Sweet Pansy has crossed The Bridge - 8.5 y/o boxer (Pituitary macroadenoma)

[pansywags]

My approximately 8.5 year old boxer (she's a rescue so I'm not sure of her age) has tested positive for Cushing's after a string of infections (3 UTIs in a row and now a bacterial skin infection). She tested negative on the ACTH test but once we got to the specialist level, a LDDS test was suggested and returned positive values. I don't know if the source of the problem is pituitary or adrenal and since I am not willing to put her through major surgery at this point in her life, I'm not sure it's worth proceeding with additional testing, especially when cost is a concern (I've spent thousands of dollars already getting to this point).

I'm a little spooked by possible side effects of the Rx drugs, in particular diminished appetite/nausea. Pansy has never been a big eater and she's been turning up her stubby little snout at more foods lately, leaving her pretty skinny at the time of diagnosis. I've read so many reports of dogs being treated and ending up with Addison's instead, and cost is a big factor - I know frequent and expensive followup testing will be required on an ongoing basis.

For these reasons, I am leaning toward treating her symptoms with lignans and melatonin. If the treatment can help her mad thirst/incontinence and susceptibility to infection, we will both be much happier. I would like to try HMR lignans rather than SDG to avoid the risk of diarrhea (she already has the occasional soft stool) but I don't know where to start with the dosage. Everything I've read indicates 10-40 mg daily for a small to large dog, which is...vague. HMR lignans seem to come in a 40mg capsule - how do I determine a starting dose for a 38 lb dog, and is it typically given once or twice daily?

I'm new to this so I apologize if any of the information above is unclear or if my terminology is incorrect. There's a lot to learn. Thanks for your help.

[Junior's Mom]

Hi, welcome to the forum. Cushings is a slow progressing disease, so there is no rush to treat it. It is also hard to diagnose, as it mimics many other troubles. Anything going on with your dog will raise the cortisol level, like the urinary infection you mentioned, so the low dose test can be prone to false positives. I would not proceed with anything further until you are sure the infections are cleared up.
Cush dogs are ravenous, constantly searching out food, they also need to drink tremendous amounts of water, and then pee excessively.
As your dog is not exhibiting these symptoms, the cushings diagnosis could be wrong.
U.T.I's can sometimes be difficult to clear up. A culture and specific check to get the right antibiotics is sometimes needed.
We are here to help however we can.

[pansywags]

Hi, thank you for the response. Pansy has had a series of UTIs which is what brought us to the specialty vet originally - she was treated with several courses of antibiotics and her last urine culture, done five weeks after completing treatment, was completely clear so I believe we have finally knocked out the string of recurring UTIs. The LDDS test was done five weeks after the urine culture came back clear so I don't believe it was an interfering factor.

She is not ravenous and is just as picky about food as she always has been, but is terribly thirsty, drinking over a gallon of water a day. We have been dealing with nighttime accidents and some occasional overflow incontinence since last summer. I gave her Proin for about six weeks but it did not really seem to be helping so I stopped giving it to her and we manage the night problems by restricting her to the hallway and judicious use of puppy pads. The silver lining to this approach is that I get to see her urine on a white 'background' regularly (hey, lucky me!). With no sign of urine discoloration or odor, I feel fairly confident the UTI has not returned.

She developed some hind leg weakness about 2 years ago and went to physical therapy for about a year - we continue with home therapy on a regular basis. Despite this, her strength is decreasing and she pants on a simple walk. She is definitely losing muscle mass.

She developed some scaly patches on her skin and has been losing small tufts of fur attached to little scabs. The vet referred to this as a secondary bacterial infection and prescribed more antibiotics and a medicated shampoo.

14 months ago she had a dermal cyst removed from her side. The incision healed well but she never re-grew the hair. She is hypothyroid and has been taking L-Thyrozine (0.4 mg twice daily) since November 2012. We rechecked her thyroid levels in the fall after the second UTi and the post-pill test showed normal ranges.

She has had two seizure-like events in the past few months. Once she lost consciousness and paddled for a bit before righting herself and the most recent event she lost limb control while walking, crossing her paws and weaving. In both cases the event lasted less than a minute with full alertness within a few more minutes and no aftereffects that I could see. Prior to her recent health problems she did have one apparent seizure about five years ago.

I am not looking for a miracle (though it would be welcome!) - I would be happy if we could get some improvement in Very Thirsty Dog behavior and associated incontinence as well as reducing her susceptibility to infection.

[pansywags]

Does anyone have any info on lignans dosage?

[Nichole]

I'm new to this site, so I hesitate to give advice but I have a pit/pointer mix that has Cushings. After a year of various treatments and tests, it looks like he has a macroadenoid tumor, which is rare, but more common in larger breeds than in small. You may want to ask your vet about this possibility. It may have caused the neurologic issues. If your pup has a macroadenoid tumor, treatment with the traditional drugs could enlarge the tumor and make things worse. We found this out the hard way. Melatonin and flaxseed didn't work for us, so I can't really advise on that.

[molly muffin]

Hi Nicole:

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Sharlene and Molly Muffin

[molly muffin]

Hello and welcome to the forum pansywags.
I'm sorry your baby girl is having so many problems.

I'll let some of the others who have used lignans and melatonin answer that question. It is very commonly used for atypical cushings, and helps to lower the sex hormones. It might also have some affect on the cortisol levels, but not enough to get it within the range needed usually and I don't think long term it keeps it down. It could be worth trying of course and isn't harmful that I know of.

However, I think based on the symptoms you've described. I would want to at the very least try the medication. Did the vet mention if the LDDS was able to determine if it is pituitary or adrenal?

We do have another boxer on the forum who has currently undergone radiation treatment at University of Davis to shrink a macro tumor with good results. Her thread is here: http://www.k9cushings.com/forum/showthread.php?t=5850

I don't want to scare you and certainly am not saying without a firm diagnosis that this is what is going on with your girl. Part of what helps on the forum though is reading other peoples journeys and gaining knowledge from them.

Sharlene and Molly Muffin

[lulusmom]

Hello and a belated welcome to you and Pansy.

I have provided a link below to the label of 20mg HMR Lignans which shows the dosing for humans and dogs in the upper right corner.

http://www.lignans.net/images/products/lrg/HMR-gold-20-mg-rev-10-13.png

Just be forewarned that efficacy of melatonin and lignans is spotty at best, especially for a dog who has overt symptoms. If they are effective, it can take up to three or four months to notice a difference. I don't recall that symptoms in a dog with a confirmed diagnosis of typical cushings ever improved with melatonin and lignans. I can relate to the lakes of pee every day. My second cushdog was stabilized on treatment and his drinking and peeing resolved. We learned to live with it and made sure we had fresh water down for him to guzzle. Thank goodness his pee was like water and odorless. I'm a special needs rescuer so I always have a few stacks of washable hospital pads. Luckily they seem to know that's where they need to pee. There is a huge difference between incontinence and the and the peeing caused by cushing's.

In our experienced, dogs that end up with Addison's, have a trail leading back to an inexperienced and/or an uneducated owner. I've seen three dogs through diagnostics and successful treatment with both Trilostane and Mitotane with no ill effects. My concern with Pansy is that she has a diminished appetite and is quite thin. Giving either drug to a dog who is not eating normally is not a good idea.

My other concern is Boxers are high on the list of breeds that seem to be predisposed to large macroadenomas. Most brachycephalic breeds are on that list. Loss of appetite and weight loss are symptoms of a macroadenoma and it is well documented that treatment can accelerate enlargement of the tumor. I personally would be in a quandry if Pansy were my dog. I would probably be doing the same thing you are. However, if I could afford it, I would have an abdominal ultrasound done to rule out an adrenal tumor. Adrenal tumors are more likely to cause loss of appetite and weight loss. If it were an adrenal tumor, I would be more inclined to entertain the idea of treatment but only under the direction of an internal medicine specialist. That's just my two cents worth.

Glynda

[pansywags]

Thanks for the information. I had a long reply typed in last night but lost it when I was logged out, and I was too tired and overwrought to type it in again.

I am trying to understand what I would gain in my situation by further testing. I may or may not have all the info right. My specialist vet has quoted $610 for an abdominal ultrasound. My understanding is that this would show whether there is an adrenal gland problem.

However, I believe it's possible to have both adrenal and pituitary-fueled Cushings, so probably additional testing would need to be done, some kind of imaging on her head, I would imagine - CT or MRI? I am hearing that her symptoms *could be* consistent with a macroadenoma, which as I understand it is a larger pituitary tumor, and it would be important to know this because treatment can make a macroadenoma worse.

I struggle with how much I want to know since I cannot afford to pay more thousands of dollars for treatment. My unemployed budget is already stretched pretty thin after paying out thousands since summer on numerous e-vet visits, UTI treatments and multiple urine cultures. I do have pet insurance (VPI) but at this point I am getting double-digit reimbursements on each multi-hundred dollar claim. It breaks my heart that it's a money issue - I love my dog so much - but I can't change the reality. Please don't judge.

I do have the ability to get her to UC Davis for testing if I decide to go that route. I think one of the contributing factors to my upset and frustration is that her care has been so spread out - her first few UTIs were treated at the emergency vet (of course she would never start urinating blood on a weekday when her regular vet is open!), the third and ACTH test at her regular vet, then the specialist picked up the final UTI clearance and LDDS testing. I'm not certain that anyone involved is really looking at the whole picture no matter how often I repeat myself.

