a hopeless french bulldog owner - Elizabeth has passed

Hi everyone,

My name is Lola and I have a five year old french bulldog, Elizabeth. We adopted her a year ago from a dog breeder where she was given hormones because of her fertility problems. She was diagnosed with Cushings in January and was prescribed Vetoryl 60mg after the ACTH test. The problem was that she had not stopped drinking and started losing her hair. We went to another vet, where she was diagnosed with hypothyroidism as well. (The vet prescribed Forthyron for hypothyroidism. ) She is still getting Vetoryl 60mg, but her skin problems are getting worse, she has red sores and she is still drinking a lot of water. Unfortunately we are from Hungary, where vets are not really familiar with Cushing's disease. I've just found this forum and I read that the recommended starting dose for Vetoryl is 1mg per pound of a dog's weight. My baby is 26lbs and still the vet prescribed 60mg. She has been getting Vetoryl for 3 months and there is only a small improvement, she seems happier. I am devastated. We are trying our best to help Elizabeth, but it is very hard and I am scared. :(
Are there any chances that she will recover one day?

Hi and welcome to you and Elizabeth!

Could you get copies of her ACTH stimulation tests and post those results for us? Also, is she getting her Vetoryl with a meal and are those ACTH stimulating monitoring tests being performed 4-6 hours post pill?

The first test was taken in January. The second one was a simple blood test which was taken 15 hours after she got her pill. The vet also used ultrasound to monitor her kidneys and her liver, they were in a good condition. At the end of the month we are going to have a test again.

She is getting her Vetoryl with a meal, usually at 5 pm.

(vér = blood, eredmény = results)

https://www.kephost.com/image/JJxk
https://www.kephost.com/image/JJx2

Thank you very much! I am very grateful!

Hello, and welcome from me, too! If you tried to post some test results in your reply, they are not visible to me. I am using an Apple tablet right now, though, so I’ll check later on my desktop computer to see if I can see something more there.

In the meantime, I want to let all our members know that we are just learning about a new trilostane monitoring system that is being used in the UK and Europe. It does not involve ACTH blood tests, but instead simply checks the dog’s cortisol level right before the next dose of trilostane is due. It’s our understanding that the closer to the next dose that the test is done, the better — like at 23 hours after the previous dose. So if this is the monitoring protocol that your vet is using, 15 hours may be earlier than is ideal. As I say, though, we’re just now learning about this protocol.

I’m sorry I don’t have time to write more now, but I did want to welcome you and talk about the monitoring testing. I’ll return later on today or tomorrow to write more.

Marianne

Hi,

I uploaded the pictures again, I hope they will be visible now, I can't see them on my tablet either.

I wish I could tell you more about the monitoring protocol my vet is using, but we were at four different vets. The first vet in November tested Elizabeth for Diabetes only, the second one in December took a simple blood test and forgot to sent it to the laboratory ( blood tests are usually examined in Budapest ) due to the holidays. The third vet diagnosed her with Cushing's disease, prescribed Vetoryl 60mg. My baby had been taking the pills for 15 days, when she started losing hair and red sores appeared on her skin, but when I called the vet he said he could not help. The fourth, who is helping us now, is a very nice but young vet. She took a simple blood test and diagnosed Elizabeth with hypothyroidism. Although it turned out that the cortizol level decreased, Elizabeth is still drinking a lot and her skin problems are getting worse. Now we are using a thermal water cream for her skin.

(vér = blood, eredmény = result)

http://www.k9cushings.com/forum/atta...0&d=1521366170
http://www.k9cushings.com/forum/atta...1&d=1521366192

Thank you for your replies! I cannot describe how grateful I am! We went through so many things during the past months and I only want my baby to get better.

Lola

Hello again, Lola. Now I’m able to see the thyroid result with no problem, but the photo of the other result — which I’m assuming is cortisol — is too small for me to clearly read. When I try to enlarge it, it is too blurry for me. So I f you will, just go ahead and type the cortisol information into your next reply. That way, we can forget about trying to see a photo image. You are doing such a great job, and working so hard, to help little Elizabeth. She is a very lucky girl to have been adopted by you!

Do you know any specifics about the hormone treatments she received? How long she received them, and how long ago they ended? I have to wonder whether they may somehow be involved with any continuing imbalances...

