I just realized my 14 year old German Shep might have Cushing's (Max has passed on)

[VetStudent]

Hello forum,

I am a first year vet student and I was reading over all the threads on this forum and wanted to ask a question since many of you here seem to know more than even some very experienced vets!

My 14 year old, male German Shepherd mix began panting a lot at night about 3-4 years ago. It has progressively gotten worse and worse. Finally, about a year ago I noticed he began to have a very stiff gait and at night his panting was intense!

I noticed the range of motion in his hind limbs was reduced, he wasn't 'himself', and just seemed in distress at night. I took him to the vet, we did a CBC and chem and his ALT and cholesterol were the only things HIGHLY elevated.

The vet told me, I doubt he has Cushing's, its probably from a tooth infection he had at the time and was on antibiotics. The vet ran some radiographs and both his patellar regions had lost cartilage and he had pretty solid arthritis.

We put him on adequan and NSAID treatment for the past 3 months. He is walking better, but the panting is intense. It is so bad it keeps us up at times, when he sleeps it goes away. I was looking at his blood work again and Chem and realized how his elevated ALT and cholesterol, plus the panting can be related to Cushing's. I read some of my vet books and saw he had all the classic signs, he eats NON stop, he is overweight, his abdomen isnt extremely distended but it does slightly stick out, however while he loses a lot of hair he has no alopecia.

My question is for you experienced users, can you please guide me towards what I should do next? I am assuming taking him to the vet to run many tests to confirm Cushing's is the best step, but would you advise treatment in his case if it is infact a pituitary tumor not an adrenal tumor?

I'd appreciate any advice, as I want to improve the quality of his life. I can tell he just isn't himself and I want to help him as much as possible,

thank you

[mytil]

Welcome our site! I am sorry your boy is having these troubles.

None of us are vets, we have just a wealth of direct experience from all types of breeds, walks of life and conditions associated with Cushing's. And believe us when we say each dog is different.

Yep, if it were me I would perform additional testing just to be sure. But I would certainly wait until all the antibiotics are given and the infection is completely gone from his body as this can skew results.

The least invasive is the Urine Cortisol/Creatinine Ratio (UC:CR) Test. It is considered a screening test, and cannot diagnose Cushing's, but it can rule it out.


A urine sample is examined for the relative amounts of cortisol versus a normally excreted protein metabolite, creatinine (the latter is used to control for the degree of dilution of the urine). The greater the ratio, the higher the cortisol level. High cortisol in urine is suggestive of high cortisol in the bloodstream. Many conditions other than Cushing's disease can cause false positives, so this test is not considered diagnostic. Nonetheless, if the cortisol/creatinine ratio is okay, the dog is not likely to be Cushingoid, so this is a good screening test.

In case you have not read through these links (sorry to repeat if you have :) ). http://www.k9cushings.com/forum/showthread.php?t=180.

The panting by itself can mean a lot of things from the pain he is experiencing, to heart problems to just unable to regulate the body heat as his age progresses. Shepherds can be loud heavy panters.

But when combined with the other symptoms you have mentioned, it is a clinical sign of Cushing's.

Quality of life is most important and if you feel your boy's improves with treatment I certainly would try, even if it turns out to be pituitary dependent.

Keep us posted
Terry

[labblab]

Hello and welcome from me, too! I am so sorry about the changes you are seeing in your boy, but very glad that Terry has started you off with some very helpful info. The one thought that I want to add quickly this morning is that, usually with Cushing's, the ALKP will be highly elevated and perhaps accompanied by more moderate elevations in the ALT and other liver markers. The fact that your dog's ALT is highly elevated in isolation would be an atypical Cushing's finding, and leads me to wonder whether whatever is going on is more liver-specific. For instance, was this bloodwork performed before or after the three months of NSAID treatment? If afterwards, I might worry that the medication is having an adverse effect on his liver. Or if beforehand, it seems there would be risk that the medication could promote further liver toxicity/damage.

Since all of the diagnostic Cushing's blood/urine tests can return "false positives" in the face of nonadrenal illness, I might be inclined to start first with an abdominal ultrasound so as to obtain imaging of the liver, adrenal glands, and other internal organs. That information may help to support or instead rule out the likelihood that Cushing's is involved, and point you in an alternative direction.

Marianne

[lulusmom]

Hi and welcome.

First let me say that 14 years old is quite senior for GSD and your boy is already past the life expectancy for his breed so I think you are a pretty amazing pet owner. That's awesome.

In reading your post, it seems that the cbc and chemistry were done a year ago but if not, how fresh are they? Can you please post the actual abnormalities, including the normal reference ranges?

With respect to symptoms, have you seen a marked increase in your boy's water intake and urination? You mention that he eats non-stop. Has he always had a big appetite or have you noticed a marked increase? As Terry mentioned earlier, GSD's tend to be heavy panters anyway but there are many other causes for excessive panting. Extra weight can put pressure on the diaphragm, adding to the panting. Overweight dogs are also more sensitive to heat, which causes more panting. GSD's are also predisposed to hip dysplasia, which is quite painful. Extra weight puts added pressure on the joints, exacerbating that pain so I'd definitely try to get some weight off of him. What do you feed your boy?

The more information you can give us, the better equipped we'll be to help you help your dog. I'm glad you found us.

Glynda

[VetStudent]

Hi and welcome.

First let me say that 14 years old is quite senior for GSD and your boy is already past the life expectancy for his breed so I think you are a pretty amazing pet owner. That's awesome.

In reading your post, it seems that the cbc and chemistry were done a year ago but if not, how fresh are they? Can you please post the actual abnormalities, including the normal reference ranges?

With respect to symptoms, have you seen a marked increase in your boy's water intake and urination? You mention that he eats non-stop. Has he always had a big appetite or have you noticed a marked increase? As Terry mentioned earlier, GSD's tend to be heavy panters anyway but there are many other causes for excessive panting. Extra weight can put pressure on the diaphragm, adding to the panting. Overweight dogs are also more sensitive to heat, which causes more panting. GSD's are also predisposed to hip dysplasia, which is quite painful. Extra weight puts added pressure on the joints, exacerbating that pain so I'd definitely try to get some weight off of him. What do you feed your boy?

The more information you can give us, the better equipped we'll be to help you help your dog. I'm glad you found us.

Glynda

This is in response to all those who replied, thank you guys for your help.

Max is 14 years old and a german shepherd MIX, so unlike a pure bred which is often 90-110 lbs, Max is only 58 lbs. Ideally, he should weigh about 53 according to the vet, and I would give him a body condition score of about 4 out of 5. He has always struggled with weight issues.

I used to feed him dry food mixed with chicken from ages 1-8, then from 9-13 I had him on the raw food diet, he loved it, but ultimately due to financial reasons it got pricey and difficult so I now have him on Hill's Science diet mobility with a small amount of can. I give him 2 cups a day with just a little bit of can.

He was very energetic until about this year, he first went progressively deaf to a point he can hardly here me unless I make high pitched sounds. His panting has progressively gotten worse and worse.

It started about 4 years ago, it got really bad as of this last 12 months. It starts at night, he is panting and his heart is beating quite fast. About 6 months ago, he had a tooth infection, I took him to his vet and the blood work showed very high levels of ALT and Cholesterol. Everything else was Within Normal Limits. I am trying to find the paper with the information so I can post it, I think I might have left it at my parents, but I will post it once I get it.

The vet looked at the paper work and said,"Looks indicative of Cushing's but I doubt he has that, its quite possibly from the stress of antibiotics from the tooth infection." He also took radiographs of him, he told me his cranial cruciate ligaments are quite damaged and that he has pretty solid arthritis in his patellar regions.

For the last 6 months Ive been treating him as if he's an arthritic patient, NSAID's and Adequan have allowed him to walk better. However, when I looked at the signs of Cushing's it looked so indicative of what he has that I realized when the vet falsely said,"looks like Cushing's but I doubt it", he may have been right originally.

I also read Cushing's causes the stiff gait? I am only a first year student and we briefly covered Cushing's, however the books only go so in depth compared to experience.

I called the vet today, he suggested an Acth test, my question to all of you is would you suggest treatment at his age or what steps should I take next to help improve his quality of life?

He is overweight, he is very long haired GS, and I am wondering if it can be just a mix of arthritis and overweight behavior.

[lulusmom]

A body score of 4 out 5 for a 14 year old dog is great and not what you would normally see in a dog debilitated by the effects of cushing's. You mentioned a very high elevation in ALT which is not common in cushing's either. ALKP is the liver enzyme that is triggered by excess steroids with moderate to severe elevations. ALT is usually only mildly elevated. It will help greatly if you provide the actual results of the blood chemistry. How long ago was that blood chemistry done? If more than three months, a fresh test should be done before pursuing any diagnostics for cushing's.

I personally would not feed my dog the brand you mention as it is ladened with grain, which makes it difficult to get weight off, especially if a dog is inactive. I also believe grains can make arthritic inflammation worse. My own overweight dog with arthritis showed a marked improvement when I put him on a commercially prepared raw diet, as did my brother's large breed dog when he took her off of grain ladened kibble. Did you see a negative change in Max, such as less energy, weight gain and perhaps increased arthritic pain after you took him off of the raw diet?

There is a rare side effect of cushing's called pseudomyotonia which causes a very stiff gait. My own cushdog had this condition and while he improved with treatment, his gait remained stiff with a wide stance. I'm not sure that is what you are dealing with as I would suspect that an arthritic dog with serious cruciate ligament damage would also have a stiff gait.

