Glad to have found you all...Isa's spirit is now free

[Isa Brat73]

I apologize, in advance, I'm on information overload and tend to ramble sometimes....

My name is Jennifer, my baby girl is Isa. I brought her home when she was about a year old, as far as the rescue had been told. She was originally owned by a troll of a woman in West Virginia who beat her, starved her, and left her in the yard as a lawn ornament. Thankfully, someone reported her and she was taken in by ACC. As things moved quickly, she went from ACC to rescue, to foster, and then to me in a matter of about 5 weeks. She was skinny at 35 pounds, confused and withdrawn. It took about 4 months for her to actually start acting like a boxer should. I have put so very much into her over the 11 years I have had her and she has given it all back to me ten fold. I chose her name as a nod to my heritage and her beginning in life (Germanic - it's meaning is "strong willed"),never expecting it to mean she would once again need to be the embodiment of her name in her golden years.

We are at the beginning of this journey with Cushing's and it seems with each article of information I pull up things seem to be good news, then bad; prognosis information varies from great to guarded to poor. Everything seems to contradict the last thing I read and my head just can't really wrap around much of it as it keeps changing. All I do know is that it appears she has it. We will be going in next week for the Low-Dose Dex test.

My vet put her on Ketoconozole about 3 weeks ago (200 2x daily) along with Milk Thistle and Sam-e. The only change I noticed in her at all was extreme lethargy, to the point I would have to wake her up to go out for potty breaks. We cut the dose in half and she's not as lethargic, but the drinking and urination is just insane (she'd drink a 16 ounce bowl all at once if I let her and pees at least 10-12 times during the day). She gets grumpy with me because I interrupt her gulping water and make her drink smaller amounts, more frequently, because she takes in so much air I'm afraid of bloat! She has CC as well. DMSO has been recommended for that, but I can't see how putting something on her that I have to wear gloves to administer can really be good for her. She's shedding so very much and needs a bath, but I swear if I give her one she'll come out a naked! I've also noticed her third eyelid isn't retracting as it should be. The vet said that it is possibly Horner's Syndrome, so that's another thing I have to be looking into. Although, it does seem to be going away a bit the past few days.

The vet said since I've seen no noticeable change in her with the Keto, I can take her off of it and the next step will be the Low-Dose Dex test and Trilostane. We just did her senior blood panel and thyroid testing (I don't have the results here, though I'll request a copy next week), and everything but a slightly elevated liver enzyme was normal.

Right now, I guess, I'm just a little lost with all of this. Is there anything going into the test next week that I need to be aware of? Something I should be looking for, or asking the vet?

It upsets me that this poor girl had to fight just to survive her first year of life and now she's heading into a fight for her final years. She's been through Hell and back in her own life, and by my side for my own struggles. Until now, her spirit has always been high and easy....now she's tired and mopey.

Any thoughts or info would be greatly appreciated as we head in next week. I just want her to be comfortable and happy for as long as she chooses to be here with me.

Thank you all for creating this space for everyone to be able to find some solid information and support. Sorry for the lengthy "Intro Post".

jn

[DoxieMama]

Hi Jennifer! Welcome to you and Isa (love the name), though I am so sorry for the reasons you've joined us. You have found the BEST place on the web to help you sort through the myriad of information out there, and the greatest support group as you find your way through this journey with Isa.

One thing that jumps out at me to ask is if you've ruled out a UTI? With the senior blood panel I'd assume that with "everything (but liver enzyme) normal" means that she doesn't have diabetes. The thyroid results will also be interesting once you have those... for the admins and other folks who know how to interpret such results.

The only other thing I want to comment on now is that it is not recommended to withhold water from a Cush-pup. If your concern is bloat, maybe a different sort of bowl for her to drink the water would be beneficial? If she does have Cushing's, then she needs all the water she wants to drink. Others can explain the reasons why better than I, so I'll leave that to them. :)

In the meantime, have a look around and get comfortable. There's a ton of information available for education, as well as personal experience from numerous members over the years. Please feel free to ask all the questions you have, and don't worry about your rambling. Some of us are good at that, too. ;) Honestly though, the more information you can provide about Isa, her symptoms and test results, etc, the better support we can provide to you!

I look forward to learning more about your precious girl and once again, welcome!

[Isa Brat73]

DoxieMama...thank you for the welcome.

She had a UTI last year, but it was cleared up quickly. That was when I first started to notice and increase in her water consumption, urination, and panting (though being a boxer, she tends to pant more than most breeds). I took her in two months early for her annual this year because of an additional uptick in her water consumption and a few accidents in the house to rule out another UTI. She also had what I though were hives breaking out on her flanks (we now know that is CC and it's looking quite awful and she's lost her hair around those areas). When her blood work came back, they did say her T4 was off and did the additional thyroid testing to rule that out ~ her thyroid levels came back normal.

I didn't mean to imply in my post that I was withholding water from her at all. She drinks between 4-5 16oz bowls a day. I just tell her "enough" so she takes a short break from drinking and allows herself to burp rather than fill up with air. The only "bowl" that is off limits to her is the toilet bowl. Until a few months ago, I have never had to worry about her drinking from it but I found her with her head in there drinking away one afternoon (despite both of her other water bowls being full). She sleeps with me and the thought of whatever germs there are in a toilet bowl being in bed next to me just kinda grosses me out...LOL

The whole situation just kind of stresses me out. Especially since we're right on the heels of dealing with some issues with my mother's Maltese mix (who serves as a seizure alert dog) that resulted in her having to have both of here eyes removed. She came through it all well and has adjusted (so long as no one forgets to push their chairs back under the table or leaves something out of place).

For now, I'm trying to just find as much positive info as I can until we get in for testing next week. With Isa being 12ish, I know my time would already have been limited if she was healthy. I just want her to be happy and feel loved for as long as I have her with me. Her beautiful black mask is all white now and she's just as pretty as ever. Rather than call her a "silver boxer" as many do when they grey out, I call her my little "frosted flake".

[labblab]

Hello Jennifer, and welcome to you and Isa from me, too! Thanks so much for all the information you've already given us, and we'll also be anxious to see those LDDS results next week.

At this point, I only have a couple quick questions to ask. The first relates to the thyroid testing. From what you've written, I'm guessing that Isa's T4 level was/is low, but that the more comprehensive testing indicates that the low T4 is likely secondary to another problem (such as Cushing's), as opposed to bring a primary disorder in its own right. Does that sound accurate? If so, it's true that the T4 reading can expect to normalize once elevated cortisol levels become well-controlled.