Marianne

Hi Lola and welcome to you and Elizabeth! :)

I can't make out the dates of the tests but here is the info given on them in the order you first posted them:

image JJxK:
2018/4315
T4 <6.4 nmol/l -17-37 nmol/l
Cortisol 168.0 nmol/l +15-120 nmol/l

image JJx2
2018/607
cortisol (t1) 219.0 nmol/l +15-120 nmol/l
cortisol (t2) 168.0 nmol/l +15-120 nmol/l

(Kortizol minta eredete means "origin of cortisol" in English - in this case ker, or "blood" - via Google)

Hi,

Thank you so much for your help!!! (:

January:
2018/607
cortisol (t1) 219.0 nmol/l +15-120 nmol/l
cortisol (t2) 168.0 nmol/l +15-120 nmol/l

February:
2018/4315
T4 <6.4 nmol/l -17-37 nmol/l
Cortisol 168.0 nmol/l +15-120 nmol/l

Unfortunately we know nothing about the hormones Elizabeth got. She had a miscarriage in September 2016 and we adopted her in October 2016. I know that she had low progresterone and that is why she got hormones. When she had two miscarriages in a row, she had to leave her previous home. The dog breeder and I have a friend in common, who told us about Elizabeth and we immediately adopted her. Last year she was neutered.

I read about Calcinosis Cutis and I saw pictures too, Elizabeth skin looks like that. Can we do anything with it? Or Vetoryl should help her skin problems?

Lola

Hello again, Lola! I just wanted you to know that I’ve not forgotten about you and Elizabeth. But before trying to interpret her test results, I’m reading more about the European trilostane monitoring system that is new to us here in the U.S. We just got more information about it this past week, so it is taking a little time for me understand what it means and how it works. But I will add more info here just as soon as I better understand things!

Marianne

Hi Lola and a belated welcome to you and Elizabeth. Without a clarification and additional information from you, we will not be able to provide you with meaningful feedback regarding the results you posted. I have listed questions below to keep myself organized and make it easier for you to respond:

1. Was Elizabeth receiving any steroid medication before, during or after being diagnosed with cushing's?

2. It appears your vet confirmed a cushing's diagnosis based on an acth stimulation test done in January. Are the results you posted the diagnostic test or was that the first acth stimulation test after starting dosing with Vetoryl?

3. Was an abdominal ultrasound done to determine whether Elizabeth has a pituitary or an adrenal tumor? Unfortunately an acth stimulation test does not make that distinction which is why an abdominal ultrasound or an endogenous acth test should be done. Treatment would be the same; however, prognosis for an adrenal tumor is not as favorable.

4. The February results you posted have only one result for cortisol. Can you tell us if that was resting cortisol only?

5. Based on current dosing recommendations, 60 mg is quite a large dose for Elizabeth so I am happy that you have seen no adverse effects. Is that a once a day dose and if so, are you giving it to Elizabeth in the morning with food? When was the last dose given to Elizabeth before the cortisol test was done in February and was that last dose given with food?

If Elizabeth's skin condition is calcinosis cutis and not caused by oral or injectable steroids, you can pretty much assume that she has naturally occurring cushing's. However, if the results of acth stimulation test you posted was done prior to treatment, those results are not consistent with cushing's. The acth stimulation test is not very sensitive so a good number of dogs with cushing's will have normal acth stimulation test result so Elizabeth's results could be a false negative. Your clarification regarding that January test will be helpful.

With respect to the calcinosis cutis, French Bulldogs and other bully breeds seem to be predisposed to this very rare symptom of cushing's. It can be very, very difficult to control. Most dogs will eventually see improvements but there is always a small possibility that dogs can have chronic flare-ups. In order to see any meaningful improvements, a dog must be on twice daily dosing of Vetoryl to insure that there is adequate control of cortisol throughout the day and the post stimulated cortisol must be within the lower therapeutic range of 44 nmol to 138 nmol. Calcinosis cutis most often gets much worse before it gets better after starting treatment. I have included a link below to a thread started some years back that might be helpful in reading about various treatments tried by members. That thread is dated but there has been little change in treatments since then. Unfortunately, there is no magic drug for calcinosis cutis and there are no guarantees that the medications that are routinely used will be effective. Again, it is critical that cortisol be well controlled. I apologize for asking so many questions but the more information we have, the better able we can provide you with meaningful information. We have had a number of members in countries where finding veterinarians knowledgable of cushing's is difficult and the good news is that you came to the right place for support and education. We are here to help you and your precious Elizabeth in any way we can. We look forward to hearing a lot more about Elizabeth.

http://www.k9cushings.com/forum/showthread.php?t=6093

Glynda

P.S. Can you also tell us which cushing's-like symptoms Elizabeth has besides in the increased drinking and skin issues.