With cholesterol and ALT being the only abnormalities on the blood chemistry and cbc, I have no idea why your vet thought these abnormalities are indicative of cushing's. NSAID's adversely affect the liver and that could very well be the cause of the ALT abnormality as well as the elevated cholesterol. It can also cause liver enlargement which could contribute to a pot belly. When your vet put Max on an NSAID, did s/he tell you that you should have Max's liver values checked frequently? Did s/he suggest putting Max on liver support? If not, that is something you should consider.

The goal of treatment is to remedy problematic symptoms of cushing's, which are usually a bigger problem for the owner than the dog. Cushing's is not a painful disease. Dogs are usually quite okay with it, especially dogs with arthritis. Excess cortisol is a strong anti-inflammatory so these dogs are self medicating, masking signs of arthritis. If Max were to actually have cushing's, lowering his cortisol with treatment could be quite painful for him so this is something to consider. Aside from the excessive panting, the two most problematic symptoms are excessive drinking and peeing which causes a once housebroken dog to start to have accidents in the house and a voracious appetite making the dog counter surf, forage for food, knocking over trash cans, whining and barking at owners to feed them. Max doesn't seem to have these symptoms; however there seems to be something that is raising a high degree of suspicion that what you are observing in Max is attributable to cushing's. Can you tell us exactly what those things are?

Based on the information you provided, I personally would not spend money on an acth stimulation test at this point in time. In my opinion, that money could be better spent on new blood tests and liver support.

I'll be looking forward to hearing a lot more about Max.

Glynda

[VetStudent]

A body score of 4 out 5 for a 14 year old dog is great and not what you would normally see in a dog debilitated by the effects of cushing's. You mentioned a very high elevation in ALT which is not common in cushing's either. ALKP is the liver enzyme that is triggered by excess steroids with moderate to severe elevations. ALT is usually only mildly elevated. It will help greatly if you provide the actual results of the blood chemistry. How long ago was that blood chemistry done? If more than three months, a fresh test should be done before pursuing any diagnostics for cushing's.

I personally would not feed my dog the brand you mention as it is ladened with grain, which makes it difficult to get weight off, especially if a dog is inactive. I also believe grains can make arthritic inflammation worse. My own overweight dog with arthritis showed a marked improvement when I put him on a commercially prepared raw diet, as did my brother's large breed dog when he took her off of grain ladened kibble. Did you see a negative change in Max, such as less energy, weight gain and perhaps increased arthritic pain after you took him off of the raw diet?

There is a rare side effect of cushing's called pseudomyotonia which causes a very stiff gait. My own cushdog had this condition and while he improved with treatment, his gait remained stiff with a wide stance. I'm not sure that is what you are dealing with as I would suspect that an arthritic dog with serious cruciate ligament damage would also have a stiff gait.

With cholesterol and ALT being the only abnormalities on the blood chemistry and cbc, I have no idea why your vet thought these abnormalities are indicative of cushing's. NSAID's adversely affect the liver and that could very well be the cause of the ALT abnormality as well as the elevated cholesterol. It can also cause liver enlargement which could contribute to a pot belly. When your vet put Max on an NSAID, did s/he tell you that you should have Max's liver values checked frequently? Did s/he suggest putting Max on liver support? If not, that is something you should consider.

The goal of treatment is to remedy problematic symptoms of cushing's, which are usually a bigger problem for the owner than the dog. Cushing's is not a painful disease. Dogs are usually quite okay with it, especially dogs with arthritis. Excess cortisol is a strong anti-inflammatory so these dogs are self medicating, masking signs of arthritis. If Max were to actually have cushing's, lowering his cortisol with treatment could be quite painful for him so this is something to consider. Aside from the excessive panting, the two most problematic symptoms are excessive drinking and peeing which causes a once housebroken dog to start to have accidents in the house and a voracious appetite making the dog counter surf, forage for food, knocking over trash cans, whining and barking at owners to feed them. Max doesn't seem to have these symptoms; however there seems to be something that is raising a high degree of suspicion that what you are observing in Max is attributable to cushing's. Can you tell us exactly what those things are?

Based on the information you provided, I personally would not spend money on an acth stimulation test at this point in time. In my opinion, that money could be better spent on new blood tests and liver support.

I'll be looking forward to hearing a lot more about Max.

Glynda

Please forgive me for the delay, I have constantly kept looking for his CBC and Chem and I realized I left it in my folder at my parents where Max lives.

I just had vet school finals for the last two weeks and today I finally returned back home and my priority is to get to the bottom of this situation with Max (also this is the first time I've seen the outside world in over 3 weeks!)

Anyhow, I made a mistake and posted ALT was elevated when in fact it was Alk phos and Cholesterol. I knew thought sounded weird when I typed it (first year vet student! Technically 2nd year now)

Now, the one thing to consider is that Max had a precarnassial tooth infection when we took these CBC's and chem. He was put under anesthesia after antibiotic treatment and the tooth was pulled out. So I am not sure if somehow the stress of the inflammation could have caused those levels, however his WBC count looks normal.

Max's biggest issue is he's overweight no matter what I do, he pants excessively all the time and its gotten so bad I'm worried, he walks with a stiff gait, the doctor saw both his 'knees' were riddled with arthritis. He responds quite well to Adequan and Meloxicam. He does not urinate in the house and he doesn't seem to display Polyuria though he urinates no matter how much I walk him outside.

I am really asking this forum from your experience what direction you suggest I go moving forward for a 14 year old GSD mix. I want to give him the best quality life moving forward, and I am not sure what that is exactly. I'm seeing his vet in a week and I want to run the appropriate tests to help him. (he's 14 years old btw not 13 as the
paper suggests)

Thank you all for your help, I would appreciate any experienced input

Report was done in December of 2013

http://l.wigflip.com/53QIUAb5/roflbot.jpg

[lulusmom]

Welcome back and I hope you kicked some butt on your finals. We'll be keeping fingers and paws crossed for you.

We all have opinions and I hope others will share theirs. If your pup was my dog, I would not pursue a cushing's diagnosis in a 14 y.o. GSD with seriously damaged cranial cruciate ligaments and pretty solid arthritis in his patellar regions. Even if comprehensive testing was done and I felt comfortable with the cushing's diagnosis, I know that while treatment usually greatly improves quality of life, it can also have a marked negative impact on quality of life for dogs with the orthopedic issues you mentioned. Uncontrolled cushingoid dogs are self medicating any inflammation in their body and once treatment reduces the excess cortisol, it can be really painful. At this point, I personally would have a complete senior screening done.

Glynda

[labblab]

Welcome back from me, too! I do agree with Glynda that, even if your dog does suffer from Cushing's, there are several factors to balance in terms of treatment decisions. With a dog of that age, comfort and quality of life become the paramount issues in my own mind. So in the absence of many classic overt symptoms, it would be a hard call for me to put a senior dog through the stress of the diagnostics and monitoring tests associated with treatment. I would be more concerned about immediate comfort than risks of long-term damage caused by chronic effects of untreated disease.

There are a couple of features of your dog's situation, though, that might give me pause. The first is the cruciate ligament damage. While it is true that circulating cortisol can act as a natural anti-inflammatory, steroids are not necessarily good when it comes to trying to heal soft-tissue/ligament injuries. This comes from an article about the effect on humans, but I believe it can be applied to dogs as well.


Numerous strategies have been employed over the years attempting to improve ligament healing after injury or surgery. One of the most important of these is based on the understanding that monitoring early resumption of activity can stimulate repair and restoration of function and that prolonging rest may actually delay recovery and adversely affect the tissue’s response to repair. Likewise, there is a shift away from the use of steroid injections and nonsteroidal anti- inflammatory medications. Although these compounds have been shown effective in decreasing the inflammation and pain of ligament injuries for up to six to eight weeks, their use has been shown to inhibit the histological, biochemical, and biomechanical properties of ligament healing. For this reason their use is cautioned against in athletes who have ligament injuries. Such products are no longer recommended for chronic soft tissue injuries or for acute ligament injuries, except for the shortest possible time, if at all.

http://www.benthamscience.com/open/torehj/articles/V006/1TOREHJ.pdf

I think a related dynamic leaves dogs with untreated Cushing's more vulnerable to ligament damage in the first place. Since your dog is overweight, I fear this is a double whammy that also places him at greater risk for new ligament damage in a different leg which would be yet another burden added.

The second issue is the panting. I don't think panting reaches an "uncontrollable" stage with many Cushing's dogs, but it definitely did with my own boy. Prior to treatment, it had gotten to the point where he was panting constantly, and unable to rest during the day nor sleep without frequent interruption at night. Of all his Cushing's symptoms, that seemed to be the one that caused him the most discomfort. I almost cried with gratitude when he started on his medication and the panting finally ceased. I hope the panting is not as bad for your dog, but I do want to tell you that I don't dismiss its potential to be a significant comfort issue.

So what to do? I agree with Glynda that a repeat comprehensive blood panel would be a good place to start. From there, if you are still interested in treatment, a diagnostic blood test and abdominal ultrasound to assess the status of all his internal organs. And if "positive" for Cushing's, perhaps consideration of a moderate lowering of cortisol level through either maintenance doses of Lysodren or low doses of trilostane. Trying to thread the needle, as it were, to give a measure of control without lowering cortisol so far as to further unmask other issues that have been helped by the anti-inflammatory effect.