I would not say, btw, that her appetite is currently unusually suppressed. She has always been a somewhat reluctant eater who occasionally skips meals, so this behavior is typical for her. I certainly would be cautious about doing anything that could suppress her appetite further, though.

carefully making a copy of this posting in case I get logged out again....

[labblab]

Just a quick note to give you some tips to help you avoid losing your replies while you are in the process of composing them. Take a look at this link:

http://www.k9cushings.com/forum/showthread.php?t=1329

Marianne

[pansywags]

Thank you, Marianne!

[grapey]

First of all, I'm sorry you're facing this. Obviously you care very much about your puppy.

I don't know enough to address your LDDS test results, but I can chime in with my experience with lysodren. I was terrified when I started it on my Elliott, but over time, I became more comfortable with it. When you know what signs to look for, it's not as intimidating. And this board is hugely helpful. I guess I"m just saying, you have *many* things to consider when looking at cushing's, but I think you would do fine if you decided to start a pill like lysodren. Even though an overdose can be problematic for sure. (My girl was ultimately diagnosed with heart disease also, and that's what did her in, not the cushing's.)

I wonder if you could find an ultrasound elsewhere for cheaper? I live in Colorado, and here one costs about $300 at an internal medicine specialist.

Pansy is so cute!

[pansywags]

Good suggestion on cost comparisons, Grapey. I'm a little overwhelmed so some obvious things are escaping me. I made a few calls. I can have a abdominal US done by a visiting radiologist at my regular vet's office for 425.

UC Davis charges 300 plus 115 for an internal medicine visit, so just a hair less than my usual vet, but that includes driving for a few hours each way. My understanding is that they have a lot of experience with Cushing's so that may make the drive worthwhile.

What kind of imaging is usually recommended to investigate pituitary tumors? CT? MRI? Anyone have any ballpark costs?

[molly muffin]

I'm sorry that this is happening to you and your girl. It really is a horrid thing to go through and can be so costly. Of course we understand that and nope, we don't judge. Everyone does what they can to the best of their ability.

One thing you can do is to get copies of all the test results from various vets and put them all together in a file on your own. Maybe something on one of the tests will give us all a further clue of which way to go next and what is reasonable to do.

Don't despair. Whatever you decide to do or not do, we are here and we are a great support group and will be in your corner of the ring. :)

hugs,
Sharlene and Molly muffin

[labblab]

Hello again! I see you've asked some questions about imaging of the head, and I'm hoping I can offer a bit more info in that regard. Before getting to that, though, I will tell you that it is very uncommon for dogs to suffer from both pituitary and adrenal tumors concurrently. So from the standpoint of gaining the broadest info for the least amount of money, I would first opt for an abdominal ultrasound. If an adrenal tumor is visualized, by far the odds are that the adrenal mass is the source of the Cushing's symptoms. Plus, the ultrasound will give you feedback re: the status of Pansy's other internal organs as well. As we like to say around here, you get a lot of bang for your buck with an ultrasound.

Imaging of the head is much more expensive than an abdominal ultrasound. I can't give you an exact quote, but we are talking hundreds of dollars for either an MRI or CT. MRIs are generally more expensive than CT scans, but for folks who are actually contemplating radiation treatment for pituitary macroadenomas, I believe an MRI is the preferred image. If all you want to know is whether or not an enlarged pituitary tumor is present (without proceeding to intervention), then a CT would likely be sufficient.

If it were me, though, I'd start first with the ultrasound. You might have your answer right there, based upon the appearance of the adrenals. If a mass is seen, the odds favor an adrenal tumor alone. If both adrenals are enlarged without a mass or tumor, you can feel confident that the Cushing's is instead caused by a pituitary tumor.

If the finding is consistent with pituitary Cushing's, then you face your next decision. Do you want to go to the expense of imaging in order to find out if the pituitary tumor is already large? Would you want to try Cushing's treatment, regardless? If radiation treatment is not an option for you, then I believe that current quality of life becomes the biggest question mark for you. Yes, there is evidence that treatment can hasten tumor growth. But the the tumor will continue growing, regardless. So to me, it becomes a trade-off of symptom relief: are the Cushing's symptoms more bothersome for your dog, or are the neurological issues?

I am speaking from some personal experience here, because my own Cushpup developed neurological issues several months after beginning a successful course of trilostane treatment. We assume that his pituitary tumor was expanding, but we did not opt for the expense of head imaging because for a number of reasons, we knew we would not choose to treat the tumor, regardless. We temporarily discontinued his trilostane dose in the hope that his neurological symptoms would improve. But they did not, and his Cushing's symptoms rebounded to the point that he was constantly uncomfortable with extreme panting and restlessness. So we decided to resume the trilo to try to keep him as outwardly comfortable as we could during the time he had left. However, we have had other members for whom the neurologial issues far outweighed the Cushing's symptoms. So for them, the better solution was to halt the trilo and to even start giving prednisone in order to reduce inflammation and swelling in the brain.

I guess my point is that, even if you start conventional Cushing's treatment in the face of an expanding pituitary tumor, you can always choose to halt it if it appears as though the neurological problems become the bigger threat to your dog's comfort. Sadly, with an untreated pituitary macrotumor, there will be an endpoint in time no matter what you do. But you may choose to swap comfort for time if the Cushing's treatment temporarily brings your dog some interim relief. I think that becomes an individual decision based upon a dog's personal symptom profile and quality of life.

This is all just a lot of musing on my part, since we have no idea whether or not your dog even has a macroadenoma at all. But as I say, if I were only able to perform one imaging test, I would opt for the abdominal ultrasound. Just my two cents worth!

Marianne

[Dawn Anderson]

If you can swing it get her to Davis, at least you will have a clear picture of exactly what is going on with her. I took my girl there and yes she had a major macro tumor and was treated with radiation to save her, the tumor was 2.5 cm.
Pls co out Buttercups thread there is lots if info there about Davis. So glad to read that you have insurance, I also have ins pets best and it has eased the cost burden greatly.

Hugs

Dawn & Buttercup

[pansywags]

First, thank you to everyone for the support. I know you all know how hard this is.

You can probably tell that I'm a planner, wanting to know what-ifs and plan next steps for all possible outcomes, so I'll try to rein that in.

One thing that makes me wonder if it's pituitary is that Pansy has had some nosebleeds. Not a lot of blood, just a drop trickling out of her nostril (pic here: http://www.k9cushings.com/forum/picture.php?albumid=840&pictureid=6248 ). Sometimes it doesn't happen for six months at a time, but there was a stretch in December when it was cold that it happened almost every day, mostly when she had been outside doing her yard biz. When this first started I thought she was scratching her nose by poking it where it didn't belong out in the yard - she has interest in one particularly thorny bougainvillea. I haven't been able to drum up any interest from any of her assorted vets on this issue.

Dawn, I am glad to hear from you. Buttercup's story is very long and I haven't been able to read much of it yet but I will. Are you local to UC Davis or do you travel to take Buttercup there? If you travel, how do you coordinate care with your local vet?

I have asked the specialist to provide her LDDS numbers, and to tell me whether there was any indication in the test results of whether it was pituitary or adrenal. I don't feel like she necessarily has a high level of Cushing's experience/information - I originally took Pansy in for recurring UTIs, and her vet bio indicated she had a special interest in urinary issues which is why I chose her.

I am hoping I will have some additional insurance coverage available soon as Pansy's policy is set to renew this month, resetting yearly limits. My reimbursement rate has been running about 30% since this all began.

[pansywags]

While I wait on the numbers from Pansy's positive ldds test, I realized I do have the records from her negtive ACTH test which was done in November. Cortrosyn was used. Pre-sample value was 2.6, 1 hour post was 15.5.

[pansywags]

The IMS vet office just sent me Pansy's LDDS values.

DEXAMETHASONE SUPPRESSION

Test Result Reference Range

PRE DEXAMETHASONE (1) 4.5 1.0 - 6.0 ug/dL

POST 4 HR DEX 3.6 ug/dL

POST 8 HR DEX (2) 3.9 ug/dL

[Harley PoMMom]

Pansy's LDDS test results do indicate Cushing's but do not differentiate between adrenal or pituitary.

Nose bleeds can be a sign of elevated blood pressure, has her BP been checked lately?

Hugs, Lori

[pansywags]

Lori, thank you for chiming in on the test results. I don't believe her BP has been checked, none of the vets have ever mentioned it.

She has had rapid significant hearing loss and I believe possibly some changes in sight and ability to smell (has to hunt for treats on the floor, etc).

[pansywags]

I've decided to take Pansy to UC Davis for further evaluation. I made an appt for next week with an IMS, and realized after getting off the phone that he is a resident. I'm considering holding out just a little bit longer (maybe a few more weeks) for an appointment with a faculty member whose bio indicates an interest in endocrinology (there are several to choose from, including Buttercup's vet). Normally I'd be fine with a resident but I feel I need to make sure in this case that the IMS has as much direct Cushing's expertise as possible. Any thoughts on specific Davis vets (PM is fine if you don't want to post publicly)?

[grapey]

Pansy is so lucky to have you.

[pansywags]

Thank you, Jen. I don't want to be so pushy with the people who are supposed to be the experts and know more than me, but it looks like in this case I need to embrace my bossy side!

