., the continued polyuria/polydipsia).

Thanks all!

[Renee]

Hey! Welcome back! So glad you checked back in with us.

I think the UA may not give you the correct results, because the urine is so diluted from the drinking, that it can mask any bacteria. The best idea is to get a culture sent off to the lab. Ask for a culture & sensitivity to be done. They will draw the urine directly from the bladder, send it to a lab and the results will be much more accurate.

Can you tell us what the latest ACTH figures are?

Also, if the stones are still present, then your chances of them growing even more and encouraging infections is still very high. You may not be able to get a handle on his UTI's and such until the stones are removed. I would encourage you to have them removed, if at all possible.

While I know some will disagree with me... there is no way, ever, that I would feed the prescription diet for crystals and stones. Just no way. The diet is very, very inferior, and in fact will increase Harold's water consumption, because one of the main ingredients is salt and cornstarch. YUCK!

Crystals in and of themselves are not bad. At least half of healthy dogs will have some crystals in their urine. Just like yeast is normal too. When the crystals get out of hand, over produce, get working with bacteria, etc. that is when things can get bad (stones form, infections, etc).

My personal recommendation is to 1. get the culture done, and 2. try to acidify the urine (to kill bacteria/crystals), by using a supplement. My supplement of choice is Berry Blend by Solid Gold. http://smile.amazon.com/937513-Balance-Nutritional-Supplement-3-5-Ounce/dp/B0006N9J7G/ref=sr_1_1?ie=UTF8&qid=1396553360&sr=8-1&keywords=berry+blend


These are just my opinions of course, and I am sure others will chime in too.

[Carrie loves Harold]

Thanks so much for your recommendations Renee! I really appreciate it.

For those of you with more experience with owning a dog with Cushings disease, would you recommend seeing an internal specialist for Cushings treatment? I am thinking that maybe I should look into an alternate vet for Harold. Thanks again.

[Squirt's Mom]

He had a UA done about two weeks ago that gave no indication of crystals, infection, or diabetes.

For others who have had Cushings dogs with crystals, have you changed their diet?

If there is no indication of crystals etc. I would not be changing his diet as if there were. ;)

[goldengirl88]

Just an FYI about crystals in urine. If the urine sample was refrigerated it can form crystals in the refrigerator. This has happened to Tipper. My vet then did an in house urinalysis with unrefrigerated urine and it was fine. Just letting you know this could be a possibility. Blessings
Patti

[lulusmom]

So Harold is into his 3rd month of Vetoryl tx (about 65 days of tx to be exact). Both of the blood checks since starting tx have shown that his cortisol levels are in the normal range (e.g., the medication seems to be doing what it is supposed to be doing). The problem is, the polyuria/polydipsia has continued, and if anything, it seems like he might be drinking more.

Can you please call the vet and get the results of both of the acth stimulation tests and post the results here? There are only two numbers on each test, a pre (resting) cortisol and a post stimulated cortisol. I had to teach one of my gp vets how to assess an acth stimulation test for purposes of monitoring treatment. Normal is not normal for a cushdog on treatment, so until we can verify that Harold's cortisol really is within the therapeutic range recommended by Dechra, we can't really offer up any feedback on why his PU/PD has not resolved. Can you also round up copies of the blood chemistry and cbc that was done prior to diagnosis and post the highs and lows, including the reference ranges?



For others who have had Cushings dogs with crystals, have you changed their diet? I know there is a special prescription diet specific for urinary issues, I am wondering if there is any contraindication for using this type of food with a Cushings dog.

My first cushdog had two surgeries within 11 months of each other to remove oxalate bladder stones. The second surgery was done within three days of being diagnosed with cushing's. Prescription diet can dissolve struvite stones but not calcium oxalate stones. It sounds as though your vet isn't too concerned with the small calculi in the bladder seen on imaging but if I were you, I'd ask the vet if s/he knows what the mineral composition is so that you know how to proceed.



Also, does anyone have a recommendation for a Vet with experience in Cushings disease treatment in Portland, OR? I have started to have doubts about Harold's current vet, as he does not seem to concerned about the issues that I continue to bring up (e.g., the continued polyuria/polydipsia).

If the results of Harold's last two stim test show cortisol levels within a therapeutic range, there are three scenarios that may be at play. 1) Harold doesn't have cushing's; 2) Once daily dosing may not be controlling cortisol long enough throughout the day for Harold to see a resolution of PU/PD. He may benefit from twice daily dosing; 3) Harold may be in the small percentage of dogs being treated with Vetoryl that may never see resolution of PU/PD. UC Davis reported this phenomenon a number of years ago. The more information you can give us, the better we can understand what is going on with Harold and offer you meaningful feedback.

Glynda

P.S. Since you are looking for another vet and if you can afford it, I highly recommend that you search for a board cerified internal medicine specialist in your area. You can use the search engine at www.acvim.org

[Carrie loves Harold]

So, I've decided to look into transferring his Cushing's care to an Internal Medicine Specialist, with how much I am already spending on his care through my old vet, I would rather pay a little more and get him the best care. I will give updates after our first appointment.

Thanks for all of your support and advice!

[goldengirl88]

Great idea as there is a lot more education in an IMS than a regular vet. They have the experience with these issues and are much more knowledgeable . I have an IMS for Tipper along with the regular vet she goes to. Blessings
Patti

[Renee]

I think an IMS is a great idea -- even if just for you to gather more information. I believe many people on here use an IMS and a general practice vet.

[Carrie loves Harold]

I had to put my Harold to sleep this morning. He had a brief seizure last night and was pretty out of it this morning. Fortunately I was able to get in touch with an amazing veterinarian who came to my home within an hour and a half of me calling to perform the procedure. It was all very peaceful and he is no longer suffering.

At the moment I am pretty miserable. I keep looking to the spots in my house that he liked to occupy during his last months expecting to see him, only to find them empty. I know the pain will pass with time, and I know that it was the right decision. It is just so hard.

I plan to get his ashes following his cremation and plant a tree in his honor when I finally own a home. I think it will be a nice remembrance of my wonderful little man.

Rest in peace, my love. you will always have a place in my heart.

[goldengirl88]

I am so sorry to hear this. You are brave to take the pain on yourself, and set your baby free. God Bless you both. He is running free of pain now.
Patti

[molly muffin]

Oh I am so sorry to hear this. Fly free Harold, you were well loved.
I know your heart is broken and I offer my sincerest condolences. That is a very sweet idea to plant a tree in his honor. Nothing a dog loves more than a good tree.

I have changed the title of Harold's thread.

hugs
Sharlene and molly muffin

[doxiesrock912]

I know exactly how heart broken you are.
Harold, look for Daisy Mae and give her a big kiss for me please. You'll find her to be an exceptional friend. Hugs.

[jxeno13]

Hi Carrie, So sorry about your precious Harold. Our thoughts and prayers are with you.

[scoora]

Carrie,
I am so sorry to hear about your Harold.
My thoughts and prayers are with you.
Hugs

[Carrie loves Harold]

Valerie,

I am sure Harold and Daisy Mae will become fast friends and they can explore their new surroundings together. I am so sorry for your recent loss too. My heart weeps for both of our fallen friends. <3

[pansywags]

Carrie, my heart breaks for you. My sincere condolences on your loss, it's clear that Harold was well loved.

[goldengirl88]

I am just checking in as I was thinking of you and wondering how you are doing. I hope the hole in your heart has begun to heal. Blessings
Patti