My big boy Gable - sweet Gabe is now at peace

[Joan2517]

I won't be able to do that yet. I am out of money...what if they aren't balanced? How do you fix that?

I can't get over how amazing his tail looks. I hadn't realized that it had lost a lot of fur. It looks like a raccoon's tail. Even my husband noticed! I hope he doesn't lose all his beautiful fur again.

[labblab]

Joan, from now on, whenever your vet does an ACTH, I’d ask him to automatically just tack on a simple blood chemistry panel. If the blood is drawn all at the same time, a simple chem panel should be relatively inexpensive and the information can be useful. In a situation of adrenal oversuppression, the chief concern is whether the potassium and sodium levels are normal. If not, a dog might need a hormonal supplement, at least temporarily, to replace the function of an aldosterone level that has dropped too low. If the ACTH shows that Gable’s cortisol level is starting to rebound, then there’s likely less need to worry about aldosterone, too. But a basic chem panel can always give peace of mind and can be a valuable addition to every cortisol monitoring test.

As far as his coat, we’re counting on the fact that ongoing monitoring tests will tell you whether, and how quickly, his cortisol may be increasing again. If it does start climbing higher again, you can restart the Vetoryl but just at a lower dose. So that should help you to preserve all the positive changes that you’ve seen with treatment, but without driving his cortisol too low.

[Joan2517]

Thanks, Marianne. That sounds good. So I am not doing the pre pill testing anymore. Back to ACTH tests.

[Joan2517]

Results are in:

Sample 1: 4.2
Sample 2: 4.6
Ref ranges the same as the last test.

So, no Addison's, thank God. If I have any money left over from paying bills on Friday, I'll get blood work done. The vet I spoke to said a urine too.

[Harley PoMMom]

I'm relieved and so glad to see his cortisol levels are coming up! The vet's recommendation on having an urinalysis done along with the electrolytes is a good one, an UTI could be a cause for the increased drinking/urination.

Joan, I'm not sure how well this hack works for testing a sodium deficiency but I'm gonna put it out there anyways; you could put some salt in your hand and see if Gable licks it up, if he would than those electrolytes may be off.

Hugs, Lori

[Joan2517]

I'll try it, Lori. But I did take him about an hour ago for blood work and brought some urine for testing anyway. His vet is perplexed and said he'll consult with a specialist. We'll see what the blood work shows. Gabe's been outside since we got back; he stayed outside most of yesterday, too.

[Joan2517]

Well, I tried the salt. He took a little lick, then shook his head, gave me a dirty look and walked away.

I just spoke with his vet. He spoke with an endocrinologist specialist. She wants to start him back on 10mgs, once per day, beginning today, and to lower his thyroid meds to 1 pill in the am and 1 at night (was 2 in the am and 1 1/2 at night).

Blood work:

ALK Phosphates 247 (H) ref range (5 - 131)
Triglycerides 670 (H) ref range (29 - 291)
Precision PSL 154 (H) ref range (24 - 140)
T4 7.2 (H) ref range (2.5 - 6)
Urine Specific Gravity 1.002 (L) ref range (1.015 - 1.050)

What do you think about the plan?

[lulusmom]

Joan, I think the mystery of the continued drinking and peeing is solved. It is most likely the over-supplementation of thyroid meds that flipped Gable from "hypo" to "hyper"thyroid. I think the plan is a sound one. I just went through something similar with my cushdog. An internal medicine specialist finally got his thyroxine dose figured out and he is stable. His triglycerides were 3500+ and are now normal after putting him on very low fat food. As I recall, Gable is a bit overweight and that can cause high lipids in the blood as can a recent meal. Was Gable fasted?

[Joan2517]

No, he wasn't fasted, Glynda, and he's not overweight anymore. He was down to 64 pounds a few weeks ago. He's a big guy. We didn't even know he had a waist!

Okay, so you think he was just over-medicated with the soloxine. I can live with that. That would be such a relief, Glynda. But that wouldn't account for the .3 and .4 results on the ACTH test, would it?

[Joan2517]

Thank you, Glynda~

[lulusmom]

Joan, over supplementation of thyroid hormone would not have a direct effect on lowering cortisol per se; however, hyperthyroidism can put a lot of stress on the body so Gabel may not have had much cortisol in reserve to respond to that stress. The good news is your vet seems to have it figured out. The triglycerides were most likely elevated due to a recent meal so all in all, things look pretty darn good.

[Joan2517]

Thank you, Glynda....I am very relieved.

[Joan2517]

I want to have Gable's cortisol tested over the weekend to get back on track with the Vetoryl. He's panting like anything and putting the weight back on. Should I do the ACTH test? Or just the pre-pill test? What do you think?

[labblab]

Joan, if it was me, I’d want to have a full ACTH performed prior to restarting the Vetoryl. I’d want to have the more complete picture of his baseline cortisol status — both resting cortisol and cortisol reserves — against which to compare any future readings.

Marianne

[Joan2517]

That was my feeling, too Marianne. I just wanted to check. Thanks!

[Joan2517]

Okay, well results are:

Pre: 2.4
Post: 2.6

I didn't do a full blood panel, don't have the money right now, so we'll test that in a couple of weeks. His weight is back up to 71.1.

[labblab]

Joan, in looking back, I see that the specialist had suggested restarting 10 mg. of Vetoryl back on February 8th. Has Gable been back on the Vetoryl since then? If so, you don’t want to increase the dose — high cortisol is definitely not his problem. I do wonder whether his thyroid meds got knocked back too much, though. Unfortunately, it may take some fining tuning to get the optimal thyroid dose worked out. I think retesting his basic blood chemistries including thyroid level as soon as you’re able will be important.

[Joan2517]

He's been on the 10mg once a day as they suggested. I have been giving him only 1 dose of the thyroid meds, instead of the 2 they suggested. It could be that he needs that extra pill. I'll check it next week after I get paid.

I'm happy with the cortisol levels.

[Harley PoMMom]

If his increased drinking and urinating has normalized than I would assume that it was because of the over medication of the thyroid supplementation. I also wouldn't want his cortisol levels to drop anymore either. How's his appetite?

[Joan2517]

He's still drinking a lot, but no accidents in the house. His appetite has increased, and he's getting heavy again. I'm wondering if I should give him the second soloxine that they recommended, or just wait until the weekend and have them check. I have only been giving him one a day instead of the two. I'm kind of afraid to give it now that the cortisol has stabilized. He could be hypothyroid again.

[labblab]

Hi Joan, sorry I missed seeing your reply earlier. Yes, since you dropped clear down from 3.5 thyroid pills daily to just one, I think it’s likely that Gable has now reverted back to being hypothyroid again. I guess if it was me, I’d add in the second pill as was suggested by the internist, see if that improves things, and hold off on retesting the chem panel for a little while in order to get a more accurate assessment of that level of thyroid supplementation.

[Joan2517]

Lol! That's just what I started today, Marianne. I'll wait and watch for the next couple of weeks, then retest the Thyroid levels. He's still drinking a lot, but slept until 6:30 this morning, left some kibble in the dishes for the rest of them for a change. His fur is still magnificent! Even my husband said it last night while he was petting him. All those hot spots we used to see on his belly will be hard to find now, there's so much fur!

I just love him.

[Joan2517]

Well it's been 6 days since I started giving him the second dose of soloxine. Yesterday morning he didn't really eat much. There was still food left in the dish when I got home from work, which is very unusual. He didn't eat anything for dinner...I put the soloxine in the wet food I give the girls. About a half hour later I noticed he didn't seem right. Kept stretching out his back legs almost like planking. He does that when he has a stomach ache. Didn't eat at all.

He started throwing up around 11:30 and continued to every couple of hours until about 4:45 this morning. He kept drinking and then by 4:30 it was almost all water coming out. I stayed home and have been watching him. He ate some this morning, hasn't thrown up anymore, and seems fine. I don't know if he ate something in the backyard that disagreed with him or what. I haven't been out in the back yet, but I don't think he has diarrhea or he certainly would've done it during the night.

No meds this morning. Still trying to decide if I should take him to the vet.

[Harley PoMMom]

Oh my, Joan, sorry to hear that Gable isn't feeling well. I wonder if it's pancreatitis? Hope he is feeling better soon.

[labblab]

Aww gosh, Joan, I’m sorry, too. Hopefully he’s staying settled down this afternoon. Often it’s just so hard to know what’s going on. Luna has thrown up a couple times this week and had some diarrhea, but basically seems fine again today. She is such a scrounger whenever she’s outside — rabbit poop in the yard, goose poop at the lake, heaven-only-knows what else ends up in her mouth :-(((. At least I don’t have Cushing’s or medication to worry about with her, but I still never know what has set her off, and I still always worry, regardless. Sometimes I feel like I just need to muzzle her whenever she’s outside, but of course I’m not going to do that and we just end up paying the price for whatever tidbit she may have found on the “buffet” that day...

[Joan2517]

Yea, he likes to eat the dried leaves, but if he's outside he'll drink from whatever is holding water too. And our fish ponds are filthy! Lena was the one who would eat anything, and roll in it. I can't tell you how many times she would come back from roaming all green from the goose poop. I loved her to pieces, but she could be really disgusting sometimes!

But I think it was probably the steak and sweet potatoes I let them have the other night. I did see the potatoes in the diarrhea I found when I went out before. My husband seasons the steaks and even though we cut off the tops and bottoms so they could just have the inside, you never know if the seasoning got through. Plus the potatoes had butter on them. Maybe too much for his stomach. He's been eating a little at a time today, and no vomiting. I'm glad I didn't make a run to the ER during the night, which is what I was afraid I might have to do.

No meds this morning and I won't give him the soloxine tonight, and maybe nothing tomorrow until I'm sure he's over it.

[Joan2517]

Okay, I am officially in panic mode right now. We did the ACTH and Thyroid test on Saturday.

Results on Thyroid: 2.3 ref range 2.5 - 6.0
I started giving him the two pills instead of one a couple of weeks ago, so that could explain the LOW

But the ACTH test:

Sample 1 is 0.5 (LOW) ref range 1.0 - 5.0
Sample 2 is 3.5 (LOW) ref range 8.0 - 17.0

Feb. 6 was:
Sample 1 was 4.2 ref range 1.0-5.0
Sample 2 was 4.6 (LOW) ref range 8.0 - 17.0

How could this be? He's only on 10mg per day. He's drinking and panting like he was before we started.

Could that very small range in Thyroid level be doing this?

My vet has left a message for a specialist at the ER where Lena died. :(

[labblab]

Okay, well results are:

Pre: 2.4
Post: 2.6

I didn't do a full blood panel, don't have the money right now, so we'll test that in a couple of weeks. His weight is back up to 71.1.
Hey Joan, we do have some question marks here, but I’m gonna try to talk you down from panic mode. I’ve included above Gable’s interim ACTH results from March. They were subsequent to restarting the 10 mg. of Vetoryl, and already reflected a decline from those earlier February numbers. Today’s new numbers come about three weeks later still, and at 3.5, his post-ACTH is actually a little higher than it was back in March. It’s right within the desired therapeutic target range. Today’s resting cortisol is indeed low at 0.5, and I genuinely don’t know how much significance to attach to that. I’ll be interested to hear what the specialist recommends. But with a post-ACTH of 3.5, I don’t think Gable is dangerously Addisonian.

His thyroid reading is still low. So it looks as though too big a decrease may have been made in his thyroid meds, going down from 3.5 pills daily to first only 1, and now 2. I don’t know whether two weeks on the new dose has actually been long enough to accurately judge the result. Again, I’ll be interested in what the specialist has to say. It looks as though some more dosing adjustments may be necessary on both fronts, but I don’t think you’re in a crisis situation. I think you can go ahead and breathe...

[Joan2517]

Oh, March...I forgot to get them to send me that one...I thought I remembered something different. Okay, so maybe it's not as bad as I thought. But every time I hear him panting and drinking, drinking, drinking it hurts me. I'll wait to hear back from the vet. My vet said the same thing about the post reading. Thanks, Marianne.

[Harley PoMMom]

I agree with Marianne, Gable's post is considered a good response. I wonder if his panting is due to his weight gain? You're doing a wonderful job, Joan!!