[Harley PoMMom]

Dr David Bruyette and Dr Edward Feldman are two, that I know of, that are recognized as exceptional endocrinologist.

[pansywags]

Thanks for the pointers, Harley PoMMom. I'm going to call and reschedule in hopes of getting the most experienced care for my girl. Despite just cleaning up another night accident :)

[Dawn Anderson]

Oh I so know about cleaning up the accidents. Butters has gotten so good at using her wee pads. She had 3 areas that she would hit, so i
would lay out the pads in those areas and then she finally chose her favorite area and now she always goes there and uses the pads.
In the beging I was sleeping on the couch ( if you could call it sleeping)
to be able to let her out when she needed to go, that went on for weeks and really put me through he77, up almost every 1 1/2 -2 hours and then still having to work & take care of the house and everything else just became to taxing on me. Thats when I said its worth the money to get the pads and they have been a god send, now I can get a good nights rest knowing that my girl will use them!!!! I always praise her while I'm picking up the dirty ones and give her lovies for being so GOOD.

Hope you can get in soon with a IMS at Davis, when you call see if they can call you should they have any cancelations while you are waiting for your appt.

Have a great day & keep you chin up.

Dawn & Butters

[pansywags]

We have a pretty good routine. After racking up quite a bill for cleaning large area rugs, I started restricting her to the back of the house at night using a big screen tv box from my neighbor that fits my extra-wide hallway perfectly. I use pads to cover the hallway runners, which means cleaning up is usually easy. Sometimes, like today, she misses and there's a little more cleanup but for the most part the system is working. I don't feel great about tossing the disposable pads in the trash but we're in a drought so that may be preferable to the extra laundry generated by washable ones.

My bigger issue is giving her access to the yard when I'm gone. My back door is basically a french door, glass all the way down so I can't install a doggie door. I'm considering replacing my back door with something that's solid on the bottom so a dog door can be installed but I want to do some testing at a neighbor's house to see if she'll even use the dog flap before I make that investment. Plus, finding a contractor, ugh.

[pansywags]

As we continue along the diagnostic path, I keep reviewing things that have changed about my dog over the last few years. One of the first things I remember noting was that her spit got kind of sticky. I don't mean while it was in her mouth, but she's a boxer and does a lot of grooming, and her fur started to get stiff when it dried after she licked her legs and paws. I guess it's more stiff spit than sticky, really.

Is this a Cushing's thing or just my pooch?



(Administrative Note: You'll see that I've merged your new question into your original thread about Pansey. We prefer to consolidate all replies that relate to each individual dog in a single thread. This way, it's much easier for our members to track your dog's entire medical history, symptoms, and treatment progress. Thanks!)

[goldengirl88]

I read about the sticky spit. I am wondering if that is why my Tipper is constantly sticking her tongue out, swallowing and trying to clear her throat? Does your dog do any of that?

[pansywags]

I have an appointment with Dr. Della Maggiore on March 10 (first available that isn't early morning - I have to drive two hours to get there). Dr. Nelson is on sabbatical, they refused me an appointment with Dr Feldman and they didn't know the name Bruyette (editing to add that I see now he is in Southern CA, not at UC Davis).

I'm sad that we have to wait so long.

Sorry, admins, for doing it wrong.

goldengirl88, Pansy does clear her throat a lot but you get a lot of snorts, grunts and hacks from brachycephalic dogs and I don't think it worsened when her spit changed.

[Harley PoMMom]

and they didn't know the name Bruyette (editing to add that I see now he is in Southern CA, not at UC Davis).


Oh crap, sorry about that, don't know what I was thinking when I suggested Dr Bruyette. :confused:

I realize this is early but...Wishing you and Pansy the best of luck with the March 10th vet visit.

Hugs, Lori

[molly muffin]

Oh don't worry about doing anything wrong. We can easily move things and in no time you learn your way around this place. :)

Sorry you have to wait, but this is a regular vet, not a resident now? I think it might be worth it over all.

We've had several people making the drive, it's a long way but if you can get an IMS and then have them work with a local vet so you don't have to drive for each thing, it can work out well.

Hang in there. I haven't heard of the sticky spit thing. Maybe one of the admins have heard something.

hugs,
Sharlene and Molly Muffin

[pansywags]

Yes, this appointment is with a regular staff vet, not a resident. It seems I chose a bad time to insist on a vet with a focus on endocrinology.

[molly muffin]

If it gets you a good doctor that you feel more comfortable with then it will be worth it. I think Davis is always busy in their endo department. :)

Sharlene and Molly Muffin

[Dawn Anderson]

Yes UCD is busy, her vet there stated that she is seeing more and more cases of Cushing's

[molly muffin]

We have 3 of you currently going to Davis, all with cc. We've had other members go there too this past year and other years. If you are within driving distance it's one of the go to schools for cushings and of course they have done extensive research into cushings at Davis.

So I can certainly see why they would be very busy, if our forum is any indication and it usually is.

Sharlene and Molly Muffin

[pansywags]

Without this site, I don't know that it would have occurred to me to go to Davis. Thanks for existing, everyone!

[Dawn Anderson]

YAHOO:D, you got Butters Dr..She is worth the wait. By chance did you ask if they could call you if someone cancels their appt. Oh heck who would cancel an apt at UCD, I know I would not. But you never know:rolleyes:.

Really like the bucket list thread, thanks;)
Dawn & Butters

Sorry to read you vet is being evasive about answering ? about CC.:(

[goldengirl88]

Glad to see you got an appointment with Dawn's Dr. Hoping all goes well for Pansy. Blessings
Patti

[pansywags]

I didn't ask about getting a call for a cancellation because of the 3 vets I asked about, the only one I could see is out of the office for awhile. We'll wait it out. It'll give me time to collect all her records from the regular vet, emergency vet and IMS - I don't want there to be any chances of documentation slowing things down (I've had a string of communication issues with the specialty vet's office) so I'll hand-carry the records to the appointment.

[molly muffin]

Happy Valentines Day. I hope you have a lovely day :)

hugs,
Sharlene and Molly muffin

[Renee]

I didn't ask about getting a call for a cancellation because of the 3 vets I asked about, the only one I could see is out of the office for awhile. We'll wait it out. It'll give me time to collect all her records from the regular vet, emergency vet and IMS - I don't want there to be any chances of documentation slowing things down (I've had a string of communication issues with the specialty vet's office) so I'll hand-carry the records to the appointment.

Excellent idea about gathering the documents yourself. When my girl got cushings, I immediately started getting copies of all her testing. It's good to have it for your own records.

[goldengirl88]

As soon as any paperwork is looked at concerning Tipper the very first thing I say is make me a copy of it. I have a file a foot thick. If you ever want to leave a practice and don't want a big hassle keep you own file on everything. Blessings
patti

[pansywags]

I will definitely be saving copies of all files for myself as well. They're a little spread out as she's been seen by her regular vet, an emergency vet several times, and the local IMS that isn't working for me. they say they don't need the hip x-rays that were taken late in 2012 but I'm going to bring them anyway, just in case.

[Dawn Anderson]

See everything happens for a reason. You have the time needed to get her records in order and that is a very good thing. Hate the pressure of feeling under the gun in these types of situations. Your a smart momma!. I actually carry hers with me it I take her to work with me just in case of an emergency I'll have them with us.

Have a good weekend

Dawn & Butters

[Renee]

See everything happens for a reason. You have the time needed to get her records in order and that is a very good thing. Hate the pressure of feeling under the gun in these types of situations. Your a smart momma!. I actually carry hers with me it I take her to work with me just in case of an emergency I'll have them with us.

Have a good weekend

Dawn & Butters

I have had all the test results emailed to me so I could have them stored in my email at all times! It's good to have it all together. ;)

[goldengirl88]

I was just wondering I posted on your old thread. Is your dog swallowing a lot? Tipper is constantly and I am wondering if she has something making her saliva sticky too? Blessings
Patti

[pansywags]

Patti, I don't think she swallows excessively, but she is the lip-smackin'est!

[pansywags]

I posted some pics of the scales on Pansy's back (mostly up top, following her spine). I suspect this might be calcinosis cutis but have not had a biopsy done. There was a patch near her right shoulder that was red and angry looking but that calmed down after a few medicated baths. Her fur was coming out in small tufts attached to scabby looking stuff but that has mostly stopped. She has a few more small bald patches near her tail. The only good thing about her fur not growing back is that I can get a really good look at this stuff, blech!

http://www.k9cushings.com/forum/album.php?u=3896

[Renee]

Definitely looks like CC to me, but it can be hard to tell.

[pansywags]

Reneé, having the tests emailed is a great idea - I always know where to find my email.

[Dawn Anderson]

Blech is right, our poor girls. I'm prayn that it doesn't get any worse then it is. At least Feb. Is a short month so the 10th will come sooner rather then later.

Dawn an Butters

[goldengirl88]

I know what you mean about the lip smacking. Some others on here have commented on their dogs doing that. They thought maybe it was neurological?? Blessings
Patti

[Dawn Anderson]

The wait must be killing ya, 11 more days, ugh. Hows she doin?

[pansywags]

Dawn, thanks for checking in. The wait feels interminable. Managing Pansy's bladder needs is more complicated with the rain (can't leave the back door open). Several friends of mine have lost their pets in the last week and it has me down in the dumps. Poor Pansy is uncomfortable and trying to scratch her back and sides on every available surface.

