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Thread: Kashmir - Cushpup with possible macro adenoma (Kashmir is now free)

  1. #11
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    Default Re: Kashmir - Cushpup with possible macro adenoma

    Hi Marianne, any appearance of calm acceptance of Kash's situation on my part is just that - an appearance. Or perhaps I come across as calm because I'm worn out and tired. I sat in my car in my garage this afternoon and wailed and cried my eyes out. I suppose the other thing I've felt is a sense of [defeated] resignation. From all the reading I did immediately after the IMS mentioned adenoma, I was positive I knew what we were facing (although I was holding out hope I'd be wrong) and I knew what the treatment options were going to be - except for the radiosurgery instead of the longer regimen; that one I missed. I think though, that it's a testament to how articulately and accurately so many people on this website described their dogs' symptoms and journeys that I could see the same things in my own dog. Thanks to the wealth of information here, I can now do my best to focus on spending time in the present with Kashmir instead of frantically researching my options. You didn't have that option with Barkis, but thanks to you and all the other people who have contributed to K9C, people like me who come after you have that gift. I am very, very grateful.

  2. #12
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    Default Re: Kashmir - Cushpup with possible macro adenoma

    We have finished day 2 of prednisone and it has definitely bumped up Kashmir's appetite. In addition to his chicken pate dog food (the only thing he was willing to eat recently), today he had some treats, chicken breast pieces and I gave him some of my vanilla ice cream - baby boy gets whatever he wants (except chocolate, etc. of course!) We went for a short walk this morning but it's been too rainy to go out again since. I saw a little more kind-of-tail-wagging, a tiny bit more pep for the first couple minutes of a walk today - so this is all good. We're not talking drastic improvement here but it is something. I should add too, that fortunately Kash doesn't give any signs of being in discomfort or pain. I feel fortunate that he doesn't pace and hasn't had tremors or seizures and I hope those things continue to STAY AWAY because right now he has good quality of life, even if he's much more subdued than the perky guy he used to be.

    The estimate for an MRI is $3000, and the estimate for CT (needed to guide RT) and 3 sessions of stereotactic radiosurgery is $7000, assuming no overnight visits. I got a copy of a 2018 study from the vet that I began reviewing. Overall survival outcomes are not very long and definitely shorter for hormone-producing tumors than non-producing ones. It's just not a great picture, unfortunately. How I wish I would've known about the potential for pituitary tumor growth when we were dealing with "just" Cushings; I would have gotten Kashmir into the neurologist immediately when the symptoms started and maybe RT would feel like more of an option than it does now.

    I am happy to share the study with this forum - is there a recommended place to post it, perhaps in the adenoma thread?

  3. #13
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    Default Re: Kashmir - Cushpup with possible macro adenoma

    That would be great if you’ll post the study on the Macroadenoma thread. The more information we can consolidate there, the better!

    In that vein, in looking back at that thread, I realize we’ve never extensively referenced there the possibility of surgery as a treatment option. This is largely because it’s so rarely performed here in the U.S. But one of our members, Lucy, was actually the first patient in a pilot surgical project conducted in L.A. as a joint venture between UCLA and Cedars Sinai Hospital. Lucy did have a successful outcome. However, I can only think of one other member who’s had similar surgery, and that’s Macy, whose mom started the Macroadenoma thread. Unfortunately, as you saw, Macy did not survive to recover. Anyway, now that I’m thinking about it, I do want to add a “surgical” post to that thread, too, even though it’s a possibility that’s seldom discussed or considered.

    Meanwhile, I’m so glad to hear that the prednisone may be helping Kashi, if only a little bit. We’ll always take “better” in any form we can get it, that’s for sure!!

    Marianne

  4. #14
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    Jun 2019
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    Default Re: Kashmir - Cushpup with possible macro adenoma

    We have had a tough few days but things are a little better now. On Thursday I tapered Kashmir down from 10 mg prednisone twice a day to 5 mg twice a day per the vet's instructions, the idea being to find out the lowest possible dose he can be on. He started to seem a little off on Thursday night and by Friday morning he had really nosedived, with no interest in water or food, going for a walk...he just laid down and didn't want to move. He was trembling ever so slightly, and his breathing also seemed a little different. Not like he was in distress exactly but more labored than usual. Neither the neurologist nor IMS was in the office Friday, but a different person there suggested I try bumping his prednisone back up to the 20 mg/day to see if it helped him. So I did that and he does seem better. He was doing poorly enough that I had contacted an in-home vet about euthanasia but I ended up not scheduling it in order to give the prednisone time to do its thing. Thankfully he was a little better yesterday and today he seems close to where he was back on Wednesday before we tapered. His appetite is better and he's drinking water, and I took him on a walk today.

