Baxter has crossed The Bridge; Question about side effects

[Baxter's Dad]

I'm new here and found this forum thru google. My wife and I have a 13 year old puggle named Baxter. He was diagnosed with Cushing's two weeks ago, and has been on Vetoryl 60mg for six days, with his sixth pill coming this evening. My question is about the side effects, which seem to be worse than the disease. Before he started meds, he was starving and extremely thirsty. He would sit in the kitchen and whine and cry until my wife came in and found a "treat" or something small he could eat. Over the last two months or so, he started drinking water by the gallons and have to go out side all the time to pee. And he lost some weight. His collar is very loose now. But he was active (for a 13 year old) and seemed in good spirits.

We're now six days into his meds and he's like a 20 year old dog. He has no energy at all. He shakes like a paint shaker even when he's nice and warm inside. We live in Indiana so it's cold now and he goes outside to pee, but he's warm and dry most of the time and still shakes a lot. He doesn't have much of an appetite and doesn't want to drink much at all either. He doesn't want to get up and walk around. It's like he doesn't have the energy or motivation to even move.

Is this the meds causing this, or the progression of the Cushing's? It's a huge coincidence if it's the Cushing's since it just started within the last week when his meds started. Should we keep him on them? Does it usually get better? How much does his age (13) have to do with this?

thanks for any insights. I've read a while before posting and this seems like a great place to talk to people with similar situations.

Perry

[Squirt's Mom]

Very quick reply - unless you have a 60lb Puggle do not give any more of the Vetoryl to your baby. The starting dose is 1mg per lb and 60mg sounds like a huge dose for a puggle. Please tell us how much your baby weighs.

Have you seen any loose stools/diarrhea? nausea/vomiting? With the shaking and loss of appetite I personally would be taking him in to see the vet for an ACTH immediately. Cortisol running too high is not life threatening for years but if the cortisol drops too low that is quickly life threatening. He is already showing several signs the dose is too high and has dropped the cortisol too low. I would take him in myself....but regardless do not give any more of the 60mg Vetoryl UNLESS he weighs 60lbs.

[Baxter's Dad]

Thank you so much for the reply. I forgot to mention in my original post that Baxter has thrown up a few times also.

I called my vet right away and talked to him. Baxter is 35lbs. We agreed to cut his dosage in half. He also suggested that we not give him any meds for a couple of days so we're going to stop for now and start up again on Wednesday or Thursday, depending on how he's doing.

In my vet's defense, I remember researching the dosage last week and came up with the same thing he suggested. 22lbs - 44lbs is 60mg starting dose. Oh well, we've got it lowered now.

Thanks again for the quick response and advice. We rescued him at 4 months and he's been our baby ever since. It's hard enough knowing that he's getting older and probably wont be with us for more than a year or two, but then to find out that he has Cushing's and we're possibly OVERDOSING him, let's just say this really sucks.... :(

[labblab]

Hello, and welcome from me, too. I’m so glad that Leslie was able to promptly reply to you because I share her concerns, and am relieved that you’ll stop giving Baxter the Vetoryl. Initial dosing recommendations have lowered dramatically in recent years due to the recognition that unwanted side effects can be minimized by starting slowly and subsequently working upward if appropriate. Here’s a link to a post on our Resources thread that elaborates on these dosing changes. It’s very frustrating to us that some of the written dosing guidelines have yet to be formally updated. But please do take a look at this post, and perhaps even copy it off for your vet to review as well

https://www.k9cushings.com/forum/showthread.php?185-Trilostane-Vetoryl-Information-and-Resources&p=1251#post1251

So discontinuing the Vetoryl is the proper first step. However, it may be way too premature to resume dosing again in just a couple of days, even at a decreased dose. As Leslie has written, overdosing has the potential to create a life-threatening situation if blood chemistries have become unbalanced alongside too-low cortisol. In that situation, emergency replacement of adrenal hormones may be required. So if Baxter doesn’t quickly show some noticeable improvement, I agree that he needs to be evaluated by your vet. Ideally, you will want to check his cortisol level and blood chemistries (most importantly, his potassium and sodium levels) before resuming treatment. Some dogs who have been overdosed take extended periods of time before their adrenal function rebounds sufficiently to require treatment again. Behaviorally, you’ll want to see a return to his original baseline before beginning treatment again.