As far as Isa's skin lesions, have they actually been biopsied to confirm CC, or cultured to determine if they are infected? Anecdotally, I have to say that boxers seem to be over-represented here in terms of suffering from CC :o. However, Cushing's can also leave dogs vulnerable to skin infection, generally. So if the lesions are not CC, or if infection is additionally present, there are medicated shampoos and sprays that can be very helpful in terms of infection resolution. I have a non-Cushing's Lab, for instance, who suffered from staph lesions for months until we discovered a medicated shampoo that helped even more than did oral antibiotics.

Thanks in advance for any additional info you can give us. And once again, welcome to you and to your sweet girl.

Marianne

[Squirt's Mom]

Hi Jennifer and welcome to you and Isa! :)

Bless you for taking her in and giving her a loving home, teaching her what it means to be a loved dog with her own place in a family. That takes a special kind of person! I know Isa's heart is swollen with love for you for all you have and are giving her.

If you have not stopped the Keto altogether, I recommend that you do so asap. It is VERY hard on the liver and a cush pup's liver is already working overtime. A cush savvy vet typically will not use Keto. I am also a bit concerned that she was given this harsh drug based on a diagnosis of Cushing's yet has not had the LDDS. Has she had any other cush testing like an ACTH and/or abdominal ultrasound? If not, what did her vet based the diagnosis on? When CC is confirmed by testing that is usually a pretty strong sign, ALMOST 100%, it is indeed Cushing's but I am one to be overly cautious so it concerns me that she may not have had the testing needed to diagnosis Cushing's. ;)

Like you, when my Squirt was first diagnosed I read everything I could find and ended up in a real tizzy. My emotions were all over the place - fear, anger, guilt - to name a few but abject terror over-road all else. By the time I found our family here I was a real mess. But with gentle lessons and support I was soon able to breath and learned what I needed to know to help my Sweet Bebe. She lived a good long while after the diagnosis bringing joy to my every day. She passed at the age of 16 yrs and a couple of months from simple old age complications, not Cushing's. There IS hope with this disease so take a deep breath and get ready to learn more than you ever thought possible about a disease you had never heard of prior. :D

I am also honored to be mom to a blind baby who has no eyeballs. She had a brother who was also blind but did have his eyes. These little Souls typically adjust much better than us humans and are able to navigate their dark worlds in myriad ways. My little guy with eyes worked by touch and sound while my baby still with me operates with something similar to a bat's sonar. She is absolutely amazing to watch and folk are always surprised when they realize she has no eyes! I love watching that reality dawn on them. :p There are things you can do to help them. Never move furniture once they have learned their way around. Some people use rugs of differing naps in the doorways of each room so the dog knows where they are. Others use different scents in the doorways to serve the same purpose. My little guy, Brick, needed protection because he was my little pinball, bouncing off of things constantly as he ran around so I had bubblewrap on all the legs of my furniture, on the corners he could hit and anything else he was able to plow into. Good Housekeeping never did list my house for some strange reason! :p:D:p Watch your mom's baby and she will help you understand what she needs.

I'm glad you found us and look forward to learning more as time passes. You should know that you and Isa are now part of our little family - you are no longer alone and will never be alone throughout her journey.

Hugs,
Leslie and the gang

[Isa Brat73]

Marianne,

Yes, she was tested because her T4 was low and the additional thyroid panel came back within range. So she isn't concerned about it being hypothyroidism. The CC has not been confirmed via diagnostics. Based on how it initially presented and how it is now, she is fairly certain that is what it is and a result of Cushings. It originally looked like hives, the hair around it then fell out, the bumps turned a yellowy puss filled color then kind of a darker blackish. Now the areas are shedding the top layer of skin and it's looking like a field of blackish pellets just below the skin. The areas are warm to the touch, but so far there has been no sign of them weeping or oozing.

Leslie,

She's had no other testing done for Cushing's, she's based it on the fact that Isa presents with just about every "classic" sign of it. The only box on the checklist I cannot exactly check off is the increased hunger. I don't free feed her and she's ALWAYS eaten her meals like it may be the last one she's ever going to get. Though she has stolen a few crackers I left sitting on my end table when I left the room, something she's never done before.

My assumption was that she wanted to give the Keto a try to see if it would help, but wouldn't go with anything else unless she did the LDDS first. She is an older vet and has been with our family animals for as long as I can remember. I've had to take Isa to the E-Vet a time or two but they are all very abrupt and just shove your bill and any meds at you without really discussing much (They also act as a primary vet...when they wanted to use ACE on a boxer I walked out and never went back).

She was a little "broken" when we brought her home, but we had adopted an Aussie/Catahoula mix at the same time (poor guy, we were his 5th or 6th home between being adopted and returned several times...he was only 6 months old!) So we did have a little help teaching her how to be a dog again and learning how to play. We lost him to intestinal tumors when he was about 2, his spirit and goofy personality are still missed.

All the info out there is a bit head spinning, so I gave up for an afternoon and decided to search out "member boards" for personal accounts of dealing with this disease. I often find that there is more "real" and manageable information to be found there. I passed up several others I found and just started poking around here finding it a more welcoming and supportive environment.

I thank you all for putting it together and keeping it going for people who are wading through the quagmire of information overload and helping to make sense of it all.

[Isa Brat73]

We have an appointment for the LDDS test on Thursday and I plan to get a copy of all the current test results as well as the blood panel that was done last year.

I took a pic of one of Isa's sides where the vet is saying that the skin issues is more than likely CC. It started up looking like hives about 4 weeks ago, now it looks like the pic. (I put the pic in my album and made it public, I haven't figured out yet how to insert a pic into the post.) Does it look like CC, or should I go ahead and have her do a skin scraping while she's in on Thursday? I've noticed the bumps breaking out around and under her nubby little tail, but they don't seem to be bothering or itching her.

Any thoughts about what it might be aside from CC? Also, has anyone tried Vetericyn with their pups (whether for CC or any other skin condition)?

Thank you again...
JN

Admin Note: Adding link to Isa's picture showing possible calcinosis cutis

http://www.k9cushings.com/forum/album.php?albumid=1162&pictureid=8748

[labblab]

Welcome back, and I'm glad you've got the LDDS set up because, yup, that picture does look like CC to me :o. Here's a link to the photo of another member's dog for whom CC was definitively confirmed via biopsy. It seems to me that there's a strong similarity.

http://www.k9cushings.com/forum/album.php?albumid=805&pictureid=5963

I do believe that a confirmed diagnosis requires an actual tissue biopsy; I don't think a simple scraping is sufficient. But if the LDDS turns out to be positive for Cushing's, I believe I'd just go ahead and assume this is CC and treat accordingly.

