Very worried Mom - Bugsy has gone to heaven

[sandi and bugsy]

My name is Sandi and my sweet 12 yr old baby Boston Terrier's name is Bugsy. He is my everything. He has had Atypical Cushings disease for about 5 yrs now, which I treat with melatonin and flax hull lignans. This has worked very well. Last year in Oct. 2014, he was diagnosed with Typical Cushings disease. In Jan. 2015, he developed a severe case of pancreatitis, which he recovered from, thank the Lord!. Now as of March 2015, he has Calcinosis Cutis. His vet said it's time to treat the cushings. Around the 1st of May his vet started him on 30 mgs of chewable Trilostane tabs twice a day. He slept a whole lot for the 1st 4 days and on the 5th day he was very lethargic and would not eat. So I discontinued the Trilostane and began Prednisone, which helped him return back to his old self. Then, 4 days into taking the Prednisone, he got Pancreatitis again. Which now he is fully recovered from. Now Bugsy's vet wants to start him on liquid Trilostane at 12.5 mgs twice a day. Im very worried about starting him back on this because of the initial reaction he had. I've been told the Calcinosis Cutis will not go away unless we treat the cushings. Anyone have any info or stories, hopefully with great outcomes, about their dogs taking Trilostane. Any help will be greatly appreciated. Thank you all!

[apollo6]

How much does your baby weigh? I am surprised at such a high dosage, and before any change you need to do an Acht stim to check on if the cortisol is within range. Also my Apollo was only on 10 mg and weighed 10 lbs. We are here to help and will ask you questions. Also when you can not give a full dosage, compounding dosage are given. The skin problems are part of the disease because of a weakened immune system. Apollo also had problems with pancreatic. And each case is different. Cushing symptoms are pot belly, excess water consumption. Others will give more input.
Also Apollo lived to be one month short of 14.

Sonja,Angel,Ariel

[molly muffin]

Hello and welcome to the forum.

How much does Bugsy weigh? The reason I ask is because the manufacture has recently changed their recommended starting dose for vetroyl/trilostane to no more than 1mg/1lb. So it sounds like he had too much. You never know how any given dog will react to it, so it is better to start low and slow. 30mg was I think too much.

Yes, cushing dogs are prone to pancreatic attacks. One thing you have to do since you know he susceptible is to make sure he is fed a low fat diet, low fat treats, everything needs to be closely monitored for fat content. You still want moderate protein just be aware of the content too.

Now, the calicinosis cutis. That is a bugger to get rid of and really from what we have seen here on the forum, the ACTH post level needs to be just under 5.0ug. So, you have to closely monitor the cortisol levels. Then skin and hair issues are the hardest to get rid of and take usually the longest, as the skin has to go through it's cycle. Any calcium deposits that are there, will push through the skin. The area needs to be kept clean and dry. Have some sort of anitibiotic spary, like a tricholor for instance to clean with, as they can be prone to getting bacterial yeast type infections.

I'm going to provide a link to Tobey's thread. Renee has had good luck in getting Tobey's cc under control, so you will probably find some value in reading through it.

http://www.k9cushings.com/forum/showthread.php?t=5908

Again welcome to the forum. Ask anything at all.

[sandi and bugsy]

Thanks for the welcomes! Bugsy weighs 26 lbs. The new liquid trilostane came today. The dosage is 12.5 mgs twice a day. I will get an acth stim test done, im kinda surprised his vet hasn't suggested this. I'm not exactly sure when his last one was done, but I will get the date and results on that soon. So, even if he has had the test done in the last few months, you are saying he needs another one since he was on trilostane for a few days? Also, the only other symptoms he has, other than having cc, are drinking a lot and of course peeing alot. No pot belly though. I also want to add that I really like his dr. but I feel like he wants me to think that he knows more about the disease and treatment than he actually does, so I appreciate all input I can get from you guys.

[molly muffin]

Normally when a dog starts on trilostane, they get a test about 2 weeks after starting and then 4 weeks. But he crashed right away on 30mg you said, within a couple days? So you always start in lower, but you need to know his values. I think the vet is thinking it was only a couple days so it is probably safe to start at this dosage. The thing is, that if you don't test, then you don't know for sure how low he dropped. Personally I don't even know if I'd start at the 12.5 twice, I'd probably go lower with 10mg twice a day, just because he did have such a reaction in such a short time. How many days exactly was he on medication before the lethargy? 3?

All vets are different too, but the thing is that a lot of GP's don't keep up with all the latest information, which if they are going to treat the disease and use the medications, I think they should refresh and keep up.

So, there is nothing wrong with you doing research and reading and taking that in to your vet to discuss with your vet.

Our Resource section has a lot of information in it that you might want to read through.

http://www.k9cushings.com/forum/forumdisplay.php?f=10

[sandi and bugsy]

The lethargy started the 2nd day into treatment, and on day 5 he could not even stand up without help. Is treating the cushings the only way to get rid of the cc? If not, and if there is any other way to help the cc, I would definately try it because I am fine with the excessive thirst and . pottying, thanks to peepee pads when i'm not home.

[molly muffin]

wow, 2 days, in that case, I'd definitely get an ACTH test done. And maybe start even lower than the 10mg x2 that I'd thought, just because of extrememe sensitivity.

Unfortunately getting rid of the cc requires the cortisol levels to come down and to come down to usually below 5.0ug post ACTH and stay there. The cc is caused by calcium deposit build up and that is caused by the high cortisol.

What we see happening on the outside, also sometimes progresses to happening on the inside of their bodies, so it is important to get the cortisol under control, you just want to be careful because of the reaction he had to the higher dose.

The good thing is that with the liquid it is much easier to adjust the dosage and not have to order pills in different mg's. So that is good.

You also know all the signs now of what an overdose looks like. If you see it, stop the meds, call the vet and get a test.

[My sweet Ginger]

'Around the 1st of May his vet started him on 30 mgs of chewable Trilostane tabs twice a day.'

Hi, was Bugsy on 30mg trilostane twice a day, meaning 60mg in total?

[molly muffin]

OMG Song I didn't even catch that twice a day 30mg part, 60mg is totally rididiculous dosage for a 20lb dog to start out on. No wonder he crashed if that is what he was on. EEEEK!

Glad you caught that. Definitely get that ACTH test, he could have easily not made it on that starting dose. So glad he is better now.

[My sweet Ginger]

I'm not familiar with the liquid type trilostane but I'd def. get an ACTH test done to see where his cortisol levels are before restarting his treatment.