I'm preparing for our appointment at Davis by collecting all the vet records, keeping a set for myself, and practicing NOT telling the vet what I already know - I want the diagnostics to start from zero with no bias from me other than a list of symptoms and history of veterinary events.

[molly muffin]

I think that is a good plan. :) Just see what they say and take it from there.

You can always step in and ask questions if something is unclear or questionable in your mind.
That is what having knowledge is all about so that when the time comes, you can be a partner in your vet to do the best possible and make the best decisions for Pansy.

Sharlene and Molly muffin

[pansywags]

A friend of mine is coming along to our appointment at Davis to be an extra set of ears (she's a vet tech) and to check me if I try to lead the vets toward the conclusions I think they should reach (secret YOU ARE BEING BOSSY LET THE VETS DO THEIR JOB signal: dropped keys) ;)

It's depressing revisiting the details of all the problems my poor pooch had since 2012 that have brought us here.

[molly muffin]

Oh that is great that your friend can come along. Funny about the drop keys. :) :)

It's good to revisit if it will give you the answers you need though. I am hoping that this visit will do that.

hugs
Sharlene and molly muffin

[Arizona Boston]

Just stopping in to say hi. You are lucky you have a friend that is a vet tech. I just read your story and have a few random comments.

Lucy's first two vets…I didn't feel very comfortable questioning (or correcting ) them. Fortunately now with vet number three, we have a great fit and I can discuss things with her. I hope you get lucky that way too.
Also I can relate to the money consideration. When my dog had a seizure just 5 minutes after we left the vet office …. my husband said " We need to take her back to the office!" and I thought "How much more is that gonna cost?" So I calmly said " Lets just observe her for a few minutes…." It worked out OK….. I called them when I got home. :)
But mostly I just wanted to comment on Pansy's skin. Her CC looks very much like Lucy's did. Lucy had a shaved area on her wrist from an IV that the hair never grew back until we got her cortisol level down.
I hope better days are right around the corner for Pansy!
Shelly and Lucy

[Dawn Anderson]

Dr.Della.Maggoire is very open and actually asked my ? about what I knew of the disease and even asked my opinion on what med Butters should have, which really surprised me. ( she knew just by Butters records that I was turning over every stone and trying to find out everything that I could to help my girl, also seeing all the money I had already spent, she knew I meant business)We both agreed with trilo since it was being driven by the pituitary gland and not the adrenals.
I am sure you will have the same experience with her, oh some times she can speak very quickly, but she will slow down if you ask her to repeat what she said so that you can have a better understanding of what the plan is. She has many case and students under her.

Monday will be here soon and will be standing by waiting for you guys.

[pansywags]

We are heading for Davis now. I may not post until tomorrow depending on how long our visit is.

[goldengirl88]

Good luck to you, I hope everything turns out OK. Blessings
Patti

[Harley PoMMom]

Best of luck and we will be anxiously waiting! ;)

Hugs, Lori

[molly muffin]

checking in to see how things are going. Good luck!!

Sharlene and molly muffin

[pansywags]

We had a long day at Davis yesterday, leaving at 8 am and getting home at 8 pm.

First, I can't say enough good things about the small animal hospital at Davis. Dr. Della Maggiore and her student Stacey were kind and extremely accommodating - they did much of the initial consult in the lobby since Pansy gets anxious around groups of dogs and I asked to avoid the crowded waiting room.

Short story: abdominal ultrasound showed both adrenal glands enlarged indicating pituitary-dependent Cushings. No other monsters were noted in the abdominal cavity. Blood pressure was normal (checked due to history of nosebleeds). CBC, chemistry, urinalysis, urine culture and endogenous ACTH were ordered, results are pending. Because of Pansy's arrhythmia, Dr. D wants to be extremely cautious and have a cardio workup before any sedation/anesthesia. Her skin condition was visually confirmed as CC, and I was told it is not a severe case. The suspected pituitary growth may be putting pressure on the part of her brain which controls appetite (resulting in suppressed appetite) as well as pressure on one of her eyes from the inside causing it to bulge.
We discussed the option of radiation and the costs involved (I think approximately 5K but I don't know if that includes any CT scan costs).

I don't know how readable this is but I uploaded the discharge notes here http://www.k9cushings.com/forum/album.php?albumid=850&pictureid=6366 - I made a pdf that's more readable but I couldn't get it uploaded.

For now, we wait for test results.

[molly muffin]

I think that is readable, at least for me when I do a control + to enlarge it. I'll have to read it later as I have a meeting in 5 minutes though.

I agree, Davis has done good things for many of our members who are within driving distance of it. Definitely worth the wait to see Dr., Maggiore. :)

Do they have any recommendations if you don't do the radiation?

Glad you had a safe trip and found some answers.

hugs
Sharlene and Molly muffin

[pansywags]

Sharlene, thanks for confirming you can read it. I'm so glad we waited to see Dr. Della Maggiore, she's great. Plus, I got to trot out the phrase "Well, Buttercup's mom said...." :)

I don't know what the recommendation would be if not radiation. Medication would not be a good treatment for her because of her already suppressed appetite. My sense is that her hind leg weakness will continue to progress (I have done everything I can to keep her strong but despite our regular home PT regimen, she now struggles to walk a mile) and I will have to let her go for mobility reasons. I promised the day I brought her home that I wouldn't let her live in pain, and that I would set her free if the day came when she couldn't eat, drink, eliminate or stand on her own.

[Dawn Anderson]

I soo understand those long days at Davis and yes they are wonderful to work with. Keeping fingers crossed regarding her cardio issues.
I sent you a PM

Dawn & Buttercup

[pansywags]

Dawn, I saw your private message about the shivering once and can't find it again. I don't know why PMs are so tricky for me here. It's not in my messages inbox and it doesn't show when I click on my profile. Is there another secret spot for PMs that I"m not looking in?

[molly muffin]

I completely understand. I won't let Molly live in pain either, if that time comes then I'll have to take the final step, not something I want to do, but would have to do. So I do understand what you mean.

Your PM's should be there in your inbox. I usually go to my user cp in the top left corner and then list messages on the left hand side on the panel, or on the top right corner under list messages.

There are also visitor messages which you can see by looking at your profile. After you click on User CP, (top left), then on the left panel you'll see Your Profile. You can also, just click on your name by your avatar and then click "view public profile"

Let us know if none of these enable you to find your message, either PM or visitor. (was it on Dawn's vistor message page?)

hugs,
Sharlene and molly muffin

[Dawn Anderson]

You can go to my home page it is there also

Dawn

[pansywags]

I can view it on Dawn's page but not in my messages or on my profile. How strange - but thanks for suggesting that I look on Dawn's page.

[labblab]

Dawn, I saw your private message about the shivering once and can't find it again. I don't know why PMs are so tricky for me here. It's not in my messages inbox and it doesn't show when I click on my profile. Is there another secret spot for PMs that I"m not looking in?

Please take a look at this thread about PMs "disappearing" to see if this is similar to what you experienced. If so, please add a reply to the thread in order to document that the problem is still continuing on our website. Thanks!

http://www.k9cushings.com/forum/showthread.php?t=5921

Marianne

[pansywags]

One of the things I forgot to ask the vet at Davis (it was on my list, but we didn't get that far down) about is that occasionally Pansy goes through spells where I can see that she's shivering when she inhales. It seems fairly localized to her torso and looks different from the shakes she gets when she's scared. She doesn't do it all the time, maybe for 15 minutes or so at a time.

Dawn tells me Butters has had this and was told it's related to hormone levels. I'll mention it when the vet calls back to discuss Pansy's test results. She called yesterday but I wasn't available so hopefully we'll speak today.

Thinking about the appointment we had, I was not surprised by the info we got so far - thanks to this group, I was expecting to hear most of what I did. The one big surprise to me was that a dog with pituitary driven Cushings can actually have a diminished appetite if the tumor is putting pressure on the part of the brain which influences behavior (including appetite). A ravenous appetite seems like such a hallmark of Cushings, I previously didn't understand how I could have a Cushing's dog who won't eat her food. Getting her to eat meals is a challenge, but between her last appointment in late January and her vet appointment at Davis, Pansy didn't lose any weight. Yay! At 38 lbs she is still too skinny but she's not dropping.

I'm glad I brought my vet tech friend along to the appointment, it was good to have a second opinion on how to proceed. It seems that after I asked my friend what she thought about something, they concluded that we're a couple and started saying things like "you two have given her a great life", etc. When we took a lunch break, she had this hilarious outburst: "They think I'm Pansy's DAD!". We just went with it.

[goldengirl88]

I have been looking in on your thread. You certainly have a lot to deal with so stay strong, your baby will need you. Great idea taking your friend to Davis. You went to a great place. I am not sure I am clear on your options though. What are they saying as far as treatment? I hope and pray everything gets better for you and your Pansy. What a cute name she has been given. Blessings
Patti

[pansywags]

Short answer: probably radiation.

Long answer: Right now we are waiting on blood and urine test results. Early indication is that nothing is growing in the urine culture yet, so probably no UTI now.

