Newbie Helicopter Pet Mom needs help/support - 12 yr old American Bulldog Part 1

[PatchsMom]

Hello everyone, new to the group and thanks for having me! Appreciate how y’all love details, (me too!) so here goes just about everything. Hope it’s not overwhelming TMI.

I’m retired in my “not so golden” years in Sweet Home Alabama. I’m just a good ole plain country folk with a brain. My fur child is Patch. He’s white with black patches (like a catahoula leopard), long haired American Bulldog mix with a bushy tail. (Yes there is such a breed). Age 12, neutered after I got him and weighs 64 ½ pounds. He’s my companion buddy. Rescued him in 2008 when he was about age 10-12 months old. He was abused and had a back leg injury that never properly healed, but he gets around fine. He’s just so laid back and easy going with a happy disposition in spite of everything. Patch always fear pants from Tstorms. Has arthritis in left shoulder and bad left back leg. He takes many safe natural supplements and vitamins, wet no grain canned and home cookin when I’m not exhausted.

I’ve been dealing with does he or doesn’t he have Cushing’s for 3 years now. Since 2017, chief complaints: pot belly, unusual panting (other than fear panting from Tstorms) and very restless at night. Up and down constantly. Daytime not so bad. I’ve been to (5) GP vets, a Cardio Vet, (2) Radiologists, (2) Vet Colleges, (2) IMS’s and a Vet Dental Specialist. Met a few very arrogant Vet’s on this journey. Different Labs have been used in testing. Question whether scorings can cause inconsistent readings.

HISTORY
3/2011 – 1/2013 – GP Vet - prednisone tablets given (4) treatments
Mar. 2017 – GP Vet – 1st and only ear infection. Given unknown allergy injection
June 2017 – GP Vet – 1st and only urine infection. Given antibiotics
Oct. 2017- GP Vet xrays showed an enlarged heart.
Nov. 2017- 1st Cardio Vet visit - echo cardiogram, diagnosed Patch with mild enlarged heart and mild aortic stenosis. (can’t take Vetmedin)
Dec 2017 – CBC – hemocrit 63%, ionized calcium 1.46 mmo/L, PTH measured at low end of normal 0.7 pg/mL. IDEXX Lab testing.
Feb. 2018 - 1st. ACTH test -1st Vet Univ (Neg.) suspected pre cushing’s. Started Melatonin and lignans.
Aug. 2018 - 1st IMS - Said asthma/bronchitis. Chastised melatonin and lignans. Lenticular (nuclear) sclerosis in both eyes. CBC- ALP 384, Chol 254. No ultrasound report or findings. Was a horrible experience overall.
Lab testing unknown.
April 2019 – 2nd visit Cardio Vet – Echo, CBC, T4 - ALP 1144 u/L, ALT 193 u/L, platelets 771, triglycerides 457 ug/L, T4 normal at 2.2 ug/dL ZNLabs testing.

THINGS GO DOWNHILL:
Nov. 2019 - GP Vet - upper molar tooth extraction. (turned out a botched job, no CBC done prior)
Dec. 2019 – GP Vet- CBC, T4, Urine - showed High BP, now on Benazepril 20mg. Suspected polycythemia. Wanted to do blood letting. Refused he wasn’t experienced. CBC platelet 673,000 u/L, ALT 161 u/L, ALP 519 u/L
T4 – 1.1 ug/dL normal. IDEXX testing.
Jan. 2020 - 2nd ACTH test (neg.) 2nd Vet Univ. - Ultrasound. Belly shaved bald. Left adrenal gland, 2.1cm. Right ok. Confirmed polycythemia, now on Clopidogrel (plavix) 75mg, ½ dose daily. Still suspect of cushing’s.
Ultrasound mentioned a splenic nodule, no measurement given. They wanted an LDDST done. Urine Protein 185.9 mg/dL Lab unknown.
Feb. 2020 – 3rd visit Cardio Vet - Echo and CBC. No pulmonary hypertension. Polycythemia not from heart. No murmur. CBC showed CO2 Low at 15 nEq/L, ALT high at 193 u/L Choles 280 mg/dL, Triclyc high at 457
mg/dL, others high, no ALP shown. ZNLabs testing.
Feb. 2020 – Vet Dental Specialist – major gum surgery after complications from Nov 2019 tooth extraction. Took 2 months to recover. Had adverse reaction to med’s and anesthesia. Traumatized Patch (and me).

ENTER COVID - NEAR IMPOSSIBLE TO VISIT ANY VET. (expenditures growing!)

July 2020 – 2nd IMS visit - went prepared with all Patch’s records in a notebook binder along with all disc copies of his xrays. He suggested melatonin for helping Patch’s belly fur regrowth, that was overkill shaved bald for the Jan. 2020 ultrasound. It’s only peach fuzz still, 7 months later. I cautioned him about the BP med interaction. He balked at any of the other supplements I give Patch. Had UPC ratio and free catch urine test. Urine Protein scored 273.6mg/dL, Creatinine 106.3mg/dL = ration of 2.6. Benazepril dosage increased to hopefully lower his protein at 20mg 2x daily. BP stabilized, systolic 120. Antech Accession Lab

IMS had a 2nd opinion radiologist review the Jan 2020 ultrasound (without my knowledge or consent. I refused full payment, but offered up a 50/50 split. Seems they wanted all or nothing and gave me a full refund instead. Didn’t appreciate them trying to take control out of my hands). This radiologist report stated Patch had primarily hypoechoic but also mildly heterogeneous small mass of the left adrenal gland, likely of the caudal pole (approximately 2.84 cm x 2.36 cm) and mildly heterogeneous spleen with a hypoechoic nodule, likely of the body (0.96 cm x 0.65 cm). Irregular, mildly heterogeneous area also likely within the splenic body (1.10 cm). Small, heterogeneous mass of the spleen that bulges the capsule (1.96 cm x 1.75 cm). Smaller right adrenal gland, measuring 0.43 cm in height at its caudal pole. Mildly heterogeneous liver with at least one, hypoechoic nodule (0.41 cm). (So much more info than original report!)

Aug 7, 2020 – New Radiologist visit - ultrasound. Report: Left adrenal gland: Cranial pole expanded by a rounded, heterogeneous mass measuring approximately 3.3 x 2.8 cm (this is increased compared to the reported prior measurement of 2.1 cm). The caudal pole measured approximately 0.56 cm. Right adrenal gland: Normal (0.46 cm). Spleen: Ill-defined, approximately 2.3 x 1.0 cm, hypoechoic nodule. Mildly heterogeneous nodule measuring 2.14 x 1.55 cm expanding the splenic tail. (Everything else internally appeared normal.)

IMS believes Patch has atypical Cushing’s or at least ADH, not sure if cancer. Patch’s adrenal gland/hormones are so out of whack. Originally wanted Patch on mitotane, changed mind and now wants Patch to start 90mg Trilostane (Vetoryl) twice daily. When questioned what made him change his mind he said “sleep.” He thinks when he sleeps he stated. (Just when I thought I’d heard it all.)

Seeing the posting 07-15-2020, by cken, “Cushing’s diagnosos 14+ yr old Vizsla - Vetoryl start dose?” and responses about the proper mg dosage was a timely huge wake up call for me! THANK YOU! (Patch’s weight is 64 ½ pounds). 180 mg a day IMO is excessive to say the least. Checked all your posted links for info, esp. Dechras site.. feel the 1 mg per pound (2014/15 dosage recommendation) is the way to go. Not sure if 30 mg 2x a day is appropriate or one 60 mg dose in the morning with food of course or to go with initially 0.5 mg/kg even if cost is more. (Feldman study I believe) With Patch’s history of not tolerating most med’s., naturally I’m cautious. Rather be a bit under mg than over and safer than sorry.

CONTINUE TO PART 2
Donna

[PatchsMom]

Newbie Helicopter Pet Mom - Part 2 Continued


Had a discussion with Dechra Monday, esp. about trilostane and benezapril interaction. (It lowers BP). No info on the Plavix. Vet Tech Services (someone in the forum posted a Dr. Allen there, only just a nice sales rep there named Amanda Allen.) Dechra still refer to 1-3mg/kg. Didn’t elaborate about the 1mg/kg dosage changed protocol. Gave me a case study reference - 2007 by Haley-Sars(?) “Trilostane and ACE Inhibitors” Any help on a link to locate? Dechra stated they’ve seen an explosion of Cushing’s cases lately. Interesting huh? They stated they appreciate groups like here. At least I have a case number for Patch. Phone number 1-866-933-2472, use option #1 for Vet Tech Services.

To try and make things easier for the new IMS, I emailed him a history outline on Patch Monday morning with some of the links about trilostane dosage learned from this forum (and studies I’d found) to back up my not wanting Patch on 90mg 2x daily. (start low, then increase). IMS emailed me back in what I interpreted as he’s annoyed, not a team player, I’m the Vet not you attitude, seemingly adamant not lowering dosage and knew all abt. the UC Davis study. Didn’t mention he looked at the online wiley, google or other links I sent to prove my case. I stated I was not undermining him, just being precautious for Patch. Not being confrontational in any way. HATE confrontations!

New IMS seems to be following a 2014 study he sent me “Long-Term Survival of Dogs with Adrenal-Dependent Hyperadrenocorticism: A Comparison between Mitotane and Twice Daily Trilostane Treatment” by C. Arenas, C. Melian, and M.D. Perez-Alenza . This study suggests 3mg per pound.

https://www.vetspecialty.com/wp-content/uploads/2014/05/paper-1.pdf

I’m feeling he is resistant to cooperate in a lose dose, given it also appears he keeps referencing for surgery which he knows I won’t risk given all Patch’s problems and age. I’m taking this as a sorta guilt fashion ploy if I won’t do. I wish it were that easy a remedy. He suggested to cancel Monday’s appointment and reschedule a pricey 2nd consultation with him abt the subject matter. It would be insane to do, a waste of time and money, if he is headstrong about the 180mg daily dose. I also questioned him as to further tests, a current CBC and to check Patch’s cholesterol, besides another reck of his urine protein. I canceled Monday’s protein recheck appointment in hopes y’all can help me rethink a game plan here before I do anything. I’m beyond discouraged and my BP is up! I can’t just go along with something that might jeopardize Patch’s well being more than it now is. What’s strange, this IMS gave me online suggestions where to purchase the trilostane, not purchase from them. Could this be a good guy, bad guy situation?