[sandi and bugsy]

Yes it was 60mgs a day. I will call his dr today to order the acth test and will post those results. Thanks so much cause we were planning to start the new dose this wknd.

[molly muffin]

Eek that is a lot 60 mg to start and not a good call on the vets part. Get an ACTH first thing then see where you should restart meds at.

[sandi and bugsy]

I have scheduled an ACTH stim test for next Tuesday and will post the results of that.

[Squirt's Mom]

Was any testing done before starting the Vetoryl (Trilostane) for the first time after the CC showed up? OR did the vet just say it was time to start treatment based on the skin?

[sandi and bugsy]

No tests were done before starting the first treatment, his vet said just because of the cc.

[Renee]

Your vet is dangerously ill-informed. Please consider getting a new vet.

The CC (of which I have experience with) is a time-sensitive issue -- but, the death of your dog or potential over-dose is much more risky. Whether you start treatment now or in 2 weeks, it will not alter the course of the CC. That takes months to heal and months of getting the cortisol into proper range and maintaining the range.

I'd also like to make sure that CC is truly what you are dealing with. Cushings dogs can be prone to many skin issues, but CC (contrary to the prevalence on this board) is actually still considered rare. Have you had a biopsy done or a visit with a derm vet?

[Squirt's Mom]

Oh dear, yes your vet is putting your baby at risk so very unnecessarily. :( The information on this disease and the drugs used to treat it are readily available to any vet who will take the time to do a bit of reading. If at all possible, I would be seeking another vet asap who has a good success rate treating cush pups - and you have the right to know that up front. ;)

CC *can* be caused by something other than Cushing's tho that is rare. If I were you, the first vet I looked for would be a derm vet - one who specializes in the skin. They can tell you very quickly if this is CC for sure and be much more likely to be able to know the cause and how to address it correctly.

[sandi and bugsy]

Very good to know that starting treatment now or in a few weeks will not make that much of a difference. I'm not really sure if there are any derm vets here in Knoxville. But I will definitely be looking for one. Are they under DVM's?

[lulusmom]

The University of Tennessee Knoxville definitely has board certified veterinary dermatologists on staff.

[sandi and bugsy]

Thankyou, I will call them asap.

[sandi and bugsy]

Does anyone know if I am supposed to bathe or clean the calcinosis cutis on my baby?

[deannah]

New here sandi, but my dog suffers from calcinosis cutis as well. From what I've read on the net that you should keep the skin clean with frequent baths. I've seen reference to and used a shampoo that contains chlorohexidine, which is a disinfectant. I have used the brand Douxo, which also makes wipes and a spray for the hard to shampoo areas.

Horrible disease this is and made worse by the body sores which sometimes happen. Looking forward to other responses about this. Not much available on the net as far as treatment for this condition.

Deanna and Puckie

[sandi and bugsy]

Thanks for the reply, His vet wont give me a straight answer on this so I have not cleaned it. I have some anti bacterial & anti fungal medicated shampoo with chlorhexidine gluconate and ketoconazole in it. Going to bathe him today. Has your baby's cc cleared up any?

[deannah]

Some sores look a bit better and others not so much. A Vet who is a dermatologist, said the Chlorhexidine shampoo was fine to use. Also have read that the only way the sores get better is to get the cortisol level under control. Have read on here that it should be down to 5.0.

[molly muffin]

Getting the cortisol lower is the main goal, but every calcium deposit that is there already has to push up through the skin, so it takes a while to get that under control.

In the mean time, yes keep it clean and dry. An antibacterial spray is good. Cut away the hair around the sores so it is easier to keep cleaned.

The sores are one of the hardest things to deal with, but once the cortisol is lowered, and the skin has cycled through, that usually goes get better too.

[sandi and bugsy]

I got Bugsy's acth test results back and it was 43. His vet wants to restart him on Trilostane in liquid at 36 mgs daily, at 18 mgs twice a day. He says we need to start this asap. I really don't want to start him on a dose that high because of the reaction he had before on Trilostane. Is 43 a really high result? Does anyone have any input as to what I should do now, start him on the dose the vet wants or lower it to 1 mg per lb of his body weight?

[sandi and bugsy]

By the way, Bugsy weighs 26 lbs.

[labblab]

Hi Sandi,

You'll see that I've merged your new question into your original thread about Bugsy. It is important for us to be able to go back and read the full history when we offer you our thoughts and suggestions. ;)

In a nutshell, I think the dose your vet is recommending is too high, especially after Bugsy's earlier reaction. Initial trilostane dosing is now based solely upon weight, not upon diagnostic ACTH results. Here is a link to a post that you may even want to print out to show him. If he has any questions about starting at a dose that equals 1mg. per pound, I encourage him to call Dechra directly so as to receive feedback and guidance from their technical staff.

http://www.k9cushings.com/forum/showthread.php?p=1251#post1251

Marianne

[sandi and bugsy]

Thankyou for merging my new question. And I agree and will print this and take to his vet. Is a 43 result of acth horribly high?

[deannah]

Sandi, my Puckie's first ACTH Sim test resultls were:
pre: 4.0 ud/gl
post: 19.1 ud/gl

She was tested yesterday at 30+ days but don't have those results yet.
Is the 43 a post result?

Deanna and Puckie

[My sweet Ginger]

If 43 (1.56 ud/gl) was post number, what was the pre number?

[sandi and bugsy]

Thats just what he said on the phone today. Im going to pick up copy tomorrow and I will post them.

[labblab]

Yes, 43 is a high number, but that still does not have any bearing on the size of the recommended starting dose of trilostane. There is a fair amount of individual variation in the way in which dogs metabolize the drug, regardless of size and regardless of pretreatment cortisol level. This is why some very large dogs end up taking even smaller doses than very small dogs.

For safety's sake, it is much better to start treatment at a dosing formula that does not exceed 1mg. per pound. At the end of 30 days, you will then know how effective or ineffective that particular dose is for your own dog, and then informed decisions can be made about the size of any dosing changes. One month is not too long to wait for safety's sake. It is always safer to start low and work up, rather than vice versa.

Marianne

[sandi and bugsy]

What is a normal result?

[My sweet Ginger]

Yes, please.

Oh, I'm sorry I thought it was nmol. Wow, then it is ver high.

