Skippy has passed; 12 y/o Yorkie with likely pituitary tumor (Trilostane)

[WinstonTheWestie]

I'm glad Skippy is showing some improvements. Winston had horrible gas when he was pretty young, especially when he was eating grain free foods. I think he just couldn't tolerate such a high amount of protein. Things improved when I tried a "regular" chicken and rice-based food. My vet at that time told me that every dog is different, some do great on grain free, some don't, but we just have to listen to them to see what they do best on.

[molly muffin]

I think it is excellent that Skippy has some some inclination to get up and move a bit more. Who knows more improvements could be coming too. They said it would take months to see a real difference right? And with the vetroyl, maybe this will continue. I do hope so.

Gosh, I don't know, molly would go through phases of having some horrendous gas, and then it would pass. I always thought it was her food too.

[Carole Alexander]

Thanks everyone for sharing your experience with our pups bodily vapors! The intensity and frequency of his gas does seem to be diminished the past couple of days, thankfully! Purdue has turned silent in response to my question about removal of the adenoma on Skip's butt so I guess it will wait until the end of the month when I will also talk with my local vet. Regarding his treatment with Vetoryl and the status of his Cushing's symptoms, it's been nearly two weeks on the low dose, 10 mg. 2 x a day and he continues to slowly improve. I suspect he is being under dosed for his weight of 28 or 29 lbs. But, I will not increase the dose until he has a stim test. And yes, it often takes months for the radiation to reduce the swelling and/or the size of the pituitary tumor, if it works.

I've been following the progress of a couple of dogs on FB who have had or are completing radiation. One had cyber knife and the other is having 16 treatments of IRT. From what I can determine, neither are miracle approaches. While cyber knife is usually three treatments as was the SRT that Skippy had, it is purportedly more precise. However, several dogs have developed long term radiation effects (relatively quickly )that are permanent. The FB dog who had cyber knife in July is already developing weird new symptoms and has lost one eye. But then again, every dog is different and I'm guessing that radiology and oncology specialists don't want the great unwashed to draw conclusions or make decisions based upon their treatment of a few or more dogs. But people are desperate for information and I and others are already making decisions with too little of it. I just want clinics to follow the dogs that they treat and publish their outcomes. I am going to write the head of radiology at Purdue and push hard for them to publish information on their website. (I would gladly document Skippy's experience from my end.) I hope that as more people pursue radiation, there will be an increasing demand for this data. I'm stepping off my soap box now. :)

P.S. Purdue radiology told Dr. Scott-Moncrieff that they would be happy to perform another CAT scan on Skippy's brain after six months. (Should he live that long!)

Carole

[liltara]

Carole - I continue to follow Skippy's journey and I am still inspired by your commitment to his care and quality of life. Had I known at the beginning of Mojo's journey that the trilostane would hasten the growth of his tumor, I would absolutely have considered radiation (no matter what the cost).

Common sense and my research tells me that the future of macro treatment does not include Vetoryl as a first line of defense and that radiation or other tumor controlling/shrinking treatments will be at the forefront. Of course, there is much research to be done and such but having watched my Mojo go through the disease progression I can say with full confidence that macro treatment must be considered differently than controllable (typical) Cushing's.

That said, I just wanted to post one last time here and say how much I've appreciated the support that you and others gave me during my darkest days with Mojo. I do hope I was able to return the favor in even the smallest way.

Coming here now, at this point in my grieving process, is not positive for me - I am finally thinking of Mojo with smiles and not tears (at least not every day!) and visiting this site reminds me of the great sadness I experienced during the late stages of his illness. I am eternally grateful for this site and will keep it bookmarked for future use if I should ever, God forbid, have another dog afflicted with this terrible illness.

I will continually pray for Skippy and you - I wish you both the best of days and experiences and happiness as you continue your journey together. You are what all pet parents should be, Carole. :)

[Carole Alexander]

Hello everyone, for once I'm not posting about Skippy. In surfing the FB Cushing's forum, I stumbled on a post about a woman whose dog's cortisol level is being tested with something called a pre pill instead of the ACTH Stim test. Here is the article:
http://www.vetpracticesupport.com/monitoring-canine-hyperadrenocorticism-using-pre-pill-cortisol-instead-of-an-acth-stimulation-test/

I emailed the article to Dr. Scott-Moncrieff at Purdue and she said that she thought the research was promising although Purdue continues to use the ACTH. I will see her next week and ask more but I do recall that they are using this procedure at a vet clinic in Yorkshire, UK. I know nothing about the cost of this procedure but I am guessing it is less than the ACTH. In reading further it also seems that there is some controversy over the accuracy of the ACTH although it remains the gold standard.

Certainly my interest is personal but also I remain concerned about all of us who are struggling with the exorbitant cost of treating Cushing's. Just yesterday my neighbor's dog was diagnosed and she is talking about getting a reverse mortgage to pay for treatment! That is just not right. I will be interested in what others of you think about this or if anyone has had any experience with this form of testing.

P.S. Skippy is okay but seems to have plateaued on 20mg daily and is back to serious PU/PD and refusing to walk. I am in Maryland but will take him to Purdue next Tuesday.

[molly muffin]

The cost would be the same as just measure the pre cortisol and not the post cortisol, which is less. Some vets only measure the pre cortisol already when they are trying to help customers keep cost down. Many dogs will have a low pre but be within range on the post, making some vets discount the pre all together. I would want to see some further monitoring studies done using only the pre cortisol, before saying it should be wide spread use.
I think there would still be times, when the full ACTH would need to be used.

[labblab]

Dear Carole,

First of all, I'm surely sorry that Skippy is having some recurring issues. He is such a trooper, as is his mom! Please give him a loving hug from his family here, and I hope that some helpful info will be gleaned on Tuesday.

Secondly, thanks for reminding us about this new monitoring protocol. This research was circulated among us a little while back, but I've really not seen any subsequent professional comment. Flaws have always been noted in using the ACTH to monitor trilostane patients, but as you say, to date there has not been a superior approach. I believe I will contact Dr. Bruyette in order to see whether he has any thoughts about it, and if so, I'll definitely report back to everybody.

Please do let us know how things go at Purdue.

Marianne

[Joan2517]

Very interesting article, Carole.

[Carole Alexander]

Hi everyone and thanks for your comments about gas; I may try changing his food but our other dog, the Dandie Dinmont is eating the same food, low fat Wellness Core. No gas, so I am enduring.

Marianne, sorry to raise a study that everyone has already seen. I will be curious as to Dr. Bruyette's thinking on this topic; it has the potential to advance the quality of life of so many dogs for owners who can't afford to treat and test according to Drecha’s protocol. I haven’t responded to Liltara’s post as it made me cry to read it, but I will. The Skippy update is mixed as usual. His trip to Purdue Tuesday answered few questions. Here’s a long summary:

Neurological: no formal evaluation but menace response is reduced, weakness in rear legs continues, still often refuses to walk, sometimes legs go out from under him, slight tremoring. Purdue thought he seems more alert, aware, interested in life and his surroundings. Dr. Scott-Moncrieff feels that we cannot assess the impact of radiation unless we can ever get his Cushing's under control. So the question of what is tumor related versus Cushing's related remains unanswered.
Cushing's: Here it gets weird; I fed Skippy and gave him his Vetoryl expecting a Stim test; Purdue kept him (I thought for the Stim, to clean up his butt and get a surgical consult on his peri anal adenoma.) He was there most of the day and when the student called she said they had done an endogenous cortisol test and his cortisol was 3.4 (normal range is 1 - 6). I said huh, what? Based on this test they felt comfortable increasing Skippy from 10 to 15 mg. BID and they will perform a full blood panel and ACTH stim at the end of October. (When Scott-Moncrieff is back in clinic.) Based on my talk with her, I have surmised that their theory of the case is something like: we know Skippy continues to have uncontrolled Cushing's (because of his symptoms) and the current 10 mg. Vetoryl BID that he's been on since 9/9 is too low. (S is now 26lbs.) I'm uncertain as to why they are not following the Drecha protocol. I suspect the reason was either to save me money or because I sent the McFarlane article. (She mentioned that they couldn't do a pre pill test that day because I had already dosed him.) Whatever the reason, I am growing more uncomfortable with where this stands. Skippy's cortisol has not been tested since last March! I know his case is VERY atypical but I worry that waiting another month for an ACTH stim test is too long. Skippy has had no response to the increased dose but it's only been three days.

Peri anal tumor: Dr. Scott Moncrieff recommends no surgery unless Cushing’s is under control. She had his butt shaved and cleaned up his adenoma and the six and growing number of suspected papillomas that have spread above the base of his tail. He would be welcomed at a leper colony. Purdue quoted 2500 to 3500 for the surgery. I am going to explore Co2 laser as an option and think about this problem in light of Purdue’s prognosis of survival for a year, beginning last July...His butt is a bit of a bloody, poopy mess but no discernible pain. My new groomer: Purdue Vet Clinic.

Radiation: Just a brief additional comment on Skippy's radiation. Likely it is too little too late. Too little because he had very high BP and pneumonia by the time I decided to try radiation. The concern was that he wouldn't survive anesthesia. It was too late because neither Purdue recommended nor I sought an MRI until six months after the Cushing’s diagnosis. The goal was palliative, i.e., Skippy won't live long enough to experience long term radiation effects and the SRT dose was small, 3 treatments of 8gy. I know very little about radiating pituitary tumors, but as I have read more this summer it seems likely that a longer treatment protocol would have led to a better outcome.
Overall Skippy remains a docile boy and although his quality of life is limited by the ravages of Cushing’s on his body and his mind, he seems sedate and evidences no pain. He can walk when he chooses to, even at a brisk pace. He is more alert, tells me when he has to go out (most of the time), wagged his tail when I returned from Maryland, follows my movements around the house, eats well and drinks rivers. His urine remains diluted but he has no vomiting or diarrhea. His hearing remains impaired but he can hear. His blood pressure has fallen to 110 and they cut the Benazepril dose in half. Skippy had a CBC at the end of August and the numbers aren’t great. His potassium was normal then but that was before Vetoryl was restarted. In light of the possible interaction of Benazepril and Vetoryl, I am watching him closely. Of note otherwise:
ALT 229 Ref Range 3-69 IU/L
Alkaline Phosphatase 1003 Ref Range 20-157 IU/L
GGT 126 Ref Range 5-16 IU/L
Cholesterol 411 Ref Range 125-301 mg/dl
Lipase 6917 Ref Range 104-1753 IU/L

Thanks for enduring the long post if you made it to the end. I don’t know if the detail is helpful to others or not. I also don’t know what I am missing that I should be paying attention to. I could take him to the local vet for an ACTH Stim test and a CBC next week or just send Scott-Moncrieff an email expressing my concern. Any thoughts on the Stim or on what else I’m missing? Thanks so much.

