Newbie - 8 year old Dogue de Bordeaux diagnosed with cushings/ Neca has passed

[jakabi]

Newbie - 8 year old DDB with 'undiagnosed' cushings

Hi,

I've had my girl from a pup and she is now 8 years old. Approx. 8 months ago I noticed 2 symmetrical patches appear on her rear either side of her tail ...

http://imageshack.com/a/img661/8764/dyKamE.jpg

The first vet I saw seemed young and inexperienced who basically said she must have rubbed the hair away somehow (secretly rubbing her rear on the carpet or something like that??) ... no creams seemed to improve the condition.

As the weeks passed we started to notice many changes in her ...

1. Weight gain! She went from a consistent 56Kg (over 5+ years) up to around 63Kg in just a couple of months (no change in exercise, no change in diet). We now feed her approx 20% less.

2. Food - She is ravenous! She will literally push you out of the way when it’s her feeding time. She will also beg and sniff around for scraps of food which she has never really done before and also eat food she has historically turned her nose up at.

3. Panting - Started to pant a lot (although she always has during summer months). Right now she isn’t panting but once the heating kicks in and the temp hits around 21/22 she will start.

4. Lethargy - At times she is extremely lethargic. If I say 'walkies' now, she actually disappears upstairs and hides!!

5. Lack of energy on walks - If I walk on the streets for approx. 25 mins she will lag behind quite a bit. I try to take to her to a couple of local forest areas now so she a walk at her own leisure, she seems a lot happier doing that.

6. Leaking after urination - Right now she seems to be ok urinating, however after she has finished I need to 'pat' her behind to soak up residual wee.

7. Lumps/Sores – I have found numerous hard lumps around her body, 3 of which have just cleared up on her bald area.

8. Hair growth - She has an ultrasound around 4/5 months ago to check her liver and was shaved. This is her right now (virtually no growth back and a pot belly look about her) ....

http://imageshack.com/a/img538/1854/TDh8Fr.jpg

…. and previously she would shed hair pretty much all year round!!

We have had the most reliable 'cushings' test done (I think the vet said 90%+ accuracy or something like) with bloods taken numerous times throughout an 8 hour period (before and after injections) and then sent to a university. The ultrasound of her stomach picked up no obvious problems with her liver and whatever else they check. We have also had more blood tests done (before and after type) with the latest being done in Jan 2015.. My vet says the results are still borderline and are still just within 'normal' levels hence the title 'undiagnosed'. He has been really honest with me and said he would not feel comfortable prescribing anything until she is diagnosed which I fully understand. So right now it just feels like a waiting game ... waiting for things to get worse before any treatment can begin.

Food wise, her diet is the same albeit less. I feed her Acana large breed dry food (60% protein), ingredients breakdown …

Dried chicken (34%), shredded oats, deboned chicken (12%), whole potatoes, peas, chicken liver (3%), whole eggs (3%), deboned flounder (3%), chicken fat (3%), sun-dried alfalfa, herring oil (2%), pea fiber, whole apples, whole pears, sweet potatoes, pumpkin, butternut squash, parsnips, carrots, spinach, cranberries, blueberries, kelp, chicory root, juniper berries, angelica root, marigold flowers, sweet fennel, peppermint leaves, lavender, Enterococcus faecium

… and in addition approx 100g of tinned sardines and 5ml of cod liver/thistle oil supplement ... twice a day. Exercise wise, I get her out once a day usually for 20 mins or so, longer if she goes for a walk off the lead.

Is there anything I should/shouldn't be doing at this stage that may help her long term?

Many thanks in advance!

[jakabi]

Complete set of results ...

15th Oct 2014

LDDS - DXM Screening Test (low dose)
Cortisol Basal ........ 68 nmol/l ... 28-250
Cortisol post (3hr) DXM ... 29 nmol/l ... <40
Cortisol post (8hr) DXM ... 40 nmol/l ... <40

Also had a T4/TSH test with the same sample from the same date (not sure which of the 3 this would be though?)

Thyroxine (Total T4) ... 12.4 nmol/l ... 13-52
TSH .......................... 0.21 ng/ml ... <0.41

Nov 2014

Thyroxine (Total T4) ... 14.8 nmol/l ... (13-52)
TSH .......................... 0.23 ng/ml ... (<0.41)

Out of range (everything else tested was within the normal range) ...