[labblab]

Every lab has its own normal range, so you will know what the range was for Bugsy's results when you pick up the copy tomorrow. Typically, the high end of the normal range does not exceed approx. 22 ug/dL. For some labs, the "normal" cut-off is lower. Bear in mind, this is the normal range when the ACTH is being used for diagnostic purposes, to decide whether or not a dog has Cushing's in the first place. When the test is being used to monitor treatment effectiveness, the range will be very different.

[sandi and bugsy]

I want to say that i like his vet but I dont feel very confident with him on this matter. I ckd with the UT vet hospital and school here in Knoxville, but I need a referral and my vet says he is going by their reccomendations on this anyway. But, I am going to insist on a dosage of no more than 1mg per 1lb of Bug's weight, and maybe even lower. I really appreciate your feedback on this, it's nice knowing people with experience on things, and who understand.

[molly muffin]

You can always take in the new recommendations from Dechra and say based on his previous reaction that you want to start at the low end and work up.

http://www.vetsonline.com/news/product-news/140722-new-lower-starting-dose-for-vetoryl.html

It can drop very quickly so you really do want to see how he reacts to it and how quickly that number comes down. While 43ug is high, my molly was 36.75ug before we started and she is still not up to her body weight in medication. She weights 18 lbs and we are at 15mg.

[Squirt's Mom]

It would REALLY help if you could a physical copy of these test results and post all the info. Getting numbers on the phone may lead to some thinking that is not right at all so having the actual test results in your hands is always, always the best way to go. Things are so easily lost when passed thru 2-3 people. ;) Start making it a habit to ask for copies of everything they did each time she sees the vet from now on - the results NOT an invoice. :) They never have any trouble giving you the invoice! :D

[sandi and bugsy]

Ok, I got Bugsy's acth results today. They are: Pre - 7.3. Post -43.3 I am taking a copy of Dechra's recommendations regarding treatment and monitoring to his vet tomorrow. I am going to insist on restarting Bug's on trilostane with a dose of no more than 1 mg per lb, and definately not the 36 mg the vet wants.

[Squirt's Mom]

Alright! Way to go, Mom! :cool::cool::cool: And thanks for the full ACTH info - that is very helpful. ;)

[sandi and bugsy]

Does anyone know how long you should wai to do an acth test after dtoppin prednisone? Just wondering if that could mbe why Bugsy's reults were so high last week at a 43 post result.

[Harley PoMMom]

What dose was the prednisone and how long was he taking it, also why was the prednisone being given?

[sandi and bugsy]

The dose was 5mg daily for 7days, then 2.5 mgs daily for 7 more days. He was on the pred after having a bad reaction with too high a dose of trilostane after being on it for 5days. Going to start him back on it with a much lower dose.

[labblab]

In Bugsy's situation, as long as he did not have any prednisone within 24-48 hours of the test, I don't believe it ought to have had any effect on the results.

Marianne

[sandi and bugsy]

Thanks Marianne, I'm starting him on 5mg twice a day this evening. I'm nervous but I know we have to get his cortisol down.

[Squirt's Mom]

Are his signs back pretty strong? Has he had an ACTH that shows the cortisol is elevated again? If not, I would not put him back on the treatment just yet. Protocol is to let the cortisol rise again until signs are present and the ACTH shows the cortisol is elevated.

[sandi and bugsy]

He had acth done last week and it was post 43, but no symptoms getting any worse.

[deannah]

Sandi, Just wanted to let you know I gave Puckie a bath today with the new shampoo (Dechra) Trizchlor 4 and it really seemed to help her a lot. Some of the crusty scabs came loose and overall her skin looks better to my eyes. She seems happier as well with more energy and aliveness, playing with toys, etc.

Just wanted to let you know that the baths, even though a lot of work, do help your fur baby. I fully recommend any shampoo that contains Chlorhexidene really seems to help. I had previously used one with 3% of that and the latest contained 4% of the chlorhexidene. Maybe my imagination or the continued use of the Trilostane, but she seemed much improved following this bath.

Deanna and Puckie

[sandi and bugsy]

Aww, im so glad Puckie is feeling good! Bugsy' been on trilostane now for 2 days and things are going good. :-) Im just nervous though because of before. Praying and thinking positive! Im gonna bathe him this weekend. Happy 4th!!

[molly muffin]

Hoping this dosage works!

[sandi and bugsy]

Today is the 6th day Bugsy has been on trilostane liquid 12 mgs daily. As of this afternoon, he ate very little food and will sniff it but doesnt want anymore. Hes been getting some ground turkey since recovering from pancreatitis about one month ago, but hes been getting more of his food. Now he will just eat a few pieces of his food. Just bought some more turkey and gonna try that. Other than this, he seems to be doing really good. Could the trilostane already be affecting his appetite with just being on it for 6 days or should I be worried about another cause?

[molly muffin]

You can always withhold the trilostane and see if he eats better, or you can have an acth run. Normally you would run one at 10 - 14 days after starting a new dose, but if it is a change that is worrying and knowing the history it is worth giving a thought to. Or like I said, with hold. My molly just went through a spell where she wouldn't eat well. I withheld the next days dose completely and then once I saw her eating fine, I gave her the trilostane again at same dose and she is fine.
I do notice though that her appetite which hasn't never been great, is even less with lower cortisol. (unless it's a treat) If he will take a treats of different kinds then likely he just isn't interested in the food.

I know that is a few different possibilities there but sometimes when it comes to eating you have to eliminate the possibilities.

So, withhold meds till eating normal
test now
or if he will eat treats or anything other than his food, try some other type of food

[sandi and bugsy]

Thankyou Sharlene, I will withhold his trilostane tomorrow and see how he does. Will one day of him being off of it make any difference in the acth test we are doing next Monday? He did eat the turkey good:-)

[molly muffin]

Since he ate the turkey good so is probably just not as hungry so can be picky with what he wants. should still be fine for ACTH. On Monday. I always error on the side of caution. And have been know to reschedule ACTH sooner or later depending on what is going on.

[deannah]

I'm having the same eating problem with Puckie. It's been 2 days now without meds. Beginning to think it's just a "picky" eater problem. Hope you get the problem solved, Sandi.

Deanna and Puckie

[sandi and bugsy]

Same here Deannah, Bugsy did not have his trilostane today and still just eating turkey. Well, he has eaten a little of his dog food but mainly just turkey. Hoping he is just becoming a picky eater also. Not sure how nutritious ground turkey is though.

[sandi and bugsy]

So today I did give my baby his trilostane since his eating wasnt any different when I withheld it, and he usually drinks very excessive amounts of water, but this afternoon he would go to his water bowl, take 2 or 3 drinks and stop and stare at the water, then repeat this for quite a few times. Why would he be doing this?