    I can tell things are changing. One of Kash's symptoms is that he favors his right side. When the vet did his neurological exam she noted how he prefers to always make right turns, even if a left turn makes more sense. I had also noticed how he would stand but have his head facing to the right; I noticed this mostly on walks when he'd take a break (I used to say these were because he was tired but I think it's a combination of that plus he's having a moment where he's in a bit of an altered state (obtundation)). Yesterday and today I've noticed how his tail is actually hanging a little more to the right side too. He also is a little more jumpy when I put the harness over his head or generally when something unexpected comes in his line of sight it's like he momentarily thinks it might hit him.

    I hope I'm doing the right thing by Kashmir. Friday I was sure the right thing was to let him go, and I don't think it would have been the wrong thing - but I'm glad to have a little more time with him as long as he's not suffering. It makes me sad that he's not the happy boy I once knew, but he's not in pain and he definitely still enjoys getting petted and especially having his ears scratched. It's really hard though to live in the present when you are dreading the future.

  5. #15
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    Default Re: Kashmir - Cushpup with possible macro adenoma

    It's really hard though to live in the present when you are dreading the future.
    Boy, truer words were never spoken! But if it brings you any comfort to know, I do believe you’re taking all the appropriate actions right now. And during those really tough moments, I surely hope you’ll feel your family here, standing right alongside you every step of the way.

    Huge hugs flowing to both you and your precious boy, today and every day.
    Marianne

  6. #16
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    Default Re: Kashmir - Cushpup with possible macro adenoma

    Huge hugs from me too.

  7. #17
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    Default Re: Kashmir - Cushpup with possible macro adenoma

    With tears in my eyes and a giant lump in my throat I am writing to tell you I set Kashmir free yesterday evening, June 18th. He was just getting so tired. The neurologist bumped up his prednisone on Monday morning to 50 mg and I know Kash well enough that if it was going to do anything I would have seen some slight sign of improvement within the next 24 hours, certainly within the next 36. But there wasn't any improvement; he just became more and more tired, rarely moving or showing interest in anything going on around him. Monday night and Tuesday he didn't want food and drank very little water...although Tuesday afternoon he really surprised me by eating two chicken breasts I had baked in the oven and cut in small pieces for him. I put the bowl under his nose on the bed and after he ate one, I got a second half, and then another, and he ate nearly all of it! We sat outside on the back stoop much of the day and I petted him and talked to him while he dozed. It was an incredibly hard decision and I second-guessed myself during the day, especially after he ate the chicken, but deep down I knew if I had had him stay longer he could probably only handle a day or two, and I would be doing it for myself, not him. And though we had a beautiful day together and he had a nice last meal, I don't think I could have handled another torturous day like last Friday or yesterday either, deciding whether to do it and then watching the clock tick by once the appointment was made. And neither could Sarena, my niece who lived with me and grew up with Kashmir but moved across the country last fall after her college graduation. She took it very hard that she hadn't seen Kash since Christmas and couldn't be here other than via FaceTime to say goodbye. She's coming into town in 10 days but that was too far away. It's going to be hard for her at first when she arrives and he's not here, but we will get through it.

    A bright spot is was the vet I found - she was so kind and caring, and assured me she believes I found the "window" we all hope for that isn't too early but avoids lingering and suffering. I do feel I made the right decision, but I miss him. My other dog Roxy and I just keep looking for him around the house because it feels so foreign that he's not here. And today I experienced many of the "firsts" -- or perhaps they are "not firsts" - not saying good morning, petting him, feeding him, scratching his ears, etc. But I know where he is now he has energy again, there are no more pills or pokes or vet trips, and he's free and happy, and someday I'll get to be with him again.

    I never thought when I first posted here that this conclusion would come so soon. I have a hard time believing it was only a week and a day ago that we saw the neurologist because so much has happened since then. But I feel fortunate that if this had to happen that it was relatively quick, and that his symptoms of sleeping all the time and altered mental state were easier to take than the seizures, pacing, crying, and other harrowing manifestations other people have experienced and written about in this forum. My heart, broken as it is, goes out to them for having to experience that with their dogs. I regret that I didn't know about the possibility of a (likely) macro tumor earlier because if I had maybe treatment would have been an option as he was in good health otherwise. But it was not meant to be.

    I am still going to post his symptoms and the study I received in the adenoma thread where hopefully they will be helpful to others, but it may be a few days before I do it, as it's emotionally very tough right now.

    I also learned about a website, https://www.aplb.org/ (association for pet loss and bereavement) that has some great resources: counselors, chat room, and a list of vets who practice in-home euthanasia. This is how I found the wonderful vet who helped make Kashmir's passing peaceful and dignified.

    Thank you to everyone here, especially Marianne, Lori and Leslie for your thoughtful replies to my posts. I hope I never have to create a new thread on this site, but I definitely will tell others about it because it provides an important source of support and resources for those of us who face this difficult Cushings journey with our beloved dogs.