Carole

[labblab]

Dear Carole,

Thank you so much for your continuing updates on Skippy. Given the complexities of his treatment journey, I am guessing it may be draining for you write them :o. But definitely, we want to know how you guys are doing and all the info and experience you share is of great value to us all.

There is no need to be sorry about reminding us of this new testing protocol!!! I'm not sure whether it had ever been openly discussed on the forum at all prior to this -- we may have just talked about it a bit among us staffers, but without any followup. I agree with you totally that it may offer a superior method for monitoring, and I'm awaiting more feedback from Dr. Bruyette. He told me that he'll be happy to write up some thoughts about it, so I'm eagerly awaiting them and will certainly share them here.

As far as the ACTH testing, I actually might be inclined to go ahead and wait until the end of the month, myself. Skippy's baseline cortisol level (I assume that's what they meant by "endogenous" testing) must have seemed robust enough to the folks at Purdue that they are not too worried about him crashing with this increase. And if you wait until the end of the month, you'll have greater confidence as to the true and long lasting effect of the increase. Of course, all bets are off if he worsens. But I know you already know that.

So once again, thanks so much for checking back in. And I'll definitely return, as well, when I hear back from Dr. B.

Marianne

[flynnandian]

2500-3500 to remove the adenoma????????
i paid 200 at my local vet to remove my flynn's adenoma. including antibiotics and painkillers. [4 years ago.]
this operation is no big deal at all!
i think your surgeon wants a new ferrari.
ask your local vet what he or she would charge you.
my flynn was a long haired border collie and his butt was a smelly mess.
despite of the cushing's he recovered very quickly.

[Carole Alexander]

Just a thank you for sharing your experience in having Flynn's adenoma removed. I agree about buying a Ferrari. I have been checking around and have found a local vet that offers CO2 laser. I likely will call and explore that option. Skippy doesn't go back for a Stim test until the 24th and IMS has said no surgery until cortisol is under better control.

Overall, Skippy is doing better although the last two days we are struggling with loose stool with some blood, likely accompany the stool. Haven't stopped the Vetoryl yet but will tomorrow if it continues. Treating with Imodium which is probably not the best. I have an email into Purdue regarding this.

Maybe of interest to some of you: I am going to ask the IMS at Purdue to test Skippy's cortisol with an ACTH Stim test and utilizing the McFarland protocol, i.e., MCFarland protocol: pre Vetoryl blood draw and then a second blood draw after dosing with vetoryl and food. Then he will have an ACTH Stim test, if IMS agrees. It is important to begin to examine whether or not the McFarland protocol is effective in testing cortisol levels of Cushing's dogs.

Skippy remains fairly lethargic, but will walk, even trot, after initial reluctance. He is far more interested in things around him, e.g., dogs, people, cats and me. He has been eating well but less and losing weight. His behind remains a disaster, large black growths continue to appear and enlarge across his tail area. Took him to groomer yesterday who had to scissor cut because of thin skin and these bleeding polyps-sores. NOT CC as best I can tell.
Neurological symptoms are limited to a loss of hearing although Skippy is not deaf - yet.

Quality of life is impossible for me to measure as he is my dog and I so dearly love him. But, I don't believe he is in pain and seems to enjoy his life within its limits. I still have hope that Vetoryl will improve his quality of life for awhile if we can get his cortisol under control. I don't know what to think about these likely sex hormone growths across his tail.

Two steps forward, one step back. Thanks,

Carole and Skippy

[Joan2517]

Awww, Carole. It's so hard when we love them so. I hope something starts to work for him. He sure is trying, as is his Mom.

[labblab]

Carole, I agree with Joan 100%!

Also, I commend you for experimenting with this new monitoring protocol. Unfortunately, I've not yet gotten Dr. B's assessment. But if and when I do, I'll definitely add it here. In the meantime, I'll be so interested in finding out how things go for Skippy. And I'm surely hoping for as many good days as are possible for our brave little boy.

Best wishes always,
Marianne

[Squirt's Mom]

It's good to hear from you, Carol. You are such a great mom and sweet Skippy is so very lucky to have you on his side. I hope the Vetoryl gives the results you are hoping for and that his poor behind can get some relief.

Hugs,
Leslie

[molly muffin]

Oh that would be awesome Carol if Purdue will do some comparison testing using McFarland protocol.

It really does sound like skippy is better than he was before the radiation from what you have said. To me it sounds like it anyhow.

[Carole Alexander]

Thanks for your comments and support. Yes, Skippy is better than before radiation, no question. Every week is a new challenge however. This week, it's the diarrhea that now has blood. I sent his IMS, Dr. Scott-Moncrieff an email early yesterday asking should I stop Vetoryl or treat or both? No response yet. (She could be away, busy, whatever. She's only in clinic a couple of times a month as she is the head of their IMS.) I then called Skippy's local vet who is collaborating with IMS. She called Purdue IMS Department expressing concern that Skippy may be overdosed on the 15mg BID (he's now 25lbs); they were unaware of any problem with Skippy. Last night, initially Skippy wouldn't eat but then did eat and I again dosed him. (I know my decision is not in accord with Drecha's guidelines.) This morning I'm out of 5mg Vetoryl so I will run to some vet, get the meds and dose him again if he will eat. Local vet will Stim him later this morning and treat diarrhea. I truly hope I'm doing the right thing in continuing Vetoryl. Nothing about Skippy's illness is typical and nothing about his treatment has followed any protocol. All of which is compounded by the unavailability of his highly expert but sometimes inaccessible IMS. So frustrating...

[Carole Alexander]

Just received an email from IMS; she says continue Vetoryl and let's treat the diarrhea for a couple of days. Stop Vetoryl tomorrow if diarrhea isn't cleared. She will test Skippy's cortisol on the 24th using ACTH stim and McFarland protocol. I will update when I know more.

[molly muffin]

Did the diarrhea stop? sometimes antibiotics plus a good probiotic will help with that.

Yay that they will use both protocols. You'll be the first to do a comparison!

[Carole Alexander]

Hi Everyone,

I just charted the past week with Skippy and am still struggling but plowing forward. Started the boy on the metronidazole on Wednesday pm. Two more doses on Thursday and another dose on Friday am, along with restarting the Vetoryl on Friday pm and no metronidazole since. He has been very lethargic the last couple of days but has been eating; he's not going out to pee much or poop at all. (Although my friend thinks he may have pooped in the backyard last night since she let him out for awhile in the middle of the night and he came back kicking his feet.) He is walking, at first reluctantly but then briskly for a few blocks. I will try him further soon. My fear is overdosing him on Vetoryl. I could reduce the dose back to 10mg BID or maybe even 15 am and 10 pm. I so hoped that the radiation would kill the Cushing's but it's not to be. And, now I am learning (relearning) all of the finer points of dosing, testing, tinkering, watching, stalking and whatever. Live in hope, die in despair and if the diarrhea reappears I will stop the Vetoryl and take him for a stim immediately.

[molly muffin]

That is always the hope that the radiation will completely get rid of the cushings, but I think that most dogs end up back on vetroyl. I wonder if it is because the pituitary is damaged from the tumor and doesn't actually recover normal functioning in cortisol production.

[Carole Alexander]

Good speculation Sharlene; I guess there is no way to know if the pituitary is damaged. Just keep on treating the symptoms...Skippy is all over the place, moments of normalcy with a fair amount of lethargy. He's becoming a gourmet people food eater, declining canned or kibble at every opportunity. Also, doesn't want to eat at all early in the morning. I'm eager for cortisol testing.

GOOD NEWS: The perianal adenoma is shrinking and drying. No bleeding in a week or more. It's far from gone but I am astonished that Vetoryl would help control sex hormones. In September when we restarted Vetoryl, his IMS, Scott-Moncrieff wanted to wait and see if Vetoryl would reduce the tumor. I was highly skeptical. We shall see if it will reduce further.

[molly muffin]

Well that would be excellent if it actually helped to get rid of the adenoma without surgery.
I think both vetroyl and lysodren help to control sex hormones if memory serves me.

[Squirt's Mom]

I am actually surprised the Vetoryl is lowering and not raising the intermediates. ;) Per the treatment sheet by Dr. Jack Oliver et al from UTK for Atypical Cushing's:


Trilostane always increases 17-hydroxyprogesterone (some cross-reactivity with pregnenolones in assays??), and frequently increases estradiol and androstenedione as well

Of course, new things may have been discovered since then and Skippy may be among those in the forefront who disprove this current theory on Trilostane and intermediates. ;) Regardless I am VERY glad his butt is getting better and I know the two of you are! :D

[Carole Alexander]

I guess it could be a case of false observation, like false memory.:) He goes to Purdue tomorrow so I'll see what they think. It has definitely shriveled and is much scabier. (This problem is disgusting especially since Skip is having another bout of diarrhea and no eating that started two days ago.) I have stopped the Vetoryl, emailed the IMS and restarted diarrhea treatment and he ate eagerly this morning. The timing is terrible in respect to accurately testing his cortisol. But, if he won't eat I can't treat. He walked this morning but no attempt to poop. What I know for sure is I have one high maintenance pup. If I were working, caring for him would be impossible between his dietary proclivities, his bathroom needs, and medicating him with five different meds twice daily. (I am losing the Denamarin battle; he spits out even the tiniest pieces of the so called chewables.) I don't think his cortisol is too low, but symptomatically...I know nothing.