[labblab]

Is there anything else about Bugsy's behavior that seems odd, or is everything else normal aside from the picky eating and this change in his drinking? Trilostane treatment is definitely intended to reduce both excessive appetite and excessive thirst, but I agree that the pausing and staring at his water bowl seems unusual. That's why I'm wondering whether he is doing anything else that is "off" or odd.

Marianne

[sandi and bugsy]

Marianne, everything else seems normal although he does seem a little depressed maybe. The vet says that is a normal side effect of trilo and progression of the disease, but like I said before, I'm not real sure his vet is all that knowledgeable on cushings and the treatment, since he started him out on a dose of 60mg and he is 26 lbs. Everytime I give him a dose, even though it's much lower, it makes me so nervous, but I know he needs it to get cort level down.

[sandi and bugsy]

Does Bugsy need to fast before his acth test today? Vet says yes.

[My sweet Ginger]

I just found this by Dr. Peterson.


The dog should never be fasted on the morning of the test. Trilostane is a fat-soluble drug and must be given with food to help increase its absorption.

[molly muffin]

No fasting before ACTH. You give the meds with food. I don't give any other food though. Just breakfast meds and then test.

[labblab]

Song and Sharlene are absolutely right. Fasting on the morning of the ACTH monitoring test for a dog taking trilostane will invalidate the results. Here's a link to the article Song is quoting from. You can even print out a copy and take it to your vet if you need to. I am worried, though, that unless your test is scheduled for later in the day, you may already have missed the opportunity to feed him along with the trilostane. If so, the test really needs to be rescheduled.

http://www.endocrinevet.info/2011/03/whats-best-protocol-for-acth.html

Marianne

[sandi and bugsy]

I gave him his trilo dose at 6 am and he did not have any food with or before it, due to what his vet said. Then I got to wondering about it and I fed him a little at 7 am. He started the test at 10 00. Hes home now and vet said the results will be in later. Im hoping the food was not too late to absorb the med.

[labblab]

Unfortunately, I'm guessing the trilostane had already been largely digested by the time you gave the food. So it will be important for you and your vet to realize that Bugsy's cortisol level would likely have been lower had the drug been given at the same time as food so as to achieve maximum effectiveness. This will need to be taken into account when considering any dosing increases.

I do strongly encourage you to bring this article to your vet's attention so that subsequent tests can be performed properly. If he has any lingering doubts, he can call Dechra (Vetoryl manufacturer) and they will confirm the info in that article -- Vetoryl must always be given along with a meal, even on testing day.

Marianne

[deannah]

Morning Sandi, Do you have results yet and how is Bugs doing? And you? Concerned about you both.

Deanna and Puckie

[sandi and bugsy]

Thanks Deanna, I am picking his results up after work today and will post them when I do. Bugsy has been doing really good. Appreciate your concern and hoping Puckie is doing good also!

[sandi and bugsy]

Yay!! I'm so so excited!! My baby's acth results from Monday are: Pre : 5.5
Post: 12.7
His results on 6-24-15 were:
Pre: 7.3
Post: 43.3
So happy with these! He has been on liquid trilistane for 13 days as of today. His vet wanted him on 12 mgs twice a day but as I've already possted, I did not give that dose. Instead I am giving him 6 mgs twice a day. I told his vet and he said to raise it to 24 mgs daily. I'm sorry but I'm not changing what I have been giving. To me, these results show this dose is working. I also read on this forum that dosages should not be changed until it has been given for 1month. Does anyone have any opinion on this?

[Harley PoMMom]

Yay!! I'm so so excited!! My baby's acth results from Monday are: Pre : 5.5
Post: 12.7
His results on 6-24-15 were:
Pre: 7.3
Post: 43.3
So happy with these! He has been on liquid trilistane for 13 days as of today. His vet wanted him on 12 mgs twice a day but as I've already possted, I did not give that dose. Instead I am giving him 6 mgs twice a day. I told his vet and he said to raise it to 24 mgs daily. I'm sorry but I'm not changing what I have been giving. To me, these results show this dose is working. I also read on this forum that dosages should not be changed until it has been given for 1month. Does anyone have any opinion on this?

That is a significant drop in cortisol, Kudos to you for sticking to your guns in giving him that lower dose and in not raising his dose. Absolutely you are correct, a dog's cortisol can continue to drift downward during the first 30 days of treatment, so a dose adjustment is not recommended at that 10-14 day window.

You are doing a wonderful job!

Hugs, Lori

[kaibosmom]

That is true...cortisol can keep falling. I found out yesterday that my dog's cortisol continued to drop over 4 months. The first two remained steady but we found out it's fallen more (and into therapeutic range) over the last two. It was my vet that didn't want to increase the dose!

[labblab]

Sandi, I also want to stress again that Bugsy's ACTH result would likely have been even lower had he been given food at the same time as the medication on the morning of the test. Were you able to clarify with your vet the confusion about not fasting Bugsy?

Marianne

[sandi and bugsy]

I just want to say that Bugsy's vet and I are on such different pages on his treatment - dose, testing times, and electrolyte testing. He has gotten to where he will not return my calls untill quite a few days later. When I talk about the research I have done on all this, he says that he gets all his info from some of the top Drs in the country. He listens to me, but always has a negative response about my studies not being as up to date as his. The info I have printed for him have dates being 2010 + 2011. Are there any pdf's about all this that are more updated on them? Anyone with websites on these please let me know. Up untill this cushings treatment, i've felt that he has been a really good Dr for Bug's. Also, Bugsy has an appt with an Internal Med Dr on Tuesday, and if all goes well she will be treating him for the cushings from now on. I just want Bug's to get the very best treatment possible. I love him so much! Thanks in advance for any responses!

[judymaggie]

Sandi--like you, I am working with a vet whose protocol is very different from that used by both the drug manufacturer, Dechra, and the veterinary experts in the field of endocrinology, Drs. Peterson and Bruyette. One thing that I did might help you--I called the Dechra help desk, set up a file for my dog and asked them several questions. I then asked my vet to call them and he surprised me by doing exactly that. I don't know exactly what transpired in their discussions but, from then on, my vet was more accepting of my preference to follow their protocol.

I hope the IMS appointment meets your expectations!