Lola, if you have a facebook account, I recommend that you join a relatively new group called Calcinosis Cutis in Dogs. You will see many pictures of dogs as well as read about treatments other members are using that might be helpful. You will definitely see pictures of French Bull Dogs. I have provided a link to that group below:

https://www.facebook.com/groups/988564191285009/

Dear Marianne and Glynda, thank you for your kind replies! (:

1. She could have recieved steroid medication before we adopter her ( October 2016 ) but since then she has not got any steroids.
2. The test which was taken on January 6 was the diagnostic test. Elizabeth’s started getting 60mg Vetoryl on January 12.
3. Yes, the vet used abdominal ultrasound to examine her kidneys and liver and they were healthy.
4. In February the vet examined resting cortisol level.
5. Elizabeth gets Vetoryl at 5 pm with meal and she is not in a good shape after it, she slows down and sleeps sitting up. I asked the vet about it and she told us these were the symptoms of Cushing’s disease. The February test was taken 15 hours after she got her pill with her dinner.

Besides increased thirst and urination, Elizabeth had a pot belly, but this is the only symptom which actually got better. The skin problems started in February, after she started getting Vetoryl.

Maybe these pieces of information could be important:
- Elizabeth has a good appetite and now she is only active when she gets treats, breakfast and dinner. She has not lost weight.
- Last year, when Elizabeth got her annual vaccines she had an allergic reaction, so the vet gave her calcium injection. She got better, but because of the calcium a little bump appeared at the place of the injection and this bump disapeared within a month.

On Sunday and yesterday I gave Elizabeth 30mg Vetoryl with meal. Today she jumped on the couch by herself. I know maybe it was irresponsible to give her half of the prescribed dose, but she seems better now.

I joined the group, thank you very much for all your help and kind words!! (:

Lola

Lola, thanks so much for this additional info. I’m really glad to hear that Elizabeth is doing a little bit better, and I think it’s interesting that this corresponds with a lower dose of trilostane. I do wonder whether Cushing’s is really the correct diagnosis for her problems.

I’m especially puzzled by the January diagnostic cortisol results. Usually when we see two cortisol values here in the United States, it’s because an ACTH stimulation test was run. But Elizabeth’s January results do not correspond with what we’d expect to see with an ACTH. With that test, a “resting” cortisol level is first taken. Then a stimulating agent is injected, and one hour later the cortisol level is checked again. The second level should be higher than the first, because the adrenal glands have been stimulated to release a stored supply of cortisol. In Elizabeth’s case, the second reading was lower than the first, and neither would qualify as a “positive” result for Cushing’s here in the U.S. For our readers here in the U.S., I’m converting her results to the lab values we see here.

t1 = 219 nmol/l = 7.9 ug/dL

t2 = 168 nmol/l = 6.1 ug/dL

So I’m wondering whether a different diagnostic test was performed. For instance, perhaps these were the second two of three values that we usually see with a Low Dose Dexamethasone Suppression (LDDS) test. If so, that would be a positive response for Cushing’s.

Interestingly, her February resting cortisol test (after starting Vetoryl) was just the same as the second of the two diagnostic cortisol readings. As I mentioned earlier, since her resting cortisol was tested 15 hours after taking her pill, I’m guessing your vet is evaluating her response to the Vetoryl using a new monitoring protocol that has been introduced in Europe. For the benefit of all our readers, here’s a link to a new posting on our Resources forum that explains this new protocol in more detail.

http://www.k9cushings.com/forum/show...=1252#post1252

According to this new protocol, a cortisol level of 168 nmol/l taken right before it’s time for the next dose of Vetoryl could justify a dosing increase if a dog was still showing symptoms. But in Elizabeth’s case, she’s already receiving quite a large dose for her weight, plus it’s really interesting that she seems to be feeling better on a smaller dose of Vetoryl. So I’m back where I started — wondering about that January diagnostic test, and wondering whether the Cushing’s diagnosis is actually correct for her.

However, if her skin condition truly is Calcinosis Cutis, then we’re back to suspecting Cushing’s. So perhaps an actual biopsy of her skin condition would help confirm that we’re on the right track.

I’m sorry to be raising more questions than answers right now. But most of all, I’ll be wondering whether you continue to see improvement in Elizabeth’s behavior on the lower 30 mg. dose.