Nor, I am willing to dish out any more cash needlessly, be taken advantage of/played, or my concerns dismissed even if I disagree on a Vet’s treatment plan. Been that route too many times. I feel this IMS is implying do as I say or go elsewhere. (This seems to be the mindset of many Vets in my area if you disagree on something). This is also a place that refuses to give any financial help/payment plan or accept 3rd party assistance. I did inquire. More on assistance for another post. My goal is to treat Patch safely and with little adverse reactions as possible. Not kill him.

I am always mindful that I am Patch’s advocate, his voice, and no one has the right to tell me what I will or won’t do when it comes to making health based decisions for him. He’s not a lab rat experiment! I’m also considering seeing an Integrative Med. Vet if reasonably available in my area. I think I’m gonna start using the CBD oil with him again as well.

What are your thoughts?? Any info on cushing dog’s dental, anesthesia, plavix interaction and CBD oil would also be greatly appreciated. Sorry if I’ve given anyone a headache. Thanks in advance.

Donna

[labblab]

Hello Donna, and welcome!!!! Sooooooo glad you’ve made it here to us ;).

Thanks so much for providing so much in-depth info about Patches. I want to take enough time to read through it thoroughly before posting my thoughts and suggestions. So I’ll be back again later on, but I wanted to at least have the chance this morning to welcome you both to our family!

Until later,
Marianne

[labblab]

Hello again! OK, I’m back with a few thoughts to throw out for your consideration. First, though, a couple of caveats. I am not a vet, nor have I had any related training. I am a pet-owner, but one who has focused on Cushing’s here and on related forums since my own dog (now a fur-angel) was first diagnosed and treated with trilostane back in 2004. So I’ve witnessed an awful lot of Cushing’s journeys during these past 16 years. Having said that, the majority of cases are pituitary in origin. Adrenal tumors are far less common and carry a host of variabilities depending upon location, growth rate, malignancy, and effect on adrenal hormone production. There’s far more that I *don’t* know about adrenal tumors than what I do know. But having said all that, here are some thoughts that I do have about Patch’s situation.

First, let’s start with diagnostics. Unless I’m missing it, it doesn’t appear as though he has ever had a LDDS test performed. Multiple ACTH tests, but no LDDS. I’m wondering whether there’s a reason for that. The ACTH is known to return a large percentage of “false negatives” in the presence of adrenal tumors. Since an adrenal tumor has been suspected for a while now, I’m curious as to why an LDDS has never been pursued. Typically, that test would be less likely to miss making an actual Cushing’s diagnosis for a dog with ADH.

Speaking of the ACTH, though, you report that Patch’s adrenal hormones (plural) are messed up, and that one IMS has included Atypical Cushing’s as a possibility. Has Patch actually had a full adrenal panel analyzed in conjunction with an ACTH? Historically, the only lab in the U.S. that performs this analysis is at the Univ. of Tennessee at Knoxville. Has Patch had this analysis done, and if so, what were the results?

Moving on to the Vetoryl treatment, I have several questions. The most important is this: what exactly is the goal you’re seeking? I absolutely don’t mean to be flippant by asking this. But especially since it doesn’t yet sound as though elevated cortisol production has been confirmed, I’m wondering whether actual elevations in other adrenal hormones have been confirmed (via that UTK full adrenal panel, for instance). If Patch does indeed have an active adrenal tumor, then medication’s only role is to control symptoms. These are the symptoms I’ve picked up so far.

Observable symptoms: pot belly, excessive restlessness (especially at night).

Possible systemic symptoms: high blood pressure, proteinuria, vulnerability to clotting, abnormalities in blood chemistries and cell counts.

Do the vets suspect his cardiac condition may also be related? That I don’t know much about at all. But in terms of his other symptoms, it sounds as though both his blood pressure and proteinuria are responding favorably to his existing medication, and the Plavix ought to be lessening the risk of clotting. So the question in my own mind right now would be, are his remaining symptoms severe enough to warrant the risks and monitoring responsibilities associated with a Vetoryl treatment. For younger dogs, I definitely see value in trying to forestall longterm systemic damage caused by Cushing’s. At Patch’s age, however, I’d be more focused on current quality of life. Does he stand to gain enough from the Vetoryl to be worth the treatment downsides?

And that finally brings us to the Vetoryl itself. Literally, I can count on one hand the number of dogs in recent years who have been started off with a daily dose equal to 3 mg. per pound. Your vet is an outlier of an outlier on this one. Does the fact that an adrenal tumor is suspected change things? Perhaps. But again, as far as I can tell, we don’t yet know whether elevated cortisol is even present in Patch’s profile. So I’m clueless as to why such a humongous dose of Vetoryl would be prescribed.

As far as your conversation with Dechra U.S.A., it’s frustrating to us that they continue to cite the 1-3 mg. per pound “range” in their conversations and on their product insert, even at the same time that other literature of theirs encourages folks to start off at the lowest possible dose that is likely to be therapeutic. Our understanding is that they feel bound by the wording in the dosing recommendations that were approved by the FDA back when Vetoryl was first introduced in this country 11 years ago. Dechra U.K. and in Europe appear to feel much freer in specifically advising lower doses. And certainly, as you’ve seen in your reading, the majority of clinicians have also adjusted their recommendations downward over the years, as well. Bottom line: there’s no way in which I’d currently start my own dog of Patch’s weight on a daily dose of 180 mg., even if I had evidence of highly elevated cortisol and felt confident that treatment was warranted.

I know you have other questions, as well, but I’m going to leave this first reply here since I can see I’ve already written a book! But we can talk more again later.

Marianne

[Squirt's Mom]

Hi and welcome to you and Patches from me too!

Marianne has cover the bases expertly as always and I have only a couple of things to add. Bear in mind, these thought apply IF and ONLY IF Cushing's is actually ever diagnosed, which to my mind it has not been at this point, plus Marianne's point about the goal of treatment is a very valid one for you and Patches. ;)

One thing I wanted you to be aware of is recent studies show that large dogs do better started even lower than the 1mg/lb discussed.... closer to 0.05mg/lb, no more than 30mg/day. Here is some info on that (btw, Glynda Pomerantz, the author of the first link, is one of our Admins here):

https://drive.google.com/file/d/155aj2gOey6_fypWyihlhenygpCjmRdUz/view

https://pubmed.ncbi.nlm.nih.gov/22708554/

Second, I am an oddball and prefer Lysodren to Vetoryl EXCEPT when the dog has ADH. Here is why; adrenal tumors take larger and larger doses as time passes to keep control of the cortisol and high doses of Lysodren are extremely hard on the digestive system plus Lysodren is more apt to cause some serious side effects at such high doses. Hence Vetoryl is best for our ADH pups.

That's all I wanted to add other than to say I am glad you found us and look forward to getting to know you and your sweet baby boy.

Hugs,
Leslie

[labblab]

It’s me, again! I’m so glad that Leslie has had a chance to post, too, and she has given some excellent additional information. I also wanted to return to elaborate a bit more re: my reservations about beginning Vetoryl treatment unless you do have actual evidence that Patch’s tumor is overproducing cortisol and/or any of the other adrenal “sex” hormones (evidence which you may indeed have). We’re aware that another type of adrenal tumor, a pheochromocytoma, can also produce overlapping symptoms such as restlessness, panting, extended abdomen, hypertension, and excessive thirst/urination. In this case, though, it’s not excessive corticosteroids that are being released, but instance substances known as “catecholamines” including epinephrine, norepinephrine and dopamine. Vetoryl has no treatment value at all for elevated catecholamines.

I’m linking you to an article about pheos. It’s dated 2010, but I believe the info is still accurate. The article rightfully states that pheos are extremely rare, but we’ve actually seen several cases among our members here throughout the years. Once again, this may totally be a moot point. You may already know that cortisol or other corticosteroids are involved for Patch. Or the radiological imaging may rule out a pheo on the basis of location or appearance. But I just wanted to mention this as an example of the complexities that can be involved in sorting out the optimal treatment approach for an adrenal tumor.

https://www.dvm360.com/view/pheochromocytomas-dogs-and-cats-proceedings

Marianne

[PatchsMom]

I'm sorry for my delayed respond. Too much going on. First I want to extend my most gracious thank you to both Marianne and Leslie for all your incites and welcoming me! It feels comfortable in knowing I'm not crazy, at least not at the present and it confirms just what I felt, 180mg daily is off the charts and LLDS might be best next step before doing anything. I asked the IMS about it and he stated that with the (2) ACTH's neg. it isn't cortico's but hormones and an LLDS would not be beneficial. Of course I'd like to have a positive diagnosis one way or the other. In any event I will send him off an email today with the provided links you posted (I printed and saved them on my desktop for my reference as I usually do). I doubt his reaction will be any more pleasing than the last reply. Thank you soooo much for that info BTW. I only scan read them, but found they drive home the point to a "T". I also intend to inquire in my email what IMS's intended treatment plan is for Patch. He may or may not give me an outline (or quit because I ask questions). At this point, all is too vague. All I know is recheck UCP, BP and the Trilostane.

I will pull up my email outline from UN of AL on exactly what they wanted done as I forgot to print that out for reference. They did mention the possibility of pheochromocytoma, but were doubtful and they wanted hormone and LLDS testing. (Hey Patch seems to be the oddball in everything else, so it would be no surprise if he did have pheo) I'll add the UN of AL info in my next post for you later today hopefully. Un of AL is a 3 hour one way drive for me. I know they charge $300 to send out to TN. So cost effective, if I can get the LLDS taken care of locally and sent off to TN for less or free, I'll do that.