Indications so far are that Pansy has a pituitary tumor (the endogenous ACTH test results may provide another data point). This would need to be confirmed with a CT scan of her head, which involves sedation. Our Davis vet does not want to sedate her until she gets a cardio workup due to Pansy's arrhythmia, and I appreciate her caution. Once we get the pending test results back, I will likely return to Davis for a chest x-ray, cardio workup and barring any gotchas from those, do the CT scan to see exactly what we're dealing with. At some point while she was sedated they would make a mask if I thought I wanted to proceed with radiation.

I believe the recommended course of treatment would be radiation to shrink the tumor. This is very expensive. I don't know how hard the procedure would be on Pansy, and like everything, there are no guarantees. I don't know that I would be extending her life, but rather improving the quality of the time she has left (and mine as well, if it relieves some of her symptoms). I am struggling with the financial end of this decision as well as the merits of improving her life vs. drawing out her death.

[grapey]

I'm so sorry you're facing this dilemma. It's so hard. When I was thinking about when we'd have to let Elliott go, I considered many things, and one of them was that I felt I could never take her in to be euthanized if she would walk into the vet lobby all happy and perky, like, "Hey everybody, what's going on?" That was one of the things we considered.

I'll pray that you know what step to take next. I know you will.

[pansywags]

Also, I'm totally creeped out that she may have a tumor that's putting pressure on the back of her eye, causing it to bulgs! First of all, that's horrible, and second, I'm totally squeamish about eye stuff, so EEEK!

[goldengirl88]

I am so sorry your Pansy is having so many issues because of this tumor. You seem to have a good plan put together and that is important. I think Dawns dog Buttercup had pressure on her eye too if I am not mistaken. This disease can do awful things to these innocent babies. I pray for a miracle for you and Pansy
Patti

[Dawn Anderson]

Butters never really had the feed me all the time symptom. It really does matter on the position of the tumor. Butters tumor grew so large that it was pressing on the optical oculant which is were the 2 optical nerves cross that provide a balance vision. She had lost her vision in the left eye for a while there, but since the radiation treatment her sight has greatly improved in that eye (thank god).

Butters sailed through the actual radiation treatment with flying colors. I would drop her off and then pick her back up about 90 minutes later. I actually stayed up there for the 3 days, did not want to put her through all the driving back & forth for she was already going through so much. I stayed at the Hallmark Inn in down town Davis they were fantastic, very animal friendly and just minutes away from the hospital.

I know first hand how stressful this is and am her to help/support you in any decision you make. Keep up the good work, your girl knows that you are leaving no stone unturned for her and she loves you for that, that's why you are her mommy.

Dawn & Buttercup

[Dawn Anderson]

Oh and the eye thing, I feel the same way. I also have a thing when it comes to eyes & teeth!!!!!!!!!!!!!!!!!!!!!!!!!

Dawn

[pansywags]

Thanks to everyone for all your kind and supportive words. You all know how hard this is. Pansy is a very special dog to me and lots of other people - my father is not well and seeing her is one of the only things that really cheers him.

On another note, I uploaded a video of her shivering when she inhales here http://www.youtube.com/watch?v=YV7mc78B1UM&feature=youtu.be - I don't totally understand the mechanism but I feel fairly confident now that this is a Cushing's effect, rather than her being cold or scared.

Still waiting to hear from Davis. At this point I figure she may be waiting until the urine culture is complete to return my call so she has all the info at hand.

[labblab]

Just viewed your video, and this is very, very similar to the tremoring my Cushpup, Barkis, exhibited, too. I've always described it as shivering across his shoulder blades (most often when he was lying down or even sleeping). Although it was not confirmed by imaging, we do believe he suffered from a macrotumor. But the tremoring began before he was even diagnosed with Cushing's, got much worse right after starting trilostane treatment, and then stopped after a couple of months (never to reappear again).

I've personally guessed that it had to do with rapid changes in cortisol level, either up or down. But I will be very interested to hear what Davis has to say since other members have also mentioned the phenomenon through the years.

Marianne

[pansywags]

Marianne, I have only seen this when Pansy is lying down, probably snoozing. There seems to be no distress associated with this (at least not for her!).

I should probably add for anyone looking at the video that while Pansy does have CC, that's not the (main) cause for her giant patch of missing fur. She had a dermal cyst removed from her side in late 2012 and the fur never re-grew. She also had a small lump taken off one of her front legs, and, strangely, the hair did grow back, but just over the site where the lump is removed. So there's a small square shaved patch on her leg with a little island of fur in the middle. Now that her belly was shaved for the ultrasound she really is the patchwork boxer. We embrace her inner beauty these days.

[labblab]

Yes, there was no apparent distress for Barkis, either. It freaked me out, but didn't seem to both him at all (except for occasionally waking him up when he tremored especially severely in his sleep). I am so glad you've posted this video, because I have been trying to describe it for years using words alone. Your video is so much more helpful!

[pansywags]

I posted this more as a resource for new members than as a question about Pansy. It's hard to describe and there are so many vocabulary options to do so that I thought a video might be preferable. Pansy's a good spokesshiverer because she's so lean (and bald!). It also freaked me out because I thought she might be in pain but now I feel pretty confident that she barely notices it.

I don't see this listed frequently as a Cushing's symptom and I wonder if it is specific to macros. We don't have a confirmed macro yet but I suspect we are headed that way.

[goldengirl88]

What you showed on the video is very similar to the tremors Tipper does only at nite too. If you look closely it is not happening on the hind quarter while it is happening in the front. I was led to believe Tipper's was a side effect of Vetoryl. Tipper's started in her rear leg, then progressed to her side, the even her eye twitches. Does Pansy ever wake up? Tipper seems to sleep thru it. If you wake Pansy does it stop immediately?? Blessings
Patti

[pansywags]

I don't think it's disrupting Pansy's sleep (hardly anything does). I'm going to experiment with waking her up to see if that stops the shiver. She doesn't do this all the time, it's usually for ten or fifteen minutes at a pop. I have noticed it more in the morning, but that's usually when I'm using the computer for longer stretches and she's asleep next to me (ears imperiled by the chair casters) so I have a pretty good view.

[goldengirl88]

Tipper does this in spurts too. It seems to happen a lot when she first falls asleep. Just keep an eye out and see if it travels to any other part of her body. Watch her eyes for twitching and see if it is happening at the same time. Blessings
Patti

[pansywags]

Sigh. Spoke with Dr. D this afternoon. Nothing of significant note in Pansy's CBC, some minor abnormalities in the chem panel (calcium and albumen slightly low, liver values very slightly elevated). No growth in the urine culture. Endogenous ACTH not. low enough to be consistent with adrenal problems. Next step would be some cardio screening and a chest x-ray prior to (day before) a CT scan, so an overnight stay.

The bad news is that Dr. D is leaving town and then needs to take some time away from patients to work on research so a (wait for it!) resident will be front-ending the tests with Dr. D overseeing. I'm really, REALLY disappointed and frustrated. We waited so long to see her and I know it's not personal but now I feel like I'm being handed off.

[My sweet Ginger]

http://youtu.be/V7R9jwWpe4A
Hi, my name is Song and welcome from me and my Ginger, too.
I saw your video and that's what my Ginger did only hers were worse I think. Ginger was doing this all day while during sleep or resting which she did most of the days. I didn't really pay a lot of attention to the fact that she was shivering only when inhaling.
I just thought it was strange happening that way but there maybe some connection to this kind of movements and macro. This particular tremor or shivering started after Lysodren treatment and I see them happening a lot less now since she started taking seizure medicine.
I will pray for you and Pansy so that you will find a treatment that works for her. We all understand how you feel. Take care.

[Dawn Anderson]

Just watched the video and that is exactly what Buttercup looked like, she was not on any trilo at the time it started after the radiation therapy. In watched like a hawk praying that is was not the start of some type of seizure, then it just stopped.

Please do not feel as if you are being handed off, Dr.D will be reviewing the case as well as the rest of the dept. Before we got to Dr. D, Butters was seen by the following dept., nero, endo, opthomology,oncology, radiology, dema, they presented her to all these depts before she even had her treatment. You are in good hands, as per Dr. Kent in radiology told me that there are over 300 Dr.s that he has access to right there in one location that specialize in every aspect of animals health needs, should I have any problems or ? That was out of his realm all he had to do was make a quick call to one if his colleges and he would have the answer for us.
Keep your chin up your doing great, I've learned that once you start the process it starts to pick up speed on its own. Once the cardio if hashed out, which I feel.will be fairly soon then things will go in to high gear. At least that's what happened for us. Diag on 11/2, seen at UCD 11/13,14,15 mri was performed, then 11/20 cat scan, radiation on 11/25,26 and 27. Looking back at it now that was one crazy month and many times I felt as if I was going to spin out of control, but thanks to my forum family here we both survived.

[goldengirl88]

Hope Pansy is doing well this morning. Sorry to hear you Dr. will be away, and hope you can get someone just as good to take over the reigns for now. Blessings
Patti

[pansywags]

Thanks, all. I'm trying to work through my disappointment, I know it's making me feel very negative about the whole situation and that certainly isn't going to help Pansy.

[Tina]

I have been following along on your thread and am so sorry that you and Pansy are going through this. You are doing great with her. We all understand how difficult it is. I understand your disappointment with the Dr situation, I know I am not happy when my boy has to see another vet in the office if mine happens to be out.

Big hugs,
Tina and Jasper

[Renee]

I have been following along on your thread and am so sorry that you and Pansy are going through this. You are doing great with her. We all understand how difficult it is. I understand your disappointment with the Dr situation, I know I am not happy when my boy has to see another vet in the office if mine happens to be out.