[molly muffin]

Calling Dechra would be an excellent option. Very much the "now". The thing is that these protocols as far as testing and administering the drug don't change that often. Follow up testing is the same recommendation now as it has always been and the dosage, was updated last year, which I think we gave you, the first time since it became available in the USA.

http://www.vetsonline.com/news/product-news/140722-new-lower-starting-dose-for-vetoryl.html

Making a change is a very big deal Testing follow up protocols are in place for safety. Dr. Peterson, is on the learning panel for vets by the manufacturer. He teaches vets how to use vetroyl.

So while how nice for your vet, you just have to stand firm and say this is how I've chosen to proceed. It is in the end, your pet, your responsibility, their care.

I think that if your vet is saying he has new information, then he needs to provide it. :) Printers are usually standard in all vet's offices, he can use it to print out any more current information he has.

We do tend to stay on top of new information coming out and I can say, that no testing protocols have been changed in the last few years and as I stated above, the dosage was only changed last year for the first time in eons.

[sandi and bugsy]

So, Bugsy had his 1st appt with his new IMS on Tuesday. We had a great visit! She is very compassionate and understanding of my fears and explained a lot. She is quite experienced in cushings and the treatments of this horrible disease. Bug's had a ultra sound, urine culture, and an ACTH test along with a very thorough exam. We got the results back today, and they have gone up from the test which was on July 14 which were - pre 5.5 and post 12.7. Now they are - pre 7.7 and post 15.5. He's been onTrilostane 5 mgs twice a day ( I realize this is a very low dose for a little guy of 26 lbs) but after we had such a scare, or shall I say Overdose, that his other vet had him on of 60 mgs daily, I've been too afraid to go any higher than the 10 mgs. We have now increased this to 12.5 mgs twice a day, which I began tonight. It was the info I've gotten from this forum that has helped me to realize what I needed to do and that was to find an IMS to care for my baby. Thankyou all for this! I can say that my sress level has come down and I finally feel that we are on the right track of conquering the awful effects of this disease. I will update on his progress!! Thanks again!!

[molly muffin]

That is wonderful Sandi! So glad you found an experienced IMS. They are a life savior in my opinion.

Now that you know where his cortisol is, then starting at an appropriate dose for his body weight is a good call.

Keep us updated for sure!!

[sandi and bugsy]

I got Bugsy's acth results back today. This was done 12 days after raising his dose to 1mg per lb of body weight daily, split in 2 doses per day. The results are Pre 4.4 and Post 8. His IMS says to continue on same dose, and that the cushings is now being controlled. God is so good!! He seems so much happier, and like he is feeling a lot better!! Acting kind if strange when he goes to drink his water. At first he stands there with his little face close to it but is afraid to drink. This last for a few seconds before he drinks. Not sure but thinking maybe at some point when I was'nt around, maybe he choked or something. Anyone ever experienced this?

[molly muffin]

That's good results. How are his symptoms doing over all? are they gone?

hmmm, have you tried raising his water bowl a bit to see if that helps?

[sandi and bugsy]

Thanks Sharlene, his bowl is already raised a little, but I will raise it more and see if that helps. And, his acting like he is starving all the time has decreased, and also his water intake and pottying. But what I love the most, is to see him more alert and jumping up on to the couch and his favorite chair, and looking overall healthier and happier!! The cc is looking quite a bit better, and the hair is starting to grow back over it on his back.

[sandi and bugsy]

Hope Miss Molly is doing good!

[sandi and bugsy]

Happy Sunday! Wanted to update since Bugsy's acth last week. His cortisol level is being controlled. :-) He's showing improvement in everything, especially his wanting to eat all the time. I have to mix his dry dog food with boiled ground turkey so he will eat his food. So yesterday he quit wanting turkey. Now giving him boiled/ baked talapia in oven. Friday was the last day he pooped. I have to be extra careful what to feed him due to him being so prone to panceatitis, and also food allergies. Anyone have any suggestions please?

[labblab]

Hi Sandy! That's great that, overall, Bugsy is doing a lot better. :)

Can you please tell us the actual numbers for his ACTH testing, though? I know we are nosy :o, but it helps us to track the treatment journey if we know how the test numbers are running. If Bugsy ends up being really picky about eating, for instance, there is always the chance that his cortisol is actually dropping too low for his comfort.

Thanks in advance for this additional info!
Marianne

[Harley PoMMom]

I got Bugsy's acth results back today. This was done 12 days after raising his dose to 1mg per lb of body weight daily, split in 2 doses per day. The results are Pre 4.4 and Post 8. His IMS says to continue on same dose, and that the cushings is now being controlled....

I believe the results from his most recent ACTH test were 4.4 and 8, so if Bugsy's symptoms are controlled than those are good results. I could be wrong :o so hopefully when Sandy comes back she can verify this for us.

[sandi and bugsy]

Yes you are right, results were pre 4.4 and post 8. I have a call in for his IMS, but havnt heard back yet. I sure hope he's just gotten picky, but his whole life, even before cushings, the little fellow has never turned down food, except for bananas, he cannot stand them. Lol. I am worried tho and wandering if maybe the accth was ran too soon after I gave his trilostane. Gave it @ 7 am and his appt was 9 30 am, he was finished by 11 30.

[Harley PoMMom]

Do you know what stimulating agent was used for the ACTH test? The timing of the post number is dependent on the stimulating agent used. When Cortrosyn is used one hour after it is injected the post blood draw has to be taken; when acthar gel is used that post blood draw is taken 2 hours after the injection.

It is worrisome when a dog that normally eats anything becomes picky all of the sudden, low cortisol can do that so finding out what stimulating agent was used and the time it was taken after injection is very important.

[molly muffin]

Anything else off? Diarrhea, etc?

[sandi and bugsy]

No diahrea, and everything else is good. He's jumping on couch and chair some and is doing the 4 steps out back good now. He is, however, when he goes to drink, he puts his mouth close to the water and stays like that a few seconds before drinking. I wonder if it could be his eyes, but he seems to be seeing fine other than that. Also, our bdrm is at the end of hall, and he stops and just looks in the other rooms for a minute before coming to the bdrm. He 's never done this before. Any ideas of why he may be doing this?

[Harley PoMMom]

How old is Bugsy? Sometimes Canine Cognitive Dysfunction (CCD) creeps up in senior dogs, it's like dementia or Alzheimer's in humans.

[sandi and bugsy]

Bugsy is 12. I read a little on ccd. I pray he does not have it! These 2 things are the only things I've noticed.

[molly muffin]

Some of our members have used Novofit for ccd. It wouldn't hurt to try and doesn't work for every dog but for some it makes a world of differnce.