Marianne

[lulusmom]

Marianne brings up a very good point about CCL damage. You indicated that your vet saw CCL damage in both knees. CCL ruptures or tears are extremely painful so I have to assume that at some point you were aware that something was terribly wrong when Max went lame as a result of a rupture or tear. How long ago did that occur? Imaging alone cannot diagnose a CCL injury but it can allow a vet to assess secondary arthritic changes in the knee joint. CCL ruptures are diagnosed through manipulating the tibia and femur for abnormal movement. Did your vet actually manipulate the legs or was s/he seeing degenerative joint disease that is commonly seen with prior CCL damage?

[VetStudent]

Hello group,

I wrote a thread about 6-7 months ago about how my dog Max might have Cushing's disease. I took him to the vet about 2 years ago after noticing the onset of arthritis and excessive panting at night. He had no signs of polyuria or polydipsia.

The results came back and he had a very high elevated Alk Phos level and moderately elevated cholesterol.

The vet thought that Cushing's was very unlikely and didnt even want to run an exam. Instead, he felt it may be early signs of liver damage but sent me home with arthritis treatment. I am a vet student myself, and I looked into it and noticed his signs, and CBC as well as chem clearly were indicative of Cushings.

I called his vet and he said we can run a very expensive exam to diagnose it and the treatment is even more expensive and Max is a 15 year old german shepherd mix at the near end of his life and if he even has Cushing's its probably helping him cope with arthritis.

Well, in this last year, I totally accepted it was 'only' arthritis and aging and I have been giving him pain medicine (Tramadol+Gabapentin+Adequan+NSAIDs) to help combat his arthritic pain.

Recently, about 1 and a half months ago he finally started showing polyuria and polydipsia. He never showed that before, he drinks water like he's dehydrated and a once housebroken dog like him is urinating everywhere. He also pants excessively, its so loud its almost unbearable. I asked his new vet to run a urinalysis and he said it was unnecessary because his CBC and chem from 5 months ago clearly indicate his kidneys are very healthy and this looks like Cushings to him.

For whatever reason, he went from wanting to combat the Cushings to just wanting to leave it alone and give pain medication (WITHOUT explanation?!) As a future vet, I apologize for how some of our colleagues are so poor at communication and so many great clients are left with more questions than answers.

To me, its obvious that Max, my best bud in the world is at the near end stage of his life. He struggles to walk, but he still eats like a monster, sleeps like a baby (if we give pain medicine). He's a shell of himself, can barely get around, can no longer go for walks, is clearly in the last year of his life at best. However, he is my bestest bud in the world and I would feel horrible if I should be doing something instead of allowing him to go through this.

I have spent a ton on him this year, in the thousands, and I'm losing motivation to keep running diganostic exams and inefficient treatments and as my family says, maybe its better to just let him be and let him enjoy his last few months with us instead of going to the vet all the time. However, if you guys suggest I should go ahead with a diagnosis and treatment, if you think that it would improve the quality of his life or somehow extend it then I will definitely do it.

I have dealt with Cushing's very minimally at vet school (but im only a 2nd year student). I would highly appreciate your guys' very experienced advice on this.

If he was 12-13, I would combat this without hesitation. Given the severe arthritis he has, I'm wondering if I'm hurting him or helping him.

[Squirt's Mom]

Hi and welcome back!

If I were in your shoes, I would not test for nor treat Cushing's for two main reasons.

1) With painful arthritis already in play, lowering the cortisol, IF he does indeed have Cushing's, would increase that pain level. Cortisol is a natural anti-inflammatory so it sort of "treats" inflammatory processes like arthritis, allergies, etc. The meds you are using now to control this would have to be changed as NSAIDS are never good for a cush pup (too hard on an already over-taxed liver). That is asking a LOT of a geriatric pup to face more pain.

2) At his age, he deserves to have as many days of comfort possible filled with the things that bring him joy, not pain and stress. Cushing's sadly requires NUMEROUS vet visits, pokes and prods, etc. and our babies end up hating anything associated with the vet - some even come to hate car rides that they previously adored. The sound of keys jangling causes many to start stressing. In fact, with my own geriatric pup, I promised her at the age of 15 "no more" and she lived to be 16+. That last year was filled with what made her happy, what put that shine in her eyes and pep in her step. Other than watching for signs that it was time, I did my utmost not to think of what might have been going on in her little body - I just sunk into her eyes and scent, knowing she was content.

That's what I would do - others may have a differing view. ;)

BTW, I sure hope your vet training covers Cushing's in more depth than what our first cush vet said was covered in her years of vet school - one brief note and mention in class that basically taught her that it was a disease not worth her time treating as the dogs don't live and owners don't comply. IF that is what you are taught, please direct your instructor here and we will show him how very, very wrong that approach is for all concerned. :)

Good to hear from you again!
Hugs,
Leslie and the gang

[VetStudent]

Hi and welcome back!

If I were in your shoes, I would not test for nor treat Cushing's for two main reasons.

1) With painful arthritis already in play, lowering the cortisol, IF he does indeed have Cushing's, would increase that pain level. Cortisol is a natural anti-inflammatory so it sort of "treats" inflammatory processes like arthritis, allergies, etc. The meds you are using now to control this would have to be changed as NSAIDS are never good for a cush pup (too hard on an already over-taxed liver). That is asking a LOT of a geriatric pup to face more pain.

2) At his age, he deserves to have as many days of comfort possible filled with the things that bring him joy, not pain and stress. Cushing's sadly requires NUMEROUS vet visits, pokes and prods, etc. and our babies end up hating anything associated with the vet - some even come to hate car rides that they previously adored. The sound of keys jangling causes many to start stressing. In fact, with my own geriatric pup, I promised her at the age of 15 "no more" and she lived to be 16+. That last year was filled with what made her happy, what put that shine in her eyes and pep in her step. Other than watching for signs that it was time, I did my utmost not to think of what might have been going on in her little body - I just sunk into her eyes and scent, knowing she was content.

That's what I would do - others may have a differing view. ;)

BTW, I sure hope your vet training covers Cushing's in more depth than what our first cush vet said was covered in her years of vet school - one brief note and mention in class that basically taught her that it was a disease not worth her time treating as the dogs don't live and owners don't comply. IF that is what you are taught, please direct your instructor here and we will show him how very, very wrong that approach is for all concerned. :)

Good to hear from you again!
Hugs,
Leslie and the gang

Thank you for your response,

I will stop giving the NSAID's, despite his vet suggesting that I should only have him on NSAID's and GABA. Instead, I have put him on his Tramadol+GABA.

I wish I could get an accurate dosage for him as I fear overdosing him. Every vet seems to have a different take on it, right now I have him only on 2 tramadol per day at 50 mg each and 1 GABA a day at 100 mg. I believe the GABA may be too low but I am not sure if I should increase it.

The biggest issue is his panting, its so intense at nights and hard to sleep. Is there anything I could do for that or let him ride it out?

My vet training is early on thus far but we have already gone over Cushing's once, I am confident we will go over it again and again. More importantly, I will go over it for a long time given that it affected my dogs life.

It's been an amazing 16 year run with this guy, its so hard watching him fall apart like this. I need a support forum for all this :(

[labblab]

We are definitely here to support you, and surely recognize how tough it is for you to see your boy struggling so. I agree that I probably would not pursue Cushing's diagnostics, either, at this stage of things due to the demands of treatment monitoring both for you and for your dog. I would be focusing on pain control. And to that end, I am going to throw a curveball and suggest that you may not want to totally dispense with the NSAIDs even knowing about the associated risks. I would not suggest that for a younger dog whose life you are trying to prolong. But from what you are describing, the quality of whatever time is left is of paramount importance to you, and the problem with painkillers alone is that they provide no anti-inflammatory relief. If your dog does not actually have Cushing's, then he is not getting anti-inflammatory benefit from elevated cortisol, either.

The panting may be due to Cushing's, or it may be due to discomfort, or it may be due to some other physiological abnormality. But if it were me, I would compare how he seems to feel with the NSAID included vs. on pain relief alone. At this stage, if he does better with the NSAID, I think I would start back with it even knowing it might be a risk overall for an acute and even potentially life-ending crisis.

But just my two cents worth. And no matter what you decide, please know we are indeed here to support you as you yourself struggle to find the best way to support your best buddy.

Marianne

[Squirt's Mom]

We will be right by your side, sweetie. Many of us have walked that Valley with our own babies and know what you are feeling. We are here any time you need to talk.
Hugs,
Leslie and the gang

[jas77450]

Hi and welcome. I am sorry your baby is having such a hard time. I agree with the others. You have done a good job to have him so long.
I would focus on best quality for him now. Hugs and prayers for you and your boy!

[ToppersMom]

Hi,

I just wanted to say Thank You for writing about your Max. I have a soon to be 14 yo (on 12/13) black Lab, Topper, and have struggled over the last month or so about whether or not to find out if he has Cushings and then whether or not to treat. This thread has helped me so much.

What an amazing group of people!

Amy and Topper

[doxiesrock912]

I was just about to suggest changing the NSAID to Tramadol.
My poor babe was misdiagnosed and given a shot of Adequan and Meloxicam and we lost her.