[molly muffin]

Molly got tired of her denamarin treats too and would just turn her nose up at them. I think, remembering back, that I switch to a different brand with the same main ingredients but a different size/flavor.

Well, yes, that does make it more difficult to get an accurate reading of where cortisol is if he isn't on vetroyl due to the diarrhea, but not to be done about that.

Ugh, I'm sure that isn't any fun taking care of and keeping clean his bum with the diarrhea. Good times eh. :) :)

[Carole Alexander]

Hey Sharlene, Yep high maintenance for this little boy. Purdue visit today was inconsequential as of now. They did a full blood panel, urine, blood pressure, but no cortisol check. BP was 110 but no other results yet. They will test basil cortisol but only to assess if it's too low. My sense is that she, Dr. Scott-Moncrieff has no real idea as to why Skippy is cycling thru diahhrea, won't eat and severe lethargy. I'm convinced it's the Vetoryl, i.e., too much. But he still has many clinical symptoms of Cushings. There was some speculation that his symptoms may relate to his continued response to radiation. They ask me to try a Royal Canin canned food to try to regulate his food. I did tonight after warming it and with beef broth. He wouldn't even sniff it although he is hungry. I fed him chicken and rice!

My plan next is to wait for the basil cortisol number and then reduce Vetoryl back to 10mg twice a day. I plan to have a stim in 10 to 14 days either at Purdue or local vet and then see where we go. Incredibly frustrating and making me crazy. My mistake was to not stim him immediately after the last episode of diahhrea, no eating and lethargy!

Sorry, no comparison between ACTH and McFarland yet...

Oh, IMS thinks the ademoa may have grown, or at least, changed! They shoot horses...

[Carole Alexander]

I received this email last night from IMS: "Skippy’s cortisol this morning was 5 . Hard to interpret since he did mot have consistent treatment for the last few days. He is also azotemic again (increased BUN and Creatinine). I am checking his urine for protein. Should have that back by later tomorrow morning. I think we should go back to 10 mg twice a day of Vetoryl and recheck his blood work in a week or so. Have to figure out if vetoryl is making his kidney function worse." I think this means he is in kidney failure possibly caused by proteinuria? I know that one of the possible side effects of Vetoryl is renal disease. But will reducing the dose help or should I ask her about stopping Vetoryl altogether? Is this condition otherwise treatable? I have no numbers so I don't know how bad this is.

I dosed Skippy last night with 15mg (before seeing her email). Don't know about diarrhea as he went out in dark of early morning and I half asleep. Hasn't moved since 7am, no interest in food, let alone Royal Canin selective. Skippy's lost 5lbs since August. Thanks for any insight.

[DoxieMama]

No insight here, but wanted to comment to let you know I'm still following along and keeping you both in my thoughts.

[Carole Alexander]

Thanks for your kind words. My pen pal, Dr. Scott-Moncrieff checked Skippy's urine and proteinuria is now secondary to chronic Cushing's. She said to stop the Vetoryl as she is concerned about dehydration. Also, we are stopping the Amlodipine as his blood pressure continues to be low. Next Tuesday they will perform an ACTH, or maybe just measure basil cortisol and another blood panel to help develop a treatment plan. I believe that if his kidney values were life threatening, she would tell me, not that I could do a thing about it.

[Harley PoMMom]

I'm following along too, and sending huge loving bugs.

Dehydration can cause a high BIN level and can even increase the creatinine temporarily. Getting fluids in by an IV or sub q would help with dehydration.

With kidney disease the phosphorus level will climb and when it gets elevated it does cause nausea. Did the IMS mention any increase with his phosphorus?

[molly muffin]

Hmm, yes if he is dehydrated then that could affect his kidney values (BUN and Creatinine) as Lori mentioned.

5ug is a good place to be cortisol wise if on vetroyl.

I've always been iffy as to whether to continue vetroyl if kidney problems arise, since dechra has said not to give to dogs with renal disease.

You don't want dehydration for sure. Would it make a difference if he were to get an iv for fluids do they think? Then take him off the vetroyl and recheck numbers in a week?

[Carole Alexander]

Thanks you guys. No mention of phosphorus level. I really wonder about the issue of dehydration; he continues to drink A LOT. Also, I give him beef broth in his food as he sure doesn't like dry kibble. I haven't measured water lately but I will. And, now that he's off Vetoryl I would expect him to drink even more. Also, while stool was firm this morning and I did't dose him with Metronidazole, soft stool has returned. No mention by IMS of further hydrating him. He is eating today but still very lethargic.

The "5" was basil cortisol. (Normal range is 1 -6.) On 10/9 it was 3. I am uncertain as to whether basil cortisol means anything with a Cush pup. My error was to not request a stim on 10/9 after he had been on 10 mg BID for three weeks. He tolerated that well but still had clinical symptoms of Cushing's OR maybe it was the kidney problem and not the Vetoryl increase to 15mg. But the dose increase was based on what they were "comfortable" with based on clinical signs and I agreed. We are where we are. If I see further signs of dehydration before next week, I'll call them immediately. Since he's off Vetoryl, I could try offering the Royal Canin Select and if he won't eat it. let him go without food until he gets hungrier. I just don't know. As he get's sicker, I get" stupider".

[molly muffin]

I know that feeling. Well normally the post is higher than the base. So he isn't being overdosed. That means the 15mg is likely okay. And if drinking that much probably not dehydrated either.
It is all so dang complicated to try and figure out. Grrrr

[Carole Alexander]

Yes, but I so appreciate your and everyone's support. Six outs so far tonight; but he is drinking steadily and ate including Royal Canin so I hope he's stable for the moment. Must sleep so I can do the 4 am shift!
Thanks heaps!

[molly muffin]

Hoping that skippy is doing okay. Is he still eating? How is the water levels doing?

[Carole Alexander]

Skippy is eating, drinking, peeing, and no diarrhea at the moment. He is much less lethargic, but no ball of fire. He does want to get up on sofa, bed, etc. and puts his paws up but won't try to jump. He shows no signs of renal failure but I have no idea of how he is doing overall. He will be tested Tuesday early AM; I'll post after I know more. Thanks for your support!

[Budsters Mom]

Well this sounds encouraging. Skippy is blessed to have you in his corner.

Kathy

[molly muffin]

This is super positive! Great he is eating, no diarrhea, and sounds much more energetic than he was.

Molly completely quit jumping up eventually and would put her paws up and wait for her "lift" I'd say, you need a lift up molly and she'd just look and wag her tail. If you ignored her she would eventually bark at you and put her paws back up. Which I always found just hilarious, but then it was all part of Diva molly and how she ran our lives.

Skippy is letting you know in his own adorable way, exactly what he wants you to do.

[Whiskey's Mom]

Oh my Carole, what a journey you & Skippy have been on! I'm so happy that your sweet, strong boy is doing better-you are both amazing! what may seem like small victories mean so much, don't they...
all the best to to you both

[Carole Alexander]

Thanks Annie, Kathy, Sharleen and everyone for your kind comments and support. Skippy spent nearly 12 hours at Purdue yesterday and enjoyed a fire drill whereby all of the peeps and pups were required to leave the clinic! Might as well start with the Cushing’s – he still has it of course. Fasted ACTH Stim #’s: pre – 10 and post – 30 plus. He’s been off Vetoryl for a week and counting. The IMS who saw Skippy yesterday was going to consult with Dr. Scott-Moncrieff, who’s away, regarding further treatment of his Cushing’s.

After another CBC yesterday, Purdue called requesting approval for another ultrasound. (This was number four in the past year.) I guess the good news is that the ultrasound revealed no masses, stones or other abnormalities. They characterized his condition as chronic kidney disease based on the last two BUN and Creatinine results but offered no firm opinion as to stage, maybe Stage II based on Creatinine of 1.9 yesterday and 2.7 on 10/24. Skippy’s liver values remain high but typical for uncontrolled Cushing’s. Pancreas and gall bladder values are high as well. Sinking into gloom, I spent my day researching kidney disease, a condition that I knew little more than zero about. Tonight, I received a call from the IMS who had consulted at length with Dr. Scott-Moncrieff and had gone back through the past year of testing. She found that his kidney values, especially the BUN, have been widely varied on both the high and low side. She now thinks that these values combined with his frequent episodic bouts of diarrhea are elevating his kidney numbers, perhaps creating false positives. They now suspect that he has ulcers in his digestive track that may be causing kidney, pancreas, gall bladder values to increase. I started him on Urisodol (sp.?) yesterday. She will prescribe another antibiotic for the anticipated diarrhea, Prilosec tablets, and another drug that I honestly can’t remember except it’s administered in slurry. Scott-Moncrieff wants me to start him back on Vetoryl 15mg twice a day, immediately. They sent me home with six kinds of renal kibble and when mixed with low fat, low salt beef broth, he’s eating it. Skippy is very hungry and is peeing like a drunken sailor, much more than before stopping the Vetoryl. I was up at 4, 5, and 6 for outs and he still peed once in the house. Total outs overnight were 7 or 8. I am very scared to restart the Vetoryl but will tomorrow; I’m equally scared, maybe more so, that he may have kidney disease as that is likely game over, sooner than later. Skippy remains about the same, pretty lethargic, will walk with gentle encouragement, but sleeps his days away; he will be tested again in two or three weeks and Scott-Moncrieff will see him then. I am well aware that Drecha recommends stopping Vetoryl when kidney disease is diagnosed, but Purdue is confident that they can manage him regardless. I wish I knew more, not to second guess, but just to understand more. I did ask about the SDMA test and the response was that it is used for diagnosis but they could do one and send to IDEXX, if I request it. I can post his blood and urine results but didn’t want to make this post longer still. If those of you who know light years more than me (probably everyone) have thoughts, ideas or feedback, I would be grateful for your input.

[DoxieMama]

I've got nothing right now but hugs for you. All you want.

I'll sit with you and wait for someone else to come along.

[Carole Alexander]

Hey Doxie Mama, you are so good and kind. Big thanks to you and hugs back!