Alkaline Phosphatase ... 1470 iu/l ... (7-173)
ALT ........................... 128 iu/l ... (0-40)
Bilirubin (Total) .......... 5.5umol/l ... (0-5)
Cholesterol ................ 12.9mmol/l ... (3.8-7.9)

Jan 2015

ACTH stimulation test

Cortisol Basal ......... 77 nmol/l ... (28-250)
Cortisol post ACTH .. 408 nmol/l ... (200-600)


Mar 2015

Started Vetoryl @ 90mg (22nd March 2015)

Mar 2015

ACTH stimulation test (31st March 2015), 4 1/2 hours after taking 90mg dosage of Vetoryl
Weight - 64.4Kg (141.7 lbs)

Cortisol Basal ......... 55 nmol/l ... (28-250)
Cortisol post ACTH .. 129 nmol/l ... (200-600) ? *I assume this range is still the same but dont have a copy of the results just yet*

[labblab]

Hello and welcome! I'm so glad you and your girl have found us :)! I apologize that I have only a moment to post right now, but the first thing I want to do is clarify the diagnostic blood tests that she has been given to test for Cushing's.


We have had the most reliable 'cushings' test done (I think the vet said 90%+ accuracy or something like) with bloods taken numerous times throughout an 8 hour period (before and after injections) and then sent to a university.

The test you are describing above is most likely a LDDS test (Low Dose Dexamethasone Suppression Test). However, the test results you have posted above -- ACTH stimulation test -- is a different test, and involves only two blood draws instead of the three draws over 8 hours that accompanies the LDDS. Can you double-check and see if you have a record of the LDDS result?

It is true that the ACTH is within normal range, but that test incorrectly returns a fair number of "false negatives" in dogs who do actually have Cushing's. So in the situation of a dog who has such strong classic Cushing's symptoms as does your girl, you would really want to perform the LDDS in addition. As I say, from what you have described, it sounds as though that test was indeed done. So it will help us a lot if you can get us those results, and we can go from there.

Thanks so much!
Marianne

[jakabi]

Thanks for the reply, I've just got word back from my vet and we did do an LDDS test. All I have for the moment is ...

Test done 15/10/14.

basal cortisol 68
3 hours after dex 29
8 hours after dex 40

I could grab more detailed results if that would help.

Really appreciate any advice or further opinion.

Many thanks

[labblab]

I'm sorry for the expense that would be involved, but I would be inclined to repeat the LDDS test since it has now been four months since it was first done, and your girl's result at that time was right at the borderline for being positive. The 8-hour value was 40 nmol/l (or 1.45 ug/dl for most American labs). You haven't listed the "normal" range for your lab, but it is generally around 1.4 to 1.5 ug/dl for American labs. If that is also true for your girl's testing, she was right at the cut-off for a positive LDDS result back in October. I think there is a good chance that with the four intervening months, she might register a more elevated 8-hour value this time around that would indeed be consistent with Cushing's.

For dogs who exhibit such classic Cushing's symptoms, we often see specialists recommending a retest in approx. 3 months if the initial test does not produce a diagnostic result. Even in the face of the normal ACTH in January, I would want a retest of the LDDS around now, because as noted above, the ACTH does result in a number of missed diagnoses.

Marianne

[Harley PoMMom]

Test done 15/10/14.

basal cortisol 68
3 hours after dex 29
8 hours after dex 40

I could grab more detailed results if that would help.

Really appreciate any advice or further opinion.

Many thanks

Could you post the cut-off range for those LDDS test results?

[jakabi]

Back from the vets again! ... full results ...

15-Oct-2014

LDDS

DXM Screening Test (low dose)
Cortisol Basal ........ 68 nmol/l ... 28-250
Cortisol post (3hr) DXM ... 29 nmol/l ... <40
Cortisol post (8hr) DXM ... 40 nmol/l ... <40

Also had a T4/TSH test with the same sample from the same date (not sure which of the 3 this would be though?)

Thyroxine (Total T4) ... 12.4 nmol/l ... 13-52
TSH .......................... 0.21 ng/ml ... <0.41

Thanks again for taking time to cast your eyes over this, it really is much appreciated!!

[jakabi]

Just booked her in for another LDDS test next Tuesday so should have the results by next Wednesday/Thursday. Will post the results up when I get them.

So glad I found this site, its been invaluable!

[Squirt's Mom]

You're a good mom!

[jakabi]

As we are going for another LDDS next week I just remembered an 'incident' we had during the last ACTH test that has me a little worried.