You can usually find it on amazon.

[sandi and bugsy]

Bugsy had some labwork done and it came back BUN is 57, crea is 4.1, and Bun/crea is 41. This was done @his regular vet, not his IMS. I'm so scared because he said his kidneys are not functioning well. It's crazy to me that before starting trilostane, these levels were fine. I've been reading and some say that trilostane can raise these. Does anyone know if this is true? If so, I will definately stop it and switch to lysodren, unless it can also raise the kidney levels. I'm so scared! His cushings is being controlled but I certainly do NOT want his kidneys to fail! Please can someone tell me which way to go now? I thought my sweet baby was doing so good, and now this. Any help on this is very much appreciated!

[molly muffin]

What is the normal range for the BUN and the BUN/Crea and the crea?

Usually it is uncontrolled high cortisol that causes kidney problems.


Have you talked to your vet about a kidney specific diet? (it also needs to only be moderate in fat due to cushings dogs being prone to pancreatis)

My dog has protein kidney loss and hypertension (so make sure his BP is being checked) It is hard to manage all these things together. :(

[sandi and bugsy]

Wanted to update and ask a question. 7 days ago we went to er and Bugsy has pancreatitis again. I cannot get him to eat. He is not vomiting and no diahrea. Actually he hasnt pooped in 4 days now. Im concerned that he needs some nutrients and not sure what to try to give him. Also along with cushings, chronic pancreatits, and now watching kidneys cause his last BUN was higher than normal. What foods can i fix for him to provide enough nourishment? His vet says Hills science diet k/d but his IMS says no to this because of too much fat. Can anyone help us?

[deannah]

No answers Sandi, but wanted you to know I'm thinking of both of you.

Deanna

[sandi and bugsy]

Thanku Deanna, hope u guys are ok

[Squirt's Mom]

For right now, try to get some NutriCal or other nutrient substitute into him. Most are a paste that come in a tube. They provide all the mineral and vitamins needed. I would boil some chicken, plain nothing but chicken and water; strain out the solid pieces so it is just broth and try that. If he tolerates that for a day, add a teeny bit of well-cooked rice, cooked to the point of wallpaper paste almost, very sticky, the grains broken open. If that goes ok for a day, gradually increase the rice in the broth. Keep adding the NutriCal, etc. to the broth and when the rice is added as well.

Let us know how he is doing!
Hugs,
Leslie and the gang

[sandi and bugsy]

Thanku Deanna, I will get some NutriCal. He will sometimes eat ground turkey boiled sometimes but not much. Is chicken less fatty?

[labblab]

Since my Peg has also had some acute attacks of pancreatitis, I've learned that even though supplements like NutriCal can be good things in certain situations, probably not if Bugsy has just been to the ER for another acute attack of pancreatitis. I'd be very wary about giving it to him this early on because it has a very high fat and sugar content. He really needs to stick to very bland and limited lowfat foods for the time being. I know you are really concerned about a lack of well-balanced nutrition, but in the short run, that is really not a big issue. You just want to get some plain, bland lowfat food in him like the chicken and rice that Leslie is describing. I will come back in a few minutes and add a link to an article that discusses therapeutic meals for dogs recovering from pancreatitis. However, if Bugsy truly will not eat and has not done so for several days, unfortunately he may need some IV nutrition.

I'll be back in a minute with that link.

Marianne

[labblab]

OK, I'm back with the link to this Dogaware article. Be sure to scroll down and read the section: "What to feed in the beginning" (when recovering from acute pancreatitis).

http://www.dogaware.com/articles/wdjpancreatitis.html

I realize that you also have kidney issues at play, so I will track down another Dogaware article that deals with food recommendations for dogs with compromised kidney function. But I wanted to at least start you off with this article.

What is your IMS recommending that you feed Bugsy instead of the Hills kidney food? I'm assuming he knows about the ER visit, and I'm hoping that he's given you some feeding suggestions that meet his approval?

[sandi and bugsy]

Marianne, Bugsy's IMS wants to wait for the result of a pancreatitis lab, or PLI, that was done last week, before recommending what to feed. He did eat some turkey with cottage cheese on it. Im afraid of the protein content in turkey though, that his vet said to lower due to his kidneys. Wow, danged if u do, and danged if u dont. Cushing dogs need protein, but kidneys do not.

[molly muffin]

moderate protein should be okay, low phosphorus is key. Turkey or chicken, lean should be okay. Egg white are good protein and low phosphorus, but not the yolks.

[Harley PoMMom]

Bugsy had some labwork done and it came back BUN is 57, crea is 4.1, and Bun/crea is 41.

Can you verify Bugsy's creatinine (crea) level for me and include those reference ranges too...thanks!

Hugs, Lori

[sandi and bugsy]

I hope everyone and their furbabies are doing good. I havnt posted anything for a few wks now and want to update on Bugsy and ask a for some help. We've had a very rough month. First if all the PLI test for pancreatitis came back normal 2 days after er diagnosed him with it. Then had to take him to get an enema because no poop in 12 days. Man was there a lot after that. Then on 9-27 after waking up from nap, he starts circling and walking in to things, eyes were moveing back and forth very fast, horrible and so scary to watch! Thought stroke or seizures and blindness. Er did mri and results are, very serious inner ear infection, and also pituitary macrodenoma. Derm. dept at hospital flushed and cleaned ears, but had to cut hole into each eardrum to do it. He was under anesthesia about 3 hrs. Afterwards he got vertigo very bad. Also both eyes going side to side (nystagmus) very fast. Per dr: this is normal after this procedure and may last up to 8 wks. The nystagmus stopped about 7 days later. But he still has vertigo, but is doing better with it. Also has a head tilt to the left drs said fron ear infection and hopefully will also go away. For a week now we've been rreating him for an ulcerated cornea, which they said anesthia and eyes being so dry caused. And for the last 3 days he wont eat. Ive tried everything I can think of, ckn, lwan hamburger boiled, all kinds if different dry and canned dogfoods, cottage cheese, sandwich turkey meat. He will eat a little of each and stop. Today he ate 1 1/2 boiled egg. Hes lost a lot of weight and so badly needs calories but being prone to pancreatitis, needs not much fat. He is drinking water which im so thankful for. This is so frustrating and sad and I feel like im out of things to try. If anyone has any ideas at all, Im begging for help. He is my world and I live him more than anything. Im sorry this is so lengthy, but im begging for any help I can get. And of course prayers for my baby. Thank you so much for taking time to read this and know that any advice will mean more than you can imagine.