[Squirt's Mom]

Personally, I would want the SDMA. And I would want those results before I restarted the Vetoryl. Dechra specifically says it is not to be used with kidney or liver disease. So I would want to be armed with all the info possible so I could decide how Skippy would want me to deal with things. :) But others with much more understanding of this drug than I may feel differently....just sharing what I would do in your shoes. ;-)

You're a good mom and I know whatever you decide will be done out of love for Skippy.
Hugs,
Leslie

[Carole Alexander]

Hi Leslie,
The IMS at Purdue is supposed to email me today with further instructions. I will ask if I could run Skipp over for an SDMA; if not there I could call the local vet. The new pharmaceuticals are now awaiting my pick-up. I haven't started the Vetoryl, yet. He is now scheduled for a recheck with Scott-Moncrieff on the 21st. Thanks for your opinion and I surely don't disagree if I can make it happen. I do think Purdue thought he might be in an Addison's state. Thank you,

Carole

[Harley PoMMom]

Hi Carole,

You and Skippy are an inspiration to us all, I'm in awe of the courage you both are showing while dealing with everything that you both are going through...sending super loving hugs to you both.

Harley was diagnosed with kidney disease so if there is any way I can help please let me know.

Other things besides kidney disease can cause elevations in the BUN and creatinine. Dehydration, UTI, a high protein meal, and even some medications such as the ones used for high blood pressure can make those levels increase So, I agree with Leslie's recommendation on having the SDMA test performed to see if there is a loss of glomerular filtration rate. What are the reference ranges for the BUN and creatinine?

Lori

[molly muffin]

They should have a mini kidney panel they can do to evaluate where his levels are. I use to get BUN/Creatinine and an SDMA at every appt. The IMS did this on the inhouse panel which was cheaper and would give us a quick snapshot to anything going on and we would do an IDEXX panel if it looked like something was changing. We did this for a year. But I agree, I would want the SDMA and I used it as a consistent base of where Molly's kidneys were at and going. Along with the BUN and Creatinine.

[Whiskey's Mom]

Hi Carole & Skippy,
Just letting you know I'm thinking of you guys & hoping for the best, as always.
Hugs to you Both!

[Carole Alexander]

Hi everyone and thanks as always for your kind words and the helpful info regarding kidney evaluation. I had an email exchange with the Purdue Docs after his visit last week. They were confident that Skippy’s high BUN and Creatinine numbers are caused by ulcers and that with treatment and restarting the Vetoryl, we will soon have him back on track. Not so much. Beyond the treatment regime, Denamarin, Benazepril, Tylosin, Sucralfate slurry (his favorite/ not), Pepcid OC, Ursodiol, and Vetoryl, there is Royal Canin’s finest renal kibble and cans. He ate the kibble lightly twice after heavily doctoring it with a chicken thigh and no salt broth. (I tasted the broth; it’s pure poison!) For the past three days, it’s been an accelerating slide downhill from eating modest but adequate amounts of food, to handfeeding his favs, to nothing last night. I’ve tried eggs with parmesan, Stouffer’s chipped beef, hamburger, steak, chicken, salmon, cheese, spam, etc. He ate the Spam yesterday but no go last night. I stopped the Vetoryl but got the other meds down with chipped beef sauce. Emailed Purdue IMS yesterday morning stating no food, no Vetoryl; she replied that maybe we were trying to transition him too fast! I replied that he won’t eat anything! No response.
Question: Is it likely that he’s nauseous? Should I ask Purdue for a med for that? No vomiting or diarrhea and he’s drinking and walking pretty well when he’s not sleeping. He doesn’t appear to be in pain.
Although my mind is a bit of a blur surrounding Skippy’s tolerance of Vetoryl, I believe his loss of appetite has been a consistent problem each time we increased the dose beyond 20mg daily. His cortisol has never been under control since diagnosis. Soon he will weigh 20lbs so I can reduce the dose if I can ever restart treatment. Purdue is adamant that getting his cortisol under control is critical to his so called “long-term” health. He’s scheduled for a recheck on 11/21.
I’ve been researching KD; my head is swimming and I am awash in frustration and anxiety; this entire saga is like the Myth of Sisyphus. How many more times can I push the boulder up the hill and watch it roll back down?

[Joan2517]

It is very frustrating, Carole, that's for sure. The 21st seems a long way off to me.

[Carole Alexander]

Hi Lori,
I posted an update on the situation with Skippy below a little while ago. But, I just realized that I didn't respond to your question about his kidney values. On 10/31 his Creatinine was 1.90 with a reference range of .50 to 1.50. and his BUN was 117 with a range of 7 -32. I stopped the Vetoryl yesterday as he just won't eat. The IMS thinks it an ulcer. I just emailed Purdue again saying, "help"! I am certain that they think I'm a pain in the butt but I really don't care what they think at this point. Thank you for your kind comments although I don't feel inspirational - just someone in way over her head. Ole Skippy is tough little mongrel though. Best,

Carole

[Carole Alexander]

Purdue will see Skippy tomorrow. At least they are concerned about why he is refusing to eat.

[Budsters Mom]

Yes, he needs to eat, or get some nutrition in some other way. That has to come first. So , so frustrating. Can't dose Vetoryl unless he's eating, so his cortisol will remain high until then. Glad he's getting in tomorrow.

[/QUOTE] Purdue is adamant that getting his cortisol under control is critical to his so called “long-term” health.[/QUOTE]

[Whiskey's Mom]

I feel for you, I really understand the frustration of getting them to eat, offering anything, ANYTHING and just hoping & praying for a few bites. This coupled with all the questions and concerns and changing situations is so much to deal with. So thankful that he will be seen tomorrow. Wishing you both a restful night.

[Carole Alexander]

Thanks Annie, how well I recall that you know. I mean KNOW. There is some confusion between vets about taking hin to Purdue tomorrow but I hope to work through it in the morning. Skippy ate a few bites of Stouffer's barbecue chicken and potato parmesan tonight. I tasted it and the bbq was terrible, but...Can[t medicate him with anything without food...I will push for more kidney tests if they will see him tomorrow. Best to you and Tex. How did you name him Tex btw? Best to you,

Carole

[molly muffin]

Did you go to Purdue today? What did they say?

I agree this not eating is Very concerning. Have they confirmed there is an ulcer?

[Carole Alexander]

Hi Sharlene, My battery went dead in the Purdue parking lot (after five hours there); I had to call for a jump and then a new battery purchase at Sears so I just got back. Skippy is on IV hydration at Purdue overnight. Physical exam offered no evidence of dehydration but after CBC his Createtime had jumped from 1.9 to 2.9 in less than a week, with a reference range of 0.50 - 1.50. The IMS didn't give me any other numbers but was insistent on hydrating him overnight and they had given him some kind of nausea suppressant/appetite stimulant by injection. They are supposed to call me in the morning. She mentioned a test that they could perform to confirm an ulcer but I just can't remember the name. Maybe my mistake was failing to try to somehow get the kidney meds down him since last Sunday night, but I just didn't know how to force them down his throat. I really don't think the Purdue IMS (this is the junior who I hope is consulting with the senior) knows what's wrong with him except that he is in kidney failure. I asked again today about the SDMA and she responded that they would secure his blood chemistry values. (This was early in the day.) I am going to send her an email next and request the SDMA test; I have no idea why they aren't recommending it. Before going to Purdue, Skippy did get up and eat a small bowl full of boiled chicken thigh and I think he would have eaten more, but he wouldn't touch the renal kibble. Since three days of reading, I know now that I could home cook food for Skippy and I will if he makes it through this. It goes without saying I am very, very worried that we have reached the end of this over a year long often tortured journey. If I can't get this kidney disease under control and get his cortisol down, I see little way forward. And, I am prepared intellectually, not so emotionally. I will ask/ request the ulcer test and the SDMA. I truly wish I had the medical knowledge to comprehend all of this to figure out the best path forward, if there is one. I've read about canine ulcers, periodontal disease (Purdue says his is severe although his teeth were cleaned about a year ago.), binders, commercial food, home cooked food, a ton of holistic meds, but I feel like I'm fattening frogs for snakes at this point. Thanks for letting me vent, yet again. I would welcome any wisdom from any of you who are so knowledgeable and experienced.

Carole

[labblab]

Hi Carole,

I so wish I had something helpful or informative to add, but I’m afraid I am stumped and would need to defer to Pudue’s expertise just as you are doing. It is such a complicated situation with so many inter-locking puzzle pieces. I am guessing that perhaps they are thinking about an endoscopy to check for an ulcer? This would involve sedating him and putting a tube/camera down his throat and into his stomach. I don’t know that there’s any other way to definitively diagnose it without imaging.

Anyway, I’m hoping that you’ll hear a more positive update this morning! We’re here, anxiously waiting alongside you.