(((Hugs)))

[Joan2517]

Dr. Plunkett talked to the Internal Medicine specialist, Dr. Sue Kimmel. She said to stop the Vetoryl and she wants to see him. The earliest appointment available is May 9, but they will call me if she has a cancellation. Plunkett is supposed to send her all his test results. They are located at the Emergency Clinic where Lee died...I hate going there.

[labblab]

Given that low baseline cortisol reading, I really can’t argue with another vacation from the Vetoryl. How about the thyroid medication — are you leaving that at the same level until you see Dr. Kimmel?

I’m really sorry that things have gotten so confusing, Joan. I can imagine how upsetting it is to see Gable continuing to be bothered by these symptoms when the answers are not obvious. I also totally understand your feelings about returning to the specialty clinic. It has to bring back a lot of painful memories :-(((. But it sounds as though it’s time to let a specialist directly eyeball Gable in order to get a better handle on things. So I’ll be hoping maybe the visit can be moved up so you don’t have to stay in limbo for so long.

Hang in there, girl. I know it’s hard, so you’ve got us walking right there alongside you...

[molly muffin]

Hi Joan Oh man I'm really sorry that Gable is going through all these problems.

I always think it is so much trickier when trying to deal with two issues like with Gables thyroid and cushings. You really are doing a great job you know.
Hugs

[Joan2517]

Thank you, Sharlene...

I am hoping that we just started him back on the Vetoryl too soon after the over suppression of Thyroid meds. He'll be off for a month now, so maybe things will settle down. He was doing so well and looking so awesome, I just can't believe how he just crashed. So far his fur still looks amazing, but he's drinking so much and panting so much that I just want to scream.

But I am so happy to see you!

[molly muffin]

what dose of vertroyl is he on? I thought it was a pretty low one but maybe it needs to be an even lower dose with the thyroid meds in his system too

[Joan2517]

10mg a day, but he was still so symptomatic. He was doing so well on 40, then BOOM! I noticed an increase in drinking and then saw something that Glynda put on about the pre pill testing that I was doing with Gable, not noting the reserved cortisol, just the resting. So I had them do an ACTH test and it was way low. We stopped the Vetoryl for a few weeks, tested again and it was rising, so put him on the 10mg a day. They said to give him one thyroid pill in the morning and one at night, but I was so freaked out about it that I only gave him one a day.

I have noticed that the lump in his neck, that Plunkett took a sample of last year, I think and said was just a cyst, is now about the size of a tangerine. I don't know if that has to do with anything, but I agree with Marianne that it's time to see a specialist. It's weird...it's the same one I had made an appointment to see the day that Lena died. I just wish we didn't have to wait so long.

I'm back to watching, waiting, not sleeping at night because I'm listening to see if he has to go out. I was so happy that he was doing so good. We all noticed around Xmas how good he looked and seemed. he had a waist, had lost about 10 pounds and was playing again. He doesn't have anymore bare patches, his fur came back so beautiful, and his tail is like a fan. We never noticed it before...and he's got so much fur that we can't see the skin on his belly! He's not shedding either.

I just don't get it, Sharlene...I really thought it would be a different outcome this time. I hate to leave him and commute to the city and I know he feels better when I'm home.

I miss Lena every single day and I don't want to lose him, too. it will be a year in May since he started on the Vetoryl. I was resistant to treat, but Marianne was right that his case was different than Lena's, and I do believe that putting him on meds was the right thing to do.

But now I'm afraid again...

[Squirt's Mom]

Hi Joan,

I wanted to help you not be so concerned about the ACTH test results. You say they were "way low" but that is not true. The ranges these labs use when performing the ACTH do NOT take into consideration whether the dog is on treatment or not. SO their ranges are always for untreated cush pups/dogs who do not have Cushing's or Addisons. So these results -


Sample 1 is 0.5 (LOW) ref range 1.0 - 5.0
Sample 2 is 3.5 (LOW) ref range 8.0 - 17.0[quote]

are not bad OTHER than the pre - which is too low. The post of 3.5 ug/dl is PERFECT for a dog on Trilostane. Remember, the normal range for a pup on Vetoryl (Trilostane) is 1.45- 9.1 ug/dl....that 9.1 is ONLY if all signs are good however. IF the dog is still showing signs at 9.1 then the dose needs to be increased a little bit to get it down to around 5.4ug/dl. Not all dogs respond the same therefore Dechra has provided a little leeway with that post. But Gable's POST is perfect...the PRE is not so I also agree with stopping the med for a bit. Here is a quote from Dechra about the ACTH results -

[quote]A positive response to the administration of VETORYL Capsules will manifest as an improvement in clinical signs and post-ACTH serum cortisol concentration between 1.45 - 9.1 μg/dL (4-6 hours after dosing with food).

https://www.dechra-us.com/therapy-areas/companion-animal/endocrinology/canine-hyperadrenocorticism/monitoring-cushings

Hang in there!
Hugs,
Leslie

[Joan2517]

Thanks, Leslie...Marianne said the same thing, but his return of symptoms is making me nuts!

[Harley PoMMom]

Joan, does it seem that his thirst/urination increase towards the evening? If so, an option could be to split the 10 mg Vetoryl dose into 5 mg twice a day to get an even control of that cortisol.

[Joan2517]

He's off the Vetoryl until he sees the specialist, Lori...May 9.

[molly muffin]

I always think it is harder when you are trying to treat two things at the same time, as you are with Gable. Now as the others mentioned the actual results weren't terrible it is the drop between the few months that is more of concern. As you of course don't want him to go lower, but my suspicion would be an interaction of what his thyroid is doing and what his adrenal glands are doing. Obviously he is producing cortisol, as his post was 3.5 and that wasn't bad at all, and only a drop of about 1.0 from what 4. something to 3.5 Some vets disregard the pre, but in this case, it makes sense to see the specialist and there might need to be an adjustment between the two medications.
It doesn't really sound like a cortisol cushing issue with the throwing up (due to the test results not supporting a cortisol crash) but something else, and that something else, eating or drinking something might have caused him to feel sick and not want to eat and throw up. Just a thought of course.

How is he doing now? physically? eating? drinking? sick at all?

[Joan2517]

He's not throwing up at all, no diarrhea, and except for the drinking and panting, seems fine. Of course he's peeing more because of the drinking, but no accidents in the house. He's not shedding anymore and his fur came back in beautifully and has stayed that way. He's put on about 10 pounds since we took him off the Vetoryl at the first drop, put him back on 10mg once a day for a few weeks, and now taken him off it again.

I am wondering if that lump in his neck has anything to do with all of this, since it seems to have gotten bigger. I'll let Dr. Kimmel advise. Dr. Plunkett seems relieved to have handed him over to her. I doubt he wants to deal with me and another crisis. I was throwing questions at him at top speed when he called last week with these latest results and he couldn't wait to get off the phone...

May 9 seems such a long way off!

[molly muffin]

Well May 9th is getting closer and closer :)
Interesting question about the neck lump. Anything can affect cortisol production and therefore treatment, well, almost, but I'd definitely have the vet take a look at that lump and see whats what with it.

[Katy1]

Hi Joan,

Well, tomorrow is the big day. I will be thinking about you and Gable tomorrow and sending lots of positive thoughts your way! I know it's not a happy place for you to physically be but necessary for Gable and his care. If they have mints or candy in a big jar on the counter, just grab an extra handful and stuff them in your pocket or purse. I have no sinister thought behind that comment....it just might make you feel better. I found that it works for me. Blessings to you and your pups. Karen

[labblab]

Good luck today to you and Gable!

[Joan2517]

1:30 is taking forever! My poor boy is starving, but they don't want him to eat anything. I'll get him a cheeseburger on the way home. For me too, I haven't eaten either...

[Joan2517]

Well, two hours and $520 later...

a brief ultrasound, right adrenal enlarged, 0.87 cm and left one enlarged, 0.9 cm. Mottled spleen, no idea what that means.
Blood pressure: 160's
Urine culture - pending

Her notes: "based on the recent tests, we know that 30mg AM and 10mg PM is too much, and although 10mg ONCE daily may be a reasonable dose (despite a lower than ideal PRE sample, the post sample was ideal), but may not be adequate with regard to the duration of its effect. In such cases, resuming TWICE daily dosing is recommended. Because of the low pre sample, we will lower the dose. Although it is admittedly an extremely low dose, given the findings with Gable in the past, I would prefer to start low and work up rather than risk making him "addisonian" again."

So, we are doing 5mg twice daily. She said that Dr. Plunkett had not been speaking with her because she never would have taken him off of the Vetoryl completely. She was very thorough and very nice. Went over everything they had sent her, although a lot was hard to decipher because they still use index cards, instead of keeping the notes computerized...that drives me crazy. Some things I could not remember or communicate accurately, but while he was getting his ultrasound, I went into this forum on my phone and found a lot of the answers I couldn't answer off-hand.

All in all, I am okay with her recommendations. We'll do an ACTH test in 10 - 14 days to see where he is at. They are more expensive, so I'll let my regular vet do the testing as they use the same lab anyway.

I will begin the meds tomorrow morning. He had a rough day, although he was an angel! We stopped at our regular vet to pick up the meds, and I weighed him there. He's back up to 75lbs. When we went to get in the car, he stopped and wouldn't get in. He had to pee! Once home he drank about 4 quarts of water, didn't want to eat even though he hadn't eaten all day. I figured he was going to barf up the water and/or the food, so he didn't need the pill tonight.

So now we start all over, it's almost a year to date. Hopefully, the urine will come back fine and we can get this under control again.

After he went for his ultrasound, I wound up crying in the waiting room, all of it hitting me once again; being back there and remembering. When we went out to the parking lot, I remembered having them bring Lena's quilt out to me because I was afraid I would never see it again. Little did I know that I would never see her alive again. She died just a few hours later...I should have stayed.

[Harley PoMMom]

You both are in my thoughts and prayers today. How were those cheeseburgers?!!!

[Joan2517]

We didn't get them, I was afraid he might throw up. He had some Peanut butter and Jelly sandwich with me when we got home.

[Harley PoMMom]

I love PB&J sandwiches, just had one of those the other day! How are you both doing?

[labblab]

Oh Joan, what a painful day for you, all the way around. I’m so sorry. I know how much you wish you’d stayed with Lena, and my heart goes out to you as you relive that final night. You had no way of knowing how that night was going to turn out, but I surely understand your regret and sorrow. Life can provide such blessings, but also such sorrow.

But turning to Gable, I feel optimistic. Clearly the internist thinks you’re still on the right track with the trilostane treatment even though finding the optimal dosing protocol remains the challenge. But I have faith you’ll get there! I hope both you and your sweet boy can get a decent night’s sleep, and tomorrow morning will dawn a bit brighter now that you’ll be restarting his medication. Good luck, and we’ve got your back!

Hugs, hugs and more hugs!

[Joan2517]

Hugs back to you, Marianne. I feel better, we are both just tired. He is such a good boy.

[labblab]

How’s Gable (and you) doing today, Joan? Hope you guys had a peaceful night and that the trilo capsule went down the hatch this morning with no problem...

[Joan2517]

He got up a couple of times to drink, but went back to bed until around 5am. I never have a problem with giving him the pill. I give it with a forkful of wet dog food and he swallows it whole!

Thanks, Marianne, we're fine~

[Katy1]

Oh Joan,
I’ve been thinking about your whole pack for three days, and my personal past two days have been so crazy I didn’t even get online until late today. I’m glad you are feeling better about Gable’s status, but I have a question and I only ask because I care. What did the specialist tell you, if anything, about the lump in Gable’s neck? Was It you that told me about the “twitchers”? I’vE had my share lately. Anyway Wednesday night, I wanted to send you my recliner so you could put it by the couch, load everybody on your couch and still have precious Gable by your side. I’m still looking for my magic wand.

I was relieved to hear that your big boy had a good restart on his meds. I hope you have a wonderful Mother’s Day weekend and Blessings to you and all your pups.

PS, I know your little Lea is barking down to you, “I love you more Mom!” and thanks for taking such good care of everyone—you’re the best mom ever and I miss you too.