[VetStudent]

We will be right by your side, sweetie. Many of us have walked that Valley with our own babies and know what you are feeling. We are here any time you need to talk.
Hugs,
Leslie and the gang


We are definitely here to support you, and surely recognize how tough it is for you to see your boy struggling so. I agree that I probably would not pursue Cushing's diagnostics, either, at this stage of things due to the demands of treatment monitoring both for you and for your dog. I would be focusing on pain control. And to that end, I am going to throw a curveball and suggest that you may not want to totally dispense with the NSAIDs even knowing about the associated risks. I would not suggest that for a younger dog whose life you are trying to prolong. But from what you are describing, the quality of whatever time is left is of paramount importance to you, and the problem with painkillers alone is that they provide no anti-inflammatory relief. If your dog does not actually have Cushing's, then he is not getting anti-inflammatory benefit from elevated cortisol, either.

The panting may be due to Cushing's, or it may be due to discomfort, or it may be due to some other physiological abnormality. But if it were me, I would compare how he seems to feel with the NSAID included vs. on pain relief alone. At this stage, if he does better with the NSAID, I think I would start back with it even knowing it might be a risk overall for an acute and even potentially life-ending crisis.

But just my two cents worth. And no matter what you decide, please know we are indeed here to support you as you yourself struggle to find the best way to support your best buddy.

Marianne


Hi and welcome. I am sorry your baby is having such a hard time. I agree with the others. You have done a good job to have him so long.
I would focus on best quality for him now. Hugs and prayers for you and your boy!


Hi,

I just wanted to say Thank You for writing about your Max. I have a soon to be 14 yo (on 12/13) black Lab, Topper, and have struggled over the last month or so about whether or not to find out if he has Cushings and then whether or not to treat. This thread has helped me so much.

What an amazing group of people!

Amy and Topper


I was just about to suggest changing the NSAID to Tramadol.
My poor babe was misdiagnosed and given a shot of Adequan and Meloxicam and we lost her.

Thank you all for your support, I apologize for the delay in responding as its finals in vet school.

I have been going through heavy grief ever since this previous Sunday. Max kept me up 2 days straight and was in clear visible pain. The drugs help but his quality of life has deteriorated and I originally thought I had until this Summer to decide on Euthanasia and the reality is I probably don't have more than another month or two with him.

He does well from morning till about 11 pm then he pants excessively and cries from the hours of 12-6 am. I went without sleep for 2 days and just studied like that. I dont know what to do, even as a soon to be vet I have no idea other than to wait till I feel its right.

He is still eating great, sleeping well during the day, he just cant get around as easily and seems to be in a lot of pain.

This is the hardest experience I've ever had, I really appreciate your guys' support.

I am still trying to find a suggestion on how to dose the tramadol+GABA together for a 55 lb dog. It seems like every vet has a different take on the risk of overdose

[Dixie'sMom]

It sounds like you and Max both are having some really rough days. I wish someone had some answers for you about his medication dosage. That would alleviate his pain and your stress a great deal. I do hope you have many, many more months with him, but I understand how you are feeling. There is something called anticipatory grief. I do it anytime one of my loved ones are threatened. (2-legged and 4-legged) I begin the grief process before the event happens. I think you may be going thru that with Max which is understandable since he is feeling so bad.

I REALLY, REALLY hope he gets to feeling better and you can get some help with his pain meds.

Hugs and prayers coming your way. You're doing all you can and doing a great job. Hang in there!

[Squirt's Mom]

The crying thru the nite - any chance of dementia? My Squirt got doggy Alzheimer's and before we found the right med for her she would do all sorts of strange things over the nite time especially. You might look into Anypril (Selegiline) and Novifit. The Novifit is a stable SAMe product that worked miracles for Squirt. You do not need a prescription for Novifit.

A thought for the pain - have you thought about Adequan injections? They can help with arthritic pain for sure. There are also products like Cosequin and Dasuquin that can help.

Dasuquin - http://www.nutramaxlabs.com/products-by-health-type/by-type/joint-bone-animal-health-products/what-is-dasuquin

Cosequin - http://www.nutramaxlabs.com/dog/dog-joint-bone-health/cosequin-dog-product-selector

Adequan - http://www.adequan.com/

Novifit - http://www.virbacvet.com/products/detail/novifit-novisame-tablets/behavioral-health

[doxiesrock912]

I have a suggestion to help him get around. Can you make a sling with a knot at the top so that you can support him as he walks? It will put less pressure on everything. Some say swimming in warm water can help too.

Just a thought.

[VetStudent]

The crying thru the nite - any chance of dementia? My Squirt got doggy Alzheimer's and before we found the right med for her she would do all sorts of strange things over the nite time especially. You might look into Anypril (Selegiline) and Novifit. The Novifit is a stable SAMe product that worked miracles for Squirt. You do not need a prescription for Novifit.

A thought for the pain - have you thought about Adequan injections? They can help with arthritic pain for sure. There are also products like Cosequin and Dasuquin that can help.

Dasuquin - http://www.nutramaxlabs.com/products-by-health-type/by-type/joint-bone-animal-health-products/what-is-dasuquin

Cosequin - http://www.nutramaxlabs.com/dog/dog-joint-bone-health/cosequin-dog-product-selector

Adequan - http://www.adequan.com/

Novifit - http://www.virbacvet.com/products/detail/novifit-novisame-tablets/behavioral-health

I have had him on everything which is what helped prolong his life from about 4 years ago when the signs of arthritis started to today.

He was on Adequan injections until this recent month when I saw for over 3-4 months they were barely helping if at all, the vet also suggested against them saying they only cosmetically look like they are helping but do not help against the pain at this point.

He was on all the supplements and treatments you mentioned above.

Currently, he is on Tramadol+GABA+NSAID's+Fish Oil+Probiotics. I recently took out the Glucosamine as well since there is very little cartilage if any left to help save at this point.


I have a suggestion to help him get around. Can you make a sling with a knot at the top so that you can support him as he walks? It will put less pressure on everything. Some say swimming in warm water can help too.

Just a thought.


I have the sling and it helps. The problem is he struggles at night the most when everyone is asleep. This is when (12-4 am) he starts walking around and falls everywhere no matter what.

I wake up and of course do NOT allow this but it takes a toll on mentally to stay up till 3-4 am to help him walk around.

Recently, I have added a 3rd tramadol pill at 2 am to help ease his pain.

[Squirt's Mom]

This is when (12-4 am) he starts walking around and falls everywhere no matter what.

Again, this sounds like dementia. And you say you tried the Novifit and Anypril but have stopped them now? You saw no improvement in his nite time roaming with these?

[VetStudent]

Again, this sounds like dementia. And you say you tried the Novifit and Anypril but have stopped them now? You saw no improvement in his nite time roaming with these?

Hi again,

I actually came here to ask the group the toughest question in the world which is about euthanasia. First though, I have never tried Novifit or Anypril, do you think it would help and could we add that to his pain regimen without him overdosing?

For the last 2 years, I tried hydrotherapy, Adequan, fish oil, glucosamine. This helped delay his signs of arthritis by a few years and then during February of this year it was time to put him on meloxicam (NSAID's) every day. I am constantly told for a german shepherd mix, that nearly 16 years is beyond a full life.

Quickly, that stopped working and I added tramadol and that helped. Now, that is not helping and I added Gabapentin and that is also not helping.

This last few months have been brutal. This is where I need advice, of course this is entirely my decision but I just need to know what you guys think. Max does not look well, but he has moments he looks fine and I can't imagine killing him. Most of the day lately, he walks around and pants excessively.

Is it the Cushing's? Is it pain? His doctors don't know. Lately, like this last 3 weeks he goes outside at nights and he starts barking almost like he's lost or something. It makes me think Squirtsmom is absolutely right about dementia is kicking in.

He has never barked at night, he knows better and I'm starting to wonder if I'm being selfish by keeping him alive. Everyone around me says I am being selfish and he's suffering but I don't know. My nature is to keep fighting but its easy for me to say he's the one in pain.

I haven't slept much lately, it's finals at vet school and Max has taken a huge toll on me.

So to sum it up, here's a day in the life of Max: Wakes up at around 10 am now and starts panting excessively, I give him his medication it helps him sleep. He eats around 12.

Then he gets up around 3-4 and starts crying again and again and again. Eats again around 6 and gets the next set of pain medicine. He relaxes.

At 12 am-5 am, this is when the nightmare really begins EVERYNIGHT. He pants excessively, very powerful and non stop panting. He just walks around over and over and over and cries out. He sleeps about an hour in my bedroom, gets back up and walks around again and goes outside to urinate then just walks back in again. Give him his final set of tramadol for the day at 2 am but it doesnt really help.

Right now, he's sitting down and we're cuddling and I can't imagine letting someone inject him with death. But then, at nights, I feel so selfish like why am I doing this to him?

I don't know what to do anymore, there's an infection in my heart that is the decision of euthanasia. :(

[labblab]

My own heart feels so very sad reading about both Max's pain and your own. First off, I do not know for certain about possible interactions between Novifit/Anipryl and the other meds that Max is taking. You may want to call the manufacturers of those two drugs directly in order to double-check the safety profiles.