Big hugs,
Tina and Jasper

I completely agree, and totally understand. We put so much faith into the vet we choose, placing our dogs lives in their hands... then, to have it change is so frustrating! It really takes away that feeling of control and comfort. I really just think Dawn is correct though, there are so many specialists available to you, everything will work out.

I have an inexperienced vet as well, and the way we work through a lot of this, is to make sure we are consulting with other specialists, reading/researching, and making ALL decisions together. You can do this!

[pansywags]

We will be heading back to Davis next week for 2 days of testing - chest xray and cardio on day 1, then CT scan the next day if nothing prohibitive is found on day 1. It was a lengthy conversation because they told me their policy is that they won't provide written estimates except in the clinic (??) so I had to kind of make my own estimate while we verbally reviewed the items.

Because Dr. D is traveling, I made the appointment with the department coordinator/assistant. I had some questions she couldn't answer:

1) What is the process for the echocardiogram and what is it intended to discover?
2) Are CT scan results reviewed real-time or will I need to wait for vet review and callback?
3) Approximately what time should I expect to pick Pansy up after her CT scan

The coordinator said she would ask one of the vets to return my call about those questions. I got a mildly exasperated sounding voicemail from Dr. D telling me she was trying to travel and if I felt I couldn't move forward without my questions being answered prior to the day of the appointment I should call back to speak with another vet (which is what I thought was going to happen anyway). I believe I may have inadvertently been tagged as a problem pet owner. And I've just realized that I need to double check whether I should feed Pansy before we leave for Day 1, we did not review that, so I need to make myself more of a pest by calling again.

[goldengirl88]

I can tell you the echo cardiogram is done to see how the heart is functioning. my Tipper has had two so far. They were also able to tell me that her heart was not enlarged, and was functioning normally. Please don't take on the persona of
a problem pet owner. This is a lot of stuff going on that you have to comprehend, and deal with so dont feel that way. You have every right to ask questions, expect answers, and be treated respectfully. Just because you are concerned about your dog , people need to understand there is a difference between that and a problem owner, and you hardly sound like a problem owner to me. Blessings
Patti

[pansywags]

On a lighter note, Pansy has been taking photos recently with a cheap collar-cam. She wore it during her first visit to UC Davis - I've uploaded some of the photos she took during her day there.

http://www.k9cushings.com/forum/album.php?albumid=856

[goldengirl88]

What an really cute idea that was. I would never put one on Tipper though as we would all be looking at the bottom of trees and piles of you know what!!

[molly muffin]

A young photographer in the making. :) :)

Hugs
Sharlene and molly muffin

[pansywags]

I had a houseguest this weekend and we were talking about how Pansy is on track to be the world's first Hairless Boxer, what with her giant shaved surgical patch, circa 2012, that never grew back, and her belly that had to be shaved for the abdominal ultrasound, and more shaving to come, I presume, for this week's echocardiogram.

My houseguest remarked that Pansy, like the Velveteen Rabbit, has simply had her fur loved right off. Awww.

[molly muffin]

Awwww, that is sweet. What a good friend.

I'm sure she is still cute as a button though. :)

hugs
Sharlene and molly muffin

[goldengirl88]

That is so absolutely adorable. What a nice thing for your friend to say. Hoping all will go well and good news on the echo. Blessings
Patti

[pansywags]

OK, please send positive thoughts our way, we are Davis-bound again today. I'll update in a few days.

[goldengirl88]

Positive vibes coming your way. Be safe, and update us. Good luck. Blessings
Patti

[molly muffin]

Have a safe trip! We'll be here. :)

hugs
Sharlene and molly muffin

[pansywags]

Quick update from the hotel in Davis: today's tests indicated clear lungs but they found a mass on Pansy's heart that the doc thinks is something called a chemodectoma. There was no clear contraindication to anesthesia so we are going ahead with the scan tomorrow with the understanding that her health is compromised by possible cancer in two areas, which carries additional risk. I have signed a DNR for tomorrow's tests - her quality of life is fairly poor right now and I see no point in calling her back to it if she crashes during the procedure. Time permitting, they will be scanning her heart as well to try to get more info on the mass there.

For all my fussing about not getting to meet with Dr. DM today, the vet we met was wonderful, and Dr. DM poked her head in to lay a little love on Pansy. Both vets will be in the room for the CT scan tomorrow.

[molly muffin]

Oh my gosh. Not the news that was expected at all. :(
Sending lots of positive strength your way. Tomorrow is likely to feel like a year for you.
You can always check in here and someone will be around to chat if you want.
Did your friend drive up with you this time too?
Everyone always says that Davis has a wonderful team. Team being the main word.

hugs
Sharlene and molly muffin

[Little CoCo Puff]

Pansywags, so sorry for the news but you are doing all you are able to do. Just think how lucky Pansy is because of you. Prayers and good luck with everything.

[Dawn Anderson]

Butters and I send our love, support and positive prayers. Comforted in knowing that UCD Vets are some of the best on the planet and that your girl is being care by them.

Dawn and Butters

[doxiesrock912]

Praying for miracles! Our pups are resilient, you never know.
Another mass! :(

[goldengirl88]

I am praying for your baby. I am so sorry another mass was found. I know how deep this hurts to hear all this. I am thinking of you both and praying for a miracle. Blessings
Patti

[Squirt's Mom]

Hoping for a good procedure and no issues from it. That DNR is hard hard hard to sign - I did one with Grace's surgery for the same reasons as you. I pray Pansy proves as strong as Grace did and this new discovery will not be as bad as initially thought. We are with you all the way, honey.

Hugs,
Leslie and the gang

[molly muffin]

Checking in on you and Pansy today. I hope things are going okay

hugs
Sharlene and molly muffin

[pansywags]

Leslie, the thing about the DNR is that it turns out it wasn't hard to sign. Pansy has had surgery before and nobody else has ever asked me to sign one, so it was a surprise and when it came up I didn't hesitate, immediately I knew I didn't want her brought back - and that drove home more than anything that her quality of life has been so low lately.

[pansywags]

In addition to the macro and heart mass, which turned out to be quite large, they found the pressure on her eye was from a third mass. They offered me the option of a needle aspiration while she was under but didn't feel that knowing more about that mass would change her prognosis and treatment options so I declined. They wanted to keep Pansy as long as possible for recovery from the anesthesia so I didn't pick her up until 6:30. We discussed the possibility of radiation but with so many unanticipated moving parts and the added expense of multiple radiation sites, I decided to go home and spoil her for the time we had left. The docs anticipated it would be a couple of weeks before her eye became painful.

When they brought Pansy in she seemed disoriented, trying repeatedly to leave the room and refusing to settle. The vets assured me she was still coming down from the anesthesia and also probably had to pee (which she promptly did while I was paying her bill, followed by a desperation poop). After she relieved herself outside she seemed more herself, moving normally toward the car and home home HOME!

A couple hours later when we got home it was clear something was very wrong. She wanted water and knew where the bowl was but seemed to have forgotten how to drink. She headed for corners and just stood there. She was knuckling and unsteady. I don't think she was in pain or distress, just confused and maybe even not aware. I called over some of her favorite people to spend a little time with her, while she laid down and even slept for awhile, but every once in awhile she would get up with great purpose and be reluctant to settle again. I wanted to do it at home but I couldn't let her spend the night like that, not after a really hard couple of days. Two of my best friends came with me to the emergency clinic and loved some more of her fur off while she went to sleep for the last time just before midnight.

My heart is broken.

[goldengirl88]

I am so sorry, my heart is very heavy this morning learning of this. God Bless you and Pansy who is running free from pain. You are a strong person, and I hope you get thru this ok. Blessings
Patti

[Squirt's Mom]

I am so sorry for your loss but am glad Pansy got to spend some time with those she loved before she flew to the Other side. You did all you could to help make her life the best possible and when nothing more could be done, you gave her the greatest gift possible.

Please know we are here for you any time you wish to talk. You always have a soft place to fall here.

Our deepest sympathies,
Leslie, Squirt, Trinket, Brick, Sophie, Grace, Fox and all our babies at The Bridge


I Haven't Left At All

I saw you gently weeping as you looked through photographs
You paused for just a moment at one that made you laugh;
But as you turned more pages the tears began to flow
You whispered that you missed me but I want you to know;
I softly licked those stinging tears that down your cheeks did fall,
I want to help you understand I haven’t left at all.

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

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

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

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

[Renee]

Oh dear. Tears here at work while I read this.

I am so very, very sorry, but also very heartened to read that she was not alone, and had you and your friends by her side.

Sail on and run free Pansy.

[doxiesrock912]

Oh no. I am crying as I read your posts. So many cushpups have left us recently.
I am so sorry for your loss of sweet Pansy. Hugs.

[pansywags]

Thank you for your kind words. We are both free of the pain, stress and worry the last year has brought. The boxer shaped hole in my heart will never fill entirely but knowing that Pansy was set free by giving her the last, best and hardest gift will help me heal in time.

[molly muffin]

Oh my gosh, I am so sad to read this. She tried really really hard and so did you. It is the ultimate gift of love to let them be pain free at last. One of the hardest things you can do, as you are the one left with the pain of their loss.