[Joan2517]

Gabe's urine culture:

Diagnostic report
12-May-2019 Urine MIC M130 Susan Kimmel, DVM
12:29 Source: Antech | Order item: Urine MIC M130 [199.739]
Sample collected: 12:36 12-May-2019 | Submitted: 09-May-2019 | Reported: 12-May-2019
Lab reference: NYAE72854215
Test Results Ref. range Unit
Culture, Urine
SOURCE Urine
- (Cystocentesis)
Preliminary #1 05/11/2019
No growth after 24 hours.
Final Report 05/12/2019
No growth present after 48 hours.

[Joan2517]

She felt the lump and measured it. I told her that my regular vet had syringed some fluid and said it was just a fatty cyst. That was that!

I could use that recliner right now! I'm working from home today and sitting at my grandson's desk and little chair. My rear-end keeps falling asleep! I can look out the window at the garden, it's pouring! Otherwise I would be sitting in the gazebo working there.

So far, so good on the meds...5mgs is really a small dose. He's still panting, but I don't think he's drinking as much. I'll have an ACTH test done over the weekend and see where the numbers are.

[labblab]

Hey Joan, all my dogs have had those fatty lipomas -- some of them have ended up being REALLY large. Depending on location, sometimes they can actually interfere with gait or other movement and need to be taken off. But if not, my understanding is that they pose no risk. So that's a relief!

So glad that at least you're seeing a little improvement with the drinking. Just to clarify, Gable's getting 5 mg. twice a day, right? He'd been getting 10 mg. once daily previously, and we're hoping that by splitting it up, we're thinking he'll get longer-acting benefit but without dropping his cortisol any lower..?

[Joan2517]

Yes, that's the plan. He was getting the 10mg in the morning, but then we stopped for a month until the specialist saw him. We'll see...

[Joan2517]

ACTH results from yesterday:

1.9 reference range 1.0 - 6.0
5.7 reference range 8.0 - 17.0
Thyroid: 2.5 reference range 2.5 - 2.6

[labblab]

ACTH results from yesterday:

1.9 reference range 1.0 - 6.0
5.7 reference range 8.0 - 17.0
Thyroid: 2.5 reference range 2.5 - 2.6

All in all, not bad ;-). Gable’s resting cortisol is now back up above 1.5, and his post-ACTH is only a sliver higher than the ideal therapeutic range, and is well within the acceptable range for a trilo dog as long as symptoms are being well-controlled. Remember, that post-ACTH range you’ve listed is not applicable to a dog taking trilostane.

His cortisol levels now are a bit higher than back when he was taking the 10 mg. once daily. But he’s also only been back to taking the trilostane for about ten days now, so his levels may still drop a little more over time.

Re: his thyroid, I see his last reading at the start of April was 2.3 with a normal range of 2.5 - 6.0. This time, he tested at 2.5, so he’s still right at the low end of the normal range. Did the specialist comment on his thyroid level during your appointment? Have you been staying at the same dose since April?

Most importantly of all, how’s Gable been doing, symptom-wise?

Marianne

[Joan2517]

He's panting and still drinking like crazy, but I'm not going to raise it just yet. I'll give it the full 30 days, I think. He's still on the same dose of soloxine. They will be sending her these results, so i'll wait to hear from her.

Thanks, Marianne~

[Harley PoMMom]

Those numbers look good to me too. Joan, is he urinating more too? Just wondering if the output equals the input of water?

[labblab]

One quick question from me, too. I can’t remember (and am too lazy to look back through your thread...), but has diabetes insipidus ever been considered as a possibility with him? With the never-ceasing thirst/urination, a trial run with the medication might be worth considering (unless, of course, you’ve already done that!).

[Joan2517]

Specialist never said anything about that . wouldn't that show in blood work?

[labblab]

DI would not show up in blood work. The chief lab abnormality is extremely dilute urine. There are more scholarly links elsewhere, I’m sure, but I quickly found this pretty decent explanation (if you just ignore the accompanying ads!):

https://wagwalking.com/condition/diabetes-insipidus

As you’ll see, pituitary tumors can cause this condition. So even though DI is uncommon among dogs, in general, we do see it here periodically among Cushpups. The classic diagnostic procedure is a water deprivation test, but that’s somewhat dangerous. So more often, vets will just give a trial administration of the eyedrops for a few days. If they work, then the diagnosis is kinda confirmed through that backdoor manner. I think Lori may be thinking about the possibility of DI, too, with her question. It definitely might be worth discussing with the specialist.

Marianne

[Joan2517]

Well Gable's test results are :

Sample 1: 2.0 Ref range: 1.0 - 5.0
Sample 2: 5.7 (LOW) Ref range: 8.0 - 17.0

Maybe he's just a big drinker and a heavy panter...I don't know. It has been hot and humid. No accidents in the house, but he stills pees like a racehorse when he goes out. His fur still looks good, a little dry maybe, but no bald patches and he still plays with his toys and with Cooper.

Vet is going to talk to someone else about him and get back to me...he just seems so uncomfortable. He hasn't gained much more weight, he's at 76.3 or 74.3, the scale kept changing. He'll still beg for food, but is not finishing off the two bowls I put down for all of them anymore. In fact, I come home from work and there's still some left in one bowl. He eats a half a bowl while I get his pills ready, gets a forkful of the Caesar wet food with the pills that I give the girls, gets to lick the container clean and then finishes off the rest of his dry food. So he's getting the pills with a full meal.

Keeping him on the 5mg, twice daily for now....

[Harley PoMMom]

Those numbers are pretty good. You could try the eye drops for DI as Marianne suggested. Unfortunately some cushdog's increased drinking/urinating never return to normal even with treatment.

Hugs, Lori

[Joan2517]

My husband reminded me that we did the eye drops last year and it was negative. He was doing so much better up to December, Lori. Glynda thought that the over stimulation of the thyroid meds is what made him crash in January, but that has been resolved. I feel so bad for him, he's got that frantic look on his face, that he had before the meds kicked in over last summer.

Let's see what the vet gets from the other guy he's going to consult with...

Thanks, Lori!

[Joan2517]

My vet spoke with a specialist who suggested increasing Gable to 10mg in the morning and 5mg at night. Then doing the pre-pill test in 3 weeks. I don't think I will wait for 3 weeks. I'll test him at 2.

What do you think?

[Harley PoMMom]

Raising the dose to 10 mg in the morning and 5 mg at night is definitely worth trying, and testing in two weeks, I believe, is the way to go.

[Joan2517]

Thanks, Lori!

[labblab]

I, too, agree that the dosing change is definitely worth a try. Certainly you can’t go wrong by testing in two weeks. If he seems to be doing well at that point, though, you could decide then whether you wanted to go ahead and wait for one more week.

Either way, good luck to you guys!

[Joan2517]

Thanks, Marianne! Are you back?

[labblab]

Not yet, but still trying to check in as often as I can ;-).

[Harley PoMMom]

How's Gable doing? And was a pre-pill test done?

[Joan2517]

Still drinking and panting. He's eating fine and no stomach problems....We did the test Saturday morning and have not heard back yet.

[Harley PoMMom]

Finger crossed for good test results!

[Joan2517]

Test results:

4.2 ref range 1.0 - 5.0

Maybe he's just a big drinker. I looked back at the first post I did here when he was 7 and it looks like I had been worried about the way he breathes for a while, so I don't know.

It was the other vet who left the message, my vet had already left. He'll probably call me today.

[Harley PoMMom]

The only other thing I can think of to try is getting Trilostane compounded into 1 mg capsules and than adding 1 mg to his nightly dose to see if this helps with the drinking/panting. The big drawback to this option is the cost of the constant monitoring for the additional 1 mg capsule.

Hugs to you both, Lori

[Joan2517]

Thanks, Lori...I'll think about that.

[Joan2517]

The vet called after he spoke again with the specialist and the suggestion was to add an additional 5mg at night, so that he would be on 10mg in the am and then 10 at night. At first I thought we should wait until we get back from our trip to Williamsburg (9/26 - 9/30), but then decided we would start it the other day and I'll have him tested before we leave. So far, so good. No change that I can see, but I did get him a cooling vest, which he loves!, and does seem more comfortable. He actually lets me put it on without any fuss and then lays down and enjoys it.

So we shall see around the 19th or 20th whether the extra 5mg is doing anything.

[labblab]

Hi Joan, that’s great about the cooling vest, and we’ll all be hoping the increase will help some, too. Per the guidelines associated with pre-pill testing, an increase is indeed consistent with Gable’s resting cortisol level in the face of unresolved symptoms. I know it’s been quite a roller-coaster with him and his cortisol levels, though. Hopefully this dose will finally turn out to be just right! We’ll be watching for further updates, that’s for sure.

Marianne

[Joan2517]

Yes Marianne, I remembered you had said that before, so I figured we would go for it.

My son Jeremy is watching them all while we are away and I know he will be keeping a close eye on him. He's already been told he has to pick up the poop in the backyard every day so he can be sure Gable doesn't get diarrhea (I really just said that so he wouldn't leave me five days of poop to clean up when I got home!)

[Joan2517]

Well, I came home to a mess Wednesday after work...poop in the kitchen and vomit in the back room by the door. Wasn't sure who did the pooping, but Gable always throws up at the back door. He didn't want dinner, so no pills for him. But I decided that since I had raised him to the extra 5mg a week ago last Monday or Tuesday, bringing him to 10am and 10pm, I would run to the vet and have them do a resting cortisol test. He called me last night to let me know it was 1.5. So now I don't know if Gable did the pooping or Cooper. Gable would throw up, thinking I would hit the ceiling with the mess in the kitchen, and he would be too upset to eat.

Vet recommended we stay on the 10 and 10. What are your thoughts? He's still drinking like crazy and he did eat breakfast and a lot for dinner yesterday, some breakfast this morning.

[labblab]

Well darn :-((((. Honestly, Joan, if it was me, I’d probably discontinue the added 5 mg. again, at least until after you’re back from your trip. Gable has shown himself to be quite sensitive to increases in the past, and the drop in two weeks from 4.2 to 1.5 is pretty dramatic. Plus, 1.5 is the “basement” — you don’t want him going any lower at all. I just wouldn’t want to risk a crash in your absence, so I think your original instinct was the best one — just leave him at his original dosing level for the time being, and then reconsider the path forward when you’re home again.

[Joan2517]

That's exactly what I thought, Marianne. When I said that it was a huge jump and that it would continue to go down, I think he got offended and said we should still do it!

No way....I gave him 10 this morning and 5 with dinner tonight. I'm not taking any chances and I don't want Jeremy to have to deal with an emergency when we are away.

Came home tonight to no messes and two full water bowls...I am losing confidence in my vet. If it wasn't for you all, and how much I've learned since Lena died, I would've done what he said. It makes me wonder how many have been misinformed by them...and that makes me very mad.

[Joan2517]

Marianne, remind me how the pre pill testing goes with twice daily dosing. I think you just do it before the morning pill, and not skip the pill the night before? That would not have made a difference from the test results the other day since I thought it was an emergency and he had his morning pill, but I can't remember how I did the one before where it was 4.2. I know I waited until after to give him the morning pill and I think I gave it to him the night before, but now am wondering...

[labblab]

Joan, my understanding is that for a dog dosed twice daily, you’d give the evening dose as usual prior to a morning pre-pill test. So if you didn’t give the evening dose prior to the 4.2 reading, that could account for the higher result. Also, now that I’m rereading what you had written about the resting cortisol taken this week, it sounds as though it was taken during the afternoon after having been given his morning dose. How close it would have been to his normally scheduled evening dose would determine how accurately it would have reflected a pre-pill reading. For instance, if it was only 4-6 hours after his morning dose as opposed to eleven hours, you’d expect it to be a lower cortisol reading because the medication was still most active in his system. If it was closer to eleven hours, it would more accurately reflect his pre-pill status. Hope that makes sense!

[Joan2517]

It does. I think I gave him his evening pill before the test that gave the 4.2 reading. And the last test was probably close to 12 hours after his morning dose.

[Joan2517]

Thank you, Marianne!

[Harley PoMMom]

Gosh Joan, I am so sorry to hear that Gable had some issues and am relieved to read that the extra 5 mg dose is discontinued. Unfortunately, even with treatment, PU/PD doesn't resolve in some cushdogs and just maybe this is the case with Gable.

Like I mentioned before, the only thing I can think of trying is getting the Trilostane compounded into 1 mg capsules and than adding only 1 mg at a time.