Marianne

Thank you Marianne for your reply! (: Last Friday we visited our vet and she told us that hypothyrodism could show similiar symptoms as Cushings’s disease and maybe the source of Elizabeth’s problems was her thyroid. Tomorrow the vet will take blood and will check resting cortisol and thyroid. She will also take biopsy of her skin. If everything goes well, we will get the results on Friday.

During the weekend Elizabeth was very happy and active, I’m still giving her 30mg Vetoryl. I’ve started using Aloe vera on her skin and the lesions seem better, though, there are new ones.

Lola

Dear all,

I am so incredibly devastated. Today the vet used abdominal ultrasound again and one of Elizabeth’s adrenal gland is bigger than the other one. Last time Elizabeth had her breakfast before the ultrasound and that is why the vet could not examine her properly, I just cannot understand why she did not ask us to take Elizabeth back with an empty stomach.

Abdominal ultrasound: left adrenal gland: 15,5 mm x 10,9 mm , right adrenal gland: 5,5 mm x 11m

According to the vet, if Elizabeth’s cortisol level get lower the Vetoryl works, if it does not, she has adrenal Cushing’s Syndrome.
I feel so overwhelmed now. We will get the results on Friday.

Lola

Hi again, Lola. I understand why you’re feeling so worried, but I have questions about what your vet has told you. If the ultrasound report is accurate, then it’s very true that Lola’s Cushing’s symptoms may be caused by an adrenal tumor. However, even if so, Vetoryl is known to have the ability to lower cortisol levels just as it does for pituitary Cushing’s. The medication is “approved” to treat both forms of Cushing’s. So in my mind, Elizabeth’s response to the Vetoryl will not tell you which form of Cushing’s she might suffer from.

Turning to the ultrasound results, if a tumor is indeed present, it is somewhat “better” for it to be located in the left adrenal gland rather than the right one. This is because it is less likely to invade the vena cava, a major blood vein to the heart. If you were to consider surgery to remove the tumor, the procedure might be a bit less difficult. However, I realize that surgery may not be an option for you to consider. That being the case, time will tell as to how much or how quickly the tumor may cause additional problems. But one possibility is that it could grow very slowly, and that the Vetoryl will help control Elizabeth’s symptoms in the meantime. I think the fact that she is outwardly doing well now on the 30 mg. is a good sign.

So, again, I do understand why you’re worried and upset. But I think your vet is giving an unclear picture as to the significance of the Vetoryl monitoring results. If Elizabeth’s cortisol remains too high, she may simply need a dosage increase. That would be the case regardless of the type of Cushing’s she has.

Marianne

Thank you for your answer Marianne!(: We did not get the results yesterday because from 2018 Good Friday is a non-working day in Hungary (I totally forgot it). I called our vet and the lab will send the results on Tuesday.

I want to take Elizabeth to Budapest to the Clinics of University of Veterinary Me. It will not be easy because the wait time for an appointment is one month and if she needs a surgery it will be very expensive, but I will do everything to see her healthy again.

I have two new questions:

Elizabeth still sleeps standing and sitting up. These have not changed with 30mg Vetoryl. Should I be worried?

I would like to try giving Elizabeth her Vetoryl dosage in the morning. We tried it with 60mg and after she got the pill she was super dizzy, but maybe with 30mg it could work and would be better as well. What do you think?

I wish I had found earlier this forum, your help and support mean so much to me! Thank you very much!

I wish Happy Easter to all of you with my puppies: Elizabeth, Bruno and Bradford! (:

http://www.k9cushings.com/forum/atta...6&d=1522490602

Lola

Oh my, what a wonderful picture of your babies!!! They are beautiful :-))))))))))))

I really don’t know what to think about the sleeping sitting up. But I do think it would be good to try giving Elizabeth the medication in the morning in order to see whether that helps even more with her symptoms during the day. I wish you a very happy Easter weekend, too, and we’ll be anxious to see those test results next week!

Marianne

Hi everyone,

Finally we got the blood test results. The Cortisol level got lower.

Cortisol: 158 nmol/l = 5.7275 ug/dL ( In February it was 168 nmol/l = 6.1 ug/dL )

Unfortunately Elizabeth's T4 level has not changed, it is still 6,4 nmol/l = 0.4972 ug/dL

Our vet wrote this:
- Unfortunately the Cortisol and T4 levels almost have not changed, probably because of the adrenal tumor and in this case Vetoryl is ineffective.