[Squirt's Mom]

Have you tried stinky things like some tuna water or Parmesan cheese or green tripe? You may need to use a nutrient supplement for a bit, something like NutriCal. It is a paste that supplies all the vitamins and minerals they need. I use it anytime one of mine gets off their feed for a while. They usually take it with no problem - I typically smear it on the top of their foot and they lick it off. Some will take it from my finger or from their plate where they eat. It apparently doesn't have a really bad taste.

Is he on any medications that have loss of appetite as a side effect? Check the product insert for adverse reactions or google the drugs online and find that info. That may be the culprit and things will get better when that med it stopped.

You may also need to get an appetite stimulant from the vet to use for a bit. Have you let them know about his appetite?

Let us know how things are going!
Hugs and prayers,
Leslie and the gang

[Harley PoMMom]

Baby food is another thing he may eat, just make sure there are no onions or onion powder in the ingredients. Also I would try making homemade broth with either chicken or beef. It is so worrisome when they don't want to eat :( I sometimes could get my boy to eat if I put the food in my hand for him.

Keep us updated and you both are in my thoughts and prayers.

Hugs, Lori

[Beaglelover]

Sandi, I'm thinking of you and Bugsy. As some other members suggested maybe try high protein low fat foods like tuna, boiled ground turkey. Please keep us updated. I had a beagle that had pancreatitis and we would give her tuna and boiled turkey and rice. She did well on those foods.

Tammy (Jenna, Sandie, Charlie's mommy)

[sandi and bugsy]

Thank You Tammy, Laurie, and Leslie,your ideas are helping me! Yesterday I got him to eat some a/d prescription formula for critical care, but today I have to stop that because it's got way too much fat. Although he loved it! He's had a boiled egg today and I'm going to try to some tuna in a little bit. Little stinker! I have been feeding him by hand but yesterday I tied something different. Seems he likes to stand with a little help, at his bowl and eat it by himself. I guess it makes him feel more independent. I so appreciate your thoughts and prayers and I will be updating again.

[molly muffin]

Do you have Halo canned food where you are? The wholesome chicken has the lowest fat and protein in it. I've been using it with my girl who has protein loss kidney disease and it's the lowest commercial canned I've found that still is nutritious and has vitamins in it too. It seems to be even better than the vets moderate and low protein foods as it is lower in fat than theirs is.

the rest gave you some good ideas too. The thing I've noticed with my dog and with others is that what they like one day doesn't always appeal the next day. I am trying to combat this by rotating foods, using the halo Wholesome, chicken/beef/salmon, so she doesn't stick her nose up at any of them.

Stinky is usually good when they go off all together. You can always throw some of that nutrical paste into the mix if it is a low eating day so that Bugsy still keeps the nutrients he needs.

[sandi and bugsy]

update on Bugsy. For the past few weeks we've been concentrating on his eye. The vet and I have decided that the tear to his cornea was caused from being left in the cage overnight at the ICU after his procedure on his ears. The cage was very hard and metal and no padding was there, and with his vertigo he experienced he kept falling and probably hurt his eye then. I'm very upset about this but we can't prove anything at this time. He is now blind in that eye. His vet and I have been trying so hard to save his eye so as to not have to have not to have to have surgery to take the eyeball out. The iris has poked through the tear on his cornea and it sticks out. Poor baby we need to have his ears flushed and now he's completely deaf and has lost one eye. It really sucks that we have no idea what these hospitals put our babies through during their surgeries and procedures. This was done at UT hospital so I figured everything would be legit. It just really makes me mad that my poor baby can't hear and now only has one eye to see out of. Last thursday we went back to his vet as we fgi everg 2 to 3 days to ck eye, and it has finally begun to scar over. Hopefully if this continues we will be out of danger and ni reason to remove eye.

[sandi and bugsy]

has anyone ever experienced with their babies having their ears flushed for an ear infection and then going deaf because of it. It happen on September 29th and now he is completely deaf. Still havnt started back on trilostane yet since at this time his eye and vertigo seem to be main priority. He is eating well now, thank God! And put on a cple of lbs. Bugsy and I hope everyone and their sweet babies are doing better!

[molly muffin]

Omg, what a horrible experience.

I have heard that flushing can cause a rupture to the ear drum that thin membrane. Some medication can be toxic if it gets into the inner ear too.

The head tilt seems to suggest one of these occurred. I think it is mycin or micin that can be toxic.

Oh no, that is terrible what has happened to Bugsy's eye. :( I do hope that scars over and he won't need surgery.

I just hate that this happened at all. :(

Sending you big hugs. I wish there was something to make this all go back in time and not ever have happened. :(

[sandi and bugsy]

Thanks Sharlene, sorry bout the other 2posts, I was using voice text and well, some parts did not make sense. Lol. Anyway, the day we picked Bugsy up after his procedure on his ears, his left eye was draining real bad and it was swelling. Next day his vet said he had an ulcerated cornea. He gave us some drops. It kept getting worse and worse untill it as hurting him so bad, you could not get near it. I called UT vet hosp where he had his ears flushed and all they said was it could be from anesthesia and his eyes being so dry. Ive since done a lot of research on this problem snd the main reason for it is trauma. Only thing we can figure is the night after procedure the hosp let us go back and see him for a cple mins and he was in a metal cage. He had vertigo terribly, and he kept trying to stand and kept falling. I asked them to put padding in cage but they said he is still groggy and would settle down and sleep the rest of the night. He had to stay there in icu that night. Its so sad that he went there seeing and hearing and this has happened to him.

[labblab]

Oh Sandi, I am so upset, too, upon reading about what has happened to Bugsy! I know it won't help to restore his sight and his hearing to lodge a complaint, but it galls me to think that both these losses were caused by improper care at UT -- and I have to agree with you, it truly does sound as though they were at fault!! Your biggest concern right now is Bugsy's health, but maybe at some point, you or your vet can write a letter to the head of the department there at UT to document the tragic outcome of his stay there. It seems as though somebody with some authority needs to know what happened so that it won't happen again to another poor dog!!

I am just so sorry for what you both are going through. Please know that you can come here and vent anytime! I would be going through the roof right now, too!!!

Sending tons of healing well wishes to your poor little guy,
Marianne

[Squirt's Mom]

I am devastated to hear this has happened to sweet Bugsy. :( And LIVID that any hospital would treat him so cavalier when he was obviously in distress...and his mom, who knows him best of all, told them he was. That the hospital in question is UTK, well I cannot express the deep disappointment I feel.