Sending huge loving hugs, Lori

[Joan2517]

I may have to do that yet, Lori...but for now I just can't afford all that testing. He seems okay. He's eating, no more poop or vomiting in the house. He loves his cooling jacket and I think he will be okay while we are away. Jeremy is very capable of handling a crisis should one arise. I've gone over and over all the signs to watch for and I will write it all out for him. He'll have my CareCredit card for an ER visit if needed and the vet can wait until we get back if he has to take one of them there. I got a pill case that has AM and PM sections and have already loaded it up for him, so there should be no problem there, not that there would've been anyway. Jeremy is HIV+ and is used to a pill regimen. Doree just need liquid antibiotic for her cold, that might be hard since she only lets Victor give her anything, but I told him to just mix it up in her food if she won't take it from him.

Sibbie is the one I'm most worried about. I've never been gone overnight since we got her and she is not happy when I am gone. When we go out, she freaks out even if I have someone hold her while I go to the bathroom. She just lays by the front door waiting for me. I'm not sure how she will react to me being gone for 5 days. Jeremy says he will not be responsible if she goes into a deep depression! :).

I'm going to buy her some new toys and he can give her one a day when he thinks she can use a distraction and maybe she'll be so tired she will sleep all night. I am taking off the day after we get back to make it up to her, hopefully she will forgive me!

[Harley PoMMom]

The new toy idea is a great one, I bet she'll love that! Tell Jeremy he can always log on here and we'll help in any way we can! I hope this is a vacation full of fun for you as you really deserve it!

[Joan2517]

Thank you, Lori!

[Joan2517]

Well, let's just say that this was the vacation that barely happened!

I started getting texts from Jeremy about how much Gable was drinking; then about how Sibbie was sitting at the front door waiting and not coming to bed; then how they were all going out every couple of hours all night long; then how Jeremy couldn't get comfortable because of his back; and how he had only gotten one hour of sleep in two days.

I had him stop the Vetoryl on Friday night (we had left Thursday). Told him to take him to the vet Saturday if there was any vomiting or diarrhea (which there wasn't), then we decided Saturday morning that it just wasn't worth all this anxiety and stress and spent the morning trying to figure out how to leave early. We couldn't change our plane tickets for anything under $700 each (the original ones were $200 each), so we decided to keep the rental and drive home on Sunday morning. Left at 5:45am and were home by 2:30pm.

They were all fine...

[labblab]

Aww Joan, I’m so sorry!!!! I don’t have any two-legged kids myself, but it sounds like sometimes the four-legged kids have more sense than the human ones.... :-(((((

[Harley PoMMom]

Aww, Joan, I am so sorry too :( Please do vent here all you want, we sure do understand...sending loving and comforting hugs ♥

[Joan2517]

Thanks, girls! I'm almost over it :) I was just looking forward to sleeping all night for the first time in years!

[Squirt's Mom]

uhhmmmm I think I would remember this when it came his time to have some fun. But I am old b____. :D I am truly sorry this happened - it wasn't fair at all.

[Joan2517]

You are so right, Leslie! And I am an old b____, too! But he doesn't need me to do anything for him. He lives alone and can get up and go wherever he wants, whenever he wants. Someday I will let him know how disappointed I am about this, but it's too soon and it won't really matter.

My babies are all well and happy that I'm home and I guess that's not a bad thing after all! Gable seems good. I think I'll have him tested again next week. He's been on the 10mg in the morning and 5mg at night for almost two weeks and I am curious to see where his levels at.

[Joan2517]

Okay, we have had another episode. Gable was up all night Monday, going out like every hour, drinking like crazy all weekend. I shouldn't have given him his pill yesterday morning, but I was so sleep deprived that I wasn't thinking, and I should have stayed home.

I came home from work to a kitchen floor covered in poop, vomit and pee. Cleaned it up in a hurry and ran to the vet before they closed. I had them do a resting cortisol test and blood work. The results won't be back until this afternoon, but I'm pretty sure he's gone too low again. I didn't give him anything last night, including dinner.

He slept all night, didn't get up until 6am this morning...that doesn't happen very often. He usually has to go out at least once during the night. He's had breakfast, no meds and seems fine. I'll wait to see what the numbers are and decide what the plan will be. I just might have to give him 5mg am and 5mg pm. It seems the 10mg am and 5mg pm just might be too much for him.

[Harley PoMMom]

Oh Joan, I'm so sorry to hear this, poor Gable and poor you...sending hugs

[Joan2517]

Help! I don't know what to do. His stomach issue is better, but he is drinking like crazy. He peed in the house and then stepped in it and walked all over the house. With that resting cortisol number, should I start the vetoryl again?

He was on 10 am and 5 pm

[labblab]

Hey Joan, what was the resting cortisol result? Also, how many hours after dosing would the blood sample have been drawn?

[Joan2517]

It was 2.8 and he had his 10mg pill in the morning, probably around 5:30 or 6:00, Marianne, and we did the test around 6:00 or 6:30. I had to clean up the mess before I took him.

I am shaking, I'm so upset. He's walking around behind me with his head down. I keep telling him I'm not mad at him, but I don't know what to do. I gave him 5mg with dinner tonight just in case he needs it.

[labblab]

Oh Joan, I feel so bad for you guys!! Yeah, I think I’d try the 5 mg. twice daily for a while again, too. I just hate it that you’re on such a rollercoaster. Poor Gabie, and poor you! Fingers crossed that things go OK overnight, and tomorrow, too.

[Joan2517]

It's killing me, Marianne. I'm getting all kinds of flashbacks to Lena.

He's such a good boy, he doesn't deserve this. He keeps looking at me like he's wondering why I can't make him feel better. If I could quit my job and stay home to take care of him I would. He starts getting anxious in the morning when I'm getting ready for work; he lays down on the bathroom floor while I'm showering and dressing, and then stands at the door while I'm leaving.

AND, AND my husband just got home and told me that he thought he left him out this morning when he left for work and sent Jess over to check around 2 or 3...2 or 3!!! when he left around 10!! and told her not to make any noise coming through the greenhouse. I'm sure Gable heard her and then got up thinking he was going out. That's what happened...I could kill him right now! I spent an hour cleaning up all the pee after I had taken two trains home from the city.

I didn't get my vacation, I can't depend on anyone and I'm working in the f@#&ing city and can't get home to the ones who love me the most!

I'm venting again... :)

[labblab]

You have every right and reason to vent, and that’s exactly what we’re here for!

As annoying as it is, at least maybe you have an explanation for yesterday’s episode. Although with that much pee, your central issue remains as to why Gable is still drinking/peeing so excessively. And for that, I just don’t have an answer. It’s so darn confusing. Maybe the GI upset wasn’t related to the Vetoryl at all, and he’d really do better staying on the higher dose. But maybe it was, and for that reason you want to stay on the lower dose. I just dunno, and I surely understand why you want to throw your hands in the air at this point. All we can do is take one day at a time, and for now, I agree with you about going with the 5 mg. twice daily again for the time being.

I can so resonate with your flashbacks of worry, though, and I so wish I could reach out to give you a big hug. Our dear Leslie often refers to “twitching” — the second sense we caregivers have that remains on high alert for signs that things are going wrong. And the more traumatic an earlier loss, the harder it is to escape the worry. I haven’t shed the worrying myself, so I’m afraid I can’t give you any advice in that regard :-((. But I surely do understand, and I’m right here alongside you. At least this is Friday, so you’ll have a couple of days at home to spend with the whole crew, and especially to monitor Gable. My fingers surely remain crossed that things will settle down for you guys!

[Joan2517]

Thanks, Marianne...I'll keep giving him the 5mg twice a day and see it helps. If not, I'll go back to the 10am and 5pm. I think I have wiggle room with that 2.8 resting cortisol result.

He needed to go out at 2am, but then stayed asleep until we got up at 5:45.

[Joan2517]

Gable had a PVT done on Friday and it came back at 1.6

I had them do blood work too. Here are the HIGHS:

ALK 311 ref range: 5-131
PSL 262 ref range: 24-140
Platelet count 635 ref range: 170 -400

What do you think? He's still drinking a lot, panting a lot, but no accidents, still eating and pooping fine. I think he's laying down a lot more, though, but will still get up and roughhouse with Cooper.

[Harley PoMMom]

It always concerns me when a dog's pre cortisol level is less than 2.0 ug/dl so I'm a bit worried that Gable's is 1.6 ug/dl. I'd recommend getting a full ACTH stim test done just to make sure that his post value is good. It's good to hear that his eating and pooping are fine!

Hugs, Lori

[labblab]

Yeah, I wish Gable’s pre-pill level was a bit higher, too. Per Dechra’s pre-pill monitoring guidelines, you can dip down to 1.45. But given Gable’s history of the surprising crash, I think I’d rather he’d be running a higher pre-pill level, too. Remind us as to his current dosing? As Lori says, a full ACTH would be optimal. But in lieu of that, since he’s basically doing OK, one option might be to just cut back on his dose a little bit again. Golly, what a rollercoaster you guys have been on. I know you don’t want his drinking/peeing to increase even more, but perhaps a small dosage decrease wouldn’t result in too bad a symptom rebound.

As far as the other lab results, that seems great that the ALK is no more highly elevated than it is. As you already know, platelets are also commonly elevated in Cushpups. As far as the PSL, I think that’s a pancreatic enzyme marker? Has that been elevated in the past for Gable? I really don’t know whether that amount of elevation is a concern. What does your vet say about that?

[Joan2517]

Vet said everything is perfect...you know I don't really trust that they know what they're doing. He's been chomping on the dried leaves outside, that could be irritating. I just don't know...

We're coming up on Lena's 4 year anniversary of her diagnosis next week and I'm getting paranoid. Sometimes when he looks at me I feel like he's trying to tell me something.

Gable is on 5mg am and 5mg pm

[labblab]

According to Dechra’s pre-pill chart, Gable is OK, but just by a hair. Their cut-off is actually 1.5 rather than 1.45 as I said earlier.

https://www.k9cushings.com/forum/attachment.php?attachmentid=8265&d=1521562345

So if it was me, I’d really feel more comfortable with it running a little bit higher. I know you’d never expect to hear me make an “alternative day” suggestion, but maybe try giving him the additional 5 mg. only every other night for a few days, to see what happens?? I dunno...just a thought.

I totally get it about feeling paranoid about things :-(. In a few months, Luna will have outlived Peg as well as Barkis. I’ve never had anybody make it to 12, so I’m watching her like a hawk now, fearing that a rotten shoe will drop...!

[Joan2517]

I'll try that and see.

Yep, I feel the same. Gable is going to be 11 this year. Doree, our teacup chihuahua is 15 or 16 with knees that pop in and out and a grade 3 heart murmur, she's already older than Lena was when she died. Andee, who we had when we got Lena and was with us when Gable came to us, died when she was 13, and other than allergies and arthritis, she had no health issues. I just know we're going to lose someone this coming year and I am dreading it.

[Joan2517]

We did an ACTH test on Saturday. His results are still kind of low. I have only been giving him 5mg in the morning, nothing at night.

Pre was 1.0 ref range 1.0 - 1.5
Post was 1.1 ref range 8.0 - 17.0

Vet wants to keep him at the 5mg and check in 3 - 4 weeks...he's still drinking a lot, panting a lot, but other than that, appetite is good and he's still playing with Cooper and toys. I don't know what else to do....

[labblab]

Dang, Joan, those numbers are definitely lower than we’d hoped. I’m afraid I’m out of ideas, too, for the moment. Thank goodness you didn’t take me up on my suggestion to increase his dose! Given those numbers, I agree that he should be checked again very soon. What a roller coaster for you two :-(.

[Joan2517]

I know, Marianne. I started to do what you said and then I thought "nah". I almost raised it because of how much he's drinking, but decided to wait. I think I'll wait another week or two, then maybe have it compounded down...I just don't know what to do to make him feel better. His neck is getting thicker and thicker, he looks like a hyena. He hates when I'm getting ready for work and just sticks to me like glue, then I get home and I know he's glad I'm here to take care of him.

It's coming up on Lee's anniversary, and I'm so afraid that he's going to go...I feel like I have to be home, and I can't be because of work...ugh!

[Harley PoMMom]

Gosh Joan, so sorry to read that Gable hasn't stabilized, one thought I have is that he may be hyperthyrodic again. What dose of thyroid medication is he getting and have his levels been checked recently?

