Leaving Cushings Untreated?

[Tipper]

Been doing alot of reading and thinking today. Wife and I talked and we are going to speak to the vet tomorrow.

If we decide to go after treatment, my #1 concern right now is, is it too late? Tipper is really doing quite well I think all things considered, so I would think that not too much damage has been done. But we suspect he has had Cushings for maybe 10-11 months or so (the vet tests that indicated Cushings earlier this year was in Jan/Feb).

Thanks for caring enough to supply all the info and comments you have provided. What do you think on our timeframe to potentially start treating the Cushings now?

[Tipper]

It's difficult to tell from the pic but there is a condition that sometimes comes with Cushing's, especially untreated, called calcinosis cutis. Here is a link that shows a pic of it -

http://en.wikipedia.org/wiki/File:Ca..._cutis_dog.jpg

Hugs,
Leslie and the gang

Thank you for this. I looked into the calcinosis cutis this morning and right now I do not think that is it. My wife might be right that it is a bruise and maybe I overreacted based on everything I had been reading.

[Harley PoMMom]

If we decide to go after treatment, my #1 concern right now is, is it too late?

No it is definitely not too late to start treatment. Cushing's is a slow progressing disease but left untreated for a period of time the elevated cortisol damages a dog's system especially the internal organs.

It can take months for one to get a confirmed diagnosis of Cushing's in their furbaby and a confirmed diagnosis is vital. Trilostane/Vetoryl and Lysodren/Mitotane are life-saving drugs for dog's with Cushing's disease.

Cushing’s is a treatable disease. Delivery of competent and humane medical care by a skilled GP and/or specialist experienced in the diagnosis and management of Cushing’s has a significant impact on patient survival and well-being. With proper medical management, close monitoring and owner observation, most Cushingoid pets can live to their full life expectancy, with complete or partial resolution of clinical signs, and good quality of life!

Please know we are here for you all and will help in any way we can.

Love and hugs,
Lori

[Tipper]

Thanks again. I will keep checking in and reading all the info here.

I did find a note I made from his urine cortisol-creatinine ratio was 38. Vet said over 13 would prompt more tests. I didn't have anything on the ACTH results, but will find out. Just know Vet said it was indicative of Cushings. That was the last test we had performed.

[Harley PoMMom]

I will keep checking in and reading all the info here.

There is a wealth of information in our Resource Forum which I will provide a handy link to:
Resources for Owners of Cushing's Dogs

I did find a note I made from his urine cortisol-creatinine ratio was 38. Vet said over 13 would prompt more tests. I didn't have anything on the ACTH results, but will find out. Just know Vet said it was indicative of Cushings. That was the last test we had performed.

Yes, please post the results from the ACTH test...Thanks!

[ShannonJ92]

I find your questions about Tipper rather interesting as I am currently feeling in a similar boat - debating about whether to treat or not to treat (in my case my 9-yr-old Yorkie Pebbles, diagnosed last month). While I know I would be very cautious with Lysodren or Trilostane regardless, Pebbles has underlying issues that may be complicated with either drug. Plus we've gotten differing opinions on which drug would be best for her which makes making a decision even harder. I'm sorry you are in the midst of trying to determine what to do as well, we want what's best for our furkids yet sometimes we don't know what that is. Just do as much research as you can and you found a good place here to talk about things. I'm still rather confused about everything (in terms of what to do or not do, very overwhelming) but it's of some comfort knowing I'm not alone and have found support here. I hope you do as well and I wish you and Tipper the best. Keep us updated and good luck.

~Shannon

[Tipper]

First off, we are quite sure the mark on Tipper is a bruise. We'll see how it heals.

I did speak to our vet today. Tipper's ACTH result was over 30, vet said anything over 20 shows the dog has abnormal cortisol production/regulation in that test.

The next step would be an abdominal ultrasound to check for a tumor. I asked about the low and high dose dexamethasone tests and was told those have fallen out of favor in the testing process of UC-CR, ACTH, x-ray/ultrasounds. The low/high dose dexamethasone tests I am told are not accurate enough to say with certainty if it is pituitary or adrenal. Basically he said if there is no tumor on the ultrasound of the adrenals then it is pituitary.

If we go down the road of treatment, he seems to think that Trilostone/Vetoryl is the best drug over the lysodren. I asked about Ketaconazole and said it can be toxic to the liver and kidneys and does not think it is best for a dog Tipper's age in treating Cushings.

I also asked about Anipryl and he said that it doesn't work. That response didn't surprise me from what I've read in the conflicting support that drug receives.

He basically says our decision for treatment comes down to quality of life. If we think that Tipper is doing well at his age maybe we would decide not to treat. If we think his quality of life is suffering from the Cushings then treatment would certainly be recommended at that point.

Just a tough decision for us because I don't know if we can expect him to live past 15 for sure, or even if he would get to 15. He'll be 14 next May so while I value the outcome of treatment, I also question the effort and potential side effects Tipper would encounter with treatment that might lower his quality of life short term. I'm not sure there is much long term left for him anyway.

Still unsure about what decision we should make even with a much much better understanding of what we are up against now after spending some time here. It is hard to sit by and do nothing and understand that the result of that decision will likely cause a life threatening condition down the road.

But on the other hand he will have some kind of life threatening condition arise due to his age at some point in the not so distant future anyway.