Also, I want to caution you that if/when you do resume dosing at 30 mg., you cannot open and divide the contents of a 60 mg. capsule. The manufacturer publishes specific warnings against opening the capsules and directly manipulating the powder. So I’m hoping that perhaps you’ve already got 30 mg. capsules on hand. If not, you may even want to start out by purchasing some 10 mg. capsules in order to give you the greatest flexibility when you’re first starting out and seeking to arrive at an optimal dosing level.

I know we’re giving you a lot to think over right now. I surely hope you’ll see some quick improvement. In the meantime, it would help us a lot if you can share any specifics about the diagnostic testing that confirmed the Cushing’s diagnosis. And once again, if Baxter were to worsen any further tonight, I agree that emergency evaluation is in order, as your vet ought to have already advised you.

Marianne

[labblab]

In re-reading your original post, I’m also noticing that you’d been giving Baxter his Vetoryl capsule in the evening. When dogs are dosed once daily, the manufacturer’s recommendation is to dose in the morning, alongside a full breakfast. It is important that monitoring blood testing be performed within a certain prescribed time period surrounding dosing, and generally this cannot be done if the dog receives the medication in the evening. Also, just from a practical standpoint, you typically want the medication to have maximum effect during the hours that the dog is awake and active. So unless there’s a specific reason for dosing Baxter in the evening, I’d shift if/when you restart the Vetoryl.

FYI, here’s a link to another helpful post that discusses dosing and monitoring guidelines:

https://www.k9cushings.com/forum/showthread.php?8925-GENERAL-GUIDELINES-for-Dosing-and-Monitoring-Treatment-with-Vetoryl-(trilostane)

Marianne

[Joan2517]

I was just about to mention the night dosing when I saw Marianne's response. It will be difficult to do the necessary testing if you can't get to the vet at night. My boy Gable was almost 80 lbs when we started him at 40mgs. last May and is doing very well. I tried to bring it down to 30mgs, but he started drinking more again, so we brought it back up to 40. He is now a trim 65lbs. and I will have him tested again this coming weekend to make sure that the dosage doesn't need to be adjusted due to his weight loss. It is better to have the cortisol running high, than to have it drop too much. This leaves lots of wiggle room to get the correct dosage. I always stop his meds if he vomits at all, even when I know it's probably because he ate something he shouldn't have (he loves to eat the dried leaves outside). If he still eats, drinks and acts normal, I'll start them back up.

I also have a Puggle who is a rescue. He does not have Cushings, but is very sensitive to any medication. Mine is under 30lbs and I usually lower whatever he needs, like flea meds, to the lesser pound prescriptions because of how he reacts. He's a handful! He's 9 years old and has separation anxiety and is OCD!

I hope Baxter feels better once you get the dosage straightened out!

[Baxter's Dad]

Well, I obviously came to the right place. Thanks to everyone who replied. This is more complicated than we thought. We skipped his meds last night, and will move them to the morning when we start up again. I talked to my wife a few minutes ago who went home at lunch to check on him. She said he's much more active this morning and was sitting near the treats waiting for one. Something he hadn't done in almost a week. He ate all his food and drank some water. So far, he seems to be better.

I appreciate the advice and kind words. :)

[labblab]

That’s great news that Baxter is already doing so much better :-). It may well be that he will indeed be able to resume dosing at a lower level pretty quickly. If you don’t end up performing blood testing beforehand, though, I wouldn’t resume until you see a return to excessive thirst/urination/appetite once again. I would want to make sure his adrenal function has truly rebounded from the effects of possible overdosing before restarting the med.

Please do keep updating us!
Marianne

[Squirt's Mom]

Oh I am so very glad to hear this! Last nite I was wondering how your precious Baxter was doing and am SO relieved to know he has improved. I know you and your wife are even happier to see him returning to his old self again!

[Baxter's Dad]

We're two days out from stopping the meds and Baxter is doing much better. He seems to be getting thirsty and hungry again, which is a good sign.

Now my next question. Someone mentioned that we shouldn't break apart the capsules and give him 30mg separately. I'm assuming this has to do with absorption rate. ?? Just how bad would it be if we used the remaining 24 capsules and split them in half for 48 days? or at least until next week when we take him back in for another blood test to check his cortisol level. We're not poor, but we're not rich either. That's $80 worth of meds I don't want to just throw away.