Sending hugs, Lori

[Joan2517]

Maybe, the last time it was checked it was okay, but that was a while ago. I forgot to have them test it the last time he had the blood work done. I'll try to have it done tomorrow after work.

[Joan2517]

Well, I don't think this is what is going on, it's only slightly lower than it should be:

Post T-4: 2.3 Ref range: 2.5 - 2.6

[Joan2517]

I took him to the vet last Friday, His neck just seemed to be so much thicker, so I wanted them to check that lump. Did a needle aspiration that came back fine. Had them do a urinalysis, which came back fine. As long as I was spending money, we did more blood work. The only things in the blood work were ALK at 523, ref range was 5 - 131 and Triglycerides at 982, ref range 29 - 291. He had breakfast that morning before I decided to take him. The Precision PSL was 150, ref range 24 - 140. but he's eating fine and isn't showing any signs of stomachaches. Vet said he's overweight, he's at 74.7 right now, but he's been much bigger than this.

He's still drinking a lot, but I just bought him an orthopedic bed with a cooling feature and he loves it. He gets anxious when I'm getting ready for work, lays on the bathroom floor while I'm showering, very clingy. I think he just feels better when I'm home knowing that he doesn't have to hold in his pee. Some nights he goes about 4 - 5 hours without needing to go out, then others it could be every 2 - 3 hours. But he's still playing with Cooper and lately he's been bringing toys to me to play tug-of-war...so I don't know.

All in all good news for $565....

[labblab]

I agree, especially the part about playing with Cooper and you :-))))))

Thanks for the update, Joan, and give Gable a big pat for me, OK?

[Harley PoMMom]

Sending hugs to you both ♥

[Joan2517]

Thank you, girls! I'll just keep watching.

[Joan2517]

I had an ACTH test done last Thursday on Gable. The results are:

Sample 1: 2.0 ref range 1.0 - 5.0
Sample 2: 3.0 ref range 8.0 - 17.0 (LOW)

What do you think? Even though he still drinks a lot, I'm still working from home so not too worried about that. He's able to go from around 10 or 11 at night until 6 or 6:30 in the morning without needing to go out; still eating good; likes the fact that I'm home so he can stay outside all day if he wants; and is still rough-housing with Cooper.

He's laying down a lot more, not standing or even sitting for long periods. I noticed last week that he's limping slightly, not a full limp, but seems to be favoring his right side. I thought it was his nails so had them clip them when he was there for the test and they didn't notice the limp. He's still doing it and I can't really tell if it's his front or rear leg. I might even be wrong about which side it is. He never complains...When vet called with results this morning, I let him know and we're going to put him on an anti-inflammatory for a week and see if it helps. I think he said Rimadyl.

The vet's office will come out to the car and take him in, but I don't want them examining him without me there so I'm not going to pursue it just yet. He could've pulled something playing with Cooper, or trotting around the backyard.

[Harley PoMMom]

Those are pretty good numbers, although I wouldn't want that post number to go down any further. I'm sorry that Gable has a limp but Rimadyl isn't one drug that I'd recommend because of its potential to cause liver damage, Meloxicam, I believe, is a better option.

Hugs, Lori

[labblab]

Yep, I think those ACTH numbers are pretty darn good, too. I think they’re up a little bit from last time when we were worried about them trending down too low, so that’s reassuring. If they stay where they are, I think that’ll be great. I also agree with Lori that if Gable ends up needing a painkiller for a longer time period, I’d prefer one of the newer NSAIDS such as Meloxicam or Previcox. I think Rimadyl does provide effective, quick relief, and my vet still uses it for shorter-term acute situations such as right after surgery. One week of it would probably be OK. But for chronic pain issues, I think Rimadyl does suffer from a higher risk of serious side effects than some of the newer options. So if Gable needs to stay on something, I’d request a different med.

I’ll bet the best medicine of all will be having you home again, though ;-).

[Joan2517]

Great! Thanks, girls! Yes, he does love having me home.

[Joan2517]

Took Gable in yesterday for a PVT and blood chem.

3.0 on the cortisol test ref range 1.0 - 5.0

ALK: 616 ref range 29 - 291
Triglycerides: 959 ref range 29 - 291 (he hadn't eaten before we went)
Precision PSL: 273 ref range 24 - 140

He's got an ear infection in both ears, they cleaned them out and put some stuff in that lasts two weeks. He's on Apaquel for his allergies and except for the panting, he's doing good. It is so hot and muggy here that I won't let him stay out longer than to do what he needs to do.

What do you think?

[labblab]

...he's doing good.
You know Joan, at this stage with Gabie, I think that’s the most important part of your whole report. Was that a pre-pill cortisol reading? If so, then I especially think that’s just fine. And we know Cushpups have elevated ALK and triglycerides. If he was acting ill, I’d be more concerned about the Precision PSL. But all in all, if he’s generally good, then I believe I’d take that as a blessing and let him relax ;-). (And you, too!)

[Joan2517]

Thanks, Marianne! He's had some soft poop days, but I think it's because we're home all the time and he's getting a lot more table food that he probably shouldn't. The limping has stopped and he's laying around a lot more, but I think that's just the heat.

And yes, it was a pre-pill test.

[Harley PoMMom]

My concern is that the test was performed while he had ear infections which could raise his cortisol levels so that result of 3 could possibly be higher than what it actually is.

[Joan2517]

I didn't think of that, Lori....I guess if I can afford it, I'll do another test in a couple of weeks.

[Joan2517]

You know Joan, at this stage with Gabie, I think that’s the most important part of your whole report. Was that a pre-pill cortisol reading? If so, then I especially think that’s just fine. And we know Cushpups have elevated ALK and triglycerides. If he was acting ill, I’d be more concerned about the Precision PSL. But all in all, if he’s generally good, then I believe I’d take that as a blessing and let him relax ;-). (And you, too!)

Marianne, what might the Precision PSL indicate?

[labblab]

Joan, that’s a marker for pancreatitis. I believe Gable’s result is high enough that pancreatitis would definitely be suspected in a dog who exhibits consistent symptoms. But if Gable seems well, I don’t know how much stock to put in that test result.

[Joan2517]

He's pooping soft again. I'm wondering if that's what's doing it...

[labblab]

I suppose it’s possible, although if he otherwise seems fine, the soft poops could be from something else. In her old age, Luna’s poops are often much softer now, seemingly regardless of what food she eats. When she was younger, her poops were always perfect, also regardless of what she ate. So who knows...?

In terms of pancreatitis, though, the chief treatment seems to be dietary. For cases of acute pancreatitis, frequent small meals of very bland, low-fat food are recommended. For a dog with chronic issues, I think lower fat remains a chief recommendation. Here’s a link to a very informative article by Mary Strauss. It covers the gamut from acute pancreatitis requiring hospitalization to longterm chronic maintenance. Thankfully it doesn’t sound as though Gable is acutely ill at all, but you may still see some tips regarding nutrition or supplements if you and your vet think that his pancreas may be involved to any extent.

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

[Joan2517]

Thanks, Marianne...I was thinking last night that since the pandemic I have started buying the larger bag of the Hills w/d instead of the 17lb bag. I think I noticed a different scent from the large bag, but didn't really let it bother me. I might try buying the 17lb bag again to see if that's what's doing it. I don't know why it would be different, but it's worth a try, although I did just open up the big bag I bought over the weekend...ugh!

[labblab]

Hey Joan, I just wanted to give a shout-out to our sweet Gable. I so appreciated your note on Peg’s thread. And now that I know that both you and I are crossing our fingers for our older babies, Gable and Luna, I’m especially hoping for still more good days ahead for us all. I figure that whatever makes our babies happy at this stage, makes us happy, too!

Please give Gable a hug and kiss from his Auntie Marianne, OK? And big hugs to you, too ;-)))

[Joan2517]

Done and done, Auntie...he seems okay, except for the food aggression, panting and weakness showing more in his back end. He's a good boy, never complaining, always happy (except for the panting episodes, then he looks just like Lee did, panicky). I know I should get him tested, he might need an increase. I'm waiting for the money that I should be receiving from the sale of my mom's house. As long as he's still eating and drinking, I'm not too worried. He's always been so sensitive to the increases that I'd rather his cortisol stay high than low. He's also sleeping all night most nights, in fact I'm up early this morning and noticed that he didn't even get up to drink water until I was up. Usually I can hear him roaming and getting up a few times to drink.

Hopefully our babies will have more time with us than we think...

Did I tell you that Jeremy got another dog?? I already told him that this time it will be his mistake if it doesn't work. I am not taking another! But it seems to be working out. He's a black-mouthed Cur, approximately six years old, weighs about 80 pounds, and is a sweetheart. He's had him for two months now, and they have bonded completely. He's good with people, even though the reason for him being at the shelter was that he was in an abusive household and the husband beat the wife and the dog attacked him...I'm not sure I believe it because so far he's been fine with everyone. I think there is more to the story because he seems too calm, too trained and kind of sad. He's a couch potato, but does love his walks. He has Lyme and has started antibiotics, but also seems to have a sensitive stomach and finding the right food/meds has been challenging (and expensive!). It has taken him this long to feel safe I think. He won't play, doesn't seem to know how, but he can sense when Jeremy is having a panic attack and will sit near, or practically on him. He's been registered as an ESA and Jeremy is waiting for clearance from the school to bring him to work. He has already been there twice and wasn't a problem at all...met Jeremy's coworkers and some of the students. He will come up to you, smell you, then lean against you for petting. I was worried the first time I met him because of the story and how big he is, but he was just fine. And Jeremy seems to have finally got the dog he can love and pamper to his heart's content...they need each other.

Just wanted to share that bit of news :)

Love, hugs and kisses!!

[labblab]

Oh Joan, I’m so glad to hear about Jeremy’s new companion! For sure, this is definitely good news to be shared and I’m so glad you did. I’ll be keeping my fingers crossed that everything continues to work out for the two of them.

And I totally understand about thinking it’s better to let Gable’s cortisol run higher rather than lower at this point. I agree with you and would do the same. We just take one day at a time now, and have to feel so grateful for the good ones!

[Joan2517]

Well, finally got some money so had Gable in for blood work. The only thing I didn't get done was the Thyroid panel because I was doing the PVT and the Thyroid panel needs to be done 4 - 6 hours after taking the pill. These are the results:

Cortisol: 3.8

Blood work:
Alk: HIGH 1688 ref range 5-131
Phosphorus: HIGH 6.1 ref range 2.5 - 6.0
Triglycerides: HIGH 381 ref range 29 - 291
Precision PSL HIGH 474 ref range 24 - 140

Okay, so he is panting and drinking like crazy. Insane whenever there is food around, which only makes him pant more. Wondering if we should up the Vetoryl to 5mg at dinner so then he would be on 5 am and 5 pm. Should I get the T-4 panel done first before adding the extra 5?

What do you think?

This is from blood work in July 2020, everything was much lower, except for the cortisol, which was only slightly lower.

3.0 on the cortisol test ref range 1.0 - 5.0

ALK: 616 ref range 29 - 291
Triglycerides: 959 ref range 29 - 291 (he hadn't eaten before we went)
Precision PSL: 273 ref range 24 - 140

[labblab]

Hey Joan, I would want to have Gable’s thyroid level checked before increasing the Vetoryl dose. If he’s getting too much thyroid supplementation, that could account for the excessive panting, thirst and appetite. Since his pre-pill cortisol level is OK for a Cushpup who’s clinically doing well, it wouldn’t warrant a med increase if those symptoms are being caused by a high thyroid level instead of cortisol. If his thyroid level does turn out to be fine, though, it’s at that point that I’d increase the Vetoryl. Since his other labs are creeping up, it’s certainly possible that he may need more Vetoryl. But I’d want to recheck the thyroid first,

Marianne

[Joan2517]

Thanks, Marianne. I had the thyroid panel done yesterday. It came back low, 1.8. I had stopped giving him the second pill a few months ago when he started drinking more (like he did that time his cortisol dropped too low).

My vet wants to start back up with the second thyroid pill and also give him the extra 5mg at night, so that he would be taking 5am and 5pm. He doesn't think the panting and ravenous appetite is from the low thyroid, but more from high cortisol.

What are your thoughts?

