Sullivan and his Cushings ordeal - Sully is now at peace

[Sullivan'smom]

Hello everyone, I've been reading on this forum for quite some time. My 13 1/2 year old boxer Sullivan was just diagnosed with Cushings Disease. He's had a few health problems in his life such as osteochondrosis dissecans when he was a puppy, about 4 years ago he was diagnosed as having pancreatitis. Last summer he was brought in due to excessive thirst and urination and was diagnosed with low thyroid levels. Started on thyrotabs for that which seemed to make him worse so my dad (who watches him most of the time due to my occupation) ceased his meds and he seemed to do better. Around Christmas (2017) the insane hunger, thirst, having accidents and mild hind end weakness started to show up but Sullivan could still go outside and move around. He was a little sleepier than he had been but he will be 14 in August so it was chalked up to old age. Well I brought him in to the vet because I noticed round patches of rough scaly skin on his back and thinking it may be ringworm, I wanted meds for him.. I also began to suspect Cushings. The vet ran blood work and confirmed low thyroid, and other markers that made her also suspect Cushings. He was sent for a LDDS test which indicated Cushings. Sullivan weighs 97lbs and was given an initial dose of 120mg of vetoryl. He was on it for 4 days when his hind end got so weak he could barely stand. I immediately took him off the meds and contacted his vet who said to cut the dose to 60mg. I was terrified he was at the beginning stages of an addisonian crisis.. He was listless, couldn't get comfortable, so very ataxicand just overall very dull. I stopped the meds and gave him electrolytes and monitored him. He seems better but he hind end weakness is still horrible. He can't really walk much more than 100m without slowing RIGHT down and when we get back home he just crashes on the floor and doesn't want to move at all.

I'm at such a loss here. His appetite has reduced quite a bit as well as his thirst. Because he isn't moving around much he hasn't been pooping with the same regularity that he was not 2 weeks ago. He definitely seems timid especially about going outside. Last night he almost refused to go outside unless I was with him and even then he walked out and turned right around to go back inside. It's breaking my heart watching him struggle to stand up or even get up on the couch. I don't want to just let him not move around out of fear that the muscle wasting will worsen and living in Ontario and it being early spring.. swimming isn't an option right now either.

I know everyone on this site has had a wealth of experience in dealing with this horrible illness and I just need some help with how else to help my fella. I won't let him suffer and when "It's time" as much as I hate the thought of it, I will do what's right for him. I just honestly can't believe how much he has degraded in the last week since starting the vetoryl.

Any advice is appreciated

[Sullivan'smom]

Spoke with the vet today, she agreed about stopping the vetoryl until we see if Sully's mobility can be improved. She prescribed gabapentin for him to go along with his Metacam. I took my boy out to get an ice cream cone (his favourite) and we went to the marina and he actually got excited! I was expecting him to want to stay in the truck and eat his cone but he would have none of that! He wanted out of the truck, eat his cone and then he slowly meandered around to explore. It made my heart melt to see him so happy and excited and just being a dog.

The vet said she would consider restarting the vetoryl in a bit if the gabapentin helps with his mobility.

Does vetoryl usually cause them to lose mobility so quickly? He was on the meds for maybe 5 days

Thanks in advance

[lulusmom]

Hi Sullivan'smom and welcome to you and your precious Boxer boy.

Let me start by saying that it is very possible that 120 mg was too high of a dose for Sullivan. Studies have shown that bigger dogs seem to be much more sensitive to the drug and require much smaller doses to achieve resolution of clinical symptoms. I've provided a copy of a full text publication of a study done by UC Davis below which I think you will find very informative. Based on their findings, UC Davis starts treatment in their larger patients at .3 mg to .5 mg per pound of body weight. Dechra recommends starting doses of 1 mg/lb and I have seen more than a few bigger dogs experience the same adverse reaction as Sullivan on these minimum doses. You may want to share this study with your vet so that she is aware of this and can dose her bigger patients accordingly. If Sullivan were mine, I would not restart treatment until he becomes overtly symptomatic again and an acth stimulation test done that shows a post stimulated cortisol high enough to indicate hyperadrenal activity. The reason for adhering to these two steps is that while rare, it is known that any dose can cause varying degrees of adrenal necrosis and if you restart treatment too soon, even at a lower dose, Sullivan could crash again if his adrenal glands have not completely recovered.