I dealt with a top Professor at UN of TN in the endocrine dept. for Patch's original ACTH and have kept in contact over time. He actually did the lab report. I'm going to reach out to him today to see what he can help me with. It is a 5 hour one way drive for me, and he saved me that trip the first time around.

Right now, Patch doesn't seem to have excessive thirst or urinating. He drinks about 2-3 qts of water a day. He hardly ever drank much water prior to tooth extraction in Nov, in which I always forced him to with homemade broth as I was concerned. This struck me as odd his not wanting to drink much and I always made mention of it to any Vet. Most of his drinking seems to be because of "dry mouth/tongue/throat" due to his panting and then I give him a little drink with ice and he's good to go. Drinks after a meal or mild activity and doesn't gulp. Goes out to potty about 4-5x daily with the last evening outing about 10- 12. BM's seem ok, I always look, although on rare occasion a little watery (could be from the benezapril/plavix) Seems more restful during the day, but starts getting panting anxious after about 6 pm. Has rarely gotten me up late at night to go out. He's just up and down all night trying to find a comfortable sleeping place. I feel he is having issues regulating his body temperature like he's in male menopause or something. IMS at least agreed with me on this one.

My original idea was to just order the 30mg and 60mg and only give Patch the 30mg daily regardless, but you both have raised some valid, commonsense, weighty concerns, so that is off the table. Just figured I already had the prescript and wanted something on hand in case IMS kicked me to the curb mindset. Just getting anxious to help Patch, but realize I have to be sure if he even truly has Cushing's before I give him anything in any mg dosage.

I will add another post later with more info. Thanks once again for your help!
Donna

Didn't see any mention in the Aug recent rad report about pheo, but I will re check to be positive.

[labblab]

So good to hear back from you, Donna. If you already have an endocrinology contact at UTK, by all means, I’d encourage you to update him and request his guidance. Just to clarify a bit more about testing, the full adrenal panel is an expanded version of the ACTH. The protocol for the blood samples and ACTH stimulating agent are identical, regardless of whether the lab analysis is checking on cortisol alone, or instead on cortisol along with additional adrenal hormones. So with the full panel, your local vet can perform the ACTH as usual, but then send it off to UTK. Perhaps UTK did perform a full panel analysis on that first ACTH — it’ll be very interesting to find out, if so. The LDDS involves a totally different test protocol which can also be performed by your local vet, but can be analyzed anywhere nationally by labs such as IDEXX.

I remain very puzzled hearing your IMS’s reasoning for not proceeding with an LDDS in the face of an adrenal tumor. It’s historically documented that the “sensitivity” of the ACTH (likelihood of correctly returning a positive result for a genuine Cushpup) is lower than the LDDS, and significantly so when an adrenal tumor is present. You can find this same info in a million places, but here’s a quote that I just quickly pulled up now:


ACTH Test Sensitivity: 73-95% in dogs with PDH and AT. Sensitivity is about 80%, if all studies are combined (looked at PDH + AT or PDH or AT alone). If dogs with PDH and AT are examined separately, the sensitivity is 87% and 61%, respectively.

Clinical Use: There may be several explanations why the sensitivity of this test is less than might be anticipated. First, a minimum degree of adrenal hyperplasia may be needed before the ACTH stim test is abnormal. Second, the presence of symptoms may not always correlate to sufficient adrenal mass to make the ACTH stim test abnormal. Dogs with adrenal tumors may have reduced adrenal mass (atrophy of non-neoplastic gland) or reduced ACTH responsiveness. The ACTH stimulation test cannot be used to distinguish between PDH and AT because results from dogs with these diseases have significant overlap.

https://www.vin.com/apputil/content/defaultadv1.aspx?pId=11196&catId=30748&id=3854240

On the face of things so far, it still doesn’t sound as though testing has documented actual elevations in any of Patch’s adrenal hormones that might be responsive to Vetoryl. So yep, I’d hold off on dosing until you gain more clarity about the situation.

As I say, that’s great if you can consult further with UTK. I was unaware that Bama has a veterinary “presence,” but another alternative of which you’re probably aware is Auburn’s vet school. Auburn may be even a further drive, but they do have an internationally renowned Cushing’s expert on the faculty there, Dr. Ellen Behrend. It’s not clear from their website whether she’s still actively seeing patients, but I assume their endocrinological department still reflects her expertise. She has authored many articles that we’ve referenced here over the years. Just a thought if you really feel as though you’re cast adrift...

https://www.vetmed.auburn.edu/faculty/behrend-ellen/

Marianne

[PatchsMom]

After reviewing my Auburn UN report (Sorry Marianne and y'all, I mistakenly said UN of AL originally) they wanted to rule out pulmonary hypertension (did that, doesn’t have), urine creatinine protein ration (did that, high), a LDDS, repeat ultrasound (did that), BP and blood work (did that), and some other testing that only goes through UN of TN. Won’t know until next week when they respond elaborating as to what tests (I assume possibly hormonal testing and/or the adrenal panel) They felt not likely pheo. Yet IMO beliefs are only an opinion.

Thanks to you Marianne, I rechecked the new August ultrasound report which stated in its conclusions: “Progressive left sided adrenal mass. Consider adenoma, adenocarcinoma or pheochromocytoma”. No other mention of pheo or ADH suspicion either. Begs to question IMS’s mindset in anything at this point no matter, even though this is 2nd mention of pheo.

Game plan. Found a close by local Vet to do the LDDS on Patch. Will personally meet with him Monday for discussion (and quizzing) about Patch’s medical history and suspected causes prior to the LDDS. I believe he also treats Cushing dogs so this may be an alternate route should that come to be. Had a backup Vet farther away, but this place is so much more convenient for both Patch and I all around and they are reasonable in pricing. They use Antech Lab and results would be in within a day. Depending on these results, the next step will be move onto pheo urine/blood test or move on with proper Cushing’s treatment. Decided best to hold off with contact to IMS until after the LDDS results, if I even bother at all.

Have spent many hours researching and getting educated about pheo, just in case. Trying not to be focused on could it be cushing’s or pheo, but I need to know one way or another.. Y’all correct, without an accurate diagnosis, can’t treat a may be, could be, with any medication.

UN of TN is basically a skeleton crew because of Covid and haven't as yet heard back from the professor. I may have to call him at home, since most staff are working from home now. TN is only taking emergency pets from info on their website.

The one thing I’ve learned over all this time, when presenting Patch’s medical records for any Vet to review, I recopy and remove the Vet’s name and info as experience has taught me, they appear to communicate with each other behind one’s back outside of medical questioning. Unless I am intend to stay with one, they don’t need to know where Patch has been. One Vet I had used for quite a time, overlooked he copied me, his correspondence to a Vet I had gone to for a 1x consult on another of my fur babies. It wasn’t ethical to say the very least. I called both out on it and moved on after that. HIPPA laws normally don’t apply to animals like humans, (unless a state law) but most good Vet’s still believe in the privacy of one’s animal records, unless given permission to disclose. Auburn UN informed me they follow HIPPA.

Other times I’ve found they neglect to consult together, even if I’ve requested them to do so or they mention they will do so. So many reckless people out there. One never knows what goes on behind closed doors.

I’ll keep y’all updated.
Donna

[labblab]

Donna, I’m really glad to hear that you’ve got plans to schedule the LDDS. That’s where I’d start, too. If that comes out “positive,” further adrenal hormone testing at UTK may become a moot point. If a dog has elevated cortisol, it’s almost a certainty that other adrenal hormones will be elevated, as well, and Vetoryl would be the recommended treatment across the board for a “functional” (hormone-secreting) adrenal tumor.

So let’s start with that LDDS, and then go from there.
Marianne

[PatchsMom]

Update on LDDST inquiry

Hello y’all. Thanks Marianne for your encouragement. Went for my scheduled meet & greet Monday with the local Vet for inquiry abt. his experience and Cushing’s testing. Was not interested in anything about Patch’s history or prior testes. It was a daunting 3 minute interaction, if that. Only confirmed did Cushing’s testing and treatment. Then exits stage right. No apology. I left scratching my head. I don’t team play with opportunist’s. First impressions are lasting impressions, even giving credence to someone having a bad day.

Inquired with the front desk folks before I left, can have an LDDST done next Monday. They don’t test for pheo, UCP ratio, BP or adrenal panel.

Feel this experience is a red flag, not meeting my needs and I’m uncomfortable bringing Patch in. Trying to be realistic, not emotional. My mindset; if a Vet can’t even be bothered to have a healthy, fundamental interaction during a scheduled appointment, what kind of care would they give to your pet?

Ultimately, it appears to go back to Auburn UN again for more conclusive thorough tests and adrenal panel for sure. (Heck, I'll take any hormone testing at this rate!) Other than time consuming, it seems to be a more logical and practical route overall. I can have many tests covered in one step. I’m hoping for an appointment soon around Labor Day. My poor Patch isn’t going to be a happy camper being “pawed” over again! But I should at least have some definite answers afterwards. Hopefully.

Even though I am more than anxious to do the LDDST now locally, it wouldn’t be cost effective, nor include other testing. I’m tired of being frustrated and scared of running out of time to help Patch.
Trying to stay calm and focused. My goal - to help Patch and get a diagnosis asap.

Any words of wisdom are welcomed. I am grateful for the much needed support.

Donna

[PatchsMom]

It’s been an arduous, 3 weeks journey, with repeated trips to Auburn UN small animal clinic. Patch had many tests, including an orthopedic exam, to check for muscle tone, strength, loss or weakness, and to rule out any possible pain issues he may be experiencing due to his arthritis and a back leg injury he received prior to my rescuing him. Patch fared very well during the examination. I am extremely impressed with the new Internist now assigned to handle his care, in attempts to thoroughly evaluate Patch. In case someone wants to know, Auburn does not do any urine cortisol to creatinine ratio testing (UCCR) or pheochromacytoma testing. One can save some expense and bring in free catch urine for testing. I also didn’t want to risk Patch to undergo another invasive needle to bladder urine draw.