[labblab]

Yes, I would have suspected that his panting and appetite could be related to a high thyroid level, but not to a low level. So I can’t argue with a trilostane increase at this point. And my only reservation about increasing his thyroid med at the same time is that once you start bringing down his cortisol level, his thyroid level may spontaneously bounce back somewhat on its own. So even though it’s a pain and an expense to monitor both his cortisol and thyroid, I believe I’d do so not too long after the increases. Because if he *does* end up being oversupplemented on the thyroid again, you’re risking a return of those very same symptoms — the panting and the appetite.

[Joan2517]

Right...so check in two weeks? Or sooner?

I'm getting a little panicky. Lena started having breathing issues a few weeks before she died and he's breathing really fast for the last week or so, and there's like a snore sound more than usual, but he's always breathed faster than any of the others, it's been really humid and hot here, plus we've had thunderstorms which he reacts to the drop in pressure, so I don't know. His blood pressure was perfect the other day and they didn't say anything about the fast breathing, he's eating fine, and I'm on "high alert" watching and listening.

I'm doing the same with my husband. He's not tolerating the chemo pills and we have to keep lowering the dose. He's not eating, he's cold all the time, and exhausted...I'm listening for changes all the time. I so looked forward to not having to work anymore and now I can't do anything but watch and wait...

[labblab]

Oh gosh, Joan, I’m so sorry about all your worries! I’d be exhausted and a nervous wreck, too. I surely hope things start turning around for your husband. And as far as Gable’s breathing, I’m afraid I don’t have any answers other than to think maybe it’s also a result of his cortisol elevating.

As far as re-testing, no, I don’t think you need to do anything sooner than two weeks and maybe you can even stretch it out longer than that if he seems to be doing OK — or hopefully even better — by then. The thyroid testing, especially, can probably be stretched out longer because I’m guessing it takes a while for significant changes to register with that. I’m afraid I’m not super knowledgeable about that. But let’s see how he’s outwardly doing over this next week or so, and then go from there.

In the meantime, sending tons of healing (and restful!) wishes to you all!

[Joan2517]

Thanks, Marianne...I'm listening to him breathe right now, and I think he sounds more comfortable already. Although it is only 60 degrees out! LOL!

[Joan2517]

I had an ACTH done yesterday, he's still panting a lot, drinking a lot and breathing very heavy so I just wanted to make sure his cortisol didn't drop too low.

Cortisol Sample 1: 3.9 ref range: 1.0- 5.0
Cortisol Sample 2: 7.6 LOW ref range: 8.0 - 17.0

Does that sound weird? Vet said it was great, keep doing what I'm doing, but it doesn't sound right to me. He's getting 5mg morning and 5mg at night, and the extra Soloxine at night. I didn't have the thyroid panel done because I wasn't too worried about that, not yet anyway.

He seems so uncomfortable and he's having trouble getting up and walking. When we got to the vet yesterday, they were running about 10 minutes late so we walked a little over to my husband's office to pick up his mail (we've done that walk before), but this time I didn't think we would make it back and that I might have to call them to come get him. We did make it back, but he was so tired. He backed up when they went to bring him in and the leash slipped off his neck and he turned around to run, but couldn't move fast enough and I grabbed him before he could get out of the parking lot onto Glen Cove Road, which he could've done at any other time. They weighed him and he's lost almost 10 pounds even though he looks really heavy to me. I think I might start him back on the Gabapentin 300mg and see if it helps. I also got that supplement that someone mentioned but he's only been getting it a week or two.

I'm getting this panicky feeling that I had with Lee the week before she died...

[labblab]

Oh Joan, I sure understand your worry and I’m so sorry. I think it’s impossible not to flash back to other bad times in situations like this. But as far as Gable’s cortisol, no it’s not too low. The range you’re citing above is the one for the ACTH when it’s being used for diagnostic purposes. That’s the “normal’ range for a dog who doesn’t have Cushing’s at all.

When used for monitoring trilostane, you want the post-ACTH result to be between 1.45 and 9.1 ug/dL for safety purposes. And if the Cushing’s symptoms are not being well controlled, the range can be dropped even further, down to between 1.45 and 5.4. So as you see, Gable’s cortisol is not too low. If anything, you might be hoping that it will continue to drift downward a bit more over the next couple of weeks if, in fact, his cortisol level has anything to do with his current symptoms. I think you started adding the extra 5 mg. about three weeks ago, so there’s still some time for it to lower a bit more. Since he’s been so sensitive to increases in the past, I’d agree with your vet and not yet want to add any more trilostane. But as far as his cortisol, if it stays where it is after another month or so, you maybe could consider another little increase if his symptoms don’t improve at all.

But of course the big question is whether it’s the Cushing’s causing the symptoms or something else. And that is the million dollar question. I so wish I could relieve some of your worry but I know that’s impossible. But I’m definitely thinking about you guys and hoping that Gable will start feeling better again soon!!

[Joan2517]

Thanks, Marianne...so that post LOW in okay?

[labblab]

Yep. It’s annoying that your lab report doesn’t print the range for the ACTH when it’s being used for trilostane treatment monitoring. Most lab results these days have the three different ranges printed for all ACTH tests:

Normal range for initial diagnostic testing to see if a dog has Cushing’s (this is the range you were given)
Therapeutic range for monitoring dogs taking trilostane
Therapeutic range for monitoring dogs taking Lysodren

The range is different in all three cases. For Gable taking trilostane, his post-ACTH would have to be less than around 2.0 (technically, 1.45 according to Dechra) to be considered too low.

[Joan2517]

Okay, thanks!

[Joan2517]

Gable started throwing up last night around 1am, 2 times food, 1 time white foam, the twice after drinking water. He was very shaky and having a hard time walking. Went out and wouldn't come in. Took him to the ER around 2am and they did blood work and looked him over.


Lymphocytes 0.99 ref range: 1.05 - 5.10 K/μL L
Eosinophils 0.03 ref range: 0.06 - 1.23 K/μL
Hemoglobin 20.8 ref range: 13.1 - 20.5 g/dL

BUN 29 ref range: 7 - 27 mg/dL H

ALT 142 ref range: 10 - 125 U/L H
ALP 1,442 ref range: 23 - 212 U/L H
GGT 14 ref range: 0 - 11 U/L H

Amylase >2,500 ref range: 500 - 1,500 U/L H
Lipase 5,971 ref range: 200 - 1,800 U/L

Resting cortisol was >10

They took his blood pressure which was fine, checked him over and he seemed okay other that the drooling, wasn't dehydrated and gave him a shot of anti-nausau

He still didn't seem okay so took him to my vet and they did the pancreatitis test which was positive, gave me pills Cerenia, for nausau.

He's outside laying under a bush and won't come in...I think he's dying. I don't know what happened. He was perfectly fine all day, except for the excitement of the trick or treaters. I gave both him and Cooper 5mg diazapem to calm them down, which did nothing. He ate his dinner fine around 6 or 6:30, then all this started happening. The vet said he might feel like he's dying but they said no. But he won't come in and he's hiding from me.

I don't know what else to do!!!!!

[labblab]

Oh Joan! I’m right here with you! I can’t think of anything else for you to do either — I think you’ve done all you can, and now it’s out of your hands. Either he’ll get better or not. But how awful for you!! I think you’re right, that it sounds like he’s gone off to be by himself the way that animals do there at the end. I keep expecting the same thing to happen with us and Luna, and I don’t know how to handle it, either. I guess don’t force him to move if he doesn’t want to. Try to stay as calm as you can (I’d be going crazy!), and just tell him what a good boy he is. If it’s pancreatitis, maybe the Cerenia will help settle his stomach and he’ll start to feel a little less sick in a while.

I’ll be here and I’ll keep checking on you.
Hugs, hugs and more hugs

[Joan2517]

Thank you, Marianne. I'm so afraid and upset. I took him back to the vet for another look because he kept hiding in the dirt and poop out in the yard and drooling. They looked him over again and said that he's not dying, that he just feels so bad that he thinks he is, and that this is normal behavior for how bad he feels. Because of the Cushing's it will take longer for him to respond and feel better. All I can do is hope they know what they're talking about. It's so weird not having him hover in the kitchen while I'm preparing dinner...

The only good thing is that because of how he's avoiding me and not letting me help him, I think that you were right that Lena didn't even know that I wasn't there at the end...at least I think that makes me feel better, I'm not really sure :(

I will update tomorrow...thank you for always being there <3

[labblab]

Joan, thanks so much for the update, and I'd be so afraid and upset, too. I totally get it. To be honest, I don't think the vets can know what's really going on right now, either, and they're just making their best guess. But truly, you've done all that's in your power to do and now it's up to Gable and how the story of his life is meant to be written, if that doesn't sound too goofy.

I do think that animals -- and humans too -- can withdraw into themselves when they feel the end is near. It's a final journey that they will be taking on their own and they are setting their own course. I remember some of the things I wrote about when you lost Lena, and I truly do believe them to be true. Souls who have been blessed with love carry that peace inside of then forever. But at the end, I believe the passage from this world is a mystery for them alone to experience.

The vet may be right and you may be wrong for right now. But you may also be right in what you are feeling. And if not now, probably the time for Gable is not far away. Truly, no matter what happens, just like with Lena, I believe your love will forever soothe his spirit and connect your hearts. And for now we'll just have to wait and see. But I'll keep checking in through the evening, too, if you want to talk more.

Love, Marianne

[Joan2517]

He won't eat, so I'm not giving him any meds including the Cerenia. He doesn't want the chicken I boiled for him, which is so not him. He got two shots of Cerenia today and I don't want to fight with him trying to get the pill down. Maybe he'll feel like eating later. Right now he's outside laying on the deck. I'm not letting him loose in the backyard to pee or poop, so he's annoyed at me everytime I put the leash on him and wont go. I can't be searching for him in the dark in the garden and dragging him in if he doesn't want to budge. He got up and made himself comfortable on the couch where I sleep at night, which he never does. He usually lays on the ottoman next to me, but not for long. He's been more comfortable on the floor since the Spring, I think.

I hope tomorrow will be a better day for both of us, so please don't stay up checking on me. I am exhausted from being up all night and hopefully so is he.

I still cannot believe how suddenly this happened...after all my watching over him, bang!

Good night, dear Marianne...

[labblab]

Good night, Joan. Hoping so much, too, that tomorrow will be a better day!

[Joan2517]

Marianne, my big beautiful boy died at 5:30 this morning. He got much worse after our going back and forth last night, and I just knew he needed to go to the ER again. Even they were surprised at how much worse he was from the night before. They kept him and hooked him up to fluids with pain medication, which they wondered why my vet had not given me the two times I was there yesterday. I asked them to call me if it looked like he was not going to make it. I kissed my good, good boy goodnight and told him how much I loved him and went home. They called at 5:35 to tell me that he was in cardiac arrest and they would keep doing CPR until I got there, which they did, but he was already gone.

I had woken up around 5:15 and it took a few seconds to remember that he wasn't home and I had not heard him drinking water or his nails as he roamed around which had been usual for the past few years. I had a picture in my mind of him standing in the cage, wagging his tail, and looking so much better before I closed my eyes again. Maybe he was telling me that he was okay now...I don't know. I hope so...I couldn't bring him home like I did with Lena, so they are taking care of his cremation, which will be private. I rubbed his ears and hugged him, cut some of his fur off (even though I knew there were clumps all over the house still, lol), and left my big beautiful boy to join his sister. I know Lee will be happy to see him, and he her. Cooper and Sibbie smelled my hands and arms when I got home, so I hope they realize that he's not coming home.

I thought I would take this better, but I miss him so much already...and here comes the guilt. Should I have stayed all night with him? Did I do enough? Should I have tried to find out why he's been panting so much? How many times did I get mad at him for so many stupid things? And again, the quiet is so, so loud...

Sleep comfortably, my big, beautiful boy. You know how much I loved you, and I know you you know that you were my boy, my guardian, my happy, good natured sous chef. I'll love you forever, Gabe...