Marianne

[Carole Alexander]

Thanks Marianne, I just spoke with Purdue and the immediate crisis has past. His Createtime is back to 1.9 this morning. Skippy is eating and jumping around. But, they still don't know what's wrong with him. I'm going to see him now. The IMS treating him is consulting with a nephrologist and with Dr. Scott-Moncrieff at Purdue. They are looking for a kidney infection. She doesn't want to restart Vetoryl now although Skippy is eating. The IMS is now saying that they may have overloaded him with meds. His BP is near normal but he's still spilling protein. They are keeping him again overnight to continue fluids and testing. The IMS mentioned Miotane or the possibility of low dose Vetoryl if they try to lower the cortisol slightly versus simply trying to manage the multitude of other symptoms and conditions. IMS hasn't ruled out ulcers but seems to be discounting it more. I no longer know what to think and the cost has truly become astronomical; I could now open a pet pharmacy with the array of meds that have now been discontinued. I am certainly glad that he's feeling better and eating but I am beginning to lose confidence, yet again, that they have a clue of whether or how to treat him. Would you all seek a second opinion? His paper records are now at least two inches thick. Dr. Bruyette now offers a vet consulting service but I think he would defer to Dr. Scott-Moncrieff but, she really isn't treating him at the moment although she supervises the IMS who is. Thanks,
Carole

[Carole Alexander]

Many of you who weighed in on restarting Vetoryl were correct. Not because it has resulted in Skippy's adenoma growing, but because it has caused acute/chronic kidney disease. His BUN and Creatinine levels are jumping up and down by at least a point, i.e., 1.7 yesterday to 2.9 this morning. (Reference range 0.50 - 1.50) I've been visiting Skippy daily and they will keep him at least until Monday. They have no idea as to whether or not they can stabilize him or for how long. They took the IV out of him and I took him for a long walk today. Now, he seems alert, eating, pooping, peeing. But, if Creatinine increases each time they slow the fluids, we are likely done. He can't live on fluids in a cage at Purdue indefinitely. I will not give up and they are running more tests to try to figure out what is causing this but I'm pretty certain it's not treatable. And, I will not let this go on much longer as we are where we are. I could look back at my mistakes over the last two months, but I took a calculated risk. I could have never restarted the Vetoryl and certainly not restarted it three weeks ago when his kidney levels were creeping higher. But, I so wanted to control the cortisol/Cushing's. They were wrong and so was I. Thanks,

Carole

[molly muffin]

Oh Carole, I hope he can be stabilized. I totally understand how heartbreaking it is to try and do the right thing, the thing that will make everything better, and then the worry, fear that it might have done the opposite. I've been there with my molly and the cortisol levels and kidney disease. We too tried everything and did what we could to give her every chance. I know that you are doing that now for Skippy and I sincerely hope that he can turn this around.

It sure is a sucky position to be in, but remember, every decision made is made with the information you had then, not what you have now.

[labblab]

Carole, have the folks at Purdue told you that they think the Vetoryl actually caused kidney damage? I may definitely be wrong, but my understanding is that the warning against treating kidney patients with Vetoryl is not so much that it directly damages the kidneys, but instead that Vetoryl levels will accumulate at a higher level in the body than expected if dysfunctional kidneys are not efficiently “clearing” the metabolites out of the system. As a result, overdosing becomes more unpredictable and a greater risk.

I write this is an effort to keep you from judging yourself, or even Purdue, harshly. Restarting the Vetoryl may not have been a mistake at all, since uncontrolled Cushing’s, itself, can cause kidney damage. It has been such an extreme challenge to balance all of Skippy’s competing needs — as it turns out, perhaps just too great a challenge to overcome. But you have done a superhuman job of giving him every possible chance to rebound, all along the way. I sooooo hope that he’ll rebound once again. But no matter what, you’ve all done the very best you could with the information that was available at any given time and day.

Sending healing thoughts to you both, and my hopes that tomorrow will bring much better news.
Marianne

[molly muffin]

I just want to say that marianne is right about not knowing if vetroyl causes kidney damage and in our case, we know that the kidney damage was not caused by vetroyl, due to timing. We had hops that bringing the cortisol down would help with the protein leaking but likely the high cortisol is what caused the damage.

It doesn't matter, because no matter, what one does, you always tend to, being human and all, look back and say, what if I didn't do this or if I did that. The thing is that non of us knows what would have happened if the decisions had been different. Things could have just as easily been even worse instead of better, so don't go down that path. It won't help. I know.

[Carole Alexander]

You all are right of course; it doesn't matter whether it was Cushing's or vetoryl and likely it will always be speculation; the IMS thought Vetoryl because of the timing, i.e., the kidney labs have been normal for the past year until when we restarted the Vetoryl The student called this morning to say that they have confirmed that Skippy has an infection; the student doesn't know if the infection is bladder, urinary tract or kidney. They are treating him now with antibiotics. A major, perhaps fatal problem is that each time they reduce the BUN and Creatinine to near normal with the fluids and then reduce the flow, the numbers jump back up to acute levels. Skippy is eating, drinking and peeing still. The student said that the IMS and Scott-Moncrieff are working on a treatment plan, whatever that means. I know nothing but will go see him this afternoon.

[Whiskey's Mom]

Oh poor little guy & you too Carole. It must be so hard to be away from him during all this. Marianne and Sharlene are so right about beating yourself up over decisions you have made. I went through it, still am. "Should I?, what if we had?, maybe we shouldn't have?" over and over. But we do the best we can with what we have at the time, and in our cases, all decisions are made out of love. So there is no right or wrong answer, and all of us are here for you! Enjoy your visit with your sweet boy, and extra belly rubs and hugs from me & Tex too.
Annie

[Harley PoMMom]

I really think that once the infection is gone the creatinine and BUN will drop down to more normal levels and stabilize. Sending huge loving hugs. Please stop being so hard on yourself, it is so very difficult making treatment decisions for our precious pups and most definitely those decisions are made with the deepest love we have for them. You are being an exceptional advocate for your boy.

[Carole Alexander]

I went to see Skippy again early this morning . He is a bit disoriented but was glad to get out of there for his fifteen minutes off the IV. I took him to a field close by for a walk; it was raining but he walked and then ate the small pile of chicken I brought him. His Creatinine was down to to 2.1 but BUN still over 100. Tonight the IMS called to say that she is going off clinic rotation and another IMS Doc will be assigned tomorrow. She has been consulting with the nephrologist and he says "patience". "Don't throw the book of meds at Skippy; let's see if the culture indicates that we are treating him with the correct antibiotic." Every time they try to lower the flow of fluids his blood values skyrocket and the IMS doesn't know why. I was pretty distraught and said that I don't want to continue to torture Skippy. The IMS suggested that I come over and
"look at Skippy tomorrow" to make a decision about whether to go forward. Of course, I will go over but what am I supposed to see?? The same Skippy that I saw today? I am going to try to reach Scott-Moncrieff in the morning to have a straight conversation. I don't know if everyone there speaks in code or if they don't actually know what's going on with him. If you all have any wisdom I would deeply appreciate your thoughts.

[Budsters Mom]

Skippy with you at his side, has fought a long courageous battle. You know him better than anyone. Would he want to continue in this way, or is he pushing through for you? Only you can answer that question. It is the hardest one that any of us ever have to answer.

We remain here for you always, regardless of what you decide to do. I am so very sorry.

Kathy

[Whiskey's Mom]

Oh Carole, I wish I could tell you what to do. Yesterday was 6 months that we said goodbye to Whiskey, it was truly one of the worst days of my life. My vet told us it was time, but more importantly, Whiskey himself told us in a way only he could. But we had a definite turning point and things went downhill quickly. It would be so helpful if the vets you are working with could not "speak in code", as you said, but hopefully you'll have some answers soon.
You're both in my thoughts.

[Squirt's Mom]

Sweetheart, you know Skippy best of all. Listen to him when you see him and he will tell you what he needs. Know we are with you all the way and trust you as your precious boy does.

Hugs,
Leslie

[molly muffin]

I hope he is better today. I hope that he can beat this. You have both been through so much and I know that you are both sooo tired. It is just so overwhelming sometimes.

Whatever happens, you know we are right here with you and if we could be there at the hospital for each visit and decision, we would be.

HUGS

[Carole Alexander]

Hello and thanks so much for your supportive comments. I so appreciate your kindness. Here is the update: They cultured his urine and began Amoxicillin on Saturday. No response. They have him on three times normal dose of maintenance fluids and have managed to get his Creatinine down to 1.7. His BUN is steadily rising, e.g., it was 90 on Saturday and today it is 139. Purdue says that their nephrologist is Dr. Adams who says there is nothing more they can do. They can’t send him home because of the high fluid requirements; antibiotics don’t work and his BUN is rising. I brought him home for a couple of hours today; he is weak and is the walking wounded but he ate greedily. (He won’t eat much there.) They will do another ultrasound tomorrow to look for clots or anything they missed but are essentially waiting for me to pull the trigger and put him down.
I sent an email to local vet to ask whether it would be worth trying to put in a port, keep him on the IV and bring him home? Keep him on the antibiotics and see if they would work to cure the infection? I know this is a pretty out there idea, but if the antibiotics need more time to work and he needs to be out of the hospital, it seems feasible – maybe.

Plan B is I will take him out of Purdue Wednesday, if he lives that long, and have him put down at the local vet because that is her first availability. Life sucks!

[Joan2517]

It sure does suck, Carole...the poor little guy has been through so much.

[DoxieMama]

Poor little guy. I wish I had the right words for you, Carole. I wish I had ideas or even better, answers.

Hugs.

[Squirt's Mom]

I have nothing to offer but empathy and ((((((((((((((((((((((HUGS)))))))))))))))))))))))) )....and a belly rub for precious Skippy.

[labblab]

Awww Carole, I’m so very sorry the options seem so grim. At this point, if you’d prefer to have him home with you, I’d endorse trying to make that happen, either with or without the IV. If his system can’t be cleared adequately with the fluids, I’d expect that he’d become increasingly lethargic as his kidneys shut down. But he’d be at home, probably peaceful, and you’d be with him. It is such a hard decision to make, though, and no matter what you decide, we are here with you.

Sending my thoughts of strength and comfort to both you and your brave little boy.
Marianne

[Carole Alexander]

Just spoke with the IMS again and they are going to aspirate one of his kidneys, if the kidneys have changed in any way, to look for renal lymphoma this afternoon. I didn't ask about bringing him home with an IV port. They likely think I'm insane already. The IMS did say that with enough fluids over months that his kidneys could heal but he's still not sure what I would be looking at. They cannot figure out why he has gone into acute kidney failure so suddenly. They don't think the infection and antibiotic not working are the problem. They pumped up the fluids yesterday after I brought him back; he fought them about going back into the cage. I am going to take him out again this afternoon after the ultrasound. It only occurred to me while talking with IMS that I should offer to donate his body if they could learn from what's happening to Skippy. Marianne, thanks for the idea about bringing him home to die. I will explore that further. BTW, the Dandie Dinmont terrier with whom Skippy lives, is highly suspicious of Cushing's; she's my friends beloved dog. She hasn't been tested yet but I'm going to secure a copy of her CBC from a few weeks ago. When it rains...

[labblab]

I am so hoping that a “fixable” explanation can be found, and I will keep checking back for news. If the options are exhausted, though, and you want to bring him home, you may want to explore the possibility of a vet who performs home euthanasia. In that way, you will be equipped to speedily ease his release at any time if he appears too uncomfortable.