I do not understand it. Elizabeth's Cortisol level, compared to the previous results, is lower. I thought this is good. :(

We have not got the result of the skin biopsy yet.

Lola

We got the result of the skin biopsy. Elizabeth has Calcinosis Cutis. :(

Oh no, I'm so sorry, Lola...

Quote:

---

Originally Posted by lolakocsy

Hi everyone,

Finally we got the blood test results. The Cortisol level got lower.

Cortisol: 158 nmol/l = 5.7275 ug/dL ( In February it was 168 nmol/l = 6.1 ug/dL )

Unfortunately Elizabeth's T4 level has not changed, it is still 6,4 nmol/l = 0.4972 ug/dL

Our vet wrote this:
- Unfortunately the Cortisol and T4 levels almost have not changed, probably because of the adrenal tumor and in this case Vetoryl is ineffective.

I do not understand it. Elizabeth's Cortisol level, compared to the previous results, is lower. I thought this is good. :(...

...We got the result of the skin biopsy. Elizabeth has Calcinosis Cutis.

---

I’m very sorry, too, that the biopsy has confirmed CC. But at least now you know what you’re dealing with.

As far as your vet, I’m just as confused as you are. If I am remembering correctly, the February cortisol reading was taken while Elizabeth was dosed with 60 mg. daily. This new reading was taken when she’s only taking 30 mg. daily. Is that true? If so, even though the cortisol has only dropped a little bit, it has still dropped while Elizabeth has been taking only half the dose. To me, that shows that she has indeed been responding to the Vetoryl, and she probably may need only a small dosage increase now to get her cortisol as low as you might want it to stay long term.

So I’m puzzled by your vet’s response. It sounds like it may not be easy to do, but if you could take her to Budapest to be seen, that may be best. It just doesn’t seem as though your current vet is interpreting things in the same manner that we’d expect.

How is Elizabeth doing now?

Marianne

Thank you Joan and Marianne! (:

Well there are better hours, when Elizabeth seems happy. She loves sunbathing and walking in the garden. Unfortunately there are bad periods as well, when she cannot stop drinking and sleeps sitting. Her skin condition is better, now we are using Aloe vera, the red parts turned into brown and some brown parts are peeling.

We will take Elizabeth to Budapest, we have to make a plan about it during the weekend. I hope that with the help of the Clinic Elizabeth will recover.

When we adopted her, on the way home I promised her that she would have a happy life with us. I am so sad because Elizabeth really deserves better and I am blaming myself, I should have noticed the symptoms earlier. In September our cocker spaniel Bradford was diagnosed with hip dysplasia and had a surgery. He could not move for 2 months and Elizabeth never left his side. It was a very hard time and I believe that without Elizabeth's support Bradford could not have recovered. She is an angel.

Lola

Awww, how sweet that she looked after Bradford.

Lena had symptoms for at least two years before I accepted that it was more than old age creeping up on her. They are so subtle sometimes that you think you've imagined them. I knew something was wrong for about a year before she was diagnosed, but just couldn't figure out what it was. Every time we went to the vet, they were for little things. The increase in drinking one early morning is when I knew something was terribly wrong. That's when her blood work finally showed up bad...we've all felt the guilt of not recognizing Cushing's. That will never happen again. I know my Gable has it even though the LDDS did not confirm it, and I am watching him like a hawk!

Aww, that is indeed very sweet of Elizabeth to take care of Bradford.

(the pictures is beyond adorable!!!)

With the cc, you are looking to get the post acth number down to under 137.8 (5ug for North Americans) This will help to keep calcium deposits from forming. I took feel like Elizabeth is responding to the vetroyl, based on dosage and numbers as Marianne suggested.

Do we have a plan for Budapest?

Thank you Joan! Whenever I'm sad I find strenght in this forum. It really helps me a lot and gives me hope that one day Elizabeth will be healthy again.

Thank you Sharlene! I also think that Elizabeth is responding to vetoryl and I hope that slowly we will reach that number! Yes, with the family we made a plan during the weekend. First I have to call the Clinic and ask for an appointment. Probably we will get one in May. One of our friend will take me and Elizabeth to Budapest, because I don't have a driver's license.

I created a new album about Elizabeth's Calcinosis Cutis, I uploaded pictures to show how it has changed through the months. In March she had big, red and puffy lesions, now she hasn't got any, they are brown.
On Sunday we had a wonderful day, Elizabeth was very active. She even walked to Bradford's basket ball, she was very interested in it. I uploaded new pictures about her to the Elizabeth album.