As far as the Vetericyn, I'm not sure about the current status of the product's formula -- it underwent a change back in 2015. Here's a link to a thread I posted about the issue back then. I, myself, shifted to purchasing Microcyn for general wound care for my dogs.

http://www.k9cushings.com/forum/showthread.php?t=7340

Do let us know how the LDDS turns out, and we can also refer you to other members' discussions of lesion care for their dogs with CC.

Marianne

[Isa Brat73]

Thank you for the link on Veterycin, I'll have to take a look at that in the morning. I'm just trying to find an alternative to DMSO before the CC gets too much worse. Currently, it's dry and flaking a bit but from what I've been seeing here and through other research...it won't stay that way for long. I've tried my best to keep Isa on a more natural path, limiting unnecessary meds and vaccines, and see no reason to put something like that on her unless there is no other choice.

She's been a good bit perkier since we stopped the Ketokonazole, but still just not quite herself. The hyperkeratosis on her nose has settled down a little as well, but I'm not sure if that's from stopping the Keto or the salve I put on it.

Hopefully, the vet will let her take her blanket with her on Thursday. She's never had any issues at the vet, but she's also never had to stay there (outside of her spay 11 years ago). She's happiest when she's "nesting" in her blanket and snoring like a buzz saw.

[Isa Brat73]

Well, Isa's at the vet for the day for her LDDS, and she was not a happy camper when she was taken upstairs. She's never been taken up there and wasn't sure why I wasn't coming with her. I guess she'll be getting some chicken in her dinner tonight to make her happy and stop with the inevitable "stink eye" she'll be giving me. LOL.

Kinda quiet around here right now.

[Joan2517]

Awww... it's so hard when we can't explain it to them. I was a wreck leaving Lena at the vet's for the day. She was not used to me leaving her EVER! She forgave me though...and Isa will too.

[Isa Brat73]

Won't have the LDDS results until tomorrow, but I did get a copy of the blood work from this year and last. I was going to try taking a pic to post them, but the copies are terrible and I doubt anything could be read. Let me know what bits you all normally ask to see and I can post them.

Also, what numbers should I ask for from the vet when they call with the LDDS results tomorrow. I probably won't be over that way until next week to pick up a hard copy.

Isa was great for them at the vet's office today, just hung out and watched the goings on quietly, no barking or whining. She was not so much happy with me when I picked her up though......the little turd looked at me and walked right past me to wiggle and say hello to another person waiting to pick their pup up from surgery. Even after some chicken and a few bits of plain pasta I'm still getting stink eye from her. LOL

[DoxieMama]

Aww I hope she doesn't give you the cold shoulder for long!!

As for the blood work, what we normally like to see is just those values that are abnormal. List those numbers and letters along with the normal range that the lab shows, so we can see how high/low each one is (every lab has a different normal range).

For the LDDS, there should be 3 numbers.

[Isa Brat73]

Here are the abnormalities from the past two years blood results:

2016:

Test: Result Range
Alk Phosphatase 276 5-121
Cholesterol 482 92-324
PrecisionPSL 355 24-140
T4 0.6 0.8-3.5
Urinalysis: ph was a little high (8), and protein was 2+

2017 (same test company and range results as above):

ALT (SGPT) 145 12-118
Alk Phosphatase 922
Cholesterol 628
PrecisionPSL 738
T4 0.5
TSH 0.39 0-0.60
Free T4 9 8-40
Urinalysis is about the same, the specific gravity is slightly low, but not all that far out of range (1.010 range is 1.015-1.050

Her LDDS results also came in this afternoon:

Baseline was 4.1, 4 hour was 4.0, and 8 hour was 4.6

The vet said that they have pretty much done all that they can do for her and want me to take her elsewhere to get an ultrasound and ACTH Stem Cell test. Most of the local area vets that I was able to contact today (I didn't get the results until after 4pm) are all unable to accommodate the ultrasound testing. I'm irritated and frustrated at this point because it's Saturday and I can't really gain any traction until Monday.

So, I get to sit here and stew until then and try to figure out what options I have and what I'm willing to put my girl through.

[Squirt's Mom]

That PrecisionPSL JUMPS out at me and makes me concerned she is going into, or HAS, pancreatitis. Just in case - feed her small meals 4-6 times a day til you can get her into the vet and do your best to limit the fat in her food til then. Is she walking with a hunch in her back? Is her tummy sensitive to touch?

[Squirt's Mom]

Here are some links on this relatively new test by Antech -

http://precisionpsl.com/faq.html

http://precisionpsl.com/

http://precisionpsl.com/about.html

[Isa Brat73]

She's never shown any signs of pancreatitis, no tenderness in the belly or bowel issues. She's always been a little "roach backed", but I believe that is because of poor breeding and poor/lack of nutrition her first year of life. She's on a scheduled feed twice a day, but I'm currently looking into changing her food to lower the fat content and adding a supplement for the high cholesterol.

[molly muffin]

Hello and welcome from me too. I remember that Lori's dog never showed signs of pancreatis but showed on an ultrasound that he did indeed have it.

I think an ultrasound is a good bet at this point and I'm surprised that your vet didn't give you a consult to an Internal Medicine Specialist. Do you have a vet ER near you or a university that has a vet school? That might be an option to call and ask your vet if they can give you a consult if one of those is near you and requires one.

How frustrating that they just said this is all they can do and not leave you with any options or a clear cut plan and on a weekend! I would find that frustrating too.

Since there was no suppression shown on the LDDS they are thinking I am sure that an ultrasound is needed to check for a tumor on the adrenal gland.

Keep in mind though that finding out about the pancrease is important as you can get a false positive on an LDDS test or any cushing test if there is another chronic illness involved.

[Isa Brat73]

I'll be on the phone again tomorrow trying to find somewhere reasonably close that has an ultrasound. In my frantic calls on Friday, there were three places that were close that were of no use (either they didn't have a diagnostic ultrasound, or they did and had no one who could use it). There is a place about an hour and a half away that can do everything in the same day, but it's going to be about $1000. If I can find someplace less expensive and closer, it would be better. The closest internal medicine vet is also over an hour and a half away. I believe UGA is the closest Vet School to me at that's over in Athens (I'm south of Atlanta). Two of the three locations I mentioned above, were ER vets.

She's not been drinking quite as much yesterday or today, but I think it's more that she's just been sleeping more. She'll drink half a bowl at a time when she gets up.

I suppose it's just gotta be one step at a time until the money runs out or the wheels fall off.