With respect to Sullivan's skin issues, Boxers and other short snouted breeds seem to be genetically predisposed to a very rare symptom of cushing's called calcinosis cutis (CC). I suspect this may be what you are seeing but your vet would need to do a punch biopsy to confirm. If it is CC, it is imperative that Sullivan is on twice daily dosing. Was he getting 120 mg once a day or was it split 60 mg am and pm? While the acceptable post stimulated cortisol therapeutic range is as high as 9.1 ug/dL if a dog's symptoms have completely resolved, it is recommended that dogs with CC have post stimulated cortisol within 1.5 ug/dL and 5 ug/dL. If you are a member of facebook and want to take a look at many dogs with CC so that you can get a much better idea of what it looks like, please check out the fb group, Calcinosis Cutis in Dogs. The url is https://www.facebook.com/groups/988564191285009/

I have also attached a handy reference document entitled GENERAL GUIDELINES for Dosing and Monitoring Treatment with Vetoryl (trilostane). Please do take a look at it and let us know if you have any questions.

8272
8273

I am sure sorry for the reasons that brought you here but I'm glad you found us. We are great hand holders but our goal is to help our members learn so they can be even better advocates for their pups and be a proactive participant in their care. We are here to help in any way we can so ask as many questions as you may have and we'll do our best to answer them as well as provide you with credible resources that may help.

[labblab]

Hello from me, too! Glynda has already given you a lot of great information, so I only have one thought to add. Given his age, Sullivan may be suffering from arthritic or other orthopedic issues that were previously “masked” by the high levels of circulating cortisol in his body. Cortisol can act like a natural anti-inflammatory in the same way that supplemental steroids do when purposely given to patients to calm inflammatory conditions. So that can be one downside to treating Cushing’s in older dogs — they may be bothered more severely by geriatric aches and pains.

I mention this just as a possible alternative explanation for the sudden onset of Sullivan’s lameness. Rather than being caused by new muscle wasting or as a direct side effect of the medication, he may be now simply be feeling more rear-end pain than before. Hopefully adding the gabapentin along with the metacam will help ease his mobility such that the Vetoryl can be resumed, albeit perhaps at a lower dose.

Marianne

[Sullivan'smom]

Thank you for the replies. Sullivan was put on a single dose of 120mg to be had in the morning with food. When I brought him in and we started to discuss the possibility of Cushings his usual vet was away and he had to see someone else. His regular vet is now back and seems much more onboard with having an open dialogue with me rather than the one who filled in and said more or less "I'm the doctor and you are the owner" in not so many words.

My boy sure has kept me and my dad on our toes through the years. We make him his own wet dog food and he's on a grain free kibble.. and I know 13 (almost 14) is a great age for a boxer. My dad's last boxer passed away at 15 years.

Sully had his first dose of gabapentin today and I will continue to monitor him throughout.

I know today was the first time I've posted on here but believe me I have been reading through the forum for the last 2 weeks and wouldn't have known what wad happening with him with being dosed so high on the vetoryl if it weren't for everyone on this forum and the stories posted. I'm sure it saved his life.

I will be reading all the info you included and I know UC Davis is a great facility and they publish great books. (I was formerly a farrier and had a few of their books and was also fortunate to work in a veterinary college and at a vet clinic - so fortunately I my vet usually listens to me as she knows my concerns are well founded and based on my own medical background)

Do either of you have experience with gabapentin? My vet said that it should work fairly quickly for him. I'm sure that due to his past of OCD and his age he is a very good candidate for arthritis or some other musculoskeletal conditions.

Poor little guy is all tuckered out from his truck ride and visit to the marina, but he seems pretty happy.

He's also experiencing quite the "cough" it almost sounds like a choking/gagging noise which has me worried.

[Squirt's Mom]

Just poppin' in to say Hi! and Welcome! to you and Sullivan! :) Glynda and Marianne have gotten you off to a great start!