But turning to your main question, from what you are describing, I do not think there is any one of us here who would judge you harshly should you decide that Max is suffering from too much pain and discomfort to continue to prolong his life. And in my own mind, unnaturally prolonging life through treatments and medications is just as much an intervention as is ending life through euthanasia. In the wild, Max would have left this world long ago. It is only through your loving care that he has survived to reach this point. But now the most loving act may be to release his spirit from his failing body. Even if he still has a few good moments, how often are those moments over-shadowed by a cloud of pain and confusion? From what you are describing, to me, the scales seem tipped heavily in the direction of suffering. So that does make me feel very worried about continuing to ask Max to face many more days and nights like these.

Since you have asked us our thoughts, I hope it is OK that I have offered my own. My heart truly goes out to you as you wrestle with this most difficult decision of all. This struggle you are enduring now signals the compassionate vet you will be when you are supporting pet parents in the future. But right now, your struggle is oh so personal and painful. I wish there was a way in which we could make it easier for you. Please do continue to talk with us, OK?

Marianne

[VetStudent]

My own heart feels so very sad reading about both Max's pain and your own. First off, I do not know for certain about possible interactions between Novifit/Anipryl and the other meds that Max is taking. You may want to call the manufacturers of those two drugs directly in order to double-check the safety profiles.

But turning to your main question, from what you are describing, I do not think there is any one of us here who would judge you harshly should you decide that Max is suffering from too much pain and discomfort to continue to prolong his life. And in my own mind, unnaturally prolonging life through treatments and medications is just as much an intervention as is ending a life through euthanasia. In the wild, Max would have left this world long ago. It is only through your loving care that he has survived to reach this point. But now the most loving act may be to release his spirit from his failing body. Even if he still has a few good moments, how often are those moments over-shadowed by a cloud of pain and confusion? From what you are describing, to me, the scales seem tipped heavily in the direction of suffering. So that does make me feel very worried about continuing to ask Max to face many more days and nights like these.

Since you have asked us our thoughts, I hope it is OK that I have offered my own. My heart truly goes out to you as you wrestle with this most difficult decision of all. This struggle you are enduring now signals the compassionate vet you will be when you are supporting pet parents in the future. But right now, your struggle is oh so personal and painful. I wish there was a way in which we could make it easier for you. Please do continue to talk with us, OK?

Marianne

Thank you so much,

I am crying as I write this, he fell tonight and I had to help him up. He's now sleeping outside as the concrete is cold and it relaxes him a little. He has always been an indoor dog, but the pain is forcing him to sleep on the concrete. He did this when the arthritis started a few years back and stopped sleeping outside, this has been how he is as of late.

It's so close to the end no matter what I decide or don't. There is a SELFISH entity in this decision that is stressing me out a lot and torturing me. Here's the two options, I think I'm dealing with.

Option A: I get a 25 day break after these exams, Max's health has caused such a depression that some part of me is wondering if it would be beneficial for HIS HEALTH and mine to euthanize him and then take the rest of the days to cope with this pain of losing him as much as possible. I have entered a depression over this as he's my bestest bud ever. I know I will be coping with this for years, but at least that 25 days off gives me some time to just lay in bed and grief. It also allows me to euthanize him while he is only in really bad shape not HORRENDOUS and needs an emergency euthanasia. However, the thing that haunts me is if its too soon.

Option B I don't euthanize, I keep pushing, the next semester begins and he is almost for sure going to die within 2-5 months AT best. Those 2- 5 months will be hard on him, and its not going to be pretty now when he falls and needs euthanasia. It wont be from needing to be put down but a stroke or something horrible like breaking his arm and it will make me feel guilty in that direction.

The only thing I'm thinking about here is Max and what's best for Max. But I do have to be honest, given the fact my entire family feels he needs to be euthanized, I'm wondering if I'm being selfish and if I should just go with Option A.

Regardless of what, I will be speaking with 2 of the expert veterinarians at our school and see what they think, as well as his vet.

This is so hard, I'm so sorry for anyone who had to go through this.

[mytil]

I completely understand and feel your immense pain in this. I too had to make that decision with my girl years ago and emotionally I was a complete basket case but all the signs told me that it was up to me to ease her pain.

Always remember you know your boy best. I too would have a talk with the vets.

Please do stay with us
Terry

[labblab]

The question of whether it is too soon or too late is the one that haunts us all. And not that this will make you feel better, but if you are like most of the rest if us, no matter what you decide you will still always second-guess yourself :o. Without the benefit of seeing the future, there are always lingering doubts that things might have played out differently, if only you could have known.

I think this is good that you will be talking to Max's vet as well as some of your professors. You are the one who knows and loves Max the best of all. But getting feedback from the vets and your family can offer additional perspective from different vantage points. The decision will remain yours to make, but it can help to talk things over with others who care about you both.

And I will add one more thought which may not feel at all comfortable to you, but given the pain and depression that you are suffering, I think it is OK for you to consider whichever option is best for both you and Max right now. You are, and have always been, a team. So whichever of your options gives you the best opportunity to take care of yourself, too, is probably the best option overall. In that sense, it is OK and not selfish to be aware of your own needs. Because that can help you to make Max's final days as calm and loving and peaceful as possible, too.

Marianne

[My sweet Ginger]

I'm so sorry that you and Max are going through this difficult time. I hope Max will turn around and starts feeling better soon.
I can't offer you much other than a couple of things on Novifit.
My pup's been on her 4th month now on Novifit. She didn't have same symptoms Max has. She was sleeping during night BN and mostly walking during days which she still does possibly less. The only change I think is see which came after 2 months on Novifit is her mentation. She seems to get stuck less in corners and lost less outside. She barks occasionally that also during the day.

There was another pup who was started on Novifit at the same time and some changes came immediately for her. She was able to sleep during night and stopped barking and so on. So each pup is different.

My pup's been on many different medications, between 5-7 meds on any given day so I was very worried about a possible drug interaction by throwing Novifit into the mix. I got an ok from her IMS and also called Novifit. I was told that this drug is safe the only possible adverse reaction so far has been loose stools for a few days for some pups. You can check with your vet too.
It only takes 2-3 business days for delivery once you place an order and you don't need a prescription.
I hope this helps and I will pray for you and Max. Max is a very lucky pup. Hugs, Song.

[Squirt's Mom]

Ahhhh, Dear Student,

I sit here with tears flowing down my face as I type. Your love for your sweet boy is so evident in every word you say about him. And I understand your angst only too well.

My Squirt came to me at 5 weeks of age and lived to be a little over 16, leaving this May 10 for the next part of her Journey. For a year I lived in a state of anticipatory grief - I knew our time was so short. The thought of something horrible happening to her, causing her great pain and suffering, was more than I could bear and came to "the decision" more than once to spare her this possibility. But she wasn't ready at those times and let me know that. It made me feel like mortal crap that I had given up on her when she hadn't given up on life. So I quit trying to head off trouble and let her be til she was ready.

I knew my Sweet Bebe better than any one else and I knew what was important to her days, I knew what she enjoyed, what brought her pleasure and comfort. I gave her everything I could for as long as she was able to accept. The day came when she could no longer stand or walk on her own, when she refused food and water, when she told me she was now ready. There was no more joy or pleasure to be had in this life.

That was a horrible day for me on one level yet on another it was a day of freedom and freedom is worth celebrating. On that day when my Soul was shattered, hers was freed from all earthly trials, all pain, all confusion. A member here said long ago something along the lines of - we take their pain into ourselves so they can be freed from it. And she was so right.

You and I are so blessed, Student. Do you know how rare it is that a human and a canine form such a deep lasting bond? On sites like this one, it may seem common...but it isn't. We are the exceptions. We are the Blessed. We have shared a love that most will never know, that most aren't capable of knowing. And it is a love that will never fade, never wan, never die. It will sustain us the rest of our days and when it is our time, that love will guide us straight to our babies once again.

You know your boy best of all. Listen to him, just to him, and he will let you know what you need to hear. We are with you all the way whatever you decide, whenever you decide it - we are here.

Hugs,
Leslie and the gang

[VetStudent]

Ahhhh, Dear Student,

I sit here with tears flowing down my face as I type. Your love for your sweet boy is so evident in every word you say about him. And I understand your angst only too well.

My Squirt came to me at 5 weeks of age and lived to be a little over 16, leaving this May 10 for the next part of her Journey. For a year I lived in a state of anticipatory grief - I knew our time was so short. The thought of something horrible happening to her, causing her great pain and suffering, was more than I could bear and came to "the decision" more than once to spare her this possibility. But she wasn't ready at those times and let me know that. It made me feel like mortal crap that I had given up on her when she hadn't given up on life. So I quit trying to head off trouble and let her be til she was ready.

I knew my Sweet Bebe better than any one else and I knew what was important to her days, I knew what she enjoyed, what brought her pleasure and comfort. I gave her everything I could for as long as she was able to accept. The day came when she could no longer stand or walk on her own, when she refused food and water, when she told me she was now ready. There was no more joy or pleasure to be had in this life.

That was a horrible day for me on one level yet on another it was a day of freedom and freedom is worth celebrating. On that day when my Soul was shattered, hers was freed from all earthly trials, all pain, all confusion. A member here said long ago something along the lines of - we take their pain into ourselves so they can be freed from it. And she was so right.

You and I are so blessed, Student. Do you know how rare it is that a human and a canine form such a deep lasting bond? On sites like this one, it may seem common...but it isn't. We are the exceptions. We are the Blessed. We have shared a love that most will never know, that most aren't capable of knowing. And it is a love that will never fade, never wan, never die. It will sustain us the rest of our days and when it is our time, that love will guide us straight to our babies once again.