[labblab]

Here’s the warning that Dechra places on the Vetoryl product insert:


HUMAN WARNINGS:
Keep out of reach of children. Not for human use.
Wash hands after use. Do not empty capsule contents and do not attempt to divide the capsules. Do not handle the capsules if pregnant or if trying to conceive. Trilostane is associated with teratogenic effects and early pregnancy loss in laboratory animals. In the event of accidental ingestion/overdose, seek medical advice immediately and take the labeled container with you.
So part of the issue relates to the danger associated with human exposure to the loose powder, either via direct skin contact or inhalation. But I’ve spoken directly with Dechra and they additionally warn that it’s impossible for a nonprofessional to accurately divide the contents, plus the active chemical may not be metabolized properly if it does not travel through the GI tract in the intact capsule form. Without exception, they say that owners should never try to open capsules and administer the medication as loose powder.

I know it’s a financial stress to reorder capsules, but you’ll actually be risking even greater expense if you try to dose with divided powder. You really won’t know what dose is actually being given nor metabolized. And given Baxter’s worrisome initial response, I think you want to be as accurate as possible with the dosing and monitoring going forward. Who knows, you may end up being able to use the 60 mg. capsules in the future since dosing changes are commonly required over time. But for now, I’m afraid you’ll need to make a fresh purchase. And that’s one reason why I’m suggesting starting out with 10 mg. capsules for the first month of treatment. That way, you know you won’t be wasting any of them because they can be used in multiple combinations, both up and down. I really wish all vets would initially start their patients off with smaller dosage increments in order to avoid exactly this type of situation.

If medication expense does become too burdensome, one alternative to brand name Vetoryl is the purchase of compounded trilostane. There are pros and cons to this which you can read about in greater detail in the link below. But it’s another option that you may want to discuss with your vet at one point or another.

https://www.k9cushings.com/forum/showthread.php?9066-Cost-Savings-for-Owners-of-Cushingoid-Dogs

Marianne

[Squirt's Mom]

The Tipper and Squirt Care for Cushing's Fund may be able to help. You can read the qualifications for eligibility under the Apply tab, which is where you will also find the pathway to the application. Check out the tab called Resources for the sub-category Other Sources of Aid as well.

http://www.tipper-squirtcushingfund.org/

[Baxter's Dad]

Again, I want to thank everyone who has commented on this thread. Your advice is invaluable. So here's my next question. Based on advice, we're going to go to 10mg of Vetoryl and underdose him instead of overdosing, and then work from there. I just called my vet's office and they have the 5mg in stock, but not the tens. I want to start him right away because he's been off the meds for a week now. (Vet's office was closed last Thursday and Friday) I could order the 10mg pills from Chewy.com, but i'd rather just go and buy the 5mg pills today. My question is can I give him two 5mg pills in the morning? The vet tech I talked to said you cant do that with some meds and she would ask the vet when he comes in. I love my vet and he's done a great job with both of our dogs since they were pups, but I don't think he's as well versed on Cushing's as some of you I've met here. So I just wanted to see what you think.

thanks.

[Squirt's Mom]

Yes you can give two 5mg caps in the mornings to make up the 10mg/day needed. This is what Marianne was saying about using the smaller dose caps - they can be combined to achieve the optimal dose without starting out using a high dose capsule. FYI - I have read some comments about a shortage on the 5mg so you will want to get the 10mg ordered. Personally, I would hold some of the 5mg back so you can up the dose by that small increment if needed.

[Baxter's Dad]

Perfect. Thank you. That's what i'll do then.

[labblab]

Hi again! Yes, Leslie is exactly right on both counts: combining capsules of any size is fine, and I’d also get in the order for the 10 mg. now. First, here’s Dechra’s printed “OK” for combining capsules of different dosages:



...Start with the lowest possible dose based on body weight and available combinations of capsule sizes. VETORYL Capsules should be administered with food.

Secondly, I want to clarify that I was guessing you’d probably end up combining two or three 10 mg. capsules as Baxter’s new starting dose — in other words, starting back at 20 or 30 mg. as a daily total for a 30 lb. dog. I didn’t necessarily mean that I’d start at only 10 mg. per day. However, in honesty, I can’t argue that starting at only 10 mg. isn’t a good idea. It probably is, given his earlier problems. You can always, always easily move upward with his dosing. And a gradual decline in his cortisol level will be much easier on his system than a sudden big drop. However, it will be good to have the larger 10 mg. capsules on hand sooner rather than later. As Leslie says, holding out some of the 5 mg. capsules will give you greater flexibility in the future. And it’s very possible that you will indeed end up increasing his dose rather quickly depending on his observable response and monitoring testing.