Glad you found us!
Hugs,
Leslie

[Sullivan'smom]

Thank you for the welcomes. Sully has now had his first dose of gabapentin in his system for a few hours. He is more unstable than ever! He can barely stand up let alone stand to pee. He seems happy enough albeit lethargic but does anyone know if the ataxia from the gabapentin will lessen or if the hind end weakness could improve? Honestly if I don't see any improvement I'm tempted to cease all meds save some holistic ones like glucosamine and such and just let him enjoy what time he has left. Watching him struggle to stand up or his hind end give out when he slides off the couch is breaking my heart. I swear I've been crying for a week solid about him!!

[lulusmom]

One of the side effects listed for gabapentin is wobbliness so it could be contributing to what you have determined to be ataxia but I believe your vet needs to rule out adrenal insufficiency via an acth stimulation test and possible disc/joint disease that may have been unmasked as the anti-inflammatory properties of high levels of cortisol were diminished by Vetoryl treatment. Is Sullivan's appetite still voracious and is he still drinking buckets and peeing lakes? Aside from the ataxia are you seeing any other symptoms that might be neurological? I ask because Boxers are a breed that is overrepresented in pituitary macroadenomas. If Sullivan were to have a macro tumor, lowering cortisol can increase swelling and inflammation, triggering neurological signs. If Sullivan were my dog, I would probably be on the same page you are right now but I personally would get him in for an acth stimulation test asap. I would also ask the vet for some prednisone to administer while waiting for the results of the acth stimulation test to see if it helps Sullivan. I hope this helps.

[Sullivan'smom]

He is a lumpy bumpy boxer and always has been so it wouldn't surprise me if one of his lumps that the vet's office has always said were lipomas or cysts wasn't. I've had fine need aspirations done on a few of his bumps and all came back clear. He does have a large "lipoma" on his throat/neck right near the thyroid. The vet I saw 2 weeks ago said it felt like a lipoma to her and wouldn't be concerned.

He slept on the couch last night and I slept on the floor at the base of the couch in case he fell or had any issues. He started out curled up with me and then climbed up on the couch.. as sad as I was that he didn't want to sleep with his mom on the makeshift bead I made.. it was nice to see him climb up unassisted. I know he gets warm and has trouble tolerating that so I'm sure the leather feels much nicer than fuzzy blankets.

This morning I had to coax him off the couch. He refused to go outside and pee last night and hadn't pooped since yesterday morning. He finally went out, a bit wobbly but better than yesterday evening. He used to devour his breakfast as soon as he came in, now he seems indifferent to it and just walked past it and went to lay down again. So despite being off the vetoryl, his appetite isn't what you'd see in a Cushings dog and is off for him. His water intake, I've been giving him unflavored gastrolyte after I was worried that he was starting to look like an addisonian crisis. He doesn't drink anywhere near what he used to.. no gulping water at all. He has some after he goes out and does his business or if he's been "exercising" going up the 3 steps to come up on the front porch or helping me by putting a paw up when we take him for truck rides.

His urine isn't clear, it's normal yellow colour and normal volume.

The vet's office had said a shim test wasn't possible because he hadn't been on the meds long enough, mind you that was one of the techs who I got mad at before. (The vet he originally saw ordered the LDDS test and said results in 24-48 hours.. He had the test done on a Monday and Friday I still hadn't heard from them. I lost it on the clinic because the results were there waiting to be looked at but the vet who saw him, who isn't his usual vet, was on holidays. I said oh how nice for her.. she gets a holiday and my dog is sick and I've already paid for bloodwork that I should have had answers about days ago.. and now you're saying I won't get results until 1 week from when he had the test. I demanded that someone else read his bloodwork and thankfully his old vet was back and took over.

[Sullivan'smom]

I emailed the clinic and asked them to send me the results of the blood work he had done initially and the results of the LDDS test. When I get them I'll post the results to see if anything looks odd to you guys.

Thank you again for your help in all this.

My fella does seem a bit brighter this morning but still no real appetite which is strange for him.. especially with his homemade food he gets on top of his kibble.

[Sullivan'smom]

I got the lab results of his LDDS test:
Baseline level: 75 reference value 28-120nmol/L
4 hours: 78 nmol/L
8 hours: 71 nmol/L

Is this of any use?