You know your boy best of all. Listen to him, just to him, and he will let you know what you need to hear. We are with you all the way whatever you decide, whenever you decide it - we are here.

Hugs,
Leslie and the gang


I'm so sorry that you and Max are going through this difficult time. I hope Max will turn around and starts feeling better soon.
I can't offer you much other than a couple of things on Novifit.
My pup's been on her 4th month now on Novifit. She didn't have same symptoms Max has. She was sleeping during night BN and mostly walking during days which she still does possibly less. The only change I think is see which came after 2 months on Novifit is her mentation. She seems to get stuck less in corners and lost less outside. She barks occasionally that also during the day.

There was another pup who was started on Novifit at the same time and some changes came immediately for her. She was able to sleep during night and stopped barking and so on. So each pup is different.

My pup's been on many different medications, between 5-7 meds on any given day so I was very worried about a possible drug interaction by throwing Novifit into the mix. I got an ok from her IMS and also called Novifit. I was told that this drug is safe the only possible adverse reaction so far has been loose stools for a few days for some pups. You can check with your vet too.
It only takes 2-3 business days for delivery once you place an order and you don't need a prescription.
I hope this helps and I will pray for you and Max. Max is a very lucky pup. Hugs, Song.


The question of whether it is too soon or too late is the one that haunts us all. And not that this will make you feel better, but if you are like most of the rest if us, no matter what you decide you will still always second-guess yourself :o. Without the benefit of seeing the future, there are always lingering doubts that things might have played out differently, if only you could have known.

I think this is good that you will be talking to Max's vet as well as some of your professors. You are the one who knows and loves Max the best of all. But getting feedback from the vets and your family can offer additional perspective from different vantage points. The decision will remain yours to make, but it can help to talk things over with others who care about you both.

And I will add one more thought which may not feel at all comfortable to you, but given the pain and depression that you are suffering, I think it is OK for you to consider whichever option is best for both you and Max right now. You are, and have always been, a team. So whichever of your options gives you the best opportunity to take care of yourself, too, is probably the best option overall. In that sense, it is OK and not selfish to be aware of your own needs. Because that can help you to make Max's final days as calm and loving and peaceful as possible, too.

Marianne


I completely understand and feel your immense pain in this. I too had to make that decision with my girl years ago and emotionally I was a complete basket case but all the signs told me that it was up to me to ease her pain.

Always remember you know your boy best. I too would have a talk with the vets.

Please do stay with us
Terry

Hello everyone,

I'm amazed this forum has been so helpful and supportive in what I consider one if not the hardest times of my life. I thank you all so much. It's amazing because I never really got down to it on whether Max actually has Cushing's or not as the signs really started appearing in his last 2-3 years and his vet disagreed on the signs.

Today, I spent most of the day calling In-Home Euthanasia services. They charged in the range of $600-$1000 with the ashes. That is so ridiculously expensive, but I might go ahead and do that if I can get it for $600.

I really don't want my guy at the vet clinic uncomfortable, as stupid as it sounds. I want him at home, in his last moments. I just keep replaying the thought of him dying in my arms and it is so difficult for me to accept.

I have seen euthanasia so many times as a vet student, and each and every time my heart has gone out to the dogs and owners as all I could think about for 15 years was,"One day, that's going to be me, treat them the way I'd want to be treated."

I will let you guys know what I plan to do, what happens, and I hope I can continue to get this support as it has helped me a lot.

[Squirt's Mom]

We are with you all the way, sweetheart. Just reach out and you will find hands reaching back.

[labblab]

Don't you worry about any lack of support from around here!!! You and Max are part of our family now, no matter what. It has been over ten years since my own Cushpup was alive, and yet you'd have to blast me away from this forum with dynamite :o. It is the love and the caring that matters around here, and definitely not the diagnosis.

Sending peace and strength to both you boys in all the coming days.
Marianne

[Budsters Mom]

Yes, there are many of us whose precious fur babies have flown to the rainbow bridge. You won't find a more supportive group anywhere. ;)

Family sticks together through joys and sorrow.

Marianne couldn't leave us! We have her chained to a very big tree!:eek::D

Hugs to you and Max,

[molly muffin]

I'm just catching up on the forum and my heart just shattered thinking of you and Max and what you are going through right now and will be going through in the future.

It is probably one of the hardest decisions that a person can make for their beloved companion. I'm sure I'll never forget the day we had to say goodbye to my golden retriever Tasha. I thought she would show me for sure when the time came, that maybe one day her tail wouldn't wag when she saw me or something profound. It wasn't like that. There just was a day when I knew that I couldn't let her suffer any more that she was not happy, she couldn't run (though she would try), she couldn't go up and down stairs (though she would try), that she couldn't hold her bladder any longer (though she did try) and it was that she was trying when she couldn't that I knew it was time, her tail was still wagging. I knew I was putting off making a decision because she has been my baby since she was 6 weeks old and had traveled all across the country, 2 countries actually with me. It seemed unbearable. It Was unbearable.

It would be so much better I think if he can go to sleep calmly at home, in his own place and with his family around him. That is what I would do if I had known someone who would come and do that for us.

We're all here for you and with you. You don't want the path alone. We have all been on it and lend a hand and a shoulder when it is needed the most.

hugs

[mytil]

I am with the others in saying you are not alone.
Terry

[VetStudent]

We are with you all the way, sweetheart. Just reach out and you will find hands reaching back.


Don't you worry about any lack of support from around here!!! You and Max are part of our family now, no matter what. It has been over ten years since my own Cushpup was alive, and yet you'd have to blast me away from this forum with dynamite :o. It is the love and the caring that matters around here, and definitely not the diagnosis.

Sending peace and strength to both you boys in all the coming days.
Marianne


Yes, there are many of us whose precious fur babies have flown to the rainbow bridge. You won't find a more supportive group anywhere. ;)

Family sticks together through joys and sorrow.

Marianne couldn't leave us! We have her chained to a very big tree!:eek::D

Hugs to you and Max,


I'm just catching up on the forum and my heart just shattered thinking of you and Max and what you are going through right now and will be going through in the future.

It is probably one of the hardest decisions that a person can make for their beloved companion. I'm sure I'll never forget the day we had to say goodbye to my golden retriever Tasha. I thought she would show me for sure when the time came, that maybe one day her tail wouldn't wag when she saw me or something profound. It wasn't like that. There just was a day when I knew that I couldn't let her suffer any more that she was not happy, she couldn't run (though she would try), she couldn't go up and down stairs (though she would try), that she couldn't hold her bladder any longer (though she did try) and it was that she was trying when she couldn't that I knew it was time, her tail was still wagging. I knew I was putting off making a decision because she has been my baby since she was 6 weeks old and had traveled all across the country, 2 countries actually with me. It seemed unbearable. It Was unbearable.

It would be so much better I think if he can go to sleep calmly at home, in his own place and with his family around him. That is what I would do if I had known someone who would come and do that for us.

We're all here for you and with you. You don't want the path alone. We have all been on it and lend a hand and a shoulder when it is needed the most.

hugs


I am with the others in saying you are not alone.
Terry

Thank you all for the kind words. I really appreciate your guys support, in fact it really gives me courage and strength knowing I'm not alone.

Not all things are like that for me, but knowing others have gone through this and made it out helps me a lot.

Here is a picture of Max btw, I have better ones but I can't find them easily, the best ones are on my newer computer which is off at the moment.

http://s23.postimg.org/icvf34s1n/IMG_1411.jpg

http://s11.postimg.org/dbm1xfprl/IMG_5385.jpg

[mytil]

What a wonderful photo of your boy!!!! He is beautiful!!!

Terry

[VetStudent]

What a wonderful photo of your boy!!!! He is beautiful!!!

Terry

Thank you :)

[My sweet Ginger]

Oh, he's so handsome and you can see the warmth in his eyes. :(

[Squirt's Mom]

What a handsome fellow and what soulful eyes he has! How are things this morning?

[molly muffin]

What a handsome lad he is.

Hugs

[VetStudent]

What a handsome fellow and what soulful eyes he has! How are things this morning?


Oh, he's so handsome and you can see the warmth in his eyes. :(


What a handsome lad he is.

Hugs

Thank you all.

Right now, I live in an apartment about 30 minutes away from my parents. I moved out last year to finish things up with vet school. I visit him every weekend and spend so much time during breaks.

It was torture moving away (Ive only been gone 1 year) but it works itself out with the 1 month breaks I get + I visit him Fridays-Monday.

No news other than he's sleeping better when I'm not there. My mom says when I come home, its like he's a little kid and pushes himself so hard to stay up for me. We used to go on walks 3-5 times a day, short little 10 minute walks down the street. I think he still thinks he can do it.

The one update is that my friend who is a veterinarian called me today and told me he would be happy to do the in home euthanasia for a huge discount, $500 instead of the usual $700-1000 most other companies charge.

After I got off the phone with him I just broke down. It seems like a daily routine now if not multiple times a day where something inside says,"I can't believe our time is almost over." A broken heart, it's something I've experienced a few times in my life. It really hurts a lot, a pain unlike anything other.

[Dixie'sMom]

Max is beautiful.

[doxiesrock912]

What unique markings Max has! He's gorgeous!

[VetStudent]

Max is beautiful.


What unique markings Max has! He's gorgeous!

Had a long talk with my father today. He said let's put Max down when I get back from finals.