Speaking of the monitoring testing, please make sure that if your vet is using ACTH stimulation tests, the test is run 4-6 hours after Baxter has been given his morning dose along with breakfast. Many inexperienced vets tell owners to fast their dogs on testing days, and this is the wrong thing to do when monitoring treatment with trilostane. Food must be given along with the medication in order to arrive at an accurate assessment of the dog’s cortisol level when the drug is metabolized properly. We can provide written directives about this if you need them to show your vet.

So good luck with starting back with the treatment! We’ll sure be anxious to know how things go.
Marianne

[Baxter's Dad]

Marianne, you're correct about the dosage and what you said earlier. I'm picking up the fives today and ordering the 10's to be delivered within a few days. I'll see what the vet says, but we'll probably start him on 20mg per day and then have our vet check him in a week or so. I'll talk to him this afternoon and see what he recommends.

Thanks for the advice.

[anniefisk]

Hello everyone, I'm Baxter's Mom. I just want to thank everyone for all their help and input on dealing with Cushings. We've been at our wit's end trying to get him on the right path. As my hubby said earlier, we're picking up the 5's today; and then ordering the 10's thru Chewy. Then, we'll make another appointment for blood work. We'll keep you posted on how he's doing. Thanks again!

[Baxter's Dad]

And here's a picture of Baxter trying to blame his sister for something we're pretty sure he did... :)

https://www.k9cushings.com/forum/attachment.php?attachmentid=8503&d=1543258255

[Harley PoMMom]

OMGoodness, what a handsome boy!!!!

[Joan2517]

He looks just like my Cooper!

[Baxter's Dad]

Hello everyone. We're back to having problems again. We have him 10mg of Vetoryl for three days in a row and he's lethargic again. He can't hardly move, he's weak and frail. He's throwing up, but i'm not 100% convinced the throwing up is a result of the meds. My wife and I disagreed on the effectiveness of the meds we so we decided to stop for today (Sunday) and see if he bounces back like before. He hasn't really gotten any better but he threw up some chicken breast we hand fed him. That's why i'm not sure its related to the meds. (no meds today) He's getting thinner and weaker every day. I have a few questions for those of you who have been kind enough to reply.

1. What can we feed him that's super easy on his stomach that he has a good chance of keeping down? We thought some simple boiled chicken breast would do it, but it didn't.

2. If we just decide the meds are causing too many problems, what will the Cushing's eventually do to him? He'll drink a ton of water every day, but will it do more internal damage, eventually resulting in death?

3. I have this overwhelming feeling that a 13 year old dog just isn't going to survive Cushing's, but no one wants to tell me. Are we wasting our time trying to treat the Cushing's and just make him comfortable until it's time? Or do you think that a 13 year old dog can regain some of his pep and live a little while longer if the Cushing's is treated?

Right now, Baxter is barely able to walk around. We've been carrying him around and when we set him down to drink or go outside, he's unstable and wobbly. Obviously, if he can't hold any food down, he's going to be weak.

We don't know what to do.

thanks for any advice.

[labblab]

Oh my, I’m so sorry to hear that Baxter is ill again. I would not give any more of the Vetoryl at all right now. Although it may be only coincidence that he’s doing poorly again, I would suspect that the Vetoryl is indeed playing a role. For whatever reason, he may never be able to tolerate the medication. There is a different Cushing’s med, Lysodren, that could perhaps be tried instead in the future. But for right now, I think the Cushing’s treatment needs to be put on the back burner until his current issues can be better sorted out. If he again rebounds once the medication is stopped, then the Vetoryl itself really is the prime suspect. If not, then perhaps there is something else going on, altogether.

As far as the potential long-term effects of untreated Cushing’s, they can be variable. A long duration of elevated cortisol can cause high blood pressure, which in turn can result in kidney damage, eye damage, etc. Dogs can become more vulnerable to infections, and damage to ligaments can be more likely. There is a particular skin condition that can be particularly troublesome. A higher incidence of blood clots can be associated with Cushing’s, and there can also be a greater vulnerability to certain gallbladder problems. On the flip side, though, senior dogs may exhibit fewer arthritic problems when their cortisol runs high. All-in-all, since the internal damage that Cushing’s can cause tends to slowly develop over a period of time, and any given Cushpup may experience more or fewer of these chronic problems, I personally advocate most strongly for treatment in dogs who have a length of time left in their natural lifespans. For an older dog, immediate quality of life seems most important to me. So if treatment is causing more immediate problems than benefits for an older dog, I’d probably opt to leave him/her alone so long as the outward symptoms are not making life too uncomfortable. So in Baxter’s case at age 13, these are some of the considerations I’d be weighing. What would you expect to be his natural lifespan? How uncomfortable does he seem to be at this point? How difficult is it to deal with his outward symptoms?