Shortly after the vet administered the drug (Cortrosyn?? - Will confirm next time I see him) we left the premises and went into the car park (probably around 5 mins from the point of injection). At this point my dog put her head down to the floor (still standing) and started to cry/whimper a few times (I'm assuming she was in a lot of pain or shock??). I rushed back in to the vets to ask the vet to come outside quickly and by the time he came back outside a minute later she seemed ok again.

To confirm her weight right now, its 63.5Kg (140 lbs).

Has anyone had this experience before ? Should I be worried about having this administered again ? Is there a likely explanation ?

Many thanks

[molly muffin]

Welcome to the forum.

When the ACTH is given the first blood draw is just the base, and then after they administer the stimulate agent, it causes the adrenal glands to dump the cortisol that is stored in them into the body.
For my dog, this causes an about 48 hour buzz of hyper activity.

I don't know if that would have caused her strange and make her whimper or not. Maybe some of the others have other ideas, some don't seem to have much reaction at all.

[ShibaMom]

Hi jakabi,

I'm glad you'll be having you baby retested. Perhaps remind the vet about the possible reaction last time, and plan to stick around for a bit longer after the injection, like 15 minutes or so? That's probably what I'd do if it were my pup.

I hope all goes well!!

Regards,
Samantha and Zanya

[labblab]

I don't have any light to shed on your dog's reaction to the ACTH stimulation injection, either. But I just wanted to point out that the two injections for the upcoming LDDS are of a different substance -- they are dexamethasone and not a stimulating agent. Instead of trying to stimulate maximal cortisol dumping, the test is designed to see whether the body is capable of suppressing natural cortisol production when a synthetic "copycat" steroid (dexamethasone) is introduced.

Anyway, the point is that if your dog was sensitive to the cortrosyn itself, that won't be an issue this time around.

Marianne

[jakabi]

Thanks for the views and support. I will definitely mention it to the vet if/when she needs a ACTH test again and hang around longer after the injection. Will update you in a couple of days once I get the LDDS results.

[jakabi]

Well its confirmed, she is now an official cush pup! Yes I'm sad, but also happy that we have a diagnosis and can potentially give her a better quality of life for how ever long she has left with us. Results only confirmed by phone and I think these are correct (will confirm in a couple of days) ...

Cortisol Basal ........ 75 nmol/l ... 28-250
Cortisol post (3hr) DXM ... 75 nmol/l ... <40
Cortisol post (8hr) DXM ... 58 nmol/l ... <40

My vet has given me all the options for next steps and taking her age into consideration my preference is to start the meds rather than put her through CT scans and possible surgery. The previous ultrasound showed no adrenal tumors but I'm aware we cant rule that out.

I did mention the Vetoryl dosage guideline changes and he knew all about it and was happy to consider/take on board my views just from reading info on this site! He has suggested that if we start the medication that we try approx. 1.5mg/KG meaning she will have 90 in total (a 60 + 30) because from his experience larger dogs seem to require less per KG than smaller dogs. Given the risks/side effects/complications I feel really comfortable going with this level (I'm aware it may take longer to get her dosage right). I 'think' he said that after 10 days he would do an ACTH test.

As always I would really appreciate any views or opinions from you guys (especially on the starting dosage level).

Mods, could you update the title please ? ...
Newbie - 8 year old Dogue de Bordeaux DIAGNOSED with cushings

Many thanks!!!!

[labblab]

Your title is now revised, and yup, I can surely understand your mixed feelings right now. But given all the classic symptoms suffered by your dog, I also heartily agree that there must be some relief in finally having a treatment path that now leads forward. I am so glad you decided to proceed with a follow-up LDDS, and once again, this just shows what a tricky disease Cushing's can be to diagnose!

For the benefit of readers who are more familiar with results reported in units of ug/dL, the diagnostic 8-hour LDDS result this time around was 2.1. And as you are already aware, neither the 4-hour nor the 8-hour result can allow you to distinguish between pituitary or adrenal Cushing's. But since you've already had an ultrasound without visualizing an adrenal mass, PDH seems like the more likely diagnosis.

I think your starting dose sounds excellent, and now I will be keeping all fingers and toes crossed that everything goes well and your sweet girl is soon on the road to recovery!

Marianne

[Harley PoMMom]

I agree with Marianne. :) That total starting dose of 90 mg is appropriate for her weight of 140 lbs.

Now, just a couple of reminders with Vetoryl; it has to be given with food to be properly absorbed, and the ACTH monitoring tests need to be done 4-6 hours after the Vetoryl is given.