If there can be such a thing as a “good death,” though, life ending through kidney failure is often described in that way. Of course, none of us can know what someone else experiences at the end, but here’s what has been written about humans who consciously decide not to prolong their own lives through dialysis.


Patients who choose to stop or not start dialysis are not required to eat or take in fluids. In most cases, a patient is allowed to eat or drink if they want to, but forcing fluids or nutrition is not recommended.

Medicines can be given for pain, anxiety, agitation or congestion. However, other medicines are often stopped when a person decides to quit dialysis treatments, since treating the chronic medical conditions is no longer a priority.

As the body’s systems shut down, a person slips into unconsciousness and the heart stops beating.

Most people who pass away from kidney failure have what family members and caregivers describe as a “good death.” A study reported that patients who discontinued dialysis described a good death as pain-free, peaceful and brief. The patients’ families echoed this sentiment, adding a good death included having loved ones present at the end.

Once again, this may not be a path that you will need, or wish, to take. But I did want to speak about it in the event that you might want to consider it. You two have been such partners all along this journey, and my greatest hope is that you can peacefully share every moment that remains.

[Carole Alexander]

Thanks Marianne, this is helpful and I will consider it.

[Harley PoMMom]

Oh Carole,

Sending huge loving hugs, wish I could do more for you and Skippy.

[Carole Alexander]

Hi everyone,
The second ultrasound of Skippy's kidneys revealed nothing; kidneys are normal, no blood clots, no renal lymphoma, no nothing except acute kidney failure of unknown etiology. Since I am stubborn and refuse to be a quitter, I ask Purdue about bringing Skippy home on an IV; I thought the IMS was going to choke but did say that he would have to seek approval from the hospital director. Okay, I see. Thinking more clearly about this idea, I can think of a dozen obstacles and a multitude of things that could go very wrong indeed as he would need to be on the fluids for weeks or months - if it were to work. He did say that Skippy is not a candidate for dialysis and based on what I've read, I truly would not put him through such an ordeal. Marianne, I did ask about bringing the boy hone to die; IMS believes it would be a very painful death accompanied by severe headache and other painful conditions. I ask about pain meds; he said nope, not from him. So, I'm picking him up at noon and will take him to local vet, who he hates as well, a few hours after. Purdue will perform a Necropsy and I've ask local vet about transporting his body, if not I will take his body back, but at least Skippy won't have to go back there alive. I saw him twice yesterday. The first for 10 minutes before the ultrasound, then last night they said I could only take him out for 10 minutes. He was ravenous and I fed him the fattest, crustiest KFC; then I took him back in but no one came for him - for one hour! We went back to the car where Skippy nearly ate the KFC box. When they finally came for him, they literally had to drag him from the front of the building all the way down the hallway until he was out of sight. It is heartbreaking.

I am trying very hard to regain perspective; there are millions and millions of tragedies daily involving violence, war, medical mistakes, accidents and such that lead to horrifying pain, suffering and inevitably, death. And, I know that Skippy is but one little mutt who has enjoyed the best of lives and the finest care a dog could hope for. In return, he has given back to me ten fold, asking for simply nothing in return. He taught me so much and made me wiser, more loving and more compassionate toward others who are experiencing their own anguish and pain. He has made me a kinder, gentler woman and it's been my privilege to spend a decade of my life with him. I am an old social worker who ran a domestic violence agency for thirty years so I've seen and experienced a lot of loss, pain and anguish personally and professionally. I've lost three dogs previously but nothing in the past prepared me for what Skippy and I have experienced this past year. I'm not a believer in afterlife, bridges and such but I know that the imprint that Skippy has had on one life, my life, is indelible and will be forever enduring. I will try to give back to this forum when I am again sane as all of you have been so wise, caring and giving of your time and knowledge. In the meantime, thank you and Godspeed Skippy.

[Squirt's Mom]

Bless you, Carole. This is one of the hardest things we have to face. You and your precious boy have fought the "good fight" from day one, side by sided, united every step of the way. I have watched your journey with joy, sorrow, inspiration, and empathy. There is so little I can do for you now but be here if you need to talk. But do let me do this for you and for Skippy - let my belief in the next life give you a bit a comfort, my belief that you will walk with Skippy by your side and I will walk with Squirt by my side once again some day. The imprint you talk about is forever...that "tie that binds" never breaks. They remain with us always in one form or the other, their memories live on. I hope one day you hear Skippy's nails clicking down the hallway as I do Squirt's and you will know in your heart your baby boy is there.

You are a great mom and have done your best, and beyond, to give Skippy the very best life possible regardless of the situation. I know he is grateful and will leave this life on the wings of your love. Please know we are here for you - we DO understand.

My deepest sympathies,
Leslie



Instructions To a Guardian Angel of Dogs
By ginger Patton

Hello. I’ve been expecting you for quite some time.
Here, come sit beside us for awhile
and let me tell you about this old friend of mine.
He might look tattered or maybe old
But I won’t say goodbye until you’ve been told.
He had the brightest eyes I had ever seen,
And wore a beautiful fur coat that would outshine a king.
He was never prissy but walked with an aire ……
And oh so polite, you could take him most anywhere.
He could run like the wind and could catch anything he chased
But he protected and sat with me when I had problems to face.
You could not find a friend nearly so dear.
Because no matter the trouble he always stayed near…
He has never asked for much from me;
Just to love and respect him and I think you’ll agree,
To give him a good meal plus a nice warm bed is not much to ask
When he has given me all his love and to him this was no task.
Now I understand you have a schedule to keep.
But I have a small favor before he nods off to sleep.
Please fold your wings around him and let him feel young while in no pain.
Dear Guardian Angel of Pets,
please keep him safe and happy until I see him again.

By Ginger Patton

[labblab]

Carole, I am here, too, and my heart and thoughts will remain with you throughout this day. You have done all that is humanly possible to heal Skippy’s body. What a journey, indeed. As heartbreaking as it is, today is the day that you will grant his spirit release from a body that just cannot be healed. The love and the memories last forever, though. And we’ll remain here, right by your side, in the days to come. We cannot replace Skippy’s place next to you, but we can celebrate his life and we can support you in your loss.

Fare thee well on your newest journey, little brave boy, and loving hugs of comfort bring sent to your mom.
Marianne

[Harley PoMMom]

My heart is breaking with yours, dearest Carole. We are here for you and always will be.

[DoxieMama]

Sending tons of loving hugs, ear scritches and belly rubs for your dear Skippy... and more hugs for you, Carole. Godspeed little one.

[Carole Alexander]

Just send me to the asylum. Purdue just called and Skippy's numbers are way down; his creatinine is 1.2 (normal) and his BUN is down to 70, still high as the top of normal is 30. But, they talked to me about bringing him HOME or keeping him there and try to taper the fluids. I will pick him up this afternoon for an hour and we will taper for a couple of days and see where we are. The IMS says that he thinks that there would be tremendous psychological benefit to Skippy to get him home, but cautions that it could all go south quickly. I no longer know what to think or if my mind is capable of thought. Thanks again, as usual.

And,no they don't have any explanation as to why this has happened. Regards, Carole

[DoxieMama]

Skippy's amazing, just like his Mom.

I'm sure we'll all join you in that asylum.

Still sending those hugs, and positive thoughts.

[Squirt's Mom]

Oh wow! I wonder if giving him sub-que fluids at home would help? This is amazing!!! I feel horrible about my earlier post now. :( I am sure hoping for the very best!!!

[labblab]

Double wow!! This is amazing news and I surely hope the trend continues! And no matter what new turns this rollercoaster ride may take, we’re with you and Skippy all the way...!

[Harley PoMMom]

That's great news, Carole!

[Budsters Mom]

You'll have plenty of company. Many of us are regulars, or visit often.

So glad that you're able to bring him home.


Just send me to the asylum.

[Carole Alexander]

Leslie, I am the one who should be embarrassed; I write this lengthy dissertation describing my feelings, etc., about Skippy's final day in this life and then he's given a reprieve. But I think we both meant what we said as sincere and genuine. As did all of you who made such loving and kind comments - and I thank you on my and Skippy's behalf. I am incredibly drained and I'm sure my cortisol is at Cushing's levels. I went to pick up Skippy to bring him home for a little while and ran into a glitch. The administrative staff at the hospital have snapped to the fact that the IMS' have been letting me take Skippy out. He came home for an hour today under the frame that I was taking him for a long walk. (This is considered a discharge and there is a hefty add on fee for readmission.)Skippy looks better and seems better and was extremely glad to be home. He again ate voraciously, slept a little, followed me around and went outdoors. He is weak and remains the walking wounded but he was quite responsive for the two hours we spent together in and out of the hospital. (He did a quick run to try to escape out the hospital door when I had him unleased for a few moments and a student opened the door.) I am trying hard not to raise my hopes or expectations. Although his kidney numbers are looking very good at the moment, he may now be a "fluid dependent" dog at this point. I will know more tomorrow, but I am worried as we approach another week end without any clear direction. While I think they might have released him with Sub Q treatment today, I felt that making an effort to taper him was the safest. And, as many of you all know well, Skippy's prognosis remains very guarded. Add to that the Cushing's, the plethora of info out there about diet, nutrition, supplements, vitamins, refusal to eat, etc., and I am more than overwhelmed. I was very grateful for the time with him today and that he's still alive; he seemed equally grateful. Today will make it harder if the end remains near and the numbers were a fluke but I will treasure whatever time I have left with him. I will wait to post again until I know something definitely definite. In the meantime, you all are the very best. Carole

[molly muffin]

Just checked in on you and Skippy. No matter what happens going forward or when, I am very glad that he is home with you and enjoying being there.