By no means am I dismissing the possibility of pancreatitis. I just figure it can be addressed when I figure out where I'm going next (for ultrasound/testing). I can't be too upset about my vet saying there's nothing more they can do for her. At least they're honest and not just tossing a turd against the wall hoping it'll stick. I've seen that happen with several friends before moving away from Virginia.

[molly muffin]

That is true, better if they are upfront. 1000 seems like a lot for an ultrasound.
I think that you can do better than that.
I'm in Canada and we're usually more expensive than the states and I think our ultrasound to start with was around 400 or 350 and then a follow up ultrasound was only 70 after that done at the same place.

The ultrasound should be able to show you all the organs including pancrease which should clear up a few things at the same time.

[Isa Brat73]

The ballpark of $1000 includes the consult fee, ACTH test and ultrasound. The ultrasound itself would be between $500-$650.

My regular vet recommended trying to get the ultrasound and ACTH test done at an animal hospital prior to finding an IMS. Once I had those results in hand, they could do a referral, if needed, to an IMS.

Looks to be a long day for tomorrow. On top of all the calls to make, my Jeep was at the shop last week for two days longer than it should have been and I'm behind on getting some things done. Between the Jeep and Isa's vet bill last week, I spent over $1000, so another week with a big ole vet bill just doesn't make me happy.

[Squirt's Mom]

We are in Arkansas and Trink's ultrasounds are less than $200! At $1000 a pop we would be guessing at what's inside! :D Goodness I sure hope you can find someplace less expensive.

[Isa Brat73]

Finally found a place that's close and much less expensive (as far as the office visit and ACTH go). The ultrasound is the unknown, but the gal I spoke to believes it will be about $200 (that's what her chart said for "abdominal ultrasound"), so I'm hoping it will be around that.

Thankfully, I have a pop (actually, step-dad) who cares about me and loves Isa too. I've been living with him and my mother for about a year, helping him take care of her and allowing him much more freedom. He keeps telling me, "It is what it is, like a people doctor, you pay the fees that are charged, just let me know how much."

We go in tomorrow for the consult and review of her blood work and testing. From how the gal spoke, I should be able to get in again before the end of the week to get the ACTH test and ultrasound.

Is there anything I should definitely be asking tomorrow while I speak with the vet?

[labblab]

One note of caution about the ultrasound: the adrenal glands can be very difficult to visualize, so in order to be useful, the imaging needs to be done using high resolution equipment and interpreted by a knowledgeable technician or radiologist. Not every general vet practice may have ultrasound equipment that is sophisticated enough to give you the info you need. So when you talk with the vet tomorrow, do inquire about the capability of their equipment.

Marianne

[molly muffin]

Family is great support to have.
Glad you found it cheaper. Just make sure that they will be able to imagine the adrenal glands and have done it before successfully. I'd ask if it is high resolution also, just so you don't throw away any money.

[Isa Brat73]

I will certainly double check about the ultrasound before scheduling it. When I spoke to the Animal Hospital, they said they had what she said was a diagnostic ultrasound and the staff to use it. Everyone else either had the equipment and no one to use it, or only had a basic ultrasound.

When I picked up her LDDS results this afternoon, I did find out why they sent us elsewhere for testing. They do not keep the testing agent on hand because it is expensive and they've never had enough call to keep it on hand or use it before it expires. If I choose to go forward with treatment, my regular vet will order a vial specifically for Isa because she will need to be retested at intervals that would merit them having it on hand for her. Apologies were made for how things were handled on Friday and one of their techs gave me a short rundown on prices for the testing and trilostane, as well as what dose she would need to be started on.

As I was leaving, I ran into the head vet tech (who is also the vet's husband) and had a long chat with him about treatment. They have a Cush dog themselves, and it is their favorite dog. As the dog's vet and owners, they've chosen not to treat for Cushing's because of his age and how hard the treatments can be on the body. By no means was he trying to push me one way or another, he was just giving their choice and experience with their own situation. It was nice for him to take the time to talk about the "why" involved in their choice and what they do, quality vs. quantity, etc.

With Isa's age, I'm still a bit up in the air about what to do. It's not something I have to decide on the spot, so I'm at least going to do the consult tomorrow and the ACTH and ultrasound. I just truly, truly, hate the fact that she had such a crappy start in life and now she's got to deal with this at the end of her years. I had hoped that it would be different for her.

I've put a lot of work into her over the years and overcome so many obstacles and issues. From teaching her how to be a dog again, to not cowering waiting to be hit when I'm chasing a fly with the swatter, to learning how to play, to not hiding under the bed thinking the vacuum cleaner is going to eat her ~ I've never begrudged a moment of the frustration. The few things I've not been able to train her out of, I've carefully managed so no one got their feelings or persons hurt (she's got food aggression issues when it comes to other animals, people messing with her food is just fine with her though). Once she settled in, she's given me nothing but unconditional love and has worked hard for me to learn what it was I was teaching. Just kind of bites that this is the situation we've ended up with now.

Lots to think on, but I'm going to try to not let it get the better of me until I know more and have these tests done. It just sits a bit heavy on the heart for me.

[labblab]

I'm popping back in to wish you good luck today, and also to mention a couple of things. I'm afraid the first is a belated comment, since you already have the ACTH scheduled. But especially if it turns out that Isa has an adrenal tumor, don't be surprised if the ACTH doesn't register in the "positive" range for Cushing's. The ACTH has a track record of returning more "false negatives" than does the LDDS in dogs who actually do have Cushing's, and especially for dogs with adrenal tumors. So given Isa's positive LDDS along with her symptom profile including the highly suspicious skin lesions, I'd tend to trust the Cushing's diagnosis regardless of the ACTH results. This doesn't mean the ACTH is worthless, because it may indeed corroborate the diagnosis. And even if not, it can be very helpful to know a dog's baseline ACTH result in the event you do opt for treatment. Since the subsequent monitoring results will be your guideposts regarding the effectiveness of dosing decisions, it's very helpful for comparison purposes to first find out the pretreatment cortisol level.

Secondly, if you do opt for trilostane treatment, it's important to know that current recommendations are to begin at doses that don't exceed a formula of 1 mg. per pound. Also, it is possible to order both brandname Vetoryl and also compounded trilostane from reputable internet veterinary pharmacies at prices that are often much lower than what vet's offices charge. So prior to placing an order for purchase through your vet, do return to us so that we can discuss both the dose and the pricing beforehand.

OK, once again, good luck today, and we'll be really anxious to hear the results!

Marianne

[Isa Brat73]

I've not had the ACTH test done as of yet, today is just a consult for them to review the info I already have. In the event I do decide to treat, I know I'll need the test done, so it makes sense to have it done at the same time she's in for the ultrasound.