After two long years of frustration and testing, Patch’s recent LDDST confirmed he is HAC positive. It is a combined relief and a stress. Complications arose initially, in that his potassium levels were extremely high (worrisome) but his protein levels had come down somewhat. Patch’s sudden excessive potassium was due to August’s increased dosage of benazepril medicine to lower the protein, so a decrease back to original dosage was warranted. It’s back to normal thankfully as well as his BP. Still an issue to monitor is his protein values and a small rise in cholesterol. Low fat diet here we come.

This Internist pointed out to me that it was imperative to get a definite Cushing’s diagnosis before placing Patch on any med’s, it could be quite dangerous otherwise and the prior trilostane dosage recommended by the other Internist I brought Patch to, of 90 mg 2x daily, was more than excessive. It was refreshing that she commended me for using common sense and not following through.

Now although it’s reassuring that the Internist agreed that Patch’s body weight is shy of 64 lb (29 kg) and a dosage of trilostane would be 1 mg per pound, (60 mg daily, being 30mg BID), I’m inclined to want him started on a low dosage of 30 mg per day, not 60 mg. In advocating for Patch, I explained I was not undermining her suggestion and explained Dechra’s U.S. literature reflects a difference in dosage here vs Europe and that they haven’t revised it for the U.S. as yet. I also pointed out that Patch is considered a large dog and that oftentimes, large dogs need and do well, on a much lower dosage as in 0.5 mg per lb (1 mg per kg). I stated I will forward her validated reference material over this weekend (the Davis info and links y’all previously posted in the forum) to back up my assertion. I stressed I was being more than reasonable in my request for Patch to start on 30 mg daily, either once or divided 2x daily total dose, as we can always increase if needed. Not to mention Patch has a history of being medicine intolerant. I can only hope my concerted efforts will convince her that this is the safest way to go. I so hate conflicts! I also realize I’m dealing with a University protocol, even though Dr. Ellen Behrand, the faculty head, is very knowledgeable about Cushing’s. I was also informed that sometimes death could occur in taking trilostane which is concerning and scared me.

I could just simply fill a prescription for (2) 30 mg bottles, and only give Patch the one 30 mg dose daily, but I’d be more comfortable with having the Internist’s cooperation. (Or combine a 5mg and a 10mg BID which would equal 30 mg total daily if a prescription). I feel that twice daily may be more beneficial overall, but safety and lower side effects is my number one priority for Patch. My concern is that Patch fares worse at night than daytime and a single morning 30 mg dose may not help him as much, since it wears off within 12 hours.

I also mentioned to the Internist, the pre and post trilostane testing vs ACTH. They aren’t quite on board with as yet, but have been entertaining it. Still appears I have some more hoops to jump through and am on the mission to find a Cushing experienced, local Vet to work in triage with Auburn and myself in treating Patch.

I welcome any thoughts or suggestions. Thanks in advance.
Donna

[labblab]

Hello, Donna, and welcome back to you and Patch. You’ll see that I’ve merged your update into your original thread about Patch. This way, we’ll be able to keep his entire history consolidated in one place.

Gosh, it sounds as though you guys have been very busy since the last time we spoke! But I’m really glad to hear that you’ve finally gotten greater clarification about Patch’s diagnosis, and also that you’re feeling comfortable with the folks at Auburn.

Two questions: Did the LDDS results lead you all to believe that Patch may be one of the rare dogs with a pituitary tumor as well, or were the results consistent with his known adrenal tumor? And are the Auburn vets still discounting the likelihood that the adrenal tumor is a pheo?

As far as the trilostane dosage, here’s a suggestion I might make. I do encourage you to keep your internist fully informed of your gameplan. But if Patch were mine, I believe I’d tell the internist I’d like to temporarily start out with just 30 mg. once daily in the morning for the first week in order to gradually introduce his body to the lowering cortisol. If he tolerates that with no ill effects, I’d be inclined to then go ahead and add in the other 30 mg. dose in the evening, with retesting in another week or two — again assuming he exhibits no ill effects in the meantime. Combining the gradual increase with prompt retesting would give me more peace of mind about trying, and evaluating, the full 60 mg. daily dose as the internist has recommended. Assuming that Patch does have a functional adrenal tumor, he may indeed require that amount of medication to provide more complete symptom relief. With an adrenal tumor, he may end up needing even a higher dose. But the prompt cortisol monitoring will help insure that he’s not being overdosed, which of course is the greater safety risk.

But whatever you decide, we’ll surely be anxious for any and all updates! Thanks so much for heading back to us now.

Marianne

[PatchsMom]

Hello Marianne. So happy to hear from you! Thanks for responding. Haven't meant to be silent lately, just off the charts busy. It is believed Patch has adrenal Cushing's, not pituitary, I think based on his recent Ultrasound showing the tumor there. But will double check with Auburn today for clarity. I do believe they mainly diagnose based on surgery. Not a way I'll go.

As to the pheo, disappointedly, although I pushed hard for it, Auburn no longer does that testing and couldn't suggest anyone that does. I've been calling around to find someone to do this testing, to positively rule this out no matter. No luck as yet, even though I believe it is simply a blood or urine test. Auburn bases their opinion on no pheo because he doesn't have all the "signs". Hey, he doesn't have all the "signs" of Cushing's either I told them! Exactly why I still want to rule it out.

I agree with you to initially start Patch on 30 mg once a.m. daily, for a least the first week, although I'm still inclined to want to do 15 mg a.m. and p.m. I worry as to him having side effects period as he has shown so many with other drugs used in the past. If things go well the first week, yes, then increase with a 30 mg evening dose. By the end of two weeks he'll be tested again and I can go from there. I certainly don't want his cortisol to drop too quickly in any event and I'm pushing for the lowest dose period! Haven't heard back from the Internist as yet to see how well they'll cooperate, if at all. I figure give them a few days to digest (or discount) all the literature I forwarded as we all should know, us "school of hard knocks" people don't have any "degrees" under our belt. I'm also in the mist of securing an educated Vet in my area, as not just anyone will do.

His LDDS score was -
pre-dex 93 nmol/L
4 hr post-dex 115 nmol/L
8 hr post dex 109 nmol/L

They consider Normal Values -
Pre Dex 20 -160 nmol/L
4 hr post, less than 30 nmol/L
8 hr post, less than 30 nmol/L
and a decrease in either 4 hr and/or 8 hr post Dex of 50% or greater compared to Pre shows "suppression".

So stay tuned for my next update. I'm sure it won't be long.
Donna

[labblab]

Hi again, Donna, and thanks for posting those LDDS results. The pattern is one that we would expect to see in a dog with a functional adrenal tumor. Dogs with pituitary tumors typically exhibit suppression to below 50% of the baseline reading at either the four-hour and/or eight-hour mark. If that degree of suppression is present, then a pituitary tumor is diagnosed definitively. A lack of suppression can sometimes occur with pituitary Cushing's, but it is much more commonly found in the presence of an adrenal tumor. So Patch's test results do correspond with the existence of the adrenal tumor that has already been revealed via ultrasound.

So "carry on," and we'll be watching for your next update.

Marianne

[PatchsMom]

Thanks again Marianne! Recently located pheo testing for Patch, but need more information if someone can help me to better understand. I was informed it would be a urine normetanephrine/creatinine ration and a metahephrine creatinine ratio. My research suggests a 24 urine catch or a 1st morning void. I was also informed that Cushing's and pheo can be concurrent. I found that the best testing uses the HPLC MS/MS method. Have yet to get the particulars from the clinic.

As to trilostane, I find a once daily usage doesn't lead to a significant decrease in catecholamines and their metabolites. Yet treatment for pheo is usage of phenoxybenzamine. Couldn't locate anything discerning treatment if a dog had both diseases. This clinic internist stated didn't matter if Patch had pheo, the treatment would be the same as for Cushing's. I beg to differ, but I could be wrong.

So now I'm left scratching my head if I should pursue the pheo testing. I still feel it needs to be determined if Patch's adrenal tumor is from this, even if concurrent with Cushing's. Auburn doesn't know which adrenal layer is affected. Naturally, I inquired.

I also have a possible Cushing's Vet within my area, that I'll meet with tomorrow. I'm hopeful it will be a positive move in any case and end this stressful part of my journey for Patch's care.

If anyone can help direct me with credible links or anything else to offer, I'd be more than grateful. Thanks in advance.
Donna.

[PatchsMom]

Happy to report, Patch has a new local Cushing's Vet! Patch and I had a positive consult meeting yesterday with this new Vet and I'm impressed. This is a huge weight lifted from my shoulders. She was super receptive to the information I provided about large dogs dosage. We've decided to start Patch initially on 15 mg's QD for week one and increase to 15 mg's BID week two if things go well and no side effects. Since he is so sensitive to most medications, this should help his body adjust in a more reasonable manner hopefully. It may take longer to see any changes, but safer for Patch all around. Naturally we'll increase dosage as we go and testing will be of great help. The goal is to possibly stabilize at 60 mg's over time.

Auburn internist will still be involved, acting in triage fashion thankfully. It is such a comfort to know I can now move forward in helping Patch and have the support I need. I'm awaiting answer on whether or not to have him tested for pheo in any case.

I'll post an update on Patch after he has started the trilostane.

Donna

[labblab]

Dear Donna, YAY I’m so glad you’ve found a trustworthy local partner for Patch’s care! I’m sorry that I didn’t yet reply to your earlier post, but I’m afraid I’m just not very knowledgeable at all about pheo specifics. If the folks at Auburn tell you they think it’s an unlikely possibility, though, I probably wouldn’t dwell on additional testing right now if it were me.

I wish you the best of luck with your Vetoryl treatment, and we’ll definitely be anxious to hear how things are going for you. Thanks so much for both your updates, and we’ll be watching for more!