So here I am tudying 24/7 for finals, away from Max, instead of sitting down and coping with the pain just so I can finish finals and come back home to put my best friend to sleep. Yes, this is officially the closest I've been to hell in my life.

[Budsters Mom]

I am so sorry. :o No matter how long we have them with us, it is never long enough.:o

You are going to make a wonderfully compassionate vet.

Big hugs,

[VetStudent]

I am so sorry. :o No matter how long we have them with us, it is never long enough.:o

You are going to make a wonderfully compassionate vet.

Big hugs,

Thank you,

It's funny you say that about the compassion. Me and my closest friend talk about how insensitive vets actually are about animals. The average person is actually much more compassionate about animals than vets are.

Even though they love animals, there is this insensitive element I cant quite explain. It's very far from how the human doctors are at our school.

Anyhow, thank you again

[Squirt's Mom]

Sweetheart, we are here with you all the way. Do your best on your studies and know that Max loves and trusts you completely in all things. Know that he is safe, warm, and content today, having no idea what you are fearing; he lives fully in each moment, not concerned about the next. He will always, always love you.

Any time you need to talk we are here.
Hugs,
Leslie and the gang

PS. I agree with what Kathy said - you display a great deal of compassion and I think that will be evident in your work. One thing I have always found interesting - the look on the faces of the vets that worked with my Squirt. Her file was inches thick and they were all shocked that anyone would go to those lengths for their pet. What they all failed to comprehend is that she was never my "pet", none of my babies are "pets" - they are my children, my family, and I will go to any length possible for them. You know first hand that parents like us exist and will fight every step of the way for our babies...and I think you will be the kind of rare vet that encourages and helps us fight.

[VetStudent]

Sweetheart, we are here with you all the way. Do your best on your studies and know that Max loves and trusts you completely in all things. Know that he is safe, warm, and content today, having no idea what you are fearing; he lives fully in each moment, not concerned about the next. He will always, always love you.

Any time you need to talk we are here.
Hugs,
Leslie and the gang

PS. I agree with what Kathy said - you display a great deal of compassion and I think that will be evident in your work. One thing I have always found interesting - the look on the faces of the vets that worked with my Squirt. Her file was inches thick and they were all shocked that anyone would go to those lengths for their pet. What they all failed to comprehend is that she was never my "pet", none of my babies are "pets" - they are my children, my family, and I will go to any length possible for them. You know first hand that parents like us exist and will fight every step of the way for our babies...and I think you will be the kind of rare vet that encourages and helps us fight.

Thank you,

you guys have been such a great support in this time. I'm not sure how much worst off I'd be without you guys here but it would be a lot worst since all I'm hearing from my family is,"It's ok, you did great, HES JUST A DOG."

I am lucky to say this and at the same time its tough to say, but this is the first huge death in my life. I have lost my grandpartents and an aunt, they meant a lot to me but for some reason seeing them say they want to leave this earth helped so much.

With Max, it's so hard because I can't talk to him. It's such a hard process, it was hard to get out of bed today.

[mytil]

Still with you!

Terry

[VetStudent]

So I finished vet school finals on Monday. Every 4 months I have exams I can't be with family or even Max for 2 weeks due to the hectic schedule. I cried so hard for those 2 weeks, I cried harder than I ever have in my entire life for anyone. The moment I finished finals I drove home as fast as possible. My parents had decided not to tell me Max's condition was really bad.

He was in horrible shape. He looked so happy to see me. I hugged him and just kept kissing him, he was in obvious pain. He wanted to go. I wrapped him in blankets and he was constantly urinating on himself and crying in pain. He would sleep a few, wake up, cry in anxiety and pain. He could finally no longer walk.

I called my friend whose a vet and he told me he could be in by the next day or if I wanted more time then in 2 days.
At night time, he was in so much pain, I decided it was too selfish to keep him around just for sentiment. My lower back sprained from carrying him everywhere for hours.

In our last 2 hours, he was crying in pain, wondering why he's still alive. In our final hour, I hugged him so hard and cried and told him its our last hour together Max and I just wanted to say thank you for everything you did for my life.

The doctor gave him propofol to ease him and then the euthanasia shot, but Max nearly died instantly just from a tiny dose of the propofol. The vet said he was holding on just by a hair, probably just to see me one last time.

I have never been so hurt in my life as I am now. I dont know why, he lived a full life, I did everything, everyday for his life. But 15 years wasnt enough when you love someone so much. He wasn't my pet, he was my family member, my brother.

RIP Max, I will always carry you in my heart.

[mytil]

My heart is with you! As well as my tears! He has the most wonderful parent all those incredible 15 years and he was telling you it is okay with all of his kisses.

Please stay with us!
((((hugs))))
Terry

[molly muffin]

I can't stop the tears running down my cheeks as I read of your last moments with max. That he held on just to see you is a testament to the bond you shared. My sincerest condolences.

Hugs

[addy]

I'm so sorry for your loss. Please know we are here for you and I hope after the pains eases you can rejoice in the life you shared with your beloved Max.

[Squirt's Mom]

Your friend is probably right - Max did hold on just to see you, to feel your touch, to hear your voice, to get your scent just one more time. He wanted to take those things with him when he flew. It is amazing how much they can take and how far they will go for us, those they love.

I think it is normal for us to feel responsible somehow, as if we failed somehow, and then the "what ifs" come along to keep us in turmoil for a while. It wouldn't matter what we did or didn't do, we would still feel guilt when "that day" came. But I think that is normal when we lose a love like this. It is a further expression the deep abiding love we will always carry in our hearts and Souls....and that our babies will always carry in theirs.

One day you will hold Max again. When your job here on Earth is finished and it is your time to cross that Divide, Max will be there waiting to fly into your arms and cover your face with kisses. You and your brother will never be parted then. Until that day, Max will watch over you with pride and love and all the devotion you showed to him.

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

A favorite quote from a favorite author -

From The Darkest Evening of the Year
By Dean Koontz

“Because God is never cruel, there is a reason for all things. We must know the pain of loss; because if we never knew it, we would have no compassion for others, and we would become monsters of self-regard, creatures of unalloyed self-interest. The terrible pain of loss teaches humility to our prideful kind, has the power to soften uncaring hearts, to make a better person of a good one.”

“Dog’s lives are short, too short, but you know that going in. You know the pain is coming, you’re going to lose a dog, and there’s going to be great anguish, so you live fully in the moment with (them), never fail to share (their) joy or delight in (their) innocence, because you can’t support the illusion that a dog can be your lifelong companion. There’s such beauty in the hard honesty of that, in accepting and giving love while always aware it comes with an unbearable price. Maybe loving dogs is a way we do penance for all the other illusions we allow ourselves and for the mistakes we make because of those illusions.”

[My sweet Ginger]

As sad as I am for the loss of Max I'm happy that he waited for you to come home so you two could spend the very special time together for the last time. All he knew was that he was falling into a deep sleep in your loving arms being showered by your sweet kisses and hugs. RIP sweet Max. Hugs.

[VetStudent]

As sad as I am for the loss of Max I'm happy that he waited for you to come home so you two could spend the very special time together for the last time. All he knew was that he was falling into a deep sleep in your loving arms being showered by your sweet kisses and hugs. RIP sweet Max. Hugs.


Your friend is probably right - Max did hold on just to see you, to feel your touch, to hear your voice, to get your scent just one more time. He wanted to take those things with him when he flew. It is amazing how much they can take and how far they will go for us, those they love.

I think it is normal for us to feel responsible somehow, as if we failed somehow, and then the "what ifs" come along to keep us in turmoil for a while. It wouldn't matter what we did or didn't do, we would still feel guilt when "that day" came. But I think that is normal when we lose a love like this. It is a further expression the deep abiding love we will always carry in our hearts and Souls....and that our babies will always carry in theirs.

One day you will hold Max again. When your job here on Earth is finished and it is your time to cross that Divide, Max will be there waiting to fly into your arms and cover your face with kisses. You and your brother will never be parted then. Until that day, Max will watch over you with pride and love and all the devotion you showed to him.

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

A favorite quote from a favorite author -

From The Darkest Evening of the Year
By Dean Koontz

“Because God is never cruel, there is a reason for all things. We must know the pain of loss; because if we never knew it, we would have no compassion for others, and we would become monsters of self-regard, creatures of unalloyed self-interest. The terrible pain of loss teaches humility to our prideful kind, has the power to soften uncaring hearts, to make a better person of a good one.”

“Dog’s lives are short, too short, but you know that going in. You know the pain is coming, you’re going to lose a dog, and there’s going to be great anguish, so you live fully in the moment with (them), never fail to share (their) joy or delight in (their) innocence, because you can’t support the illusion that a dog can be your lifelong companion. There’s such beauty in the hard honesty of that, in accepting and giving love while always aware it comes with an unbearable price. Maybe loving dogs is a way we do penance for all the other illusions we allow ourselves and for the mistakes we make because of those illusions.”



I'm so sorry for your loss. Please know we are here for you and I hope after the pains eases you can rejoice in the life you shared with your beloved Max.


I can't stop the tears running down my cheeks as I read of your last moments with max. That he held on just to see you is a testament to the bond you shared. My sincerest condolences.

Hugs


My heart is with you! As well as my tears! He has the most wonderful mom all those incredible 15 years and he was telling you it is okay with all of his kisses.