I'll post later with what the new vet has to say about the whole situation.

Thank you for the well wishes.

[Isa Brat73]

I apologize, in advance, if I ramble a bit and the post gets a little long. The Animal Hospital trip today was not exactly what I though and I left a little irritated. Firstly, whoever it was I spoke to the other day was incorrect about their ultrasound...they have a basic machine that "we may be able to see what we're looking for". Secondly, they just assumed that I wanted to walk out of there with a $90 box of Denamarin. Not saying that I wouldn't use it, but I can certainly get it for less than they are charging.

On a better note with them, there was no charge for the visit because they do no cost "second opinion" visits. We talked about options, both treating her and not treating her for the Cushing's, dosing amounts, etc. They said they would look into finding somewhere closer than St. Francis AH that could do the ultrasound and also if there is anything that can help the CC (I know it will not go away unless I treat Isa, but maybe they can find something that can make it a little more comfortable for her).

I'm still sitting on the fence about treating Isa. I'm leaning more towards treating because of the CC and the fact that it appears to be spreading across her little bum and between her shoulders.

I'm asking you all for a bit of clarification:

1. LDDS results were pretty much flat between 4.0-4.6, this would dictate that it is more than likely adrenal, correct?

2. Assuming that it is adrenal, there's no real need for the ACTH test unless I decided to move forward with treatment (then it wouldn't really be diagnostic, but used more as a pre-treatment baseline used for dialing in the amount of trilostane to administer)??

3. Assuming, based on the LDDS, that it is adrenal and I have no desire/intention to put a 12yo boxer through a tricky surgery, there's no real need to have an ultrasound done? Correct?

4. Barring the CC, how quickly would you expect to see improvement in the Cushing's symptoms if I started the trilostane?

5. At her age, leaving it untreated can cause as many issues as there are possibly side effects of the meds?

I'm just kind of trying to figure out the true merit of both sides and what will be easiest for her. I've already been green-lighted on any funds I would need to spend should I decide to go forward with treatment. My folks know how much she means to me and they've both fallen in love with her since they welcomed her into their home. (They are little dog people and thought, especially with her being a boxer, that she would be too much for them to handle having in the house.)

Both vets I've spoken to have given the same dosing information at about 1mg per pound. Seeing as how her regular vet has stated she would order the testing agent for Isa if we go through with treatment, I opted not to go with the new place for the ACTH or ultrasound. I don't see throwing money at something that isn't going to do much in factoring into my decision (as I've already state, I won't put her through a surgery at her age).

As always, any thoughts, opinions, and definitely corrections to my assumptions are greatly appreciated. I'm trying to figure it all out and get through the mounds of information both on this sight and the internet regarding Cushing's. I'm one of those people that gets driven to extreme trying to figure out how things work and why (a long line of appliances, toys, and many other items met their demise to my curiosity when I was younger).

I'm also looking into a formulation for dogs for liver support. Currently, she is taking "people" milk thistle and Sam-e. So if anyone has suggestions for that, I would greatly appreciate it. As well as anything that has helped reduce the inflammation of the CC.

Thank you all for being there and being patient with those of us who are just beginning our journey with Cushing's.

[DoxieMama]

Jennifer,

I'm no expert, and will defer to those with more experience than I... but since I have a few minutes this morning I thought I'd throw in my two cents. It's just that, though... my limited experience and personal opinions (somewhat caffeinated but only just ;) ).

I personally did not have an ACTH test done on my dog Visuddha before starting treatment. Our LDDS results along with his symptoms was sufficient to confirm the diagnosis in my mind, and it didn't matter the cause as I would not have put him through surgery either (he was 13 when diagnosed). We did have an ultrasound done but it was later and for another reason. I'd considered it but did not deem it necessary before starting treatment. (If I could have a do-over, I can't say for sure if I would or not... though I think I would.)

As for symptoms, V's PU/PD improved quite rapidly once we started trilostane. I'd have to go back to his log to confirm but I want to say that was essentially resolved within the first couple weeks. That's the only symptom we were really hoping to resolve, as we weren't dealing with CC. His muscle wasting, thin skin and belly weren't an "issue" for us, per se. He never took meds long enough for further improvements.

I did give Visuddha Denamarin, but after the first bottle I switched to Denosyl (Amazon (https://smile.amazon.com/gp/product/B00LK87FTK/ref=oh_aui_detailpage_o00_s00?ie=UTF8&psc=1)) and Milk Thistle (Amazon (https://smile.amazon.com/gp/product/B00M26PEYM/ref=oh_aui_detailpage_o00_s00?ie=UTF8&psc=1)) as they were cheaper (and in the case of the Denosyl, chewable). My vet provided a box of Denosyl (non-chewable) at no cost once, so we used those too.

I'm sorry the trip wasn't as useful as you'd hoped, but glad they didn't charge! That's pretty cool, actually.

Know that whatever you decide, we'll support you - and Isa - in your journey. :)

[labblab]

Thanks so much for all this additional info, and I'm happy to make a stab at answering your questions. ;)

Actually, I'm going to cut to the chase by saying that I think that the possibility of CC is the pivotal issue here. If Isa was my own dog, the first thing I'd do right now is ask my vet to submit a biopsy sample of tissue for actual analysis. If CC is confirmed alongside the positive LDDS, I would feel no need for further Cushing's diagnostics, unless you do want the ultrasound to determine whether or not an adrenal tumor is present. If you already know you wouldn't opt for surgery, regardless, then the ultrasound is likely a moot point. As far as the ACTH, it's nice to have baseline results prior to beginning treatment, but it's not necessary.

So aside from diagnostics, why am I harping on the CC? It's because without any doubt, uncontrolled CC can raise the biggest immediate quality of life issue for an afflicted Cushpup. It can explode in severity, and render a dog's life miserable. I believe we have suffered through more forced euthanasia here as a result of CC than any other direct Cushing's symptom. And unfortunately, boxers seem to be especially vulnerable. :(

In terms of resolution of other classic symptoms, the time frame can be variable. My own boy stopped his excessive drinking and peeing within three days of starting trilostane. But for others, it can take several days to several weeks to see relief. But turning back to the CC, unfortunately it can continue to worsen for a while even when treatment has started. But as I said above, in the absence of treatment, the lesions can explode. So if my own dog was definitively diagnosed with CC, I would run -- not walk -- into treatment.

Marianne

[Harley PoMMom]

Renee, a member here, is our resident expert when it comes to CC, she and her sweet Tobey have had a couple rounds treating that CC. I'm including a reply she posted to another member who was also dealing with CC:
Hi there,

Just checking in to share with you my experience and knowledge on CC.