[Sullivan'smom]

I've switched him back to regular water and called the vet's office to inquire about the ACTH stim test and electrolyte check. They said he would need to be there all day for it because it was his first test.. I asked about the price and was quoted $430 Canadian for both test.. when I asked what the difference was in the first test to the monitoring tests.. she said 100 and didn't know what else was different about them. Considering I've dropped over a thousand dollars there in the past like 2 weeks.. they gave me 120mg vetoryl caps and wouldn't take them back because they dosed him too high and basically wasted $150 of mine on the pills.. I'm getting rather upset at that office. They got another $50 from me yesterday for gabapentin.. tried to get me to buy 60mg vetoryl caps for him and got upset when I said that IF I put him back on vetoryl at some point, did they not think it wiser to get lower dose ones so we can adjust them (like buy the 10mg or 30mg caps instead)? They had no answer. Sooooo frustrated

So I'm waiting for the vet to call so I can discuss the tests with her. The receptionist isn't a tech and doesn't understand what she is talking about. I also sent my vet the paper on dosing vetoryl for large dogs so she has it for reference - whether she will appreciate it or not remains to be seen.

[labblab]

I got the lab results of his LDDS test:
Baseline level: 75 reference value 28-120nmol/L
4 hours: 78 nmol/L
8 hours: 71 nmol/L

Is this of any use?
Thanks for this information. Can you check, though, to see what the reference range was for the 4 and 8 hour values? It will be different than the range given for the baseline level. Even without seeing the exact range, however, I do believe Sully’s result is consistent with Cushing’s. (For the benefit of our U.S. readers, both the 4 and 8 hour values are greater than 2 ug/dL.). However, this pattern of results does not distinguish between Cushing’s caused by a pituitary vs. an adrenal tumor. And actually, this pattern is more frequently produced when an adrenal tumor is present.

Has your vet discussed the possibility of an adrenal tumor with you? Further testing would be required to sort that out — either another specialized blood test or an abdominal ultrasound. In looking back, I don’t believe an ultrasound has been mentioned, and honestly, that might be the best use of your money at this point. There are various types of adrenal tumors, some are cancerous and some are not. The location of an adrenal tumor can also be important to know so as to determine whether there is encroachment on other organs or major blood vessels. I mention this, in part, since Sully seems to be doing so poorly right now. It may turn out that he has a pituitary tumor, after all. But even if so, there may be some other internal issue that is causing this rapid decline, and an ultrasound can give you views of other key organs in addition to the adrenal glands.

If you’ve already had an ultrasound performed, then you can just ignore all that I’ve written above!
Marianne

[lulusmom]

I am glad to hear that Sullivan For ease of reference and organization, I've typed my comments in blue below.




His urine isn't clear, it's normal yellow colour and normal volume. Did your vet do a urinalysis as part of diagnostic testing and if so, did that test show dilute urine with low specific gravity? If so, it would appear that Vetoryl has done its job and decreased cortisol enough for kidneys to start concentrating.

The vet's office had said a shim test wasn't possible because he hadn't been on the meds long enough, mind you that was one of the techs who I got mad at before. If you are conducting an acth stimulation test to see if the Vetoryl dose is effective, I would agree; however, Sullivan crashed and it would be routine to conduct an acth stimulation test to determine if adrenal insufficiency is responsible. In my experience, vet techs are famous for thinking they know more than do and if it involves a cushingoid dog, they are often the biggest source of misinformation in a gp practice. (The vet he originally saw ordered the LDDS test and said results in 24-48 hours.. He had the test done on a Monday and Friday I still hadn't heard from them. I lost it on the clinic because the results were there waiting to be looked at but the vet who saw him, who isn't his usual vet, was on holidays. I said oh how nice for her.. she gets a holiday and my dog is sick and I've already paid for bloodwork that I should have had answers about days ago.. and now you're saying I won't get results until 1 week from when he had the test. I demanded that someone else read his bloodwork and thankfully his old vet was back and took over. You shouldn't have to demand a practice to do their job and act in the best interest of their patient. Given the multiple failures of this practice, have you considered asking for a referral to a board certified internal medicine specialist? I had a miserable experience with my first cushdogs gp vet and she was eventually diagnosed and treated by an internal medicine specialist until the day she passed. In hindsight, I realized that had I consulted with an internal medicine specialist immediately, I could have saved my dog a lot of angst and myself a lot of money. If I were in your shoes, I would not waste any time in asking for that referral.