    ~ Lori
    Last edited by Lori C; 06-20-2019 at 01:08 AM.

  8. #18
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    Default Re: Kashmir - Cushpup with possible macro adenoma

    I'm so sorry, Lori. I've been following and hoping that things would improve. He sounded like a lovely boy and we all know how much he will be missed. All the "firsts" are so hard and dreaded. My first year without Lena, I couldn't wait for each of them to be over, but waited for them just the same. When a memory pops up on Facebook back to when she was still alive, I always hope it's one of her, or at least she might be in a picture with whatever we were doing that day.

    You gave Kash a great life. He was beloved and loved you back. I think that is one of the greatest gifts in life...the unconditional love of a pet.

    Hugs to all of you...
    Joan
    Joan, mom to my Angel Lena, Doree, Gable, Cooper, Angel Phoenix and now Sibble.

  9. #19
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    Default Re: Kashmir - Cushpup with possible macro adenoma (Kashmir is now free)

    Dear Lori, I am so deeply sorry, too. This news is hard to hear, yet we’re so very grateful to be included in your journey, every step of the way. We’re especially touched to be able to honor Kashi’s sweetness and his bravery. He’ll be forever remembered here on our special thread:

    https://www.k9cushings.com/forum/sho...Left-Us-(2019)

    If you would ever wish for us to add a photo link to his memorial line, you can email us a photo at any time — now, or at any point in the future: k9cushings@gmail.com.

    We know that there are really no words that can make any of this feel better. But if there is any comfort at all in knowing that we’re always hear and ready to talk, that is the truth. I often say to folks that “we stand ready to walk alongside you,” and that is truly the case. I know the continuation of this journey will be painful in so many ways, but please know you’re never alone if you’d welcome some company. And whenever the time comes that you would want to add onto our Macroadenoma thread, that will be a gift you’ll be passing on to others who are also seeking help and direction.

    It is also very helpful to know what a fine resource the Association for Pet Loss and Bereavement has been for you. We have listed them for many years on our Grief Resources thread, but I’ve never had direct contact with them myself. So this information is also a gift that you’re passing on, as well.

    On this first sad morning without your precious boy alongside you, my heart is aching for you and Sarena and Roxy — for all who miss him and love him so dearly. But you did the right thing for your boy, Lori. You did the right thing.

    Always in loving memory, and always here for you.
    Marianne

  10. #20
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    Default Re: Kashmir - Cushpup with possible macro adenoma (Kashmir is now free)

    Dear Lori,

    My heart is shattered to hear your news. We come to love our babies here almost as if they were our own and it is never easy to read such loving posts as yours about the most difficult decision so many of us have to face. But I know without doubt that Kashmir holds that last day in his heart as a treasured gift he will carry with him until that day when your job here is done and he can be by your side once again. You gave him the best life possible his whole life with you and in the end, gave him freedom from his failing shell. It is my belief that our babies remain with us always, just in a different form. Sometimes in the dark of night I can smell my Squirt and I know she is beside me or I feel a tickle on my ear and know that Trinket is laying by my head or hear the rapid clicking of nails on the hall floor and know Brick is running in to say hi or so many other tiny almost insignificant things that tell me my babies are still with me and always will be. I still grieve for them all and will til my final day.

    Grief is a personal thing; there are no rules, no time limits, no guidelines. For me, grieving is a way to honor the love we shared so I hope I will always find myself with tears on my cheeks and a sob catching in my throat from time to time for all those precious Souls who shared their lives with me. For you, it is new and raw and I remember those days, too. We are here for you if you need to talk, to scream, to cry, whatever - we understand because we have walked in your shoes, most more than once or twice. So please know you can come here and we will listen any time you need or want. We also have a memorial thread in the In Loving Memory section when, IF, you wish to write a tribute to your precious boy; we would be honored to help celebrate his life with you.

    The works of John O'Donohue have brought much comfort to me over the years so I leave you today with these words from "Eternal Echoes":

    A Blessing For Absence
    John O’Donohue

    May you know that absence is full of tender presence
    and that nothing is ever lost or forgotten.

    May the absences in your life be full of eternal echo.

    May you sense around you the secret Elsewhere which holds
    the presences that have left your life.

    May you be generous in your embrace of loss.

    May the sore of your grief turn into a well of seamless presence.

    May your compassion reach out to the ones we never hear
    from and may you have the courage to speak out for the
    excluded ones.

    May you become the gracious and passionate subject of your own life.

    May you not disrespect your mystery through brittle words or false belonging.

    May you be embraced by God in whom dawn and twilight
    are one and may your longing inhabit its deepest dreams
    within the shelter of the Great Belonging.
    "May you know that absence is full of tender presence and that nothing is ever lost or forgotten." John O'Donahue, "Eternal Echoes"

    Death is not a changing of worlds as most imagine, as much as the walls of this world infinitely expanding.

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