Lola

Yes I see where the cc doesn't look as angry and red.

Did you get the appt in budapest yet?

Hi (:

Yes, I talked to the Clinic. They told me the exact cost of the necessary medical examinations, which would be a huge amount of money. So now we are trying to save money and as the summer begins I will have another job, so if everything goes well we will take Elizabeth to Budapest in June.
Elizabeth's condition has not changed, it is not worse or better. She is still drinking a lot, her skin is not red but there are new lesions. Next week I will take her to the vet for blood test.
She loves being outside, so we are at garden as often as possible.

Lola

Let us know what the blood test shows. It's not surprising about the new lesions as anything there has to come up and out, then the skin heals and the skins cycle is a long one. Just hang in there. You're doing great.

Elizabeth passed away today. I will write soon. Thank you for every support!

Oh Lola, I’m so deeply sorry to read this news! Thank you so much, though, for letting us know. Elizabeth has now joined our other precious companions on our memorial thread of honor. You and she will always remain members of our family, and we will be grateful if you do return and tell us more — and also how you are doing.

http://www.k9cushings.com/forum/show...Left-Us-(2018)

Elizabeth was so lucky to be rescued by you, and I know you will miss her dearly. I send you my warmest thoughts and consoling hugs on this sad day.

Always in loving memory of your sweet and very brave little girl,
Marianne

Thank you Marianne! Your words mean a lot to me!

Some parts of Elizabeth's skin got infected. The vet started treating it, it got better. One day Elizabeth started drinking less, maybe it was a sign already, but I was happy that maybe because her condition was better, but then she stopped eating, she only accepted food from my hands. We run to the vet, it turned out that she had pharyngitis. She got injections and yesterday she was better, she was drinking and eating. During the evening Elizabeth started coughing, she was dizzy, she collapsed and left us. It was so sudden, I still cannot believe it. I am devastated and blaming myself. The house is so empty without her, my heart is breaking.

Lola

Oh Lola, how awful for you! How sudden, and what a shock. I understand that you are blaming yourself — I think we all feel the same way when we lose these precious little souls. We know it’s an awesome responsibility to take care of them, and it’s natural that we blame ourselves when something goes wrong. But truly, I don’t believe there is any blame in this for you. You have worked so hard to try to heal her from all these problems. She has been a very sick little girl, and I don’t think any of us could have done anything any different to save her from this crisis.

Most importantly, you have loved her dearly during this past year. This is the very best gift you could ever have given her. She left this world finally knowing she was treasured. By far, that is the most important thing of all.

But now, so sadly you are left behind with your own heart broken. Please feel free to come back at any time to talk with us. We understand how hard these first hours and days will be. So you can come back and write anything that comes to mind. We’ll remain here with you, always.

Sending many hugs flying across the miles,
Marianne

Oh Lola....I'm so sorry for your loss of dear, sweet Elizabeth. The emptiness is so loud when they leave us.

Lena was such a tiny girl, but after she was gone, it was so quiet, even with three other dogs. I never knew how much I was listening to her until she was no longer here....the sliding sound of her paws, the way she hopped down the two steps into the family room, the way she pushed the food around in her dish, the way she breathed...they are such a huge part of our lives.

Dear Lola,

I am so sorry to hear about sweet Elizabeth. If there is any silver lining it doesn't sound as if she suffered but rather was taken quickly and painlessly. Regardless we are never ready and never find that emptiness easy to learn to live with. Know we are here anytime you wish to talk, vent, cry, scream, whatever - we DO understand.

My deepest sympathies,
Leslie

Rainbow Bridge: Sequel To The Original

Oh, when we get to Heaven
We hope that we will find
The souls that once we loved
Who left us all behind.

Some left us at the right time
They left this world in peace
Others left too sudden
Without the chance to say Goodbye,
They were gone before we had
The chance to even cry.

There's a special place for grownups
A special place for kids
Me? I'll be on the other side
The side called Rainbow Bridge.

Across the dark green meadow
A'top the hills I'll run
Where the colors from the rainbow
Glitter from the sun.

And there I'll find my sweetheart
Running fast toward me
In my arms where he belongs
for all eternity.

Jean McColgan

I am very sorry to hear of Elizabeths passing and so unexpectedly at that. Just heart wrenching.
My sincerest condolences. :(