[Sullivan'smom]

He hasn't had an ultrasound done. I asked the clinic about it and was told that their ultrasound machine wasn't very good and that they would need to call in a specialist to the tune of almost $500. The clinic refuses to run a stim test on him unless he has been on vetoryl for at least 10 days and they said they won't do the test. They haven't done a urinalysis on him at all either.

The problem I have is that this is a fairly small town and there aren't a lot of options for clinics around here.. along with my job where I am away a lot.. it is making for this all being so difficult.

The paperwork I got from the lab for the LDDS doesn't show any other ranges it just lists if the 8 hour result is >50% of baseline level it is likely a pituitary gland tumor.

I gave sully his meds last night a bit later than the day prior so he was sleepy and more wobbly during the night when he was going to be asleep. He seemed better with that routine and slept through the night without any issues. He got up this morning and seemed quite bright and went out for his morning business without a problem (no falling or near falling over at all).

I'm going to research some other clinics that people have recommended.. one of my friends has 2 massive African Mastifs and he gave me the name of his vet. I also found a clinic about 2 hours away that has both naturopathic vet's and traditional vet's.. it may be worth talking to them as apparently they have experience with Cushings dogs.

I think now that the vetoryl is out of his system and he is on the full dose of Metacam and Gabapentin he seems better for strength although he did slip off the couch right before I went to bed and I had to help him back up.. but today he actually sort of hopped off the couch.. it's the little things like that that just make me smile and feel some comfort that we are hopefully on the right road.

[labblab]

He hasn't had an ultrasound done. I asked the clinic about it and was told that their ultrasound machine wasn't very good and that they would need to call in a specialist to the tune of almost $500.
Well, at least they were honest about that part — most GP vets don’t have equipment that’s sophisticated enough to properly view the adrenals. But they should be prepared to perform a monitoring ACTH at any time that an overdose is suspected. And yes, they should have done a urinalysis in conjunction with the diagnostic process. All in all, I think you’ll be well-served to seek out a second opinion!

I’m glad to hear that Sully seems to be a bit perkier, and as a result, I’m hoping you’re past the risk of an acute cortisol crisis. But for all these reasons combined, I sure hope you’ll be able to track down a vet who can offer more comprehensive feedback and care.

Marianne

[Sullivan'smom]

Sully's condition has taken another turn. He started retaining massive amounts of fluid and gained 10lbs in the last week. The vet is certain that he has many other tumors in his abdomen. She saw him today for a quick check and noticed his very laboured breathing and increase in mobility problems. He can't stand to eat a full meal anymore and even going outside to do his business has become a strain for him. His abdomen is full of fluid and what the vet seems to think are tumors. After discussing his age and all the health issues with the vet and my dad.. we have made the appointment for tomorrow at 5. I've been crying nonstop about this and can't fathom a world without my boxer boy in it.. but moreover seeing him sleep over 18 hours a day and no longer enjoying the little things that make being a dog so great, leaves me feeling that I can't watch him degrade any more.

My boy is with me and is being spoiled and cuddled nonstop. My heart is broken but I'm treasuring every moment I have with him and thinking of all the ways he has bettered me as a person. He is truly an incredible dog and my love for him.. beyond words.

Thank you all for your support and words of encouragement.. I can't imagine having gone through all this without your support.

[Joan2517]

I'm so sorry. Enjoy every last moment with your darling boy. That's what he will bring with him, your love and comfort. Many, many hugs to you and Sully~

[Sullivan'smom]

Thank you. He is my heart and has given me so much, if I could give some of my years to him, I wouldn't hesitate. I will be with him through it all, it's the least I can do.. he has saved my life many times over and made me a better person for having him in my life for almost 14 years.

[labblab]

I am so deeply sorry to read this news, but I’m also very grateful that you’ve come back to let us know. I’ll surely be holding your family in my heart come tomorrow afternoon, and we’ll remain right by your side in the coming days if we can be a support to you in any way. Please do give Sully a huge gentle hug on behalf of his K9C family here. And we send so many hugs to you, as well. Peace and comfort be with you both as you share these precious moments together, and in your memories of a life well-lived and well-loved.