I am sorry your girl is suffering so bad. I can truly relate, as my girl had lesions all the way down her back before we got things controlled.

Firstly - there is no cure for CC, other than lowering the cortisol. What I am unsure about with your girl, since her's is induced by pred rather than traditional cushings, is how low her cortisol needs to go. In a normal dog suffering from traditional cushings, the cortisol needs to come into therapeutic range of below 5 ug/dl and stay that way long-term. In a dog that has CC induced by pred, assuming traditional cushings is not at play, I would make a best guess that just getting off the prednisone will lower her into the appropriate range her body would naturally be at.

There are many different ideas about what may help or not help with CC. My personal opinion, through trial and error, is that DMSO is a complete waste of time. It smells horrific and I found absolutely no significant improvement that made it's use worthwhile.

Instead of DMSO, I would suggest a combination of tea compresses on the lesions, tramadol for pain (if that is an issue), and adding probiotics to her meals. You'll probably need to run a course of abx on occasion, as the lesions are highly susceptible to secondary infection. There is also a topical spray some have used, but I cannot think of the name off the top of my head.

Some people have used medicated weekly baths, but I felt that too much moisture was actually detrimental, and I never bathed my girl until she healed up somewhat. The lesions will crack, bleed, ooze, look raw and angry. Getting them wet is the last thing they need. You'll know you are heading in the right direction when they begin to dry out and flake, rather than ooze and be angry.

Keep in mind, even as you wean her off the pred, the lesions that are below the surface will continue to come up and break through. It will go through many stages. It will take months for the lesions to run their course and heal up, and that is only if you get her cortisol into proper range.

I see I've typed a lot, so I hope this can help you for now and gives you some hope.

And when you have some time on your hands, I'm providing a link to her thread: http://www.k9cushings.com/forum/showthread.php?t=5908&highlight=calcinosis+cutis

Also, another link to an article where they had success in treating the CC with minocycline: https://www.researchgate.net/publication/264167484_Minocycline_as_a_treatment_of_dog_with_c alcinosis_cutis

Hugs, Lori

[molly muffin]

I'll throw in what I told another member about cc. Keep it clean and dry. clip hair around it and use an antibiotic spray to prevent bacterial infections in the lesions.

CC is calicum deposits that are pushing up and out through the skin. As long as the cortisol is high, those deposits continue to develop and worse case scenerio they can develop internally as well. That is something you don't want to happen. (eyes, internal organs califying, etc) Once you start treatment you want an ACTH post result consistenly below 5.0ug. This we have seen is where the best chance of the calcium deposits not forming any further is at.
Even once you get that low, every deposit currently under the skin, has to come up and out, so sores can continue for many many months, while those push up.

I think that is pretty much the main sum of my knowledge of CC.

[Isa Brat73]

Thank you for all the info. I am going to try to get a hold of my vet today and talk to them about starting treatment. I'm not sure if they are stuck on getting the ACTH test done before starting trilostane or not. If so, I'm not sure when they can get what they need and get treatment started.

I have noticed that she is drinking and peeing a little less than usual, but she is sleeping more. It's only a minor decrease (about a 16oz bowl less per day and a few less trips outside).

Hopefully, she will respond well once we start treatment and I'm not putting her through all that treatment entails for nothing. I'm not sure I would at her age if it weren't for the CC.

[Isa Brat73]

Between the vet not getting the meds in quickly and dropping the driveshaft in my Jeep, I'm just getting Isa set up on taking the trylostane. She's about 65# and she's being started on 60mg daily. Today was day two. I'm dog sitting for an old neighbor, so I have my Pops keeping an eye on her while I'm out. So far, so good, and there have not been any adverse reactions. She will go back to the vet in two weeks for the ACTH test and a blood panel. Is there anything I need to make sure to ask the vet when she goes back in, and what kind of numbers are we looking for with the ACTH test? We did not do one prior to her starting the Trylostane.

Before starting the meds, she stopped drinking as much (was between 4-5 16oz bowls, now down to 3 bowls). Should I be concerned if she drops below that amount?

To any members dealing with CC.....what should I be looking for in the progression of the condition? It started out looking like hives, then skin started sloughing and exposing the dark spots/bumps. It's spreading, but not rapidly. The areas affected are still dry and if I gently rub over them with my fingers I am gently dislodging flaking skin and sometimes little blackish "pebbles". It started about 2 months ago and is still dry....there is no bleeding or oozing that I've seen in pictures. I've tried to find a site that has pics of how it progresses, but there don't appear to be any out there. I have a pic of what it looked like last month in my photo album and it still looks much the same. I have a spray that was recommended, but don't want to use it unless there is bleeding/oozing as from what I've read you want to keep it dry.

Any thoughts, info, or suggestions would be greatly appreciated. I want to make sure I'm doing the right things and not making things worse. Because of her age (12yo boxer), I was unsure about treating at all, but with the CC in the picture, I can't not treat her and possibly end up letting her go because of a skin issue that may well be lessened/resolved by treating.

Also, is it best to give the full 60mg in one dose, or has anyone found it easier on their pups to split the dosing during the day? Currently, I have no choice, but if it seems to work I'll be looking for an alternative source for the meds (it's about $70 for 30 capsules).

Thank you again for being here and sharing your wealth of knowledge with all of us who are new to Cushing's and struggling to find our way through the maze of information.

Jennifer

[Joan2517]

I just noticed you're from McDonough, GA...I have a very good friend who lives there. She used to breed Salukis...we bought one from her in 1990! Our Isis died in 1996 from Canine Lymphoma, but we have stayed friends for all these years.

[Harley PoMMom]

Gotta make those post quick, I'm at work and right now we are so busy :eek:

Two very important rules that have to followed with Trilostane: it has to be given with a meal to be absorbed properly; those monitoring ACTH stimulation tests have to be performed 4-6 hours post pill. I would ask the vet if they are following these two protocols.

The ACTH stimulation test consists of two blood draws. One is the pre number which is what the cortisol level is at resting and is known as the baseline. The second blood draw entails injecting the stimulating agent, generally Cortrosyn is used, and taking a blood draw 1 hour later, this number is the post stimulated value. Trilostane's therapeutic ranges are 1.5 ug/dl - 5.4 ug/dl and if clinical symptoms are controlled that post can be as high as 9.1 ug/dl.

Adverse effects to be on the lookout for are: vomiting, diarrhea, lethargy, loss of appetite, or Isa just not acting herself. If any one of these symptoms are noticed stopping the Trilostane is advised.