Marianne

[PatchsMom]

Sorry it's taken me a while to post an update on Patch, as I have had way too much going on lately. The good news, Patch's 1st ACTH test showed he is tolerating the vetoryl at 15mg twice daily. Pre test was 1.5, post was 4.6.
As of late Patch is having difficulties in getting up from a lying position which appears he is having some muscle weakness in his hind legs. He also seems to have some problems in climbing up the 3 steps into the house. Also, his once bushy awesome tail has recently been losing fur and it is upsetting to see his boney end tail. Being quite concerned over this, the Vet lowered his vetoryl dosage down to 15mg in the morning and only 10mg at night. Haven't seen any changes as late. He also started galliprant 60mg at night recently for his arthritis. Makes him less alert during the day and tried only 30mg with no changes.

Not sure what is going on, just that I was more than excited with his first ACTH testing, and now to see Patch most likely is having side effects from the vetoryl. I've temporarily discontinued his galliprant to see if that is causing Patch's weakness. Haven't seen any changes.

Can anyone offer some ideas or suggestions here? I'm at a complete loss.
Donna

[labblab]

Hi Donna, so glad to see you back here with an update! I’m sorry to read that you’re having some new concerns, though.

First of all, that initial ACTH result really did look good. Can you tell us more about the timing of the test — how long ago it was taken, and for how long had Patch been taking the trilostane? Cortisol levels can continue to drop during the first few weeks of treatment even when the dose has been left unchanged. So it’s possible that Patch’s cortisol has subsequently dropped to an uncomfortable level for him. Now that you’ve lowered his dose, do you have another ACTH scheduled in the near future? That will be the only way to know whether or not his cortisol level is where you want it to be now.

If his cortisol level remains within the desired range, then I know it can be hard to sort out the true cause of his new mobility issues. Since we know he has some pre-existing leg issues, it’s indeed possible that the lowered cortisol is causing them to flare a bit due to the loss of that “natural” steroid. Of course, aside from the Cushing’s, natural aging may also be catching up with Patch. At age 12, many big dogs do start exhibiting increasing orthopedic issues. With my own non-Cushing’s Labs, that age range of 11-12 has really seemed to be the time period when aging mobility issues have emerged, and rather quickly. I would hope that the Galliprant would help with pain control over time. So you may want to go ahead and start back with that since discontinuing it hasn’t seemed to help. Also, as an aside, here’s something that I just wrote to another member yesterday:


As far as pain medication, I'll defer to your specialist. I see that Jet is already taking Galliprant, and that's supposed to be one of the newer, safer pain meds. You do have to be careful with traditional NSAIDS when treating Cushpups due to risks to the kidneys and liver. Also, when cortisol levels are high and uncontrolled, the risk of GI bleeding due to NSAIDs can be elevated. However, once cortisol levels have been stabilized within therapeutic range, some of the newer NSAIDS such as Meloxicam or Previcox may be considered a worthy trade-off in terms of quality of life. As I say, though, that's a question I'd pitch to your specialist. I've asked my own vet about Galliprant, and he says that, based on owners' anecdotal reports, he thinks it sometimes doesn't offer as much pain relief as do some of the traditional NSAIDS. But the safety issues may be an over-riding factor that makes it the better choice.

One thought about the fur loss on his tail: one irony is that we’ve often seen Cushpups suddenly lose fur for a time after cortisol levels are lowered into therapeutic range. This seems very strange since balding areas are a classic symptom of uncontrolled high cortisol. Why would dogs start shedding after the cortisol is lowered? The explanation we’ve been given is that untreated Cushing’s can disrupt the normal hair growth cycle — kind of putting it to sleep. Once cortisol is lowered to a more normal range, the hair growth kicks back in again, and can result in a rather sudden shedding cycle. This happened with my own Cushpup. He had developed large bald areas on his flanks where no hair regrew prior to treatment. But after starting treatment, he suddenly started massively shedding even more! I was really freaked. But when I examined his skin, I saw that there was fresh soft baby hair underneath the shedding. And sure enough, before long he started filling back in with a new fluffy coat. I don’t know whether this is what is going on with Patch. It’s a bit odd that only his tail would be affected, since hair loss along the flanks and haunches is also typically involved with Cushing’s. But I wanted to at least mention this possibility.

OK, that’s about all I can think of for now. It does seem as though you’re in a bit of a holding pattern for the moment, awaiting further ACTH results from the dosing decrease. Once you have a better idea as to where his cortisol level is settling, you may also be better able to judge whether the mobility problems are related to the medication or instead to something else. Please do continue to keep us updated.

Marianne

[PatchsMom]

Your response has given me some comfort Marianne. Thanks. I'll first address the vetoryl history on Patch for you. Patch started Oct. 7th on 15mg once daily for 1 week. Week 2, the dose increased and he began 15mg twice daily. That's 30 mgs. Nov. 4th he had his first ACTH test, wherein the results were, pre 1.5 and post 4.6. The Vet used Antech Lab. A CBC and urine was also done, wherein his bilirubin was extremely high. They forgot to run the urine creatinine protein. His blood pressure was fine.

I forwarded the results to Auburn since they are in the loop and they called me seriously concerned and asked me to get Patch down there, which I did on Nov. 9th. They wanted to do another ultrasound, x-rays and chemo panel to check his gallbladder, pancreas, his adrenal tumor, etc., for fear he may have something serious going on. Thankfully all went well and all his numbers were fine. My pocketbook wasn't, not to mention the trips there are exhausting for this old lady! Auburn stated to have his urine creatinine protein checked at his next ACTH test, not overly concerned about it at the present. His Vet said Patch should be retested by Dec. 11th coming. I'm unsure if that is outside the normal range for test two.

During Patch's Auburn LLDS test of Sept. 20th, I had the orthopedic department give Patch a thorough exam, as a precaution, to hopefully catch any issues before anything got worse. Their report stated most what I already have known of over the years and they felt Patch wasn't in pain. I begged to differ having arthritis and spine problems myself. I discussed this with the new Vet on Nov. 4th and that's how Patch came to be on Galliprant. 60mgs seemed to make him inactive and drowsy, but a half dose of 30mg made him more responsive daytime. Either way had a ZERO noticeable effect on him for any pain relief. The Vet suggests we might add some gabapentin into the mix but not really wanting to add more med's to Patch. So don't know what I'll do.

ow we are entering week 7 on the vetory, 30mg daily. In week 4, (1st week Nov.) Patch lost interest in breakfast. I'd find something edible to trick him into at least eating even a small amount of food with his med's. Shredded cheese, cottage cheese, mashed up chicken. Anything I knew he'd eat just for the pills. Night feeding hasn't really been an issue.

At the Nov. 4th first ACTH test at the Vet, they had trimmed his nails and hit the quick on his left front toe nail. He also slipped afterwards on my car ramp, when we were leaving, hitting that same leg. I noticed him limping the following day, mentioned it to the Vet and kept watch on him. Over that weekend he seemed to be fine. Of course I used a heat pack, massages and Yankee ingenuity and put baby oral gel on that toenail, thereafter liquid nails to feel confident I had closed up any damage that may have occurred. I know that hitting the quick is painful. So I reasoned I knew why he was limping. Last week I found he was having a difficult time getting up off the floor, but didn't seem to need my assistance to get up. Saturday, I noticed he was really struggling to get up off the floor. I placed several rugs and fatigue mats all over the house. I noticed the Vet, we dropped down on the vetoryl to 25mgs. Seemed now it is his back legs were giving out.

Yesterday was terrible in that I had to use a towel underneath him to help him up, go up or down my 3 house stairs, and just to help him to get to his bowls. I was freaking out, called the Vet to report his worsening condition, trying to brainstorm, searched the internet for possible causes, just worried sick. I had a beautiful cat die a couple years back from a sudden aortic thrombosis and now I was forced to recall that sad experience, scared to death Patch may die! I found if you cut the sides off a cloth shopping bag you can use that as a sling with handles, so that's what I'm currently using. Thanks to some posting it on the Net! I'm still saddened over his tail fur loss, but I appreciate you addressing it Marianne and giving me some hope for regrowth. It was a shock to get a handful when I brushed him!

I have a Monday Vet appointment for Patch. They're not open on Saturdays unfortunately. Thinking that Patch could have low calcium, low thyroid, a host of spine or degenerative diseases, low blood pressure (vetoryl can cause problems with BP med. benezapril) or whatever, I decide to stop all his med's until Monday except the vetoryl. Whether right or wrong, I dropped him down to the original 15mgs, all to see if he reacts better by Monday. He didn't have any issues until week 4 on 30 mgs. I hate this roller coaster ride!

This morning after just omitting last nights vetoryl dose, Patch was hungry for breakfast this morning and eat he did! I'm seriously beginning to think Patch needs no more than 20 mgs daily. But the back legs issue is another thing, even though he got up by himself a couple of times this morning as well. As long as he was on a rug and not under my kitchen table.

I'll update after Monday's Vet appointment. Trying to hang in there over the weekend and praying he doesn't get any worse.
Donna

[labblab]

Hi again, Donna. Gosh, I’m so sorry about this turn of events. Mobility issues are such a nightmare for those of us with big dogs! Not only do we have the worry as to what has gone wrong, but we also must wrestle with the practical issues of trying to help them up and around. The suggestion about the shopping bag is genius, though. We had bought a handled harness online when we were struggling with hind end issues with our Lab girl. But honestly, the shopping bag sounds as though it would probably work just as well. So thanks for sharing that tip with us.

I’m afraid I don’t have any brilliant thoughts as to what might be causing this sudden decline, but I’m very relieved that you’ll be heading back to the vet tomorrow. For what it’s worth, I’d be inclined to totally discontinue any more Vetoryl until Patch can be seen. Since he seemed to perk up when you eliminated that evening dose, at this point you may want to give him a total break until he can be further evaluated. Who knows, maybe his cortisol level really had dipped too low.

Anyway, I’m surely hoping that things have stabilized since your posting, and that tomorrow’s appointment may yield some answers. I’ll be watching for another update!