Marianne

[Squirt's Mom]

My heart is aching for you, knowing only too well how you feel today. Please know you are giving your precious boy the greatest gift possible - freedom from a failing vessel. I have no doubt his heart is full of gratitude to you for having the courage to take this most difficult step, for loving him enough to end the suffering, for taking his pain and making it your own.

We are here for you now and in the days and weeks to come. Anytime, we are here to listen, to empathize, to hold your hand, to cry with you.
Hugs,
Leslie


Instructions To a Guardian Angel of Pets
By Ginger Patton

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

By Ginger Patton

[Sullivan'smom]

Thank you so much Marianne, you and everyone here have been such a blessing to Sullivan and I. He's enjoying an evening of rubs and cuddles along with some of his favourite treats like an ice cream cone.. because.. well, he may as well enjoy his last day as much as he can. I just wish I could do more for him. This is the first time I have had to make the decision.. previous pets were either taken from me or my last boxer suddenly became ill (on Easter weekend) and his organs started shutting down rapidly. I did every test they could to find out what was going on and it was still a mystery.. he began to slip away and I made the decision to help him along. This time.. I just can't stomach what is going to happen.. I know he is pushing 14 and that is working against him.. I see how much he has gone down hill and meds aren't helping at all.. he is having a hard time moving around due to the rapid weight gain and fluids.. and now his breathing is so laboured.. I know what must be done and I'm trying not to be selfish but.. I can't imagine my world without him.. without his little face.. without getting a lick from him when I say "give mom a kiss"

Perhaps years ago when I adopted him, I saved his life. Not many people would keep a dog they had for 2 days after finding out he needed a massive costly surgery.. but he saved my life so many times along the way. After my marriage fell apart.. when my mom died.. through really tough times and I wanted to give up.. I thought of him and his little face and getting a kiss from him and I could get through anything.

I hate this.. so much.. their lives are so pure and good and far too short.

[Harley PoMMom]

Thinking of you today and sending hugs.

[labblab]

Me, too. I’m here, too, and thinking of you and Sully and sending hugs.

Marianne

[Sullivan'smom]

Sullivan went peacefully after a day of his favourites (mini donuts, ice cream cones, homemade dog food) and more snuggles and cuddles and kisses than he probably cared for. He was surrounded by myself, my dad (his "pop-pop") and my boyfriend. We all wept when he passed and I had my arms around him telling him I love him and that he was a good boy the whole time.

I feel like my heart has been ripped out and there is this massive void that just aches and aches. I can't believe my boy is no longer on this earth and I keep reminding myself about how I will see him again at the bridge. What a beautiful soul he was, my best friend and my constant. My world feels so dark without him.

Thank you for all the love and thoughts.

I promised Sully that despite my heartache, I wouldn't swear off another dog.. and I would adopt again. He would want me to, but it will take some time before I could consider that.

This sucks... I don't want to NOT feel the pain because it is a reminder of the bond and love we shared and I just wanted.. more time.. more walks... more cuddles.. more TIME! We can protect them from everything except time. My angel boxer boy, my Sullivan

[Joan2517]

I'm so sorry that you had to go through this. Even though he is at peace, it's so hard to accept. I wish so much that I had been with my Lena. Sully left this world knowing he was loved. What a wonderful way to go.

[labblab]

I can only imagine how hard it is for you to awaken this morning without your boy beside you. Please know that we’re always here for you to talk, to vent, to honor and remember. As it turns out, we learned yesterday of the passing of another sweet soul, as well. So now, both Sully and Kaiser are joined alongside each other on our special memorial thread:

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

I’ll contact you soon to see if you’d like us to add a photo link to Sully’s name. But in the meantime, we will surely continue to hold you both in our hearts.

Sending huge consoling hugs to you, in the memory of your precious boy.
Marianne

[Squirt's Mom]

My heart knows your pain today. I am so sorry. We are never ready no matter the circumstance. Please know we are here anytime you need to talk, vent, cry, or just be with those who understand.

My deepest sympathies,
Leslie

[molly muffin]

I just want to send my sincerest condolences on the loss of your dear Sullivan. :( I am so very sorry. It is a terrible heart break to lose them.