Here's a handy link from our Resource thread where you will find information regarding Vetoryl/Trilostane: Trilostane/Vetoryl Information and Resources (http://www.k9cushings.com/forum/showthread.php?t=185)

Please do keep us updated. ;)

Hugs, Lori

[jakabi]

First ACTH results are in after 10 days on Vetoryl ...

Started Vetoryl @ 90mg (22nd March 2015)

ACTH stimulation test (31st March 2015), 4 1/2 hours after taking 90mg dosage of Vetoryl
Weight - 64.4Kg (141.7 lbs)

Cortisol Basal ......... 55 nmol/l ... (28-250)
Cortisol post ACTH .. 129 nmol/l ... (200-600) ? *I assume this range is still the same but dont have a copy of the results just yet*

post ACTH was 408 in January.

My vet has advised to stay on 90mg for another 4 weeks then do the next ACTH.

As always, any advice or opinions would be much appreciated.

Many thanks in advance!

[Harley PoMMom]

The reference ranges for a dog being treated with Vetoryl/Trilostane are: 1.5 ug/dl - 5.4 ug/dl (40 nmol/Lto 150 nmol/L) with a post as high as 9.1 ug/dl (250 nmol/L) if symptoms are controlled.
So, converted to ug/dl, which are the units we are used to seeing here in the U.S., they come out to:
Cortisol Basal ......... 55 nmol/l = 1.99 ug/dl
Cortisol post ACTH .. 129 nmol/l = 4.68 ug/dl


Good numbers!!! And I am glad to see that the dose remained the same and an ACTH stim test will be done in 4 weeks....Great Job, Mom!!!!

[molly muffin]

These numbers are very good. Since cortisol can continue to drop for 30 days, then I'd just keep an eye out, as he may go lower in the next 2 weeks. Not usually as much as the first drop, but it all depends on the dog too.

This is good though! How does she appear to be doing? Any reactions to the testing?

[jakabi]

Doesn't seem to be any adverse reaction at the moment, no sickness, no diarrhea, eating all her food, drinking is similar to before and I'd say not really excessive.

All I would say is that she seems more tired but then she has always been a lazy dog ... think that's a common trait in DDB's!

Will see how she goes over the next 4 weeks, thanks for the input!

[jakabi]

I'm now 22 days into Vetoryl treatment and it does seems to be affecting her now ... but not in a good way.

She seems extremely tired, sleeping most of the day and night. She has also started to limp on her hind legs and is struggling to get up off the floor and navigating stairs. Having said that I walked her yesterday morning for a little bit longer than usual (maybe 20/25 mins on a field at her own pace off the lead). This could have added to her stiffness/weakness ???

She had a wellness test with cortisol levels on Friday and I should get a call in the next hour or so from the vets with the results.

Is this a common side effect ? Could it indicate her cortisol levels are dropping too much on the current dose ? (90mg / weight 142 lbs).

... a little bit worried today :(

[Harley PoMMom]

Yes, it could be that her cortisol has dropped too low and those ACTH stim results will be able to show us. Please do post those results ;) Is she eating normally, any change in her bowel movements, any vomiting?

Sometimes symptoms of arthritis may show up when the cortisol has been decreased, those arthritic symptoms were masked from all that extra cortisol running around and now the Vetoryl has lowered that extra cortisol which makes those arthritis issues come forward. Is she taking any supplements for arthritis?

Hugs, Lori

[jakabi]

Got a call and there is nothing that looks out of place or would suggest addisons. I didnt have an ACTH but did get a reading for cortisol @ 5 hours after the vetoryl which was 56.

For now my vet suggested to drop her down to 60mg, give her 1 patacetamol 3 times a day and see how she is in 5 days.

Re supplements, she has cod liver oil every day (5ml), additional sardines every other day or so and gets fed acana which also has ingredients for joints.

Not sure if there is anything else I can do for her, suggestions welcome!!

[Harley PoMMom]

Got a call and there is nothing that looks out of place or would suggest addisons. I didnt have an ACTH but did get a reading for cortisol @ 5 hours after the vetoryl which was 56.



We really need to know what test they did and what that "56" represents, also please include the unit of measurement. The only test that is used to monitor dogs that are being treated for Cushing's is the ACTH stimulation test. This test is performed 4-6 hours after giving the dog their morning dose of Vetoryl/Trilostane, it includes 2 blood draws; the first blood draw result is known as the "pre" number; a stimulating agent is injected and the second blood draw is taken and this result is the "post" number.