What an incredibly sweet momma you are. To bring her special people to her so everyone can say their good byes and tell her how loved she is and will always be.

My sincerest condolences.

Sharlene and molly muffin

[Trixie]

I'm so sorry to read about Pansy. What a heartbreaking situation. So sad and difficult to deal with the loss of your sweet girl. No more suffering...you did everything you could have but I know that doesn't make it any easier to lose her.

Barbara

[BostonLover]

:( I am so sorry for your loss. Crying as I type this....Sending you hugs and love and positive vibes.

[Harley PoMMom]

I am so terribly sorry too. Although I realize that there are no words to help ease the pain you are feeling, I do hope you can find some comfort in knowing that we are here for you and really do care deeply.

Godspeed sweet Pansy

With Heartfelt Sympathy,
Lori

[Little CoCo Puff]

Oh Pansy, so sorry you have crossed. I have been reading every post on you and then my Little CoCo Puff passed. Perhaps Pansy and CoCo made the trip together - the big and the small - that brings a little smile to my very sad face. It is always tough to make choices when there are so many unknowns. Please know Pansy had you with her until the end and felt your love.

[Trish]

I too would like to add my sympathies on the passing of Pansy, so sorry to read this about your dear girl. My condolences to you and the rest of her family. Big hugs to you too x

[Spiceysmum]

So sorry to hear that Pansy has passed away. My thoughts are with you.
Linda

[pansywags]

I just got back from a lap around the park where I've been walking Pansy for years. Good memories of many excellent poops!

I put Pansy's ID tags (her rescue tag from when I got her, the tag she wore for years and the new one I got her just about a month ago) on her collar and hung it from my bedpost so she can, in spirit, sleep in my room once again.

Man, there's a lot of dog stuff in my house.

[doxiesrock912]

We do tend to spoil them, don't we? Lot's of doggy stuff means a life well lived.

[goldengirl88]

Thinking of you and your wonderful Pansy this morning. I pray for you to get thru this. Blessings
Patti

[pansywags]

Yesterday was a hard day, my first day in my Pansyless life. My home is silent and strange, but I keep hearing phantom boxer huffs and puffs coming from corners (anyone with a snorty dog will understand how much a part of your aural landscape this becomes).

I asked one of my sisters to break the news to my dad. He is in an assisted living center in poor health and this is going to be such a blow for him, although I tried to prepare him as best I could. He just loved Pansy and would annoy the staff when I visited with her, using his call button to summon people to his room to admire "his" dog. I just don't have the oomph for that conversation right now. Pansy, who volunteered for a time as a therapy dog, was one of the few things that truly made him happy.

We all love our dogs so much. but this little boxer was loved far and wide. I have always said there would be a national day of mourning when she went, and the phone calls have been very hard. Not a single person has called me that hasn't ended up in tears within the first sentence. I know my people feel terrible for me, but every one of them had their own bond with Pansy and are really personally grieving for her right now, not just sad-for-me-because-I-lost-a-pet. Needless to say, these conversations are setting me off again. Before she became The Velveteen Boxer, she was called The People's Boxer, and her public misses her terribly.

[molly muffin]

You know that says so much Pansy, what she was like, her personality, that so many people across the world, loved her and miss her terribly and are grieving for her themselves. The emptiness is one of the hardest things I think. I remember after losing my Tasha, that the world seemed emptier and the house and yard especially so. The sounds, the smells, the rituals of food time, walk time, this and that. It just all went away in the blink of an eye.
Sending you big hugs.
Sharlene and molly muffin

[grapey]

I am so, so sorry for your loss.


Pansy was set free by giving her the last, best and hardest gift will help me heal in time.

You said this very beautifully. It's so true. I take great comfort to know that I did for Elliott what she couldn't do for herself--what she needed me to do for her. Knowing that she's at peace takes away a lot of the pain, because I felt so much more pain during her struggles. At least now, the only one hurting is me, and I'm glad for that.

Giving Elliott a peaceful death was my last gift to her, but it was also a gift to me, because even though it was unbelievably hard, it was also so beautiful. Something I will never, ever forget.

Thanks for letting me talk a little about that in your thread :)

[goldengirl88]

Just checking in to see how you are today, and let you know I am thinking of you. Blessings
Patti

[addy]

I was reading a very old book about grief the other night and found this:

The soul would have no rainbow, had the eyes no tears

I lost my little girl five short weeks ago after dealing with Cushings for 4 years.

Know that we all care and are here to listen and love and hug as you adjust.

[Iraklis]

The soul would have no rainbow, had the eyes no tears



no words...this says it all...love it...

[pansywags]

Thanks for checking in. I am just OK.

The upside of having a super popular dog is that nobody is giving me the it-was-just-a-dog, you'll-get-another-one routine. Instead they're sending flowers and cards and treating me very gently.

Yesterday I went to the garden center and planted a beautiful bowl of pansies in the yard with Pansy's ID tag adorning the bowl: http://www.k9cushings.com/forum/album.php?albumid=869&pictureid=6573

Despite the overwhelming sads, I also feel a sense of freedom. I can leave the house for more than 2 hours at a time. I don't have to leave the back door wide open all night. I can sleep with my bedroom door open. I can go somewhere and stay overnight. I may take myself to Yosemite for a few days as a peaceful little treat.

[molly muffin]

I think it is a double edge sword between the newness of freedom to do things that you wouldn't have before, and then just missing them.
We had one girl, who after her dog passed, took her other dog and went to mountains and just spent a quiet weekend, doing things that she always had enjoyed doing with her babies. She did this several times if I remember correctly.
Everyone deals with the loss in their own way. There is no right and no wrong way to feel. :)
Yosemite would be a nice treat! It's a lovely area.

hugs
sharlene and molly muffin

[scoora]

I am so sorry to hear of the loss of your sweet girl Pansy.
My thoughts and prayers are with you.

[Tina]

I am so sorry to read about Pansy. I have cried many tears this weekend for your sweet girl. You are in my thoughts and prayers.

Big hugs,
Tina

[goldengirl88]

Thinking of you and hoping you are ok. Blessings
Patti

[goldengirl88]

Thinking of you still and sending you big hugs. Blessings
Patti

[BoxerMominBeantown]

Thanks for checking in on us. Hope you are doing as good as can be expected. Sending hugs your way.

[pansywags]

Thanks, everyone, for checking in. I'm still devastated but having so many people share my sorrow eases my burden somewhat - one of my neighbors called the other day in tears, saying she and her husband were at their tax appointment when she saw my note on facebook, and both of them ended up weeping in front of their accountant.

A neighbor I don't know well walked by with his girlfriend and her dog, stopped to say hello and innocently asked 'don't you have a pitbull mix of some kind?'. I got the words "I had a boxer...until Thursday" out before I burst into tears. AWKWARD!

I am crying a little less and laughing a little more. I know some days will be the reverse.

[Trixie]

Awww..not awkward..anyone with a heart would understand your tears, I'm welled up just thinking about you breaking down. It's so hard to deal with the loss...so many emotions always right there on the edge. It's good that you let it out...even in front of the neighbors.
Hoping time will make things a little less painful...but it's way too soon to expect that.

Barbara

[pansywags]

I'm battling a monster case of the what-ifs today.

What if my vet had suggested testing for Cushing's earlier, rather than waiting until I proposed it? What if the local IMS I used had better communication and hadn't delayed the process by months? What if Davis had been more aware of the signs of Pansy not being right after her procedures? What if I had pressed the issue with them more?

In the meantime, my days are filled with not letting Pansy out to the yard, not tarting up her food with toppers of escalating yumminess and then hand-feeding her the rest, not taking her to the park for a walk, not doing her physical therapy, not giving her medications, not reassuring her that it was OK for us to be in different rooms for two minutes at a time. The things I am not doing are so much bigger than the things I am.

[goldengirl88]

The what its can really eat at you, I know. SometimesnI wish we had the ability to shut our minds off and not think anymore. I know what a hard time you are having, all I can do is praymit gets better for you. Blessings
Patti

[apollo6]

I am so sorry for the lose of your sweet Pansy. What a sweet and beautiful little girl. There are no words to heal your pain,no right way to grieve. Let us support you through the grieve. When you love so hard the lose is even greater.
Hugs Sonja and Angel Apollo

[Iraklis]

Being the king of guilt and what ifs.......i don't have words of comfort...i know nothing can do that...absolutely nothing!

Yet...Right after i woke up today, i pulled out the very few photos i have of my female maltese Penny who died of kidney failure 13th February 2003 (1 day 1 month 11 years before Husko...).
Realized photographs have a way of ''digging up'' memories from the brain.

I don't have any photographs of the doggies i had before that when i was a kid in the 80s' (Rudy ,Wolfy ,Wolfy II, Run -just one of her i think-...came to realize many years later that all of them never survived more than a few months because the mother of my father poisoned them :mad::mad::mad: :mad::mad::mad: ...if she wasn't dead already...i'd kill her...).
I think as time passes by ,our survival instinct ''buries'' ''selected'' memories in order for us to endure and continue living...

I wish you have lots of photographs and videos ,so that many years ahead...you can pull 'em out and remember and honor Pansys' life and memory...

[molly muffin]

Pansy had so many things going on, I don't think any "what if" would have been the perfect answer. Not that we can go back and change things.
Still those thought do strike us all from time to time.