You will find a wealth of information about CC from Renee, our resident CC expert, I'm providing her link again: http://www.k9cushings.com/forum/showthread.php?t=5908&highlight=calcinosis+cutis

Renee also has an album with various stages of CC: http://www.k9cushings.com/forum/album.php?albumid=805

As far as once vs twice a day dosing it is dependent on the dog and/or the vet's preference, however if diabetes is in the picture than twice a day dosing is recommended.

Gosh darn it work calls again :(

Hugs, Lori

[Isa Brat73]

Lori,

Thank you for the links, it was just what I was wanting to see. None of the pics I was finding on the internet looked very much like what Isa's skin looks like. The pics on Renee's album look much more like it. I'm going to try sending a PM to her tomorrow to see if she might be able to answer a few questions about CC.

Today is day three of the Trilostane for Isa and I'm not seeing any ill effects. The only thing I've seen that isn't "normal" is a bit of excess eye goop. She's always has eye boogies, but not quite like the ones she's had the past few days. I can't really judge the lethargy aspect because she's 12 and has been lazy the past year or so. I'm just glad that she's an easy girl to pill and I don't have to fight her to get anything in her. Breakfast time, I just plop the pill on a spoon full of wet food and it's gone. Afternoon pills (milk thistle and SAM-e, get wrapped together in a 1/4 slice of cheese and they're gone!

I will definitely make sure when I take her for the ACTH test that I review the testing protocols with them before I go. I truly don't want a false reading that causes any issues with over/under dosing meds. I'm hoping that we can keep her on as low a dose as possible.

With the CC, it is still very dry. I have picked up the MicrosynAH spray, but probably won't start using it until there is breakage of the skin. She seems to enjoy when I gently rub the area right now, but I think it's mostly because it's dislodging the loose dry skin. Once I'm done dog sitting my old neighbor's dog, she's going to be getting an oatmeal bath.

Thank you all again for caring and being so helpful with your experiences, wisdom, and support.

[molly muffin]

I know with cc that Renee saw the best results with that post ACTH number under 5.0ug. I think that has been consistent across the forum for those who deal with cc, so that is your goal.

Good the sores aren't open, they can look pretty gruesome and it is definitely one of the hardest symptoms of high cortisol to clear up, since hair/skin go by cycles, so months.

[Isa Brat73]

It's been just about two and a half weeks since Isa started the Trilostane. She's not drinking or peeing near as much and her non-warranted panting has pretty well abated.

I took her in after 14 days for her first ACTH test and blood panel. Her first sample came back at 2.5 (range 1.0-5.0) and her second came back at 4.7 (range 8.0-17.0). The trilostane seems to be doing its thing and she will stay at the 60mg dose for now. In about 3 weeks, she'll go back for her next ACTH and be re-evaluated.

The vet has her own Cushing's dog that she had previously decided not to treat. After seeing how Isa is responding, they have decided to move forward and treat their little guy as well.

[DoxieMama]

Jennifer,

That's awesome! I'm so happy to read this update. Good results for Isa, and the vet's Cushing's dog who will hopefully respond positively as well! :) What a wonderful start to my day. :)

Shana

[Harley PoMMom]

So happy to read that Isa has had a positive response to her treatment, and that is great news that this has made the vet decide to start treatment for her own dog, though I really don't understand why she didn't in the first place. :confused:

Those stim numbers are awesome but the reference ranges listed are for a dog that is not being treated for Cushing's. The therapeutic ranges for Trilostane/Vetoryl are 1.5 ug/dl - 5.4 ug/dl and that post number can be as high as 9.1 ug/dl if symptoms are controlled.

You're doing a fantastic job!!

Hugs, Lori

[molly muffin]

Very good news and glad the vet will now treat their own dog too!!!

[Isa Brat73]

We go in tomorrow for Isa's next ACTH test. Outside of sleeping a bit more, she appears to be doing better. Her drinking and urinating is about back to normal and she only pants occasionally (outside of what is typical). She's still eating normal and not trying to steal food.

On the down side though, she looks like she's lost a bit more muscle in her rear legs and the CC still isn't under any control. I know that the CC is slow to abate and gets worse before it gets better, but I was hoping she wouldn't break out with as large a new area. She's losing handfuls of hair if you so much as run your hand over her backside. She's got bumps from right behind her ribs all the way down and across her bum. It breaks my heart because she's never had the best coat and now she's got bald patches. I know it can't be comfortable for her, but she's always been fairly stoic regarding aches and pains. So far, though, the CC is not to the point of oozing or weeping or showing any sign of infection.

She was quite pleased on Monday being spoiled by us all for her birthday (12). I'm sure she'll be happy again on Friday for her "gotcha day". Hard to believe it's been 11 years already that I brought her home.

Keeping fingers and puppy toes crossed that her test/blood work comes back with good numbers.

[Joan2517]

Awwww...Happy Belated Birthday, Isa! Hoping for good news on her ACTH test!

[DoxieMama]

Happy 12th Birthday, Isa!!

[Squirt's Mom]

Happy 12th Birthday, Isa!!

[Harley PoMMom]

Happy 12th Birthday, Isa!!

[molly muffin]

Happy 12th Birthday Isa! And a Gotcha day in there too. What a great week.

:) :)

[Isa Brat73]

Okay, so now I'm a bit perturbed with my vet. I took Isa in last week for her ACTH test. I gave her her Trilostane at 8:15am and dropped her off about 9:00am at the vet. I got a call a bit after 11:00am saying she was ready to be picked up and they would have the results in a day, maybe two. After a very irritating and confusing conversation about "how can she already be ready to be picked up" and "we followed procedure, same as last time", I went in to get her. Before leaving though, I went to the Dechra website and printed out their info on Vetoryl and ACTH testing.

Long and short of it is that I'm guessing the test they did at 2 weeks has no real value and we're well over 30 days and waiting for more testing agent. So, Isa's been on 60mg of Trilostane daily for almost 7 weeks and we have no clue if she's needing an increase or what. With the testing at close to $300, they were smart not to charge for their screw up last week, but nothing can be done about the previous test.

If they don't have what they need in by tomorrow, I'm just going to take her to a different vet. Outside of the CC breaking out everywhere now, she seems to be tolerating the situation. The first area where she had the CC break out does have new hair growth and looks better, but the current area is bigger and she's got a near naked rear. It looks awful and I know it's itchy, but it's not oozy or anything thankfully.

[Harley PoMMom]

Oh Geez :mad:

Man, I would be so angry :mad: How is Isa doing? Still have an appetite? Any diarrhea or vomiting? How's the drinking/urinating?