Love, Mom

[labblab]

Oh Joan. My tears are flowing and my heart is with you. Please, please don’t believe that you did anything wrong because you absolutely did not. This was just his time to leave this world and rejoin Lena. You sensed it yesterday even though the vet did not. Your mother’s intuition knew, and you were right. And just like with Lena, I absolutely believe that your love was surrounding him no matter where he was and no matter where you were. His spirit knows you are always with him even though by last night his body was beyond the point of knowing. That is truly what I believe. He was letting you know yesterday that his time had come. Thank goodness you were listening with your mother’s heart so that you could love on him at home yesterday and then take him in for the pain killer overnight to ease any suffering. I’m betting his mind had already drifted away, lulled by the pain killer, when his dear heart gave out.

As closely bound as Gabe and Luna have become in my mind, I’m feeling as though Luna has lost a brother from across the miles. It makes me cry. I’ll go right now and add Gable to our memorial list — for sure, he’s one of our beloved Cush Angels now. I’m so sorry Joan. I have no words to tell you how sorry I truly am. I’ll be here to talk, any time at all.

Fare thee well, sweet Gable. Until we all meet again.
Love, Marianne

[Joan2517]

I feel the same way about Luna, just as I did with Peg.

Last night the tech said that with pancreatitis the dogs salivate a lot which was why it was just dripping from him, as well as pain. And I've been going over in my mind and realizing that even though he hasn't been drooling, he was always leaving saliva on the floor, couch, etc., licking his front paws where he would be resting his head. And the panting that I thought was Cushing's related, might've been pain...and of course I am kicking myself for not having it checked out. Maybe he would not have died this soon, although I knew it was coming.

I hate this....my poor boy.

[labblab]

If only they could talk!! Oddly enough, Luna’s been licking like crazy lately, too. Licks her legs, licks her crate, licks the carpet. We can’t figure out why. Her blood work was all normal last month. She’s also gone through periods of hypersalivation, too, sometimes even when she’s sleeping comfortably and soundly. It’s so strange. My best guess with Gable, though, is that his panting really was from Cushing’s as opposed to pain and that what happened now came up so quick and acute that you really couldn’t do anything about it. A younger dog might have had the strength to rebound, but this hit Gable so hard that his heart couldn’t handle it. I just don’t think there’s anything you could have done differently that would have really changed things for him.

But you got him the painkiller that he needed last night. That was probably the most important thing of all, to give him peace there at the end. I know you miss him so dearly, though. What a very, very good boy he was. I’ll be lighting a candle tonight, especially for him. Forever in our hearts.

[labblab]

Joan, I just wanted to come back and tell you that I’m not writing the stuff that I am just to make you feel better. I truly honestly think that you did everything you could have done under the circumstances that were thrown at you.

But if you’re like me, I’m also guessing that the questions and the guilt you’re feeling cannot be changed by anything anybody else says. They’re your genuine feelings and you need to be able to talk about them without worrying about what we think, one way or the other. You need to know that we’re truly hearing what you need to say. I *know* I made mistakes with Barkis. Hopefully fewer with Peg. And heaven only knows about Luna right now. But it’s always meant so much to me to be able to talk about both the good and the bad about what I’ve done here, to get if off my chest for myself. But no matter what, I did the best that I could at the time. And I know the same has always been true for you, too — mistakes or no mistakes. But for what it’s worth, again, I just want you to know that I think that it was Gable’s time, you did all I would have known to do, and you loved him dearly, and nothing is more important than that.

[Joan2517]

I know that, Marianne. When that thought came to me this morning, I felt like I should keep it to myself because I was afraid someone might say that it was my fault. But I knew that I would tell you here because I knew this is where I could. I miss him so much...I honestly didn't think it would hit me as hard as Lena's death did. I loved him as much, but it was different with her. I guess I just loved him as much in a different way.

It is so, so quiet. And I realized about an hour ago that we have not had to fill the water bowls all day, and that just made me start bawling again. I'm going to have to start locking the doors again because he was so big that no one would dare come into the house, even though he would never have bit anyone, but they wouldn't know that. I had all these recipes for snacks that I was going to make him because I knew he would love them...and now I just don't feel like making it for the rest of them. I still have frozen squash and watermelon balls in the freezer because he loved them so much; and I just boiled up two chicken breasts for him to eat while he was sick. Now I see them and cry.

My husband is even crying and all he ever did was complain about trying not to trip over him, or yelling that he was trying to kill him by constantly being under his feet (lol). Since he's been able to eat again, that's all he's been doing and Gable was right there with him. Any time he went into the kitchen no matter how quiet he tried to be, Gable heard him and sat and waited for the tidbits that he always gave him. I caught him going through his phone looking for pictures and crying. Jeremy is heartbroken because he didn't get to say goodbye. And I miss him so much.

Josh face-timed me this morning after he heard and said all the right things. I know he just wanted to see how I was. He was only 8 when Lee died and I think he only remembers me not being able to talk about her.

And Cooper keeps crying in his sleep, he's doing it now, and I wonder is it because of Gabe? He never did this before. Gable was the one who used to cry. I wish I knew what he had been dreaming about. I don't hear him breathing or his nails on the floor while he was dreaming or roaming at night trying to find a comfortable place to sleep, or the sound of him drinking, drinking, drinking...and I miss all of it.

I have a headache and my eyes hurt from crying and I just want to sleep and forget...just like I did with Lee. Good night, my darling boy. Kiss Lena for me.

Good night to you too, Marianne. You are and always have been a comfort to me.

Love, Joan

[labblab]

Another morning dawns, my friend, and I know it’s a tough one. Closing my eyes and sending you huge hugs from across the miles. I’ve just spent several minutes trying to Google a quote of comfort that I had seen a few days ago, before we all lost Gable. I thought at the time, I should write this down but I didn’t. I so wish I had because I can’t find it again this morning. But of all things, I did find this quote from “Winnie the Pooh.” It’s with a picture of Pooh holding Piglet’s hand:


How lucky I am to have something that makes saying goodbye so hard.

I’m guessing that lucky is nowhere near the first word that would have come to your mind today. But how lucky Gabe was to have you for his mom. How lucky we all are that Lena first brought you to us. And how lucky we also are that we’ve gotten to share Gabe’s journey with you ever since. Especially me. All through these last few challenging months with Luna, I’ve felt such a bond of support coming from you and Gable. It’s so hard this morning to say goodbye to him, but what a gift it has been to have him in our lives, and for that I feel both lucky and grateful.

Love, Marianne

[Joan2517]

That's very sweet, Marianne.

I'm still dealing with guilt...now I'm thinking that if I had brought him earlier, instead of listening to the vet who said all of his behavior was normal for a dog dealing with pancreatitis, that maybe the pain meds and fluids would have made him more comfortable and his poor, big, gentle heart wouldn't have given out.

I am so, so sad and can't stop crying. And I yelled at them all day Halloween for the barking and trying to get to the trick or treaters. I keep trying to think if anything was different that night before he started throwing up and I don't think there was. The only thing he ate that day besides regular food was a few pieces of waffle and a banana. The day before I made a buttermilk apple custard pie and he and I shared the two or three extra apples, which he always loved.

I just don't understand how it got so bad, so fast...my mind knows, but my heart still can't accept it.

[Harley PoMMom]

Dearest Joan,

I am just now seeing this and I am so very sorry for the loss of your beloved Gable. We all can see how deeply he was loved and how lucky he was to have you as his Mom.

Please stop being so hard on yourself, I know this is easier said than done as I've gone through those woulda, coulda, shoulda, I believe any one that loses their furbaby goes through this as well.

I'm sending huge and loving hugs.

With Heartfelt Sympathy, Lori

[Joan2517]

Thank you, Lori...I know I keep saying that I can't believe how fast this happened, but thinking back it was the same with Lena. I guess maybe it always feels this way. I just wish I had brought him to the ER earlier that night, even if he died anyway he wouldn't have gone through as much pain as he was in. i am kicking myself for trusting the vet yet again, when my instincts were telling me otherwise.

The vet who had seen him on Monday called me yesterday when he heard, to offer his condolences, but it sounded more like he was making excuses for what he told me the day before when he saw him TWICE, about it being normal, and made it sound like it was my decision not to leave him there for overnight, which it was because they don't have anyone there at night, but he also said that the ER's would do it just to make money and that he didn't need it. He wasn't even Gable's normal vet, who I have not heard from AT ALL, which really pisses me off.

This is the second time that one of my dogs has died under their care after not paying attention to what I know about my dogs. It's my fault for not going with my instincts, but I am going to look around for another vet.

I'm so sad, and so mad at myself...

Thank you for listening to me vent (lol).

love, Joan

[Joan2517]

You're coming home tomorrow, my darling boy. They texted me tonight and I will come get you before I take Josh to the Halloween Parade.

I miss you terribly, Gabe. I keep listening for you panting and drinking. I am only using one of the two bowls for water and have only had to fill the bowl twice since you've been gone. The other I'm using for Cooper's food. I put your bowl, collar and leash away...I can't bear to see them right now. Cooper and Sibbie keep looking for you in all the places you were hiding the other day, but I think your scent is disappearing.

I can leave kibble down and it doesn't disappear, we aren't stepping over you, you aren't laying in front of the oven in the kitchen, I don't wake up hearing you drinking, drinking, drinking then heading for the back door to go out to pee, and when I take my shower, you aren't laying there on the floor waiting for me anymore. All of this makes me so sad.

I got a card from the ER with something special written by everyone who was there that night, which was so nice. And a card from Brookville signed "Dr. Kraznov and staff"...that one went right in the garbage. Childish, I know, but I am still so pissed off at them.

Good night my big, beautiful boy and my angel Lee...I miss you both and love you with all my heart.

Mommy

[labblab]

Huuuuuuuuuuuuuuuge hugs flying up to you on this morning that I hope will bring you at least a bit of peace, Joan.

Your Angel is coming home.

Love, Marianne

[Joan2517]

I took Sibbie with me to go pick up Gable's ashes. Before we left I took her for a quick walk. On the grass was a white feather. I have seen white feathers ever since Lena died, so I thought it was from Lena letting me know that he was with her and okay. Then as I was driving, I realized all the feathers that I have always found were small. This was a big white feather and I think (and hope) that it was either Gable letting me know, or Lena letting me know it was for him, and he was okay. When we got home I went back and got it. I'll put it with the ones that I have saved from Lena.

[labblab]

Oh I hope it was exactly that!! A perfect sign from your Angel babies, together once again and forever…

[Joan2517]

Oh, Marianne...

I do so hope that Luna pulls out of this. I know how worried you must be and I know how stressful it is to be watching for every little sign.

I can't seem to cry anymore. I feel like I'm going to, but the tears just won't come. Josh was here again yesterday. Called me early and asked if he could come over. He walked here (they only live a couple of blocks away). He, Sibbie and I went looking for bargains at a barn sale. Then he played in the playground there that was enclosed so we let Sibbie run around and play with him. I got some really nice pictures. Next time we'll bring Cooper so he can run around too. He seems really lonely without Gabe and was trembling yesterday when he knew we were leaving. I keep telling him that he's the man of the house now...

Then Josh, Sibbie and I took a ride to Morgan Park, which is on the beach, where there's a new food stand. We got some hot chocolate, Sibbie had whipped cream, and just sat and talked while we watched the waves. He keeps trying to cheer me up...telling me the bright side (no more pills; no more getting up in the middle of the night to let him out; less poop to pick up; food and vet bills will be lower). It doesn't help, but I let him think it did. We were waiting for the owner to finish making the soups for the day because Josh wanted some. He got potato and bacon. We went back home and him and Sibbie both fell asleep before dinner...LOL, too much fresh air!

After dinner we drove around to see if anyone had started decorating for Xmas, or if there were anymore Halloween decorations still up. And we sang Xmas carols the whole time before I took him home.

Honestly, I was happy to have the distraction and a reason to get out. It is too quiet in the house without my big, beautiful boy. The silence makes me so sad...

I'm going to start walking Sibbie and Cooper around the neighborhood. Maybe they will both get over their aversion to other dogs. I couldn't do it when Gable was alive because I couldn't walk all three and he couldn't make it too far with all the weakness in his back legs. I wouldn't take them without him because he would've wanted to come and I didn't want to hurt his feelings. I wish I had taken him to Jeremy's at least once, but Jeremy has a huge staircase to climb and I just didn't think he would be able to get up them as many times as he would need to going out to pee.

I have so many regrets, just like with Lena. I know it will get easier...but Halloween will be forever ruined. It's only been six days, but it feels like yesterday and also so long ago...weird.