I think it is the what you aren't doing things that are the hardest to handle :(

Take care of yourself. Grief remember, takes its own time.

hugs
Sharlene and molly muffin

[pansywags]

I know - and obviously I can't change things. In low moments I can't help but think that I diagnosed her right into dying, cheating us both of those last precious few weeks of decadent spoiling.

Logically I know that I was trying to help her, we may have had just a few weeks at best, and that those weeks would not have been high quality time for her overall.

Logic isn't winning out right now, though.

[goldengirl88]

Thinking of you and hoping you are able to go on. Blessings
Patti

[molly muffin]

eh well, logic is grossly over rated when the heart is involved. Sort of like patience. :)

hugs
Sharlene and molly muffin

[KatyGirl]

So sorry to hear about the loss of your doll, Pansy.

[pansywags]

I've summarized Pansy's events from start to finish in the macroadenoma thread http://www.k9cushings.com/forum/showthread.php?t=3567 in the hope that reading about her progression might give insight and help other owners get the right help at the right time.

[molly muffin]

Thank you.

I'm sure that wasn't easy to have to go back through.

hugs
Sharlene and molly muffin

[pansywags]

It's been seven weeks today, I can't believe it. This has probably been posted a million times but this is so much harder than I anticipated. I knew it was coming (though not when), so I thought I'd be better able to adjust...but no. Everything is still right there, barely below the surface, bubbling up multiple times a day in unexpected ways and leaking out through my poor overtaxed cryballs.

In the spirit of fake-it-'til-you-make-it, I'm trying to turn things around by adapting my thoughts and phrases from being crushed about what I lost to being grateful for what I had. We had 7.5 years together to celebrate and reminisce over, and Pansy touched a lot of lives, including doing some pet therapy work. She 'turned' a few people who didn't think they liked dogs, she stayed by my side during some very trying times, she tolerated silly Halloween costumes and my insistence on marking her fake birthday and our Pansyversary every year. She greeted each new morning and each time I walked through the door with such exuberance that frequently I just had to dance right along with her (wiggles are so contagious). We had a grand time together, and she enriched my life in so many ways. I hope in time I'll have the privilege of loving another pet as completely.

[goldengirl88]

This touched me to my very soul. I feel for you and know the pain you are in. It is wonderful to have an animal to love, but devastating to lose them as sometimes you feel you cannot ever recover. Blessings
Patti

[Iraklis]

I hope in time I'll have the privilege of loving another pet as completely.

You will...you'll know it...

[pansywags]

A few months later things are still pretty hard but I am having a few days where (I think) I don't cry so that's progress. I've done some traveling and the change of scenery helps, though the homecoming is hard. This weekend a friend will be visiting and has already warned me that she plans on bursting into tears when she comes through the door to find no Pansy greeting for the first time.

A few mornings ago I woke up in a panic because I realized I was late giving Pansy her monthly dose of flea meds. It took a few minutes for me to realize why. Apparently my internal clock needs a reset.

[goldengirl88]

My heart goes out to you. This has to be one of life's most difficult times. Please stay strong and take care of yourself. Blessings
Patti

[molly muffin]

Sending you big hugs! Some days just seem impossibly hard.
I'm sure it will be traumatic for you and your friend both, but it will be good to share it and have some good memory stories together.

hugs
Sharlene and molly muffin

[pansywags]

You're right, Sharlene - it's not easy but it is good and helpful to know how many people join me in missing Pansy. My friend this weekend won't be the first to lose it upon walking into my house (nor, probably, the last).

Thanks, Sharlene and Patti, for your kind and supportive thoughts.

[Robert]

Hi know the feeling and know nothing I can say will really hope but know that I pray for you pansy my tom and tam and all other dogs and people who know that feeling.

[doxiesrock912]

Taking care of these guys becomes an ingrained routine. It is so hard.
In time, you'll love another. Each of them has their own personality, quirks, etc. We love each one for their uniqueness. Hugs.

[addy]

Oh, I can so relate. Sometimes I think my Zoe has come into the room and I feel her so clearly I say "Hi Zoe" and then look and realize, she is not there.

It is a process. We have good days, bad days. The other day I was looking up Traumatic Grief, I really was having a bad week.:o

Big hugs

[goldengirl88]

Thinking of you and wondering how you are doing? I hope things are getting better, I know how hard this has to be. Blessings
Patti

[pansywags]

Patti, it is so kind of you to think of me - thank you. Last week marked three months since Pansy and I parted ways. The milestones are still a challenge but in general things are getting easier. Hearing of anyone losing a pet is a real trigger for me still. Despite that, I think time is doing its trick and I am starting to think the time is not too far away (probably a few months still) when I'll be ready to rescue another needy pooch. The breed rescue I have done some volunteer work with has told me I can have my choice of any of their dogs when I'm ready, so I won't have to look very hard!

[Harley PoMMom]

I am glad to hear that things are getting easier, it does take time. I'm also happy to read that you are thinking about rescuing a new furbaby, Bless your heart!! Please do keep us updated, ok?

Many loving hugs to you, Lori

[goldengirl88]

I am so glad to hear from you, I have been wondering how you are doing. That is a great thing to do by rescuing another baby. I know it will take time, but it is good your heart is starting to heal. I hope you have a good summer, and I hope the rest of it is shared with a fur baby. Blessings
Patti

[molly muffin]

Glad to hear that things are getting a bit better and maybe not every day is as hard as the one before.
It's good that you have a rescue that you already work with and whom you can rescue a furbaby from. Just wait, one of these days, one of those precious ones will speak to your heart and say, we were meant for each other and that will be that :)

hugs,
Sharlene and molly muffin

[pansywags]

I have an admin request: can the title of Pansy's thread be changed to include 'pituitary macroadenoma' for anyone in the future looking for macro info? Take whatever you need off the end of her title. Thanks!

[Budsters Mom]

I did the same thing with Buddy's thread, for the same reason. Bless you for wanting Pansy's thread to be readily available for others in need of help.
Hugs, Kathy

[pansywags]

You gave me the idea, Kathy - I'm just a copycat :^)

[labblab]

Title change has been completed. :o

Marianne

[Budsters Mom]

We all learn from each other here.;) That means copy what we can use and pass on what could possibly help someone else. So feel free to copy me anytime. :p

[pansywags]

I'm happy to report a milestone.

It's been almost five months and I still miss Pansy terribly, and I have good days and bad days. Many of you can relate when I say I wasn't able to travel for quite some time due to her caretaking needs so I have been doing a lot of pent-up travel since she's been gone. Basically, I've been home for 2 weeks this summer. Yesterday I returned from a three week trip, and it's the first time I came home after travel and didn't feel a crushing loss when I came through the door after being away from home. In fact, it was a few hours before I even realized it hadn't happened.

I'll always miss her but it's great to start to be able to do that without falling apart all over the place.

[addy]

Healing is a process and congrats on the milestone. All of these things are so hard.

Pansy will always be with you. Hopefully, we reach a point when memories bring us joy and laughter.

I dont think Pansy or my Zoe would want us to be so sad, so I am sure
Pansy approves!!!

[molly muffin]

Thinking of you and remembering Pansy this holiday season.

hugs,

[pansywags]

Thanks, Sharlene, for thinking of me and Pansy and everyone else who is missing their furry family this holiday season. Another 'first' behind me.

[Dixie'sMom]

I'm glad to hear you are doing better. I know Christmas brought back many memories of Pansy. Although I don't post much on this thread, I do think of you every time I see her sweet face on a post. And I believe your quote is my very favorite. Thank God there are still folks who love us even when we aren't pretty and perfect any more.

I hope the time is even closer for you to share some love with a new rescue. There is a perfect-for-you furbaby just waiting for you somewhere and when you are ready. Hugs to you this holiday season and I'm hoping your new year will bring you Joy!

[pansywags]

Hi, just popping in to say I can't believe it's been a year. Boy, do I miss the little stinkpot, every single day. It's been a hard week, but this is the last of the big firsts.

I was thinking last night about how she came to me (through a rescue, who pulled her from a shelter after she was picked up as a stray) and how scared and sad she must have been in the shelter, pregnant and skinny. So today I went to the pound (we have quite a large one) with three bags of treats and gave every single dog there treats and love in her memory. The big ones, the small ones, the happy ones, the sad ones, the playful ones, the growly ones, every dog that's up for adoption got a treat (or six, or ten. I do play favorites). I did skip the tiny puppies because I don't know what their systems can process.

Once this seemingly endless insurance process is behind me and I'm once again set up in my house I hope to rescue another dog (even though my confidence is shaken by having to re-home Shadow last year). In the meantime, I visit the pound pooches and continue helping with boxer rescue.

[molly muffin]

Awww, that is so sweet! What a wonderful tribute to your love of Pansy and she of you.

You did good with Shadow! Who knows what would have happened if you hadn't opened your heart and your home, so all would know what great potential she had. Don't doubt yourself for one minute. You did an excellent thing with Shadow!

Super big hugs!

[Harley PoMMom]

That was such a lovely way to honor your sweet girl. And I agree with Sharlene, in the future :) you're gonna make a certain doggie very happy by giving him/her such a loving home.

Hugs, Lori

[Dixie'sMom]

Awww... just think of how happy you made those dogs today. What a wonderful thing for you to do. I know Pansy would be so proud of you and so happy to call you her mom.

I lit a candle in Pansy's memory. Hugs to you today and the days to come.