Hugs

[Carole Alexander]

I have gritted my teeth since waking up at 5 am. Talked with IMS at noon; Skippy is having a pancreatitis flare up which has elevated BUN and Creatinine. Numbers are C -2.5 and BUN 93. But he thinks there may have been a testing mistake with Creatinine! They were going to run blood and presumably urine again at 1pm and have put him on lowest fat KD if he's eating it; they gave him an anti nausea injection as he was licking lip. IMS says he looks good and is active. I really would like to try to bring him home with Sub Q if they will agree. IMS is supposed to have called me two hours ago with PM test results. I am going to run over there and find Skippy's student to get a copy. IMS rattled off numbers this morning that all seemed high but it was too quick for my addled brain.

[Harley PoMMom]

Oh no, Carole, I sorry to hear that his pancreas is acting up, it's such a fickle organ. Please keep us updated.

[Carole Alexander]

I took Skippy out for a half hour walk late afternoon. He was lively all things being relative. And, he walked gladly; anything to get out of the cage - remarkable since he has not wanted to walk for months. His values are back down - BUN is 63 and Creatinine is 1.4. They had not started the KD but will tonight. Who knows whether he will eat. They are starting to taper the fluids tonight by 15%. He still has soft stool approaching diarrhea. IMS said this afternoon that he thought there was a 50/50 chance he would recover. And who knows for how long. One day at a time...I have so many other questions but I'm so, so tired. Sweet dreams everyone.

Carole

[Carole Alexander]

Last night, Skippy tolerated the first taper at 15% reduction. He was receiving 175 (is it kg?) of fluid since he was admitted. They started a second 15% taper this morning and will do labs at 4pm. He is eating a little of the KD and the student thinks he's alert and looks good. They are treating the diarrhea. This morning's labs are BUN 64 and Creatinine 1.3. Maybe, just maybe the chief nephrologist who told the first IMS, "give it time" (and money), may be right.

[Harley PoMMom]

I'm so glad to read that Skippy is improving and hopefully those kidney values will stabilize. Great job, Mom!

[Joan2517]

These ups and downs are so stressful, Carole. The poor little guy! I hope he gets to come home soon.

[Carole Alexander]

I saw Skippy this afternoon and took him for my 15 minutes. He had a massive diarrhea attack in the middle of Purdue's hallway as soon as the student handed him over. The student and her colleague did the cleaning; the student was lamenting this week that she had never seen the dog poop. I said, "here you go, pudding". Lengthy chat with the IMS this afternoon; I just wish I could remember half of what he said. Skippy's BP is down to 110 and he's not anemic, but the taper is raising sodium levels. He has consulted with Scott-Moncrieff multiple times and they are in agreement that his primary problem of the moment is NOT Cushing's. If he survives, Scott-Moncrieff thinks that we may see further reduction in his cortisol levels because of the radiation. This IMS is more concerned about the pancreatitis than his kidneys which are looking much better each day. I forgot to ask about proteinuria. They, of course, would like to keep him until he is completely stable in respect to his labs, off the fluids and not needing subQ. (I said let me create a GoFundSkippy page.) He's reluctant to offer a prognosis. He and Scott-Moncrieff are concerned that Skippy may develop diabetes (the boy's glucose is normal currently) and the explanation involved Cushing's, the pancreatitis and his kidney disease but I will have to ask him to explain again and I will record. He said there is no research that he's found supporting the notion that Vetoryl triggers kidney disease. Skippy is hating the hospital and will walk anywhere that is away from the place; I have to carry him the last half block in. He's on a low fat food that he's reluctantly eating and on diarrhea meds, the fluids, amlodipine and his weight is stable. I'm unsure if he is peeing as much as they are hydrating him. He's very hungry for real food. They did labs tonight but I haven't heard any numbers; this IMS is very thorough and seems to be trying hard to figure out Skippy's puzzling situation, especially now that he's moved on from his Tuesday pronouncement that, "you must give Skippy death with dignity now". I am more hardened to the reality of the situation now and if I don't have to file for bankruptcy over this, Skippy and I will plunder forward with clearer eyes. I hope everyone is good and hugging their pups. I am blessed.
Carole

[Harley PoMMom]

The pancreas maintains the body’s blood sugar balance, as the primary hormones of the pancreas include insulin and glucagon, and both regulate blood glucose.And because of this important funtion from the pancreas, unfortunately, diabetes is the most common disorder associated with pancreatitis.

Regarding proteinuria, many things can cause protein loss such as high blood pressure, UTI's, and even certain medications, so my thought is that with everything that is going on with Skippy the chances are likely that his urine does contain an abnoral amount of protein.

It is a really positive sign that he has an appetite. Some foods that are ok to be given to dogs with pancreatitis and kidney issues are chicken breasts (skinless, boneless), rice boiled to a mush consistency, eggs, and fish.

Love and hugs, Lori

[Carole Alexander]

Lori, this is very helpful; I am not sure that Skippy and I can "do" one more disease but I won't get in front of my skis. Back at you,
xo, Carole

[Carole Alexander]

The IMS is truly dumbstruck about Skippy. This morning after a 50% reduction in fluids, Skippy's BUN is 33 (Range is 15 -30) and Creatinine is .09 (Range is .05 - 1.9). He ate half a can of RC low fat for me this afternoon and I took him some pumpkin that IMS requested to offer for the diarrhea that he had yesterday. IMS said he's holding his breath and does not want to talk to me about what's going on as they continue the taper. Took Skippy out for a brief walk and he walked directly to my car and put his paws up; He looks and acts significantly brighter than he has in weeks and I had to carry him back in. Holding my breath.

[Harley PoMMom]

That's a great update!! Keeping all various body parts crossed that he continues to improve.

[Squirt's Mom]

What wonderful news!!! I so hope this trend continues!!

[Whiskey's Mom]

Wow that's great! Skippy's a little miracle man! Let's hope his good days outnumber his bad!

[molly muffin]

Great news! I'm so happy to see this. I'm going to be away for awhile, so I hope to see continued improvements when I get back. Go Team Skippy!!

[Carole Alexander]

Annie and Sharlene and Everyone,
Skippy came home last night after 14 days on fluids; he has acute and chronic pancreatitis, kidney disease of indeterminate stage, a urinary tract infection and of course, Cushing's. He is on low fat RC and will not eat it; last night and today, I mixed it with boiled chicken breast to get pancreatitis meds down but he's eaten a third of a can and a handful of chicken breast since yesterday. He's lost several pounds since this crisis and while Purdue won't say, it seems improbable that he can bounce back from this. IMS called tonight and will call again in the a.m. He thinks it's likely that Skippy is holding out for better grub and says we can go for a while without eating as long as I can get the meds down and he's drinking. He walked eight or ten blocks today, no diarrhea, no vomiting but sleeping mostly. Underlying cause of assault on pancreas is uncertain, likely idiopathic and Cushing's related.

One thing I learned from this IMS,who is specializing in kidney disease, that may be useful to others, is that Ursodiol has been used to treat pancreatitis in humans for a while. IMS says now they are treating dogs using this drug. Skippy is his first. Skippy is not on subQ as they didn't think it would help much; he will be retested tomorrow or Monday. His labs yesterday were BUN 77 and Creatinine 1.1. Thanks again for your support.

[Budsters Mom]

So glad that Skippy got to come home. There's nothing like your own turf, bed, everything.

You are one very strong lady Carol. I would not been able to hold everything together as long as you have. I have yet to figure out which one of you is stronger. You both must pull strength from each other. When it's time for Skippy to fly, know that you did everything you possibly could for him. He loves you for that.

Kathy

[Harley PoMMom]

I am so glad to hear that he is home!! Getting them to eat can be a chore to do. Is the RC kibble or canned? If canned I wonder if warming in the microwave or baking in the oven would make it more desirable to eat. You could probably do this with the kibble too, maybe adding chicken broth to the kibble and letting it sit until the kibble has soaked up the broth.

I didn't know that Ursodiol was being used for pancreatitis, thanks for sharing that, and I hope it will help Skippy with his pancreatitis. You are doing such an exceptional job with Skippy. You both are in my thoughts and prayers.

Hugs, Lori

[Squirt's Mom]

I, too, am so glad he is home and who knows....home may be just the medicine he has been needing most of all. Let us know how things are going as you can but spend as much time with your precious boy as you need and want!

Hugs,
Leslie

[Carole Alexander]

Kathy, Lori, and Leslie, Thanks for your support. I feel like Skippy is alive day by day right now. IMS called this am, but I missed the call. Tried to call back but only the emergency service is reachable. So I called his local vet and will take him in for labs this pm; I'm afraid to wait until Monday. They didn't give me subQ as the IMS didn't think it would help much. They prescribed Purina EN, gastrointestinal and he is now refusing it altogether, but he will eat a few bites of chicken breast and I managed to get all meds down except the Clavamox so far this morning. I tried heating the food, nope. Leslie, I will try baking it maybe mixed with chicken breast (That they don't want him to have.) Lori, Ursodiol for pancreatitis is new; this IMS went to a conference a couple of weeks ago and learned that it's now being used with dogs successfully. Two weeks in a cage and Skippy now wants to sleep on every soft thing here; he's now asleep on the sofa with my friend. They are most concerned about the pancreas flaring again; do you all know if there is anything else I could put on his food that's reasonably safe to try to get him to eat it? I will research as well. Thanks...

Carole

[Harley PoMMom]

I wonder why the chicken breast is a no- no, I thought that was considered a food mainstay with pancreatitis. How about white fish? Tuna in water has a low fat content so maybe this could be used as a food topper. Baby foods could work too as long as no onions or onion powder are in the ingredients.

Is he getting any pain medication? I realize that adding another med to his list sure doesn't sound good but if he is having some discomfort this could dampen the appetite.