[lulusmom]

First off, we are quite sure the mark on Tipper is a bruise. We'll see how it heals.

I am pretty certain what you are seeing on Tipper's neck is a bruise from a blood draw. Dogs with cushing's bruise easily and from my experience really big. One of my cushdogs is a bald Pomeranian so it is very easy to see the huge bruise on her neck whenever the vet does a blood draw from the jugular vein. It takes a long time for these bruises to go away too. The good news is that you aren't dealing with calcinosis cutis or some other skin lesions.

The next step would be an abdominal ultrasound to check for a tumor. I asked about the low and high dose dexamethasone tests and was told those have fallen out of favor in the testing process of UC-CR, ACTH, x-ray/ultrasounds. The low/high dose dexamethasone tests I am told are not accurate enough to say with certainty if it is pituitary or adrenal. Basically he said if there is no tumor on the ultrasound of the adrenals then it is pituitary.

Your vet is correct that the high dose dexamethasone suppression test has fallen out of favor. This is due to the fact that if a dog fails to suppress on the low dose dexamethasone test, they will fail to suppress on the high dose as well. The low dose dexamethasone, however, remains the gold standard in diagnostics for cushing's. It is the acth stimulation test that has fallen out of favor. Per reknown expert, Dr. Mark Peterson, the acth stimulation test is poorly specific, with only 50% to 60% of dogs tested having an exaggerated response of greater than 25 ug/dl. You can find more information on this on Dr. Peterson's blog. This blog is for petowners and veterinarians so please feel free to share the link below with your vet.

http://endocrinevet.blogspot.com/201...s-disease.html

He basically says our decision for treatment comes down to quality of life. If we think that Tipper is doing well at his age maybe we would decide not to treat. If we think his quality of life is suffering from the Cushings then treatment would certainly be recommended at that point.

Just a tough decision for us because I don't know if we can expect him to live past 15 for sure, or even if he would get to 15. He'll be 14 next May so while I value the outcome of treatment, I also question the effort and potential side effects Tipper would encounter with treatment that might lower his quality of life short term. I'm not sure there is much long term left for him anyway.

Still unsure about what decision we should make even with a much much better understanding of what we are up against now after spending some time here. It is hard to sit by and do nothing and understand that the result of that decision will likely cause a life threatening condition down the road.

But on the other hand he will have some kind of life threatening condition arise due to his age at some point in the not so distant future anyway.

I certainly understand the quandry you are in and I'm not sure I wouldn't do the same in your shoes. The risk of adverse reactions to treatment can be mitigated and usually completely avoided if the pet owner is educated and the vet is experienced. My two cushdogs have treated with both Lysodren and Trilostane. Nothing about either of those drugs is a mystery to me so if I decided not to treat, it would not be for fear of the drugs. A dog's quality of life can be greatly improved with treatment. My dogs are a living testimony to that but for a very senior dog, the question is how stressful will it be for the dog to undergo the necessary testing required to monitor treatment, do I have the money or access to financial assistance to pay for those tests and what if severe arthritis or any other painful and chronic problem is unmasked once cortisol has been reduced?

My first cushdog was diagnosed and started on Lysodren at 3 years old. She is now 10 years old and doing great. My second was diagnosed about four years ago. We rescued him from a shelter so we don't know how old he was at diagnosis but I'm pretty sure he's at least 14. The two years life expectancy with or without treatment would be a pretty accurate guesstimate if a dog is at or within a few years of life expectancy for their breed. However, young dogs have a whole lot of living yet to do so deciding whether to treat is not difficult.

Bottom line, the goal of treatment is to remedy the symptoms, symptoms that are usually more problematic for the pet owner than the pet. If Tipper's symptoms are not a problem for him or you right now, then wait until they are before revisiting the decision to treat. In my non professional and very layman opinion, a very senior dog with mild symptoms is probably more likely to pass away from a non adrenal illness before cushing's could progress enough to shut down internal organs. That's just my opinion.

[jrepac]

It's always tough when you have a senior dog; if the symptoms are mild and tolerable, you may only want to give Sam-e and milk thistle and call it a day. But, they are bound to increase over time. You have to balance out quality of life factors; treatment might make your pup much more comfortable, if you can afford the cost.

I too, had an older dog, and opted for a fairly mild course of treatment, which alleviated the symptoms and made her last few years good ones.

Cushings is very slow moving, so it is not too late to start treatment. It's not unusual for it to take many months to diagnose (or to reach a point where it is easily detected, given the nature of the disease).

Your vet's course of diagnosis seems reasonable; hopefully the ultrasound will rule out a tumor. I can't speak to trilostane (have only used lysodren & anipryl), but many here have had great success with it. Keto and anipryl are pretty much fall back options, as their track records are spotty/conflicted, but you'll find a few folks who had success with them.

Best of luck

Jeff, Angel Mandy, & the Girls.

[HarrysMom]

Our dog was initially diagnosed with elevated estrogen, but no Cushing's per U Tenn adrenal panel. His symptoms progressed, but we waited 6-8 months for the LDDS test, and we finally started the treatment. Unfortunately, by then, he developed diabetes. I was not aware that untreated Cushing's causes insulin resistance - leading to Type 1 diabetes. Had I known this, I would have treated right away as it is NOT fun to deal with diabetes.