If that "56" is the post result from an ACTH stimulation test and the unit of measurement is nmol/L, which converts to 2.0 ug/dl, you definitely do not want that number to drop any further. One of the top canine Cushing's expert, Dr. Mark Peterson, states:
When using trilostane, it has become increasing clear that we do not want the cortisol values to drop too low, because that may indicate early or mild adrenal necrosis (1,11,12). In contrast to the protocol used in this reported study, I recommend stopping the drug in all dogs that develop a ACTH-stimulated cortisol values less than 2.0 μg/dl, and repeating the ACTH stimulation test in 1- to 2-weeks in those dogs. Some of these dogs will require that the drug be restarted at a lower dosage, but others will maintain low to normal serum cortisol concentrations for prolonged periods of time. And a subset of these dogs, presumably because of mild adrenal necrosis, will never need any further trilostane treatment to control the signs of Cushing's syndrome. http://endocrinevet.blogspot.com/2012/12/low-dose-twice-daily-trilostane.html

Dr. Peterson is highly published, is also a contributor to Dechra's continuing education site, has coauthored more than a few chapters of veterinary textbooks used in vet schools around the world. Your vet may want to confer with Dr. Peterson, he can field questions to him via his blog.

Hugs, Lori

[jakabi]

Cortisol Basal ........ 56 nmol/l ... 28-250

In addition to the cortisol reading she had a wellness test to check cholesterol levels etc and there were no red flags so to speak.

I've given her the lower dose of vetoryl this morning and at the moment she isn't limping ... and managed to navigate the stairs without much trouble. Ate all her food, drank all her water all as normal. Maybe the it was a combination of walking her too far and the vetoryl really starting to kick in which made her stiff and tired over the last two days ??

Will see how she goes for a few days and report back.

[molly muffin]

I think they did a baseline cortisol draw only, not a full ACTH test from the results you have posted, so Lori is right, you don't want that to go any lower.

It is not unusual for us to see bigger dogs need smaller doses and small dogs need larger doses. If you notice any more weakness and lethargy, get in and have that cortisol at minimum baseline checked.

I'm glad things are better on the lower dose, but do keep an eye out.

[jakabi]

Just had latest ACTH results

22nd March 2015 - Started Vetoryl @ 90mg

31st March 2015 - ACTH stimulation test, 4 1/2 hours after taking 90mg dosage of Vetoryl, Weight - 64.4Kg (141.7 lbs)

Cortisol Basal ......... 55 nmol/l ... 28-250
Cortisol post ACTH .. 129 nmol/l ... 28-250


14th April 2015 - Had some trouble with her hind legs so got her cortisol basal checked out

Cortisol Basal ........ 56 nmol/l ... 28-250

**Vetoryl reduced to 60mg per day**

5th May 2015 - ACTH stimulation test, 4 1/2 hours after taking 60mg dosage of Vetoryl, Weight - 64.4Kg (141.7 lbs)

Cortisol Basal ......... 44 nmol/l ... 28-250
Cortisol post ACTH .. 93 nmol/l ... 28-250

-No change in weight
-Still lethargic
-Struggling on walks (15 mins), not wanting to go for walks
+Liver and cholesterol levels still high BUT have improved
+Seeing hair growth
+Spurts of energetic activity, i.e wanting to play. Only happened a few times to date but haven't seen that behaviour in months

Vet would like to keep her on 60mg for 3 months before another test or unless something changes.

I thought we may have seen more improvement in energy levels and her weight but nothing so far. Am I being impatient ? Can it take months rather than weeks to see them bounce back ?

As always your comments and opinions much appreciated.

[Harley PoMMom]

Converting nmol/l to ug/dl, those May ACTH stimulation numbers are: pre = 1.59 ug/dl; post = 3.4 ug/dl. So glad that her Vetoryl was reduced from 90 mg to 60 mg, I am a bit concerned that her pre number is hovering over 1.59 ug/dl, I would feel more comfortable if it was =/>2.0 ug/dl.

Since she is still lethargic she may be one of those dogs that needs their cortisol to run a little higher. Are her symptoms controlled? If so, I would contemplate lowering her Vetoryl to 40 mg and see if her energy level improves. If she does seem to be feeling better on the lower Vetoryl dose but her clinical symptoms start coming back then you could try adding a 10 mg Vetoryl capsule, which would take her to a total of 50 mg, or having the Trilostane compounded into 5 mg capsules so you could tweak her dosage strength more slowly.