Tons of huge loving hugs being sent to you both, Lori

[Carole Alexander]

Hi Lori, took Skippy to local vet this afternoon; they did labs (results tomorrow), immediately tried to get Skippy to eat their low fat canned stew. (Nah) and then the vet offered him a low fat treat that he gobbled down. They taught me how to give him sub Q and sent me home with the remainder and directions. They gave him an injection of Cerenia and a few pills of Mirtazapine to try. They tried to pill him with the Clavamox, the so called chew-able. Three techs and the vet tried six times with pill injector, the hand method and low fat treats - finally, finally, he swallowed it. By then he was exhausted from the World Wide Wrestling match. Tonight after cooking bacon for the smell as an inducement and another wrestling match over the Mirtazapine, he finally took the evening meds and ate a little of the low fat food and a few bites of boiled chicken. IMS also called and said he didn't want me to offer Skip anything but the low fat Purina food as he is worried that it will further inflame the pancreas. Skippy is hungry for anything but...IMS doesn't like sub Q as he believes it is hard on the kidneys. (I think there is major disagreement on this topic.) I do wonder about taking him to local vet for daily IV fluids for a bit. Final thing, although it is certainly rare, today the local vet volunteered and the other Purdue IMS last week said the same, the Vetoryl caused this entire system failure/episode. #Givemestrength. I know it will all be better tomorrow...:o

Carole

[Budsters Mom]

That is very interesting indeed. Did they say it was because it was dosed post radiation (due to the macro)? Or, possibly because it was given when Skippy was already in a weakened state. I just wondered if they said any more?

Kathy


Final thing, although it is certainly rare, today the local vet volunteered and the other Purdue IMS last week said the same, the Vetoryl caused this entire system failure/episode.

[Harley PoMMom]

With Sampson, his sub-q's had to be stored in the frig and then heated up, I used a heating pad for this, before I gave them to him. Oh Carole, I so wish I could reach through my computer screen and give you a huge hug.

[Carole Alexander]

Kathy, they didn't say. I had the impression that they were talking about the period subsequent to radiation but I will probably never be sure...

[Carole Alexander]

It's been a hellish week for Skippy and me; he stopped eating upon discharge last Wednesday from Purdue; he ate nothing until Monday. His labs on Friday had doubled, sky high for Creatitine and BUN/Phos. He has acute/chronic pancreatitis and has an infection, maybe urinary tract. Purdue and local vet walked away over holiday leaving me with meds and SubQ fluids. Purdue has jumped back in saying PTS; even if I can heal pancreas and UTI, Cushing's will kill his kidneys. IMS tonight thinks that If I don't stop the meds and he doesn't eat, he will starve to death. If I do stop the meds likely no healing of pancreas and UTI driving the kidney failure. I've stopped the meds to try to slow the nausea and am now trying anything, along with fluids, to try to get him to eat. Tonight he ate a small portion of chicken drumstick and rice. (I'm well beyond low, low fat only as I cooked him turkey breast this morning that he sniffed and walked away.) Oh, and they think Lysodren will kill him and he can't tolerate Vetoryl. I am pulling day and night shifts watching him so I'm not totally rational. No need to write kind comments as I knew this was inevitable. Just didn't know that it would go this way. I will post more when I can or I've decided what to do next.

[Harley PoMMom]

I sure do sympathize with you on the struggle in getting them to eat. Slippery elm bark is one herb that you can mix with water and administer either with a syringe or eye dropper. Here's an excerpt about slippery elm bark:
Slippery Elm is said to relieve inflammation of virtually any mucus membrane, and has been used in the treatment of inflammatory conditions of the lungs (bronchitis, asthma), kidneys, bladder (cystitis, FLUTD symptoms), throat (tonsillitis), and joints (arthritis).

Slippery Elm contains many nutrients (carbohydrates, protein, fat, ascorbic acid, beta-carotene, calcium, and several trace minerals) that can be beneficial for recuperating pets, and it may stay down when other foods are not tolerated. It is known as a “survival” food; George Washington and his troops survived for days during the bitter winter at Valley Forge eating nothing but gruel made from Slippery Elm bark. However, Slippery Elm may interfere with the absorption of certain minerals and pharmaceuticals, so is best given separately from any concurrent drug therapy.

I'm including the link to the article where that quote came from: http://www.littlebigcat.com/health/slippery-elm/

(((Sending hugs)))

[DoxieMama]

I wish so much that we could physically be there with you right now. Be kind to yourself, and give your little one a scratch behind the ears from me.

[Budsters Mom]

Slippery Elm gruel was the ONLY thing that helped settle Buddy's stomach toward the end.

hugs,
Kathy

[Carole Alexander]

Yesterday, I had the second round of blood work completed; Skippy's kidney values had nearly doubled yet again in only one week. There was no possibility that he could recover. Skippy ended his life journey this morning at Purdue where he spent so much of this past year. They will perform a necropsy and I will post when I am able to.

Carole

[Squirt's Mom]

Dear Carole,

I can barely see the keys thru the tears to type. Skippy's journey has been one so many of us have walked with you as best we could and my heart is broken with yours. I know, to great depth, what you are feeling now. So much has changed in the blink of an eye and the one you would reach out to for comfort is no longer there. The questions racing thru your mind too fast to capture or put in words. All those emotions so raw and cutting deeper than you ever dreamed possible. Take whatever time you need to gather your thoughts as well as you can...we will be here for you any time you are ready to talk. Please know we love Skippy and you dearly. You and he have taught us so much and given so many badly needed inspiration. Know in your heart you did all you possibly could to make each day a great one for your precious baby boy...and I know he is grateful for your love and TLC.

My deepest sympathies,
Leslie

My favorite poem and the one that brings me the most comfort...



Beannacht
by John O'Donohue

On the day when
The weight deadens
On your shoulders
And you stumble,
May the clay dance
To balance you.

And when your eyes
Freeze behind
The grey window
And the ghost of loss
Gets into you,
May a flock of colours,
Indigo, red, green
And azure blue,
Come to awaken in you
A meadow of delight.

When the canvas frays
In the currach of thought
And a stain of ocean
Blackens beneath you,
May there come across the waters
A path of yellow moonlight
To bring you safely home.

May the nourishment of the earth be yours,
May the clarity of light be yours,
May the fluency of the ocean be yours,
May the protection of the ancestors be yours.

And so may a slow
Wind work these words
Of love around you,
An invisible cloak
To mind your life.

(From "To Bless the Space Between Us: A Book of Blessings")

[Budsters Mom]

Oh Carole, I am so very sorry. You both fought a very long, tough battle. True warriors indeed.

Athough Skippy's pain and struggle are now over, yours is just beginning. Please return to chat with us whenever you feel up to it. Cry, scream, rant, whatever you need to do. There is strength in numbers. Many of us already have Cushings Angels at the rainbow fields, so we understand the depth of your pain.

Fly Free Sweet Boy, Fly free!!!
hugs,
Kathy

[DoxieMama]

I ... I just don't know what to say that doesn't sound hollow. Much love across the miles.

Run free on the wings of love, Skippy!

[Carole Alexander]

I will reply to your very kind and supportive comments as soon as I am able. Tried to think of something this afternoon to quiet the bizarre,confusing, disquieting and perhaps just plain crazy stuff that happened to Skippy in the past month. This afternoon I thought more about what he meant to me. This is goofy but my small first effort in a crazed mind.


A Decade -
You were my every day and all ways partnership
The walks, the talks, the barks, the farts
The growls, the howls, the baths and the laughs
The balls in streams and your wild dreams
You licked me, bit me, snuggled and kicked me
When you were hurt you would hide
I would coax you back by my side
When Cushing’s hit you with a jolt
It hit me like a lightning bolt
These past years
So often full of tears
You fought off the perils, brain tumor, radiation, and pancreatitis -
You said bring on your slings and arrows
Last month your kidneys failed
My heart was impaled
I cursed you and nursed you
I kissed you and hissed at you
I held you and huddled by you
I researched and read
Your diseases fill my head
I shopped and I cooked a potpourri of tasty treats
None of which you would eat
When they said you were dying
I said no, you are lying
I was wrong
You were strong
So I’ll follow your lead
My Skippy, Godspeed

[labblab]

Dear Carole,

Your words are so moving and your journey alongside Skippy has been nothing short of amazing. Ever since reading about Skippy’s labs on Thursday, I’ve struggled to find words of my own to add here. I remain at a loss, but I just don’t want to wait any longer to at least tell you that even though I am deeply sorry about the story’s ending, I remain so grateful that you have shared Skippy with us. What an incredibly brave and resilient spirit has been housed in that tiny body, and now, to have been released. We will always honor him here, and we’ll always remain a suppprt alongside you.

Sending my warmest thoughts and biggest hugs flying along to you in the absence of your beloved little partner.
Marianne

[Budsters Mom]

Beautiful words from a loving mom describing her amazing boy. Thank you for sharing Skippy's journey with all of us. Several of my fur babies are off happily frolicking in the rainbow fields. Or, at least, I need to believe they are. Skippy wil never be alone.

Kathy

[Squirt's Mom]

Your poem is beautiful, Carole, and so heartfelt. I know Skippy hears your words and rejoices in the life and love he shared with you.

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

[Joan2517]

Dear Carole, I don't know what to say except how sorry I am that Skippy has passed. I have been following along and hoped I would not see this, even though I knew in my heart that it was coming. He put up a good fight, the darling boy. I am sure he did not want to leave you, a mom who would not give up on him.

Rest in peace, little boy. Take care of yourself, Carole...

[Harley PoMMom]

Dearest Carole,

I'm at a loss for words, I just don't know what to say, as there are no words that can help ease the pain you are feeling. You both are truly an inspiration and I am in awe of the courage that you and Skippy displayed through it all. We are here, Carole, with our arms outstretched to wrap you with our love and support. Come back to us at any time and we are ready to talk with you, grieve with you or just sit quietly and hold your hand, we love you, dear Carole.

I am so, so sorry.

With Heartfelt Sympathy, Lori

[Whiskey's Mom]

Dear Carole,
I have no words except I'm sorry- and I offer you my love, comfort, condolences and understanding. Skippy was so lucky to have you as his Mom, and you were lucky to have him as your boy.
Annie

[molly muffin]

Oh Carole :( I am so very very sorry to read of Skippys passing. Your poem is beautiful. You two had such a journey and it was so inspirational. We will always thank you for the knowledge that you and Skippy shared with all of us here at k9cushings. You are a wonderful researcher and did so much to help Skippy and to allow him that extra time with you.

It is never easy to say goodbye to our best friends and I don't have any words to ease that journey. It is long and painful and yet it is what it is because we loved them so much. :(

Sending you big hugs