Marianne

[jenner1026]

Hi Donna,
Sorry to hear about Patch's issues - it's SO hard. I just wanted to pop on and say hello and good luck! Wow, I have never seen anyone advocate for a dog like you - it's amazing all the information you're able to retain and understand. This stuff all goes over my head!
I am Jet's mom, who Marianne quoted within your thread about her reply to me about Jet regarding the Galliprant. It's just so interesting to see how this disease varies from dog to dog. Gosh, I can't believe Jet is taking 120+60 and Patch doesn't seem to be responding well on only 30mg! And as much as medication my dog is on, he STILL cannot wait to eat - he cries when it's approaching dinner time because he just doesn't want to wait! I definitely would know if something was wrong if he stopped eating. Patch's cortisol levels seemed to be pretty good too on the Vetoryl, am I right on that?

I am also experiencing some very small mobility issues (lame front leg, and some rear leg shaking)...I am so afraid it's going to get worse and I will also need to start helping him up. I just dont think I could physically do it. Jet is 75 pounds and I am only 95 pounds! I will struggle, so it really makes me nervous. The Galliprant may be helping but I am really not sure. Not sure how many mg he is on right now either but its once a day.

I will follow your thread to see how Patch is progressing and what meds you may have him on. Jet has his next test and bloodwork on Wednesday.

Good luck!
Jennifer

[PatchsMom]

A HUGE thanks to both Marianne and you Jennifer (Hello there. My daughter's name also)!! This group has kept me from losing my sanity and such a comfort! Even without this awful covid, I'll take whatever imitation hugs I can get! Having serious lumbar issues and scoliosis, although I manage (not wheelchair bound ever hopefully) I've learned a thing or two about backs over the years. Know what constant pain is as well. Dedicated to my Patch? You bet! He's had so many problems, some at the hands of bad careless vet's over time and I constantly try to educate myself to be able to help him. So wish our babies could speak human. It certainly would make our lives easier.

Patch has been getting up by himself since Sunday morning, as long has he has traction under him, like a rug. No traction on the bare laminate floors. (His pads are trimmed from excess fur). Can do the few outside house stairs and even took a couple of short walks throughout the day. He still shows some signs of hind leg weakness no matter, but a relief in that he can at least get up most times.

I found this bit of info below to share in hopes it helps someone. I'll be presenting it to the Vet later today. At least I have a more than willing and cooperative new Vet who truly cares and is concerned about Patch's wellbeing.

I hope the link works. If not just google type it in.
Dr. Pippa Elliott, BVMS, MRCVS By Dr. Pippa Elliott, BVMS, MRCVSAug 1, 2019

Hind Leg Weakness: When Your Dog's Back Legs Give Out (petful.com)

There are so many causes of weak leg muscles, you almost need to be a rocket scientist to sort them out. I made up a spreadsheet listing and will try to convert to a pdf file and post later on this week. Hopefully I may get some answers today, but I'm thinking Patch may have to go to a neurologist specialist or at least (my choice) a Vet Chiropractor which I've located here for an evaluation.

Jennifer, I tried gabapentin with Patch last year. Didn't work. This new Vet thinks we may try that along with the galliprant (lower dose), but she's not really keen on wanting to add more med's to him. His cort levels were fine at 1st ACTH test. He was on 30mg vetoryl then for 3 weeks or so. The galliprant 60 mg, makes him so groggy the following day. I've experimented with half dosage and no real relief did I see. I hear you on trying to lift a big dog. Patch is 64 pds. But if you see I mentioned cutting the sides off a cloth shopping bag (with handles) to use as a sling underneath the dog, is a cheap enough easy fix vs purchasing one. Even though I sew, this was a no brainer. Also at my age, nearing 70, I can't run the risk of further back injury. I thank you for your compliments.

Lastly Marianne, I dropped Patch down to 20mgs vetoryl, seeing that he did well on the original 15mg's, I opted to try 20 instead of the 25mg. May have to stop it completely temporarily. I also noticed Auburn as to this newest dilemma of Patchs'. Two Vet heads are better than one. Will have a better prospective after Patch's visit today.

I'll post again soon with an update. Thanks y'all
Donna

[PatchsMom]

Patch’s Vet visit went well for the most part. Had a full blood workup. Thyroid, calcium, salt, creatinine and electrolytes were within normal range. His BUN, TP, GLOB, ALT, ALKP, GGT, and TBIL were slightly high.

X-rays showed his hip dysplasia had worsened a little from previous x-rays of a couple years past. Didn’t see any bulging discs, dislocations or slipped discs in the images. An MRI would have produced a better understanding, but not available at most Vet’s.

Vet did a manual exam of his legs and feet to check for possible nerve damage and muscle weakness. She felt sure it was his hip dysplasia causing his weakness. Boy, did his back legs shake while standing. I presented her with the printout of possibilities with simple testing for such, but although she glanced it over, I don’t feel she was too impressed. I was delicate to explain I wasn’t undermining, just trying to cover every possible cause and doing my job in advocating for Patch. No pin prick of his skin for sensation or a knee reflex test was performed.

Being on a limited income, I’m the one paying all these amounting Vet bills and not in the habit of financing someone’s business. Let’s get real and upfront. I expected a thorough exam and nothing less. I insisted his ears be rechecked from an earlier visit as he’s still shaking his head on and off. Sad one has to do this. I’m not out for a popularity contest, and done with paying the big bucks for an intermediate exam visit. Although clean ears, it revealed some yeast. Naturally, I opted out of the Vet priced zymox when presented. Thinking outside the box, with Monistat for starters and yogurt. I think he even has some on his belly although not itching anywhere.

Overall, I’m not convinced we’re out of the woods just yet. Doubtful hip dysplasia alone is the cause of Patch’s sudden hind legs weakness. He’s still having difficulty rising, is more thirsty than usual, and now seems to have little interest in eating, just sleeping. I’m back to human grade meats for him, which I know he’ll eat! The exam did drain him. I’m investing in a rug for under my table and bought some more cost effective, floor fatigue mats to aid in his traction. More vacuuming isn't on my list. Under the table is off limits for now. Patch loves cold floors, but it’s way too hard to pull him out from under it. The mats are less hassle and cheaper than those foot grip booties or rubber toenail tips that are sold. My handy “sling” is always close by. Realizing that my 18 ft. hallway is a race track for my cats, it’s a good thing I‘m feeling like an OSHA employee in safety these days. I’m exhausted!

Vet wants to continue the 25mg of vetoryl. Marianne, I’m taking your comment to heart and stopping for now because I feel the vetoryl is contributing to Patch’s leg weakness. It’s worth the experiment for a couple of weeks to see what happens. I’m beginning to think Patch may be experiencing some kind of withdrawal also by his behavior. People close to me have stated that Patch acts like he’s been on anesthesia. I’m leaning on not restarting the vetoryl, because I feel it’s done more harm than good, but if I do, I’ll begin with the 15mg and only increase by 5mg at a time. What I did take notice of though, the 1st week even on 15mg, Patch suddenly started with frequent urination and accidents in the house. Things that hadn’t been a prior issue ever as many complain about their cushpup. His panting seems to have increased as well and he’s gotten a little dehydrated from all the urinating. Since week 2, it’s been 30mg daily. Regardless of the dosing, Patch’s health has gotten worse over these past few weeks. But he stills wags his tail!

I only find vetoryl side effects makes mention of weakness and lethargy. Nothing specific as to what weakness. Are we not being told the whole story? The literature mentions side effects and when to stop giving it to your dog.

In my search for answers, I discovered that until 1994, trilostane was used to treat Cushing’s in humans. But, it was banned for this purpose because it was no longer considered safe. I was not aware of this information, as many other pet owners probably aren’t either, before I began giving this to Patch. I’m also very disturbed that Patch has been getting sicker instead of feeling better, even though every Vet I’ve been to promised he would feel better. Begs to question, why was it considered unsafe for humans, yet give to a dog?

I also decided no galliprant, (possibly a contributing candidate to muscle weakness?) rather opting for the next 3 days to give Patch a regular 325mg aspirin, once or twice a day for his pain and forego the dose of his blood thinner plavix during this time. Aspirin is a blood thinner and he doesn’t need both. I’ll figure out something pain med wise later. He cannot tolerate many he’s already previously tried. Tried CBD oil way back, before he started any med’s, with no effect. One can never be too careful in cross checking adverse medicine interactions nonetheless.

Jennifer, I’ve been thinking about that high vetoryl dosage for your dog. You said 120mg plus 60mgs? The specialist I first saw wanted to start Patch on 180mgs.. way too much and so happy I didn’t listen! I hope you’ve explored why he’s having muscle issues, with at least some x-rays. He’s a large dog and no breed is immune from hip dysplasia.

Which leads me to add, I’ve learned everything I could absorb about hip dysplasia for the last couple of days. I came across what I feel is great information to share. While I’m a fan of Dr. Marty Becker and Mercola.com I happened upon a Dr. Andrew Jones of Canada in his You Tube videos about hip dysplasia. There were many other good videos from others as well, including how to test your dog’s muscles yourself. I also found some easy home exercises I’ll be starting on Patch too.

It’s easy to find by typing in Google “Veterinary secrets Dr Andrew Jones YouTube”. He has videos for many of our pets ailments to explore. I always say, choose your poison and believe what you like, using your own judgment. I’m unusual in that I am open minded and use common sense.

I found that underwater hydrotherapy is good for hip, muscle and mobility issues, as well as acupuncture and Chiropractic care. Patch has a Chiro appointment next week for a complete assessment/2nd opinion. Thankfully it’s not breaking the bank. In two years I have racked up alarming Vet expenses. Patch deserves a much better quality of life than what he’s been experiencing lately. I’ve applied for many organizational grants for Vet assistance, but haven’t received anything to date. This Chiro is an AAHA member and said they should be able to get some assistance for Patch. That’s comforting.

Until next time, my mission continues.
Happy Thanksgiving everyone. You know Patch will be getting some turkey!
Donna

[PatchsMom]

Hello. I just realized I haven’t posted in almost a year and I can’t believe it! So sorry Marianne! You have helped me sooo much! If I've placed this posting in the wrong place, please put it where it should go.