Many, many hugs to you. I wish we lived closer to each other. Give Luna a big hug and kisses from me. Gable would have loved her...

Love,
Joan

[Joan2517]

One week today, my darling boy. I still can't believe it. As soon as I think about you being gone, my head starts shaking "no", it can't be. Then my heart starts to hurt and I know that it is. I went food shopping today and almost everything I bought made me think of you...bananas, pears, carrots, celery, chopped meat, sour cream, and ice cream. Making dinner tonight all I could think of was how you were always at my feet and I would peel extra carrots for you and cut up extra celery because you loved it all, my sous chef.

Juan was here yesterday and was shocked that you had died. I swear he was going to cry. You loved being outside on Mondays when he came to work. You were his buddy and I used to hear him talking to you as you followed him around the yard. I don't understand what happened...

But Lena must be happy that you're with her even if I'm sad that you're gone. Now I miss the both of you and will be counting down the weeks again like I did after she left us. I love you both...I love all of you that are there, too many to mention. I'm just not used to missing you yet. I love you now and forever, just like Lee, Gable.

Mommy

[labblab]

Still thinking of you every day, Joan. And Gable too. We’ll never forget your dearest big boy. Forever in our hearts…

Love, Marianne

[Joan2517]

I still can't believe you're gone, Gabe...it is so, so quiet and I miss you so much. I keep thinking that it's all a mistake, and I just want to sleep. When Lee died you were my comfort, my couch buddy and you kept me warm and watched over me while I cried and slept. Cooper and Sibbie cuddle with me, but I don't think they know why I'm so sad. Cooper is crying in his sleep a lot. I think he's lonely without you so I hold him until he stops.

I miss your big happy face and sweetness. I miss tripping over you in the kitchen and in the bathroom when I get out of the shower. I still wake up in the middle of the night listening for you, then I can't get back to sleep wondering what happened and what I might've done to change it. Even though I knew it would happen, I can't believe it did.

I know that Lena, Andee and Tem are happy to have you with them, but I still want all of you back with me.

Goodnight, my sweet babies. I think of you every day and miss you with all my heart...

Love,
Mommy

[Joan2517]

It was not easy cleaning the broccoli rabe without you today, Gabe. I missed you terribly while peeling the stringy parts off of the stems and sharing the way we used to. Sibbie had some, but I threw most of them away. It just made me sadder. I had nobody to trip over in the kitchen and that just made me cry...I miss you my beautiful boy. I am still not used to the quiet...and tomorrow I'm roasting butternut squash, which you loved...another difficult Thanksgiving. But Josh is so looking forward to it so I'm going to have to smile and pretend just like I've been doing since Lena died...

Mommy loves you all....

[Joan2517]

Josh and I went to Jeremy's for an after Thanksgiving Thanksgiving since he couldn't bring Charlie here because Sibbie hates him. I was fine until I was sitting on the floor with Charlie and put my arms around him, then the tears came. I used to hold you like that, especially when you got out and I had to sit and hold you until someone came to help me get you home. I just held on and cried. He's such a good boy and just stayed still and let me...maybe he could feel your presence and knew I needed it.

I love you, Gabe...

Mommy

[Squirt's Mom]

Dear Joan,

Having been offline for a bit I missed this completely. My heart is shattered reading your posts. You did everything you could so please don't beat yourself up. Sweet Gabe had a great life with you as his mom and caretaker all these years. And I know he left this life of the wings of the love you shared. Today his pain is gone and he is running and playing with Lena and Phoenix as well as his new friends from here. Please be good to yourself now especially....Gabe would want that as do we.

My deepest sympathies,
Leslie

[Joan2517]

Thank you, Leslie...I miss him so much. And I know that I'll never really know what happened no matter how many times I go over those two days in my head. Even food shopping is painful! I walked into the produce section yesterday and saw the little mandarin oranges that he loved and I started to cry. I couldn't even buy them for myself...

I know it will get easier. I talked to one of my closest ex-coworkers today and she said that this last year and a half must've made him very happy having me home with him and that if I had still been working like I was when Lena died, that I would have been just as guilt-ridden as I was then....she knows me so well (lol).

Your words are always so comforting, Leslie. I don't know how I ever could have handled this without all of you.

Love,
Joan

[Squirt's Mom]

Oh I understand that grocery store business for sure. The last batches of food I cooked for Squirt and for Trinket are still in my freezer...I simply can't throw them out. For a long time after Squirt passed buying fresh sweet potatoes resulted in a breakdown in the produce section of Kroger. I didn't care. Just being out of the house was a major accomplishment at that point. I'm still apt to start crying this time of year in the meat section when all the turkeys come out and in the toy section of WalMart when the Holiday Barbies come out. It's ok. That just shows how deep the love is, how real it is, how very important it is to who and what we have become and will become as we learn daily how to grow with it.

((((((((((((((((((((((((((HUGS)))))))))))))))))))) )))))))))

[Joan2517]

Yes, I've still got watermelon and butternut squash balls in my freezer that he loved. Cooper likes them, too, but I just can't bring myself to share them, yet...even though Gable never minded sharing. I was going through my texts yesterday looking for something Jeremy had sent me that he wanted for Xmas and there was my text to him telling him that Gable had just died...jeez did that start me crying.

Hugs right back at you, Leslie!

[Joan2517]

Marianne, could you put the picture of Gable under the boxwood looking straight at me in the memorial thread, please? I just realized we forgot to do that. It's in his album...

[labblab]

Of course! It’s all taken care of, and what a perfect, sweet picture it is! Thank you so much for sharing it with us, my friend.

Huge hugs coming your way,
Marianne

[Joan2517]

Two months today, Gabe...Christmas was so different. You were not underfoot in the kitchen; did not get to open any presents; didn't get to see Charlie here having his first Christmas breakfast with us; and missed your favorite prime rib dinner. I thought about you and Lee watching from Heaven and hoped you were both happier than I was. I love you and miss you both. The ornament I got for you is a picture of you when you were young, muscular and healthy, and Lena, yours is the one of you and Doree sitting in front of the fireplace together watching the flames...I have always loved that one.

Mommy loves you always and forever....

[labblab]

Giant hugs, Joan! On this winter morning, thinking of you and your angels, knowing how dearly you miss them.

Their K9C family misses them, too. Forever in our memories ~ Forever in our hearts.

Love, Marianne

[Squirt's Mom]

I heard Brick coming down the hall at his normal breakneck speed and looked up so happy to see him...then remembered. It's so hard when we love them so very much.
((((((((((((((((((((((HUGS)))))))))))))))))))))

[Joan2517]

It is, Leslie...so many memories.

How's Luna doing, Marianne? I think about her every day...

[labblab]

Oh Joan, that's so sweet of you! Thankfully she's eating pretty much normally again right now. The vet is letting me keep her on the appetite stimulant indefinitely, and whether or not it's actually helping I don't know, but I'm also not gonna stop it to find out! She was picky again on Christmas Day, and I thought, on no here we go again. But she was hungry again by the 26th. Also, the fleas seem to be gone for good, and in retrospect, they could really have been sapping her strength and making her feel really crappy back earlier in the fall. So the main issue remains her mobility. She's wobblier and wobblier, but still hanging in there. I was so grateful and relieved that we did make it through Christmas. I know you would have given anything to have been able to spend one more Christmas with Gabe, and I'm so very sorry that it was not to be. I still think of him every day, too. It truly gives me some comfort to think of him being right there to greet Luna when the moment comes. And then for them to romp together on healthy legs once again and forever! But that doesn't change the loss for us here. Things just can't ever be the same for us again after they leave us, and that is such a sorrow.

Hugs, hugs and more hugs.

[Joan2517]

I miss you, Gable...my big, beautiful boy. Pictures of you and Lee came up this morning on a Facebook memory. One of her last snowstorms with all of you. And there you were with that happy "it snowed" look on your face; running around with Cooper while she watched; eating the snowballs I threw at you and covered with the snow that I shoveled all over you. She was so frail and you were so big and healthy and I wish you were both still here.

Mommy loves you all, now and forever...

[Joan2517]

You've been gone nine months yesterday, Gabe...and I still miss you so much. I talk to you and Lena every day. I look for you both in old photos, just to see you again. It's tomato season and every time I make something with them I can still see you eating them, you and Cooper, and now Sibbie likes them too. I keep thinking I should put away the flag I made of you that's supposed to be for next Winter, but I like where it is, hanging on the fire screen where i just have to glance up and you are looking at me. I still don't understand what happened, and I never will.

You were my best boy, and I love you with all my heart. Give Lee a big kiss for me, and all the others who are with you.

Mommy loves and misses all of you forever and ever....

[labblab]

Sending hugs to you, my dear friend, flying across the miles.

Always in loving memory. Always.

[Joan2517]

Always, Marianne...

[Joan2517]

Wednesday was your one year anniversary in Heaven, Gabe...and I've missed you every day. I love you, my big boy. Give Lee and all the others a kiss for me. I miss you all...

Love, Mommy

[labblab]

We miss him, too, Joan. Luna and I miss her big brother from across the miles, too.

Sending you much love and many (((((((hugs))))))))

[Joan2517]

Hugs to you and Luna, too!

[labblab]

Good morning, Joan. Something — or somebody — gave me the urge to stop by Gable’s thread this morning. I’m thinking the somebody must be Luna, and that she wants me to know that she and Gable are playing together today. She and Gable want us both to know. At least, that’s what I’m thinking and it makes me smile if even just for a moment. So I’m here to hopefully pass that smile on to you, from our two big dogs who are now fast friends forever.

Love, Marianne

[Harley PoMMom]

Sending huge loving hugs.

[Joan2517]

Sending huge loving hugs.

Thank you, Lori. Right back to you!

[Joan2517]

Funny...I also had an urge to come here yesterday. A memory came up on Facebook from January 18, 2019 yesterday of him in the snow. He looked thin and his eyes looked like something wasn't right, so I searched this thread and realized that he started having cortisol issues shortly after, or maybe that was the beginning and I hadn't noticed it yet. Maybe they were reminding me, and you, that some days were not so good, but they are now. He would've loved Luna, especially if she liked the snow as much as he did.

That's something that definitely brings a smile to my face!

Love, Joan

[Squirt's Mom]

Squirt LOVED snow! She plowed it with her face and would come up grinning like mad with all these little snow balls hanging from her face. LOL She will be playing with any of the Rainbow babies who love snow! One day we will be able to watch them all playing in the snow again.

[Joan2517]

Gable, my beautiful boy...today marks two years that you've been gone. I think of you and Lee all the time, every day, and I miss you both very much. I know you know that, you must hear me talking to you, and about you. You're always in my thoughts. Andee must be taking good care of all of you, she always did. Kiss them all for me, Gabe...Mommy loves you all...

Forever and always, my sweet babies.

[Harley PoMMom]

Sending huge hugs with love.

[Joan2517]

Same to you, Lori...

Love,
Joan

[Joan2517]

Squirt LOVED snow! She plowed it with her face and would come up grinning like mad with all these little snow balls hanging from her face. LOL She will be playing with any of the Rainbow babies who love snow! One day we will be able to watch them all playing in the snow again.

Lena always came in with the snowballs all over, LOL! She loved it. I used to warm them with my hands until they melted. I think that was her favorite part.

[Joan2517]

Gable, my darling boy...today is three years since you left us. I miss you and Lee every, single day. You would've gotten such a kick out of Raina...remember when we got Sibbie and you, me and Cooper just sat on the couch watching her? You were always so good with all of them. You were our guardian, our big beautiful boy. I never had to worry...

Kiss them all for me, Gabe. I miss you all more than I can put into words.

Now and forever, Mommy loves you....

[labblab]

Sending love and comfort to you, my friend. May Gable and Luna and all our other babies run and play together joyfully, until the time we’re all reunited once again. I do believe with all my heart that love is forever.

❤️❤️❤️

[Harley PoMMom]

Sending huge and loving hugs.

[Joan2517]

Thank you, Lori...

[Joan2517]

Thank you, Marianne. What a wonderful sight that would be!

[Joan2517]

Merry Christmas in Heaven, my darling boy. You and Lee just loved Christmas, and now you have Daddy with you all. Give everyone a hug for me. I miss you terribly, Gabe. I know if you were still here with me you would be hovering to make sure I'm alright. I will be...

Love,
Mommy