[Isa Brat73]

She appears to be doing OK. Drinking fine, not asking to go out every 45 minutes, not had any tummy upset. Her appetite is normal.....I wake up to her smushy face staring down at me every morning and know in the evening that her dinner time is close when I start hearing the "wailing walrus".

She sleeps most of the day, but she's always been a bit on the lazy side and she's 12. I've been making her walk a bit more when I take her out, but just laps around the house so we can just stop easily when she gives me the look. She's lost a bit of muscle in her hind end over the past 8-12 months.

My biggest complaint is her skin/coat. It just looks awful and I know it's not that pleasant for her. I'm running hers and my blankets through the wash every few days because she's dropping so much hair and flaking skin. She's also a bit smelly, which she's never been.

I just feel bad for her having to deal with this all. At least we have the timing corrected with the vet for future tests and I don't have to leave her all day long. I can drop her about noon and only have her there for a few hours.

[molly muffin]

The thing about cc is that all the calcium deposits that were under the skin have to come out and that causes the newer sores. This makes cc often look and become worse before it gets better.
The key is to have that cortisol at a low enough level that no new calcium deposits form.

Sheeezzzz I'd be po'd too. At least they didn't charge you for this one. What where they doing? Like an hour later? if you dropped at 9, they took a draw at 10 and then another at 11? or sooner?

There are some vets who like to do a 2 -3 hour acth instead of 4 - 6 hour. The main thing is to be consistent. We always did about 4 1/2 - 5 hour with a finish of around 6 hours.

I'd want to know too where her levels are, but it doesn't sound like she is currently having any ill effects so that is a good thing.

[Isa Brat73]

I'm not sure exactly of the timing, but I gave her the vetoryl at 8am and dropped her off at 9am. They called a little after 11am to say she was done and ready to pick up. I believe they told me they drew blood and administered the test about 930am. So, they couldn't have even had 2 hours before or after giving the test on the blood draws.

I know the CC will get worse before it gets better, I was just hoping since the first area that broke out was on the mend and growing new hair that it might not break out quite as severe somewhere else. I'll see if I can post a pic tomorrow of her backside. If she loses much more hair she's going to have a naked bum and I'm going to have to add a doggie stripper name to the long list of nicknames she gets called. LOL.

[molly muffin]

Definitely not within any time frame recommended.

Hmmm Isa Boom Boom brat? :D

[Isa Brat73]

It's been some time since I've posted, but I wanted to thank you all for the information on this site and your help along the way.

Unfortunately, I had to make the heartbreaking decision to let Isa go free. She had started her Cushing's treatment in February of this year and was doing incredibly well with it. Her blood work always came back strong. We tried adjusting the dosage down, but it didn't seem to help as much. Instead, we went to twice daily dosing ~ which seemed to make her more comfortable in the latter half of the day.

In late September, she started to pace around in circles......obsessively. Then had an issue with her ear. I was hoping it was something "simple" like an ear infection or Geriatric Vestibular Disease. Unfortunately, with the symptoms and lack of response to medications, the vet believed it to be the result of a brain tumor. Being that Isa was about 12.5 years old, I make the choice to set her spirit free from a body that was failing, to let her go with her dignity intact.

Our vet was wonderful and came to the house to allow Isa to go in a place she felt safe, comfortable, and loved. She passed peacefully in my arms, curled up on my bed. Dr. Lisa took her with and she was ready for me to pick up the following day. She will be with me always.

[Joan2517]

Oh, I am so sorry for your loss. What a peaceful way to go, wrapped up in your loving arms in her own home. I hope that brings you comfort, I'm sure Isa felt your love surrounding her as she passed into a world where there is no pain, only peace.

[DoxieMama]

I agree with Joan. Surrounded by love, curled up on your bed.. what a peaceful picture.

I am so sorry for your loss.

[Squirt's Mom]

Dear Jennifer,

I am so so sorry to hear about your sweet baby girl but I believe she left this life on the wings of your love. It is never easy to make "the decision" but all to often that is the card we draw and just as you have since the day you found each other you did what was best for her. To be able to take that next step on our journey with dignity is something all living things deserve. I know Isa is so grateful for all you have done for her and for all you have spared her. One day we will hold our babies again, then journey on together always.

My deepest sympathies,
Leslie


When We Meet Again

I was laying on the couch early one day
a dog was barking; from where I couldn't say
I got up from the couch and went outside
then off I went out into the countryside

I took a path thru the bushes and trees
but the sound of that bark kept nagging at me
I followed the path till I came to a river
I reached for a branch and caught a sliver

Under an oak tree I sat down to rest
I watched all the bird's fly from their nests
After a while a group of ducks waddled by
then a fox gave chase so they decided to fly

I walked down the river past a small ridge
and down in the meadow there was a bridge
Down by the bridge thru the fog
I saw what I thought was the barking dog

Like a bolt of lightning in the dark
I knew right then that was my old friend's bark
I looked thru the fog toward the bridge again
and sure enough there was my old friend

As healthy and beautiful as the day we met
I ran down thru the meadow to greet my pet
She ran thru the meadow at such a fast pace
it was like the old days when we used to race

I hugged and kissed her as she licked my face
all her sickness was gone there wasn't a trace
We were together again after such a long time
the sun was shining and all was fine

We walked toward the bridge together again
then we crossed it together me and my friend
This is the way I know it will be
when we meet again my pet and me

John Quealy

[molly muffin]

I too want to offer my condolences on the loss of your precious Issa. I'm so sorry. That is a wonderful that you could hold her close to you.

[Carole Alexander]

I'm so sorry to learn of Isa's passing. What a wonderful mom and caretaker you were to her through this lengthy illness. My sympathy,
Carole

[sammisam]

So sorry to hear about Isa and she is your angel now. I think it's absolutely wonderful that the vet came to the house and Isa was at home, with you in her safe comfortable space.

I didn't even know that vets did this until my beautiful 18 year old kitty was suffering with kidney disease. We kept her alive for two extra years due to my Vet's recommendations and she lived an extra two happy, healthy years.

She started to go downhill and we had to make that decision. We found these two wonderful vets (they're actually husband and wife) in Los Angeles that will come to your house within a moments notice and that at least gave us some peace that Veronica was home. They weren't even our vets, this is just what they do.

I'm so happy Isa had a wonderful life with a great Mom it sounds like. And, I really love she was home curled up in your bed where she felt loved and safe.

Everyone here on this forum has been so loving, so informative, so SMART, so supportive and I'm glad you got to experience that. They ALL are really such a blessing helping us all get through the rough times and the knowledge everyone is has is just beyond words!