But first things first, and that means seeing what it takes to get him back to normal again. As far as bland foods, you could try cooking up some plain white rice with plenty of water until it becomes a starchy paste. You could then add some chicken shreds, or jarred baby food (making sure no onions are in the food), or some scrambled eggs. Sometimes adding some stinky water from a can of tuna or some Parmesan cheese can help stimulate a dog’s appetite.

I’m really hoping that Baxter will already be doing better this morning by the time you’re reading this note. Please do let us know!

Marianne

[Harley PoMMom]

Slippery elm bark (SEB) may work too and you could try making him chicken broth. Article about SEB: https://www.whole-dog-journal.com/issues/5_5/features/5455-1.html

[Baxter's Dad]

Marianne,

Thanks for all that info. That really helps. We're now on the fourth day of stopping his meds. He's a little better, but not all the way back unfortunately. He's still moving slow, very lethargic. But he's only thrown up his food once in the last few days. We're giving chicken breast cut up and mixed with rice with a little beef broth mixed in. Of course because of the Cushing's, he's drinking a ton of water a day. He goes outside to pee, and then comes right back in and fills up again.

I'm a member of a few Puggle forums and I've never heard of a puggle getting to 15 years old. Only a few have made it to 14, and Baxter is 13 and four months. We've decided that because of his age, and what the meds do to him, we're not going to give him anymore. He's clearly not in any pain. His quality of life isn't much now, but he does sit on our lap in the evening and chill with us. We're going to hold him and spoil him (like usual) until he can't get up and move around or wont eat or drink. EVERYONE we know has told us HE will tell us when it's time, and we'll know it in our hearts. It could be days, weeks or even a few months from now. Heck, without the meds he may bounce back and be very active again. But the meds had a bad reaction with him and i'm not putting him thru that again.

Just so you know, this little guy has had a GREAT life. My wife and I go camping every weekend in the summer so he's had woods and trails to run on. At home, we have a large fenced in back yard where he's spent hours chasing squirrels and rabbits that he has zero chance of catching.. LOL Puggles are not known for blazing speed. He's always had the run of the house when we're not home and a doggy door to get outside. He sleeps in the bed with us every night and hasn't seen the inside of a crate since we rescued him at four months old. Overall, he's one happy dog who has never wanted for anything. As long as he's not in pain and can still get up and eat and drink, we'll keep spoiling him. Until it's time.... :(

[labblab]

I cannot disagree with your decision, even one little bit. Quality of life is the most important thing of all, and if treatment is hurting more than it’s helping, then I would not restart it either. Clearly, you and your wife have gifted Baxter with a wonderful life, a truly “dogworthy” life. I surely hope that there are still some wonderful memories to be made and savored together. No matter what, please know that we will continue to stand alongside you here — to receive any updates, to talk over any questions, and to share in any challenges that may present themselves. You all are part of our family now, and we’ll remain eager to know how you’re doing.

I also surely hope that Baxter will continue to rebound. If not, it may be wise to get one more test of his blood chemistries and cortisol to make sure that there is not any lingering abnormality from the medication that needs to be addressed. If his excessive thirst and urination have returned, it’s hard to imagine that his cortisol hasn’t started to rebound, as well. But you never know, and some of his blood chemistries may still be out of whack. I can imagine that you hate to poke and prod him any more, but one more blood draw may be advisable.

Sending my warmest wishes to you all, and please continue to let us know how your sweet boy is doing.
Marianne

[Joan2517]

I think you are spot on in your plan for Baxter! Sometimes the best thing to do is to do nothing. If the treatment makes them uncomfortable and ruins whatever time they have left, it's better to just love them until that time comes.

[Squirt's Mom]

I agree with your plan 100%. When my Squirt turned 15 I stopped her treatment even tho she had handled it very well (she was on Lysodren). But she had had a stroke and was developing dementia. I promised her no more vet visits unless absolutely necessary, no more pokes and prods, no more car rides which she once loved but had come to hate since Cushing's came to visit. We had a little over 1 more year together and I never regretted my decision.