I am with Marianne - tend to your precious boy now, help him recover and adjust, then start researching what your options are. It certainly sounds as if UTK is at fault. :mad::(

[molly muffin]

I couldn't agree more. I like the idea of a letter from your vet to the head of department. This is totally unacceptable.

Just beyond words at how pissed it makes me.

[sandi and bugsy]

Thankyou all so much for your sweet words and well wishes! You guys are great at understanding and giving support! And yes, im very very angry, but now the main thing is to get Bug's thru all this and pray the vertigo goes away so my sweetie can walk on his own, and have some independence without having to be carried everywhere, and be out of the playpen lined with pillows on all sides, which is where he has to stay when not being held. He wants to get down on the floor so bad and be normal again. This afternoon his eye started bleeding and serum coming out. His vet says it is the bodies way of cleansing the eye, letting some pressure out. If he was 6 yrs old, they would have already removed the eye because of these flareups, and he will more than likely have more before it completely scars over. But, when he does get well, you betcha I will make sure the head of UT vet hospital knows all about their negligence andwhat has happened to my sweet baby!! I pray no other innocent furbaby ever has to go thru this!

[mommyslittlegirl]

Sandi, I like you. took my baby to a place where everyone said she would have the best care possible. That was suppose to be Texas AM Teaching School. When I took her for Cushings, she was put on 5 mg, than 10 mg.Than 15 mg, and 20 mg. of Trilostane. Even talked about 25 mg. This baby WEIGHED only 7 pounds. On the 20 mg. she began to have issues. They quickly lowed her dose. Very close to addisons. In 5 months, she went from 7 pounds to 5.8. Even though they kept her cortisol up. she never PUT on any weight.. I did send a letter to TAM. To several different places there. And they did not do a mri which I wanted to do. A letter will not bring sight or hearing back to your baby, but it might help a tiny bit to release those feelings you have for them.

[sandi and bugsy]

Thankyou for responding to my post. Your words simply made me cry for you and your sweet baby. I can feel your pain and know its hard for you to talk about. I realize we are all human and make mistakes, but had these people listened to our concerns and really cared for their patients maybe the outcomes would have been very different. Its so frustrating, and makes us feel so helpless. I truly believe you will be with your baby once again in Gods sweet time and till then he is taking great care of your angel for you.

[mommyslittlegirl]

Thank you Sandi. Another thing I did was to telephone and talk to the school including the business office. I owned them a small balance and told them I was not going to pay them.. Like you, when Bugsy was in the cage and you knew something was not right, I felt like something was not right. they raised her trilostane to much and to fast. The main thing is your Bugsy. I know you will take great care of him. And enjoy and love him . .

[sandi and bugsy]

Can anyone recomend a healthy commercial dog food for Bugsy to help him gain weight, but is ok for dogs prone to pancreatitis?

[Renee]

Instead of changing food, if he's doing well on his regular diet, I would suggest just adding in something a little high calorie, but gentle, like carbohydrates. I know it's quite popular to avoid grains, and I myself try to avoid the more common cheap ones, but adding something like barley, oats, instant potato flakes, steamed sweet potato, pumpkin, etc, may help increase calorie intake, while avoiding fatty, rich foods.

Also, in moderation, you could add some coconut oil or fish oil. And, consider feeding a three times a day, rather than just twice.

[Harley PoMMom]

I agree with Renee, it doesn't take much, and sometimes nothing at all, for that stubborn pancreas to flare up so I wouldn't change his feed since he is doing well on it. Like Renee mentioned adding carbs may help in gaining weight, pasta or rice, are two more options. ;)

Hugs, Lori

[sandi and bugsy]

Thanku guys. He is on royal canin gastrointestal can food now but the ingredients are not so good, lots of nasty by products. He's also eating some ckn soup for the soul but to get the lowfat, it is the weight mgmt kind, so not mant calories My little sweetie needs to gain weight.

[molly muffin]

If the food he is on isn't so great then try a slow transition to a different food. I like Fromm's or other foods of that nature, but yes you do have to watch fat content. Since you aren't going weight loss, perhaps a moderate fat rather than low fat would work?

[sandi and bugsy]

My sweet, sweet Bugsy went to heaven yesterday. He was such a fighter. This is the hardest thing ever. I've not been able to have children, and he was my baby. I loved him more than anything in the world. He would have been 13 yrs old on Jan 1. I literally cannot stop crying. I just want to hold and kiss and cuddle him again some more. I want to thank ecveryone on this forum for caring so much and asking about my baby, and all the helpful information on this horrible, horrible disease.

[Budsters Mom]

Dear Sandi,

I am so sorry to read this news today. My heart breaks with you.:o Thank you for coming back and letting us know. Bugsy has now joined our other fur angels at the rainbow bridge. They will watch out for him now. We remain here for you as always.

FLY FREE SWEET BUGSY, FLY FREE!!!

Hugs,
Kathy

[judymaggie]

Sandi -- my sincerest condolences to you during this most difficult time. Your love for Bugsy was very obvious and I'm sure he felt that every day he was with you. Give yourself time to grieve but be sure to take care of yourself as well.

[labblab]

Dear Sandi, I cannot tell you how sorry I am to read about sweet Bugsy. You both have been so brave and you tried so hard to overcome his problems. I know there are no words that can change your grief and your loss, but as Kathy and Judy have said, we are right here to walk beside you. You are not alone, Sandi.

As hard as it must have been to come back and tell us, thank you so much for letting us know what has happened. We will never forget your sweet boy. And we will never forget everything you did to help him.

Always in loving memory of your darling Bugsy ~
Marianne

[sandi and bugsy]

Thankyou very much. I miss him so so much!

[molly muffin]

Oh Sandi :( My heart just broke when I read this news. I am so very sorry. Gosh you both tried so hard.
I really have no words. I just want to give you a big hug and tell you that we are here for you.

[sandi and bugsy]

Today is a very hard day for me. I miss my baby Bugsy so very much! He always made my Mothers day so special! I'll always love you my sweet boy! I also want to say Happy Mothers Day to all who have lost their babies, and all who are lucky enough to still have them! Have a blessed day!

[Renee]

Oh Sandi, I am so sorry to read of Bugsy's passing. :(

Sail on fast and free beautiful Bugsy.

[molly muffin]

Sending you hugs. These days are so hard. :(