Summing things up since then, things had been going fairly good since I took Patch off the vetoryl. All his fur grew back beautifully and thick. He still had an occasion with trouble getting up from laying down, but could do the three outside house steps. His appetite was normal. We continued with many supplements. I was hopeful with his improvement. I looked forward to a few more years of his companionship.

This past September he had his physical. He was starting once again with hip and back legs issues so I had x-rays taken. Nothing had worsened, yet he seemed weak in their use. His protein level was a bit elevated and his blood work showed low thyroid levels. New medicine caused diarrhea so had to stop that.

Here we are about 6 weeks later and I brought Patch back to the Vet today as he’s been having awful labored breathing issues, not eating much, no energy, trouble with his hind end after a week of seeing it wasn’t getting any better. I thought he might have an upper respiratory infection or something needing antibiotics. I was quite worried.

Boy, was I so wrong! X-rays show Patch has lymphoma. Lumps in his neck glands, stomach and one hind leg behind his knee. I’m unsure, but guessing at Stage III. I can hardly wrap my head around this! I’m in total shock over this sudden turn of events, since September x-rays didn’t even hint at a problem when we compared. I know he cannot take chemo due to his old age, nor prednisone because of the cushings, yet I’m grasping at straws hoping for a miracle. At this point it doesn’t make sense to see an oncologist. Let alone have Patch tested to learn what kind of lymphoma. Not that I could even get a quick appointment. I know I’m facing to have to put him to rest in the near future to ease his suffering. The Vet wanted me to do it today as she doesn’t think he’ll make it for two more weeks as this is an aggressive cancer. She’s also worried about him internally bleeding. But I just couldn’t do it. I was alone and scared. I don’t do well under pressure on a normal day.

I did learn that there is a tumor drug called Piroxicam (Feldone) that helps fight inflammation and may help reduce the size or growth, but my Vet doesn’t have any history of it working on lymphomas. It’s not as effective as prednisone. Naturally, I suggested we at least give it a try for a few days and see if any improvement, especially Patch’s breathing, and she agreed, so I’ll start Patch on that tomorrow. I just have the panic to rush and try every available avenue before I say good-bye. I don’t know how I’m going to cope with losing my best friend.

Does anyone have any words of wisdom to share? I’d be grateful.
Thanks,
Donna

[Joan2517]

Gosh, that's so sad. Honestly at this point I would just let him be, and enjoy every minute you have with him. Lymphoma is not easy on any dog, let alone one with Cushing's and everything that goes with that.

I lost my big boy last week, they think to pancreatitis, but who knows. I am still in shock and going through all the "should haves" and "what ifs". I loved him so much, but he went downhill so fast that I don't know if anything I might have tried would have saved him.

I had a dog with lymphoma back in the 90's and we did chemo with her and to this day I wonder if it was fair to put her through all of that. She died anyway...

I am so sorry that you are going through this. It is an awful decision to make because we want them to stay with us as long as possible, but we have to think of what is fair for them.

I know that panicky feeling, I have felt it many times. I will be thinking of you and Patch and hoping for whatever is best for you both.

[labblab]

Hello again, Donna (and you posted exactly correctly on this thread). Like Joan, I’m so sorry about Patch’s lymphoma. It’s got to be such a shock for you, for sure. For what it’s worth, we’ve had a few other Cushpups here who subsequently developed lymphoma, and I think the decision was typically made to do whatever was best to treat the lymphoma regardless of the underlying Cushing’s diagnosis. That meant that if prednisone was the best tool for fighting the lymphoma, go ahead and give it. So I’ll just throw that out there in the event the Feldone does not end up helping.

No matter what, though, I know how heart-breaking and terrifying these end-of-life issues can be. Joan has just lost her darling boy. And as fate would have it, my own elderly Lab girl is deteriorating markedly and rapidly right now. I wish I had some words of wisdom for us all, but I’m pretty much struggling right now, myself. I’m trying so hard to stay as calm and “present” for my dog as I can when I’m with her, but it’s sure not easy! I guess my biggest piece of advice is just to keep coming back and talking to us. We can’t change things for Patch, but I do believe that the heavy burden that we’re carrying, ourselves, becomes a tiny bit easier to handle when the burden is shared. We’ll stay here alongside you if there are more decisions you have to make, or just to talk things over.

I’m so sorry about Patch, Donna. But I’m grateful you’ve found your way back to us, and we’ll do our very best to help you in any way we can.

Marianne

[PatchsMom]

My heartfelt thanks to both you and Joan and I'm sooo sad for you both. I'm sooo grateful to everyone for being there for me, as we each travel that unknown road in support, that it seems even our closest family and friends cannot comprehend. Even though well-meaning. I will not be a stranger and will do my best to continue to check in from time to time. I sooo appreciate y"all!

With near inconsolable grief and sadness, my precious baby Patch, passed away Monday morning. It was a heart wrenching and tragic event to experience. I was with him as he took his last few breaths, vs having him put down. My religious convictions are strong about “thou shall not kill”. I only wish I could have held him, but at 60 pounds and the tight spot where he always laid, made that impossible. I pray he knew I was there with him. Patch passed on his terms.

Since November 11th, it has been a nightmare roller coaster of events. The first and 2nd Vet’s wanted to end his life then and there, but Patch was determined to keep going. I found a more cancer experienced Vet Monday, the 13th an hour away, who placed him on prednisone and sent off some tests for pathology. results as yet. Patch’s lower jaw had swollen suddenly that morning and he couldn’t close his mouth. By Wednesday, the 13th, his jaw was back to normal, and his neck and back legs glands had shrunk tremendously. I was more than hopeful we still had a fighting chance. To share with others, this Vet suggested to get yunnan baiyao, but I could only locate it by online order. The other remedy was Apocaps. Another treatment I was exploring is called LDN which is low dose naltrexone. I offer this information for anyone who has a cancer/cushings dog.

At suppertime that Wednesday, the 17th, Patch appeared to had a stroke. I was frightened, in near panic mode and needed help to lift him into my car to race to the Vet. I finally got my local Sheriff to come to the rescue. The belief was that Patch was at the end of his life and would be put done. Amazingly, he had seemed back to his old self at the Vet’s, other than back leg weakness, and hope was renewed. As a precaution, I left him there for two days for observation. That didn’t go well, and his care was more than neglectful. I was disgusted to say the least. I was told Patch is back to his normal self. When I picked him up on Friday morning the 19th, to travel to Vet #3 for better treatment, Patch could barely stand up, appeared extremely weak and was heavily panting.

Vet #3 was more attentive and gurneyed Patch in. They weren’t impressed with the turn of events prior. X-rays were taken and showed Patch had a spleen mass that may have leaked and/or was leaking. Not determined if he had a stroke without an MRI. They didn’t have that equipment. It showed some masses in his stomach as well. It was suspected Patch may have two kinds of cancer. I left there with high hopes again, more medicines and instructed to call Tuesday with an update. If Patch didn’t show any improvement, the kind thing to do he said, was to have him put down. I reluctantly concurred.

Over the weekend, Patch slowly regained some energy, got up by himself on occasion, was alert, still walked a bit wobbly, ate the numerous small round the clock feedings I gave him. He got my undivided attention with palliative care. Sunday evening he seemed restless and appeared a bit disoriented. His breathing began to be more labored which put me on high alert all night. I kept up with giving water, even by syringe to keep him hydrated. He didn’t want food of any kind. At 7 am Monday morning, I knew things were going quickly downhill. His breathing had worsened and figured he’d given up and would have to have him put down, so I quickly made arrangements with a local Vet. My help was enroute, but by 8:15 I felt Patch slipping away, although my brain didn’t want to accept it. I held Patch’s head so he could drink the water I offered using a squirt bottle. He acted as though he’d been in the desert for days and incessantly gulped it down. Then he just put his head down as if to say I’m done. He no longer seemed to have an ounce of energy. I was terrified to say the least! Within a couple minutes after, he took 3 last breaths and passed. Anyone who’s witness their pet passing, knows the rest of the story. This was my first. No amount of preparation for this event actually helps you to keep it together. Especially alone as I am. The most difficult part, is dealing with the pain, the physical loss, and accepting it. Not to mention how disruptive your normal daily routine goes thereafter. I realize part of life is death. Everyone, at some time or another experiences this and we all have our individual ways of coping. Mine is “one day at a time.” God gave me Patch to love for 14 years and I always will. I will miss my best bud forever.

[Joan2517]

I'm so sorry, Donna...it hurts so bad when no matter how hard we try, they go anyway. I read somewhere that they know they are dying 24 - 48 hours before it happens. I think Gable knew on Monday. I feel terrible that he must've wanted to die at home in the yard that he loved so much, rather than in the ER with strangers. I just never know what the right thing to do is and the guilt consumes me.

14 years is a long time. Your were blessed to have Patch that long. Gable was one when he came to me and I only got to love him for eleven years, but he was always my big, beautiful boy. To love a dog is the greatest thing, I think. And to lose them is the worst. Again, I am so, so sorry.

Love,
Joan

[PatchsMom]

Thank you so much Joan. I know you are hurting as well. I'm sure you are experiencing the same feelings of loss, as I, this Thanksgiving Day and I send my love to help comfort you. Each day that passes gets a tiny bit better, but we all know, the emptiness will never go away or be replaced. We just somehow go on and move forward, one day at a time.

I share a website I found that may be helpful to someone experiencing the imminent death of their dog. Being curious why Patch was so unusually thirsty just seconds before he passed, I needed an explanation. I also wanted to ease my mind, feeling somewhat guilty that I may have not done enough to help him. I do know I did everything I could, but we always second guess ourselves. This information helped me, even though after the fact. Forgive me as I am not well adapted to do the actual link.

Signs Your Dog is Dying: A Caring Message to Bring You Peace - Dr. Buzby's ToeGrips for Dogs

Then feeling sad this holiday season and needing to feel "normal", I found these below sites that helped as well. Hopefully they are also helpful to others.