Please stay with us!
((((hugs))))
Terry

Thank you all for your kind words. It means so much to me to know I'm not alone. I don't why, when I've lost other people it never helped, maybe because everyone understands how hard it is to lose a person but very few understand how equally hard it is to lose a dog, especially the one you grew up with from your childhood to your young adult days (15 years old for me till 30).

I haven't gotten much sleep, I am trying to fight the inevitable depression I'm going to go through. I have a good amount of friends and family being supportive a well as my girlfriend.

In his last day, I asked for my family to say goodbye to him. 1 by 1 they all cried and said goodbye. No one wanted to see him get euthanized, I was all alone though they asked to be with me, I refused. They keep telling me how strong I am to let him die in my arms, but they don't understand how badly I wanted him to know I was with him till the end.

[Renee]

Sail on Max, fast and free.

My condolences.

[Squirt's Mom]

Sweetheart, Max knew, he knew you were coming and he knew you were there for him, just for him. He knew he was laying the best place in this world - your arms. He knew he was safe there, always safe there, and drew great comfort in the warmth of your embrace. Trust those feelings and know your sweet boy is always with you.

[judymaggie]

My condolences to you--Max knew how loved he was. Please take some comfort knowing that he is running pain-free with all of our loved ones at the rainbow bridge.

[Dixie'sMom]

From your very first post it was evident how much you loved Max and the bond you shared with him. You have been as devoted a "brother" as anyone, human or 4-legged could ever ask for. In this time of grief, please be assured that you did everything possible up to the last minute of Max's life for his good, despite your own pain. I salute you for being strong enough to do what was best for Max despite your own grief. He was waiting for you. It's so obvious, and he knew that you would help him as soon as you got there and you did. I'll be keeping you in my prayers and close to my heart in the coming days. Please know that all of us are here for you and we will all remember Max when we honor our furbabies at the bridge. Thank you for allowing us to share this difficult journey with you. You are going to make an amazing vet.

[Julie's Mom]

My condolences on your loss. Your posts however have given us all a bit of Max to remember. You are a great "mom" and you will be a great vet.

[VetStudent]

Sweetheart, Max knew, he knew you were coming and he knew you were there for him, just for him. He knew he was laying the best place in this world - your arms. He knew he was safe there, always safe there, and drew great comfort in the warmth of your embrace. Trust those feelings and know your sweet boy is always with you.


My condolences to you--Max knew how loved he was. Please take some comfort knowing that he is running pain-free with all of our loved ones at the rainbow bridge.


From your very first post it was evident how much you loved Max and the bond you shared with him. You have been as devoted a "brother" as anyone, human or 4-legged could ever ask for. In this time of grief, please be assured that you did everything possible up to the last minute of Max's life for his good, despite your own pain. I salute you for being strong enough to do what was best for Max despite your own grief. He was waiting for you. It's so obvious, and he knew that you would help him as soon as you got there and you did. I'll be keeping you in my prayers and close to my heart in the coming days. Please know that all of us are here for you and we will all remember Max when we honor our furbabies at the bridge. Thank you for allowing us to share this difficult journey with you. You are going to make an amazing vet.


My condolences on your loss. Your posts however have given us all a bit of Max to remember. You are a great "mom" and you will be a great vet.

Thank you all for the comments, I think I have to start posting in the thread for support. I can't sleep, I barely eat, and the scariest part is I'm just numb and not overwhelmed like I thought I would be. It's been 3 days with 0 hours of sleep and 2 weeks with 3 hours of sleep a night given my vet school finals and me knowing his end was near.

I know Max wouldnt want me to do this to myself, but I have taken this so badly. I lost my sisters dog of 9 years just a month ago, he wasnt mine but he was Max's best friend and I helped her raise him (shes also neighbors with us and I would take Max over every single day except for this year when Max fell apart). The passing of both of them has left a void I can't even describe.

[pansywags]

I am so very sorry for your pain and loss. You can lean on this group for support - so many of us know how hard it can be. It's beautiful that Max waited for you to help him on his way - you were very lucky to have one another. I hope that in time the memories of happier healthier days help you smile when you think of Max.

[Dixie'sMom]

Be gentle with yourself Mark and try to get some rest. You were exhausted already and had to take on the grief on top of exhaustion. Nothing will take the grief away, but a good night's rest could go a long way to helping you deal with it. Tylenol pm maybe? Hugs honey. We are with you all the way.

[molly muffin]

Thinking of you and sweet Max this holiday season.

hugs

[VetStudent]

Thinking of you and sweet Max this holiday season.

hugs

Thank you so much,

it's such a struggle. I have moments where its so overwhelming and then hours where I'm ok. I'm at that point now where I dont know if I should keep looking at pictures of him.

He was such a rare and perfect mix for me, a german shepherd mixed with border collie. I cant just find another a few years from now, he was a 1 in a million look and character. Its so overwhelming, I dont plan to get another dog anytime in the next few years, but eventually.

[molly muffin]

There will Never be another Max.

I learned that after Tasha and when I was ready to get another dog, I didn't look for a golden retriever to try to be like her. I looked for the one who spoke to our hearts that said, I can be yours and you can be mine. And so we have our molly, a shih tzu/llhaso mixture, a rescue from a high kill shelter in Quebec who didn't understand english, and french only when she wanted to. It's been a perfect combination for us all.

I can still look at pictures of Tasha and miss her so much. That's okay, and for awhile I only looked occasionally as it was all a bit overwhelming when the pain is still raw. That will get better with time. Don't force anything, if you want to look at his picture then do, if it is too much then don't. There aren't any rules you know. It's just grief and it has no timeline.

I think that as a vet what you will come to know in your heart and counsel your patients owners is that every day is a treasure, there will never be enough time to spend with them and we will always miss them and that is okay.

Hugs

[mytil]

If you do want to look at his photos please continue - it is part of the grieving process. As mentioned above there are no rules in this.

I too had a once in a lifetime soul doggie (Mytilda - Australia Shepherd) and I still miss her even after all this time. But I do smile thinking of her life with me. When I was ready to have another, it took one look and I knew. It is hard to describe this, but when it is time, you will know and know that your boy will be there too.

We are all here
((((hugs))))
Terry

[Dixie'sMom]

Just stopping in to give you a quick cyberhug and tell you that I'm thinking of you.

[VetStudent]

If you do want to look at his photos please continue - it is part of the grieving process. As mentioned above there are no rules in this.

I too had a once in a lifetime soul doggie (Mytilda - Australia Shepherd) and I still miss her even after all this time. But I do smile thinking of her life with me. When I was ready to have another, it took one look and I knew. It is hard to describe this, but when it is time, you will know and know that your boy will be there too.

We are all here
((((hugs))))
Terry


Just stopping in to give you a quick cyberhug and tell you that I'm thinking of you.

Sorry for the delay in responding. Been taking time to figure out what 'this' is before I just started venting.

It's a week shy of a month and I'm doing ok. I miss him a lot...the 'war' of fighting for his health for the last 2 years has taken a toll on me both mentally and physically.

Physically, in his last 2 months when he could still walk but needed me as a crutch when he would fall, I apparently seriously sprained my back in an attempt to carry him everywhere. I never had any prior back pain so hopefully this is a temporary thing and nothing serious in regards to a herniated disk. I have a radiograph appointment to determine that.

Mentally, instead of going straight to the I miss him so much phase, I'm drained. Of course I miss him so much, but I keep reminding myself of how much he was suffering. In an attempt to remind myself so much on how he was suffering I have made that last year his entire life and all the other memories are overshadowed by the ending. I find myself exhausted and instead of thinking what I would give to see him again, I'm more in the zone of 'I'm so happy he's at peace.' That last 2 years really took a toll on us all in this household.

One of my many goals is to focus on his entire life and legacy that he left behind for me and where I go from here, instead of just focusing on the ending. I find myself often looking at pictures, thanking myself so much that I appreciated everyday with him and had no regrets. I have nothing I can say like 'Oh I wish I didnt ignore him so much for school.' I was always there as much as I can be.

Do you guys ever get this feeling, that if they could think or if they were in doggie heaven, they would feel bad for what we're going through? I know I would, I would feel terrible if I left someone behind who loved me so much. We're all kind of like Demi Moore in Ghost and our dogs are Patrick Swayze

[mytil]

Yes what you are feeling is completely normal and I too ran through the entire gamut. I personally believe that if they could speak they would tell us above all - Thank You for our life together and we will always have that tremendous tie of love that can never be undone. We will carry this where ever we go and whatever we do.

BTW Ghost is a amazing movie and that is a great comparison :)

My continued (((hugs))) to you and your family.
Terry

[apollo6]

Please know we understand only to well your loss,your pain,your anger. Feel your feeling . They widdle their way into our hearts and we are never the same. You lost a part of yourself when he died. It doesn't 't matter how long they live,because it is never long enough for us. Don 't listen to what others tell you. No matter what anyone says at this time it won't help,because what you want is your baby back. Write to him. Do what ever comforts you . Talk to him. If your are open to it, you may feel his presence.
I lost my boy over two years and I miss him every day, some days are good and out of the blue I will cry thinking about him. Feeling are okay, remembering is okay. The lose will always be there. But you will be left with the love and beautiful memories. I am so sorry for your loss.
Hugs Sonja and Angel Apollo

[doxiesrock912]

Grief is unique to everyone. Do what is right for you. There are no rules. Eventually, the happy memories will be more plentiful than the sadness that you feel now. Hugs