Hugs, Lori

[molly muffin]

I agree with Lori. You want her at where she feels best at and since she isn't feeling so good now. I would reduce and bring it up just a tad and see if there is any improvement. Not all dogs respond well to the lower cortisol levels. So I'd talk to your vet about trying that.

[jakabi]

Hi,

Just wanted to post and let you know our girl left us on Sunday 13th March :(

We actually took her off Vetoryl around August last year because she was struggling more and more with walking. There was hair regrowth but not much and her belly didn't really go down at all whilst on it. Within days of taking her off Vetoryl there was a massive improvement but over the months it gradually got worse which makes me wonder if something else was going on (cancer maybe?).

She started trembling about a month ago and more recently started to go off her food and bones like her mouth was hurting her. Walks had all but stopped and she looked like she was walking on broken glass sometimes (weighing nearly 150 lbs probably didn't help). She was taking paracetamol and tramadol every day but I guess you never know how much pain a dog is really in. She would pretty much sleep 23 hours a day and just get up to go to the toilet and eat. We made the heart breaking decision to let her go last Friday and spent a couple of days with her so the kids could say their goodbyes.

She was in my arms until the very end and she went peacefully within 30 seconds. We did everything we could for her and I know it was the right time but that doesn't make it any easier. She had a good full life with best food and best walks and 9.5 years for a DDB is quite a good age I'm told. Dealing with the grief is hard but we are just accepting it for what it is, we grieve because we loved her. I do find comfort in looking at all the pictures we have of her because they make me smile and even laugh at this sad time.

For anyone dealing with cushings, just remember its not your fault and you can only do your best for them. Quality of life is key and once that has gone they are not living anymore, they are simply existing. When that time comes its kinder to let them go.

Sweet dreams girl, you are in our hearts forever xxx

Neca 2007 - 2016

[Joan2517]

I am so sorry for your loss. Watching them deteriorate is heartbreaking and losing them is just awful. I lost my Lena 4 weeks ago this coming Friday and I miss her every day. I am thinking of you at this time.

Joan

[Harley PoMMom]

Oh sweety, I am so very sorry for the loss of your dear girl and my heart goes out to you at this most difficult time. Please know we are here for you and understand the pain you are feeling.

With Heartfelt Sympathy, Lori

[jakabi]

Thank you for your kind comments and thanks to everyone who shares their experiences, knowledge, kindness and compassion.

Just to add, we did try various anti-inflammatory medication with the Vetoryl to counteract the reduction in cortisol but unfortunately she got two huge open ulcers on her back within days of being on it (the last one was Metacam). So we had to stop that and some Manuka honey healed the ulcers within a week... just in case anyone runs into the same problem. Vetoryl was part of the solution but it was a double edged sword for us in the end.

She was on all kinds of joint care supplements which may have give her some relief, but I guess I'll never know for sure.

One of our favourite pics from her younger days (Circa 2008) ...
https://drive.google.com/open?id=0B8L6FY5BncufQ3lJaXJhLU8yYWc

[molly muffin]

What a great picture.

I'm very sorry for your loss. :(

[budindian]

I am so sorry for your loss. I also sometimes second guess myself. I do know if I ever have another dog with cushings I will do things differently the next time. With the help of all the kind people here I learned a lot. I miss my baby everyday. Be good to yourself, its a hard journey.

[Joan2517]

That is a gorgeous picture of her...

I too will do things differently if I should ever have to, which hopefully I won't. I don't think I could go through the ups and downs again...and Lena only lived two months after her diagnosis. I still wonder if I should have put her on the Vetoryl at all considering she would have been 15 this coming Saturday. The "what ifs" torment me....

[Tammysmom]

So sorry for the loss of your sweet girl. They are so much a part of our lives. A member of our family. Take comfort in knowing you were a great mom and gave her a life filled with love. Thoughts and prayers. Brianna

[judymaggie]

My heart goes out to you at the loss of your sweet Neca -- you gave her a wonderful life and I'm sure she left this world knowing she was very loved.

[apollo6]

I am so sorry for the loss of your beautiful Neca. There never is enough time with our fur balls. The years go by so fast, because of all the joy, love, companionship they give us. Like you the vetryol was a double age sword for my baby Apollo also.
May you know be at peace, Neca.
Sonja, Apollo

[mytil]

I am so very sorry for your loss! My heart is with you.
Terry