Grieving the loss of a pet during the holidays (healingpetloss.com)

Pet Loss and the Holidays: Four Things To Consider When Grieving During the Holidays (animalsinourhearts.com)

Surviving the Holiday Season After Pet Loss - Fidose of Reality

Thank you to everyone. We are all in this together. Sharing and caring.

Donna

[Joan2517]

Thank you, Donna. I will be interested in reading these. Hugs to you....

[PatchsMom]

Your very welcome Joan. If you or Marianne could enlighten me please, I would like to have Patch listed in memory of, but don't know how to add him. I also want to do a picture, and if you recall Marianne, I was unable to do so way back because of some glitches.

Patch was 14 when he past on Monday Nov. 2nd recently. I rescued him when he was almost a year old (like you Joan with your baby) from drug dealers who abandoned him. Not that that is important. He certainly was a happy boy and knew he was so loved!

I read an interesting article today I thought might be helpful to someone. I subscribe to Dr.'s Karen Becker and Mercola's newsletters. I think I figured out how to add links and hope I did it correctly below.

Compassionate Care for Senior and Terminal Pets (mercola.com)

https://healthypets.mercola.com/sites/healthypets/archive/2021/11/27/compassionate-care-senior-terminal-pets.aspx?ui=1d064ce40419e3c6ec2d4b980a3ee320c6e24 851626cf551b9de8bfa1a58a40a&sd=20200527&cid_source=petsnl&cid_medium=email&cid_content=art1HL&cid=20211127Z1&mid=DM1042356&rid=1333998730

Moving on best I can, one day at a time. Many hugs back to you Joan as well,
Donna

[PatchsMom]

Well, I finally figured it out and added just a few pictures of Patch!!! Wasn't so difficult after all! Now to figure out how to show Patch's pic with my name.... Patch was like a little kid who loved to dress up and show off .. such a patient baby.
Donna

[Joan2517]

There's a link, Donna, about frequently asked questions. I think you can add your avatar there. I just went in and changed my signature to include Gable as an angel. Marianne or one of the other admins will be able to add Patch to the Loving Memory page. I don't have the rights to do that (and wouldn't know how anyway, lol).

And thank you for the information you sent. I knew he was dying from the fact that he was hiding in the yard and am furious with myself for letting our vet talk me out of that. He was in pain all day into the night...if only I had gone with my gut feeling.

[labblab]

Oh Donna, I’m so sorry I’ve been tardy about checking in — I had been away from home over the holiday and am just now back once again. I’m doubly sorry to have missed your news about sweet Patch. Absolutely, he’s now been added to our memorial list of Cushing’s angels, and it would be our privilege to also add a link on his memorial line to one of your new pictures. They’re all wonderful. If you tell me which one you’d like to have added to our memorial album, I’ll take care of it right away. Or if there’s a different one you’d like for us to use, just let me know that, as well.

As far as adding an avatar, take a look at this link:

https://www.k9cushings.com/forum/faq.php?faq=vb3_user_profile#faq_vb3_signatures_av atars

As long as you’ve already logged in before viewing the information, there should be embedded links that will take you directly to the area of your personal Control Panel that will allow you to add your avatar.

Once again, I’m so sorry about your loss. Thank you so much, though, for returning to tell us what has happened. This way, even though we know the days ahead will be hard, we can celebrate Patch’s life and beautiful spirit alongside you. Fare thee well, sweet boy.

My warmest thoughts are with you,
Marianne

[PatchsMom]

Hello Joan and Marianne. Thank you both for being there for me. Marianne, I would like to add Patch's pic #3 in his blue horse coat if you don't mind. Thanks. Not up to adding any new pictures as yet .. too many tears. Can't bear to see his Santa picture!

I’m sorry I haven’t posted lately. It’s hard to believe it has been one month since Patch passed. I couldn’t deal with the pain, and I shut down. I just couldn’t face the world, nor put on that fake happy face feeling so miserable. It’s been hard to accept reality and move on, but I’m trying. I became very sick due to being overwhelmed with grief, but finally realized I was avoiding it and reluctantly gave in to let it take its course. I’m doing better at taking care of myself. The pathology report finally came in recently and was positive for lymphoma. Not that it matters now. It’s just confirmation of what was suspected.

I’m still having trouble sleeping, but I’ve gotten through a few days here and there, without tearing up. Some days I feel like I’m in a time warp. It seems the same bad movie keeps replaying in my head. I struggle with the events leading up to and when Patch passed before my eyes. Questioning if I did anything wrong, if I could have done more and didn’t, all the ifs, if only and why’s. I know it’s all natural and part of the process I must experience. It is so lonely without him and all the wishing in the world won’t bring him back.

I have support which I’m grateful for. I do reach out. Some wanted to get me a new puppy, thinking that would ease my pain, although well intended. It’s way too soon to even consider at this time, if ever, for me. A miniature pet cow might be something to think about, down the road. I still have my cats for a focus thankfully. My daily routine has been difficult to adjust to and it will be a while before I can get back to feeling somewhat normal. There is this hollow feeling, an emptiness. No physical presence of what was, in my house, or any room, just memories.

With great pain, I packed up all of Patch’s bedding, sweaters, bowls, car ramp, bath and grooming items, leashes, harness and anything that was his. It’s amazing how many items you don’t realize you have. Yet I still find something that brings back reminders. Things I have no control over. Thunderstorms and how scared Patch was of them, let alone him not wanting to get wet when out for potty. Or how he’d seek solace with me in my office and crouch down under my chair to try and hide. These cold windy days lately, remind me of how I’d make sure he had a sweater on, especially at night in my drafty bedroom. When I hear the coyotes, I’m reminded of Patch barking to scare them off when they came too near the house. I gave away all his food and treats to someone in need and all his unused medicine’s, donating them to his local Vet. I used every ounce of energy to return the Christmas sweaters I had bought him, but I still can’t go in the areas of my yard where we walked. I believed if out of sight, I’d have no pain.

I’ve experienced many bad times in my life, and I’ve lost many fur babies, but this time seems to be the worst to endure. Most people consider a dog just that, but Patch was more like my child. We shared unconditional love, 24/7. I accept it’s going to be a rough course and I’ll eventually make it through, even if baby steps, one day at a time.

I’m hoping the link I’m sharing below works as it seems it wasn't so easy to do this time. The subject can always just be Googled in any case. My sincere hope is that it's an asset to someone grieving the same loss as me. It has been very educational and a great help in understanding during my pain. Ironically it was just posted yesterday, when I needed it the most. Part I and II videos run for about 2 hours, but well worth watching. We all deserve peace in our lives, even if not Christmastime. And Joan, I so hope the below helps you to overcome the blame we all go through or the misdirection we were given for our precious babies during our most vulnerable time. I still have the anger, mood swings and everything that grief hits us with. It's okay to be sad and to those uncaring others who don't understand, I say GET LOST! I'm slowly taking my power back.

Grieving the Loss of a Pet (mercola.com)

"https://healthypets.mercola.com/sites/healthypets/archive/2021/12/19/grieving-a-pet.aspx?ui=1d064ce40419e3c6ec2d4b980a3ee320c6e248 51626cf551b9de8bfa1a58a40a&sd=20200527&cid_source=petsnl&cid_medium=email&cid_content=art1ReadMore&cid=20211219Z1&mid=DM1064515&rid=1354644038"]

Thank you for being there for me. I’m humbled. I'll not go MIA for long again.

Donna

[Joan2517]

Oh Donna, everything you've said is how I feel. That emptiness in paralyzing and I miss him so much. Thanksgiving was awful and I know Christmas will be worse. This morning's Facebook memory was him sleeping in front of the tree last year while I was decorating it. I still can not believe he's gone. I want to give my son his cooling vest for his dog, but keep forgetting, so it's right where I see it all the time...maybe I don't really want to give it to him. I made a photo ornament of him and it's hanging on the tree next to Lena's. I know she was happy to greet him and have him there with her. All of my old-timers are together again, except for Doree who I think will be next.

I know this will get better for us, Donna. We will never forget them, but we will start to smile at the memories again. There's no time frame for grieving and I have learned not to let the ones who don't understand, know how I feel. I went through the same thing with Lee. There are those who seem to just get over it and expect me to do the same. I can't, that's not who I am, and it's not who I want to be. I will grieve as long as I need to and I don't care what anyone else thinks.

I wish you peace and comfort for Christmas and the New Year, and know you can always come here. We all get it...

Love,
Joan

[labblab]

Dear Donna,

Your sweet photo of Patch in his blue coat has now been added to our memorial album, with a link in place to his personal line on our “Remembering” thread. I can surely see why you picked it — he has such a dear expression on his little face. Just like an Angel.

Once again, I want to “second” everything that Joan has written so beautifully above. Your family here will always be waiting for you at any time you might wish to talk. For sure, we realize how many different emotions the holidays can trigger. Years ago, we started a special thread that serves as kind of an “open house” during the holidays for all our members who have suffered losses. Every year, we open the doors once again. If you should wish to join us this year, here’s a link:

Holidays can be hard… (https://www.k9cushings.com/forum/showthread.php?3790-Holidays-can-be-hard)

Either way, I’m continuing to send you my warmest thoughts, always in loving memory of your precious boy.

Marianne

[Squirt's Mom]

Dear Donna,

Life has sadly kept me away from the forum much more than I would like lately so I am late in offering my heart-felt condolences to you and yours. You fought so hard and did everything humanly possible to make Patch's every day as wonderful as it possibly could be. There is no doubt he flew from this life on the wings of a deeply shared love. Nor do I have any doubts that we will all hold our babies once again when it comes our time to cross that Great Divide. Until then, he is watching over you with the same devotion you gave him all those years.

My deepest sympathies,
Leslie

[jenner1026]

Dear Donna,
I haven't visited in a while. I am devastated to hear about Patch...
I hope you can find some peace in knowing you were an above and beyond parent to him and gave him the best care and life any dog could ask for. It is just so hard and there aren't many other words I can say to make you feel better.
I wish you the best in the future and want you to know I have learned so much from your posts.
Regards,
Jennifer