Hugs,
Leslie

[Baxter's Dad]

I promised her no more vet visits unless absolutely necessary, no more pokes and prods, no more car rides which she once loved but had come to hate since Cushing's came to visit.

Well that made me cry. :( We tried Vetoryl two different times, a high dose and a fairly low dose and both times it knocked him on his behind. Humans or dogs, there comes a time when you just don't want to be bothered anymore.

[Baxter's Dad]

Hello everyone. I wanted to stop by to tell you that we have an appointment this morning to take Baxter to the vet. He's getting worse every day, he can't keep any food down, and he's almost skin and bones now. He seems confused when he stands up and he's not steady and seems like he's going to fall over at any time. We made the decision over the weekend and waited until this morning when everything opens again.

I can't thank all of you enough for the kind words and the advice about handling Cushing's. I think he was just too old and weak for anything to really have a chance of helping him. Like I said a few posts ago, he's had a wonderful life. He's been with us for 13 years and was a spoiled rotten house dog that was happy and wanted for nothing. We'll always have him in our memories.

Thanks again....

[Joan2517]

I'm so sorry. He was loved and he knew it, and that's what matters most. My sincere condolences to you and your family.

[Squirt's Mom]

I know Baxter is so very grateful to you for giving him his freedom. He is once again strong and running thru the Rainbow Fields chasing butterflies with all his new friends who were there to greet him. For many of us it is the hardest decision we face but it is one we make from a place of love. So even tho we shed tears today we must remember we do what we do because we love them so.

I had added Baxter's name to our In Loving Memory thread where he will always be remembered as a cherished member of our family here. We would love to add a pic with his name and if that is something you would like please send a copy to k9cushings@gmail.com and we will take care of that for you. Also, please feel free to start a memorial thread for Baxter in the In Loving Memory forum; we would be honored to help celebrate his life with you and his family.

My deepest sympathies,
Leslie



Your Pet In Heaven
by Ken D. Conover

To have loved and then said farewell, is better than to have never loved at all.

For all of the times that you have stooped and touched my head, fed me my favorite treat and returned the love that I so unconditionally gave to you. For the care that you gave to me so unselfishly. For all of these things I am grateful and thankful.

I ask that you not grieve for the loss, but rejoice in the fact that we lived, loved and touched each others lives. My life was fuller because you were there, not as a master/owner, but as my FRIEND.

Today I am as I was in my youth. The grass is always green, butterflies flit among the flowers and the Sun shines gently down upon all of God's creatures. I can run, jump, play and do all of the things that I did in my youth. There is no sickness, no aching joints and no regrets and no aging.

We await the arrival of our lifelong companions and know that togetherness is forever.
You live in our hearts as we do in yours. Companions such as you are so rare and unique.
Don't hold the love that you have within yourself. Give it to another like me and then I will live forever. For love never really dies, and you are loved and missed as surely as we are.

https://www.k9cushings.com/forum/showthread.php?8846-Remembering-All-Who-Have-Left-Us-(2018)

[Baxter's Dad]

Wow, I thought military basic training was tough. I've never had to do this before. It was one of the hardest things I've done in my life. I held it together while the vet was doing it and I was there holding on to him and petting him, but I absolutely lost it when I was carrying him out to the car to take him to the place where we arranged the cremation. I cried like a toddler that didn't get something they wanted. Damn, that hit me hard. I cried all the way to the pet memorial place and held it together long enough to make the arrangements. I said good bye to his lifeless body one more time and then walked to the car and lost it again in the parking lot knowing I'd never see him again. Dogs sure have a way of crawling inside your heart and making a home for a very long time. It's crazy how much they can affect us.

Again, I just wanted to thank all of you for the advice and kind words. It was much appreciated.

[Joan2517]

It is awful...it's heartbreaking. I think it's so hard because they depend on us for everything and give us such unconditional love.

I can still breakdown at a memory, a thought a picture. Sometimes I can't believe I still have tears left to cry. Everyone here feels the same and we know that your heart is shattered right now. It will get easier.

We never stop missing them, we just get used to it.

[Harley PoMMom]

It is one of the most difficult things to do...one of our members has said that we take their pain and make it ours and that is so true because losing them is just so very hard but we make the decision to release them from the deep love we have for them....you are in my thoughts and prayers.