New Cushing's Diagnosis - Vetoryl Concern

[Margot]

Hello, I'm so happy I found this forum! There seems to be great info here.

I'm writing about my 12 yo Shihtzu, Margot, who was recently diagnosed with Cushing's. I noticed about a month ago she was drinking more water and going poddy a bit more than normal. Her whole life I have struggled to her to to go 1x a day, and now she is going about 3x on a typical day. Her vet did bloodwork to rule out Diabetes, which she does not have, but he did find that her APL was high at 887. Last year her APL was 297 and we were just keeping an eye on it. Next we did the LDDST and her results were: Cortisol #1 was 3.1, Cortisol #2 was 0.84, and Cortisol #3 was 1.9. Finally we did a Urine Cortisol Creatinine Ratio and her results were 69. He didn't do any imaging or scanning. He wants to start her on Vetoryl 10mg to begin. She weighs about 11 pounds.

I'm extremely nervous to start her on this medication after all the horror stories I have read about dogs getting very, very sick and/or dying. She has had a heart murmur her whole life which adds to my concern.

She doesn't have a ton of symptoms that I can see. She is drinking/poddying a bit more, but no accidents. She was diagnosed with bladder crystals when her urinalysis was done a few weeks ago and she is currently on Royal Canin SO to clear those up. Her appetite is good and seems to be in fairly good spirits, but she does have days that she seems not as spunky as normal. She has a mild pot belly that I only noticed once I read it was a symptom of Cushing's. Her hair has never been great, but she does seem to have a thinner spot on her side but no balding or major hair loss.

I have a few questions about how to proceed. I'm curious if Vetoryl is as dangerous as some of the reviews make it seem? Are there are other treatment options that I'm unaware of? Can Cushing's be monitored and not treated?

Thanks in advance for any information. I really appreciate it!

[Harley PoMMom]

Hi and welcome to you and Margot!

We are so glad you found your way here but are sorry for the reasons that brought you to us. Although her LDDS test was positive it can yield a false positive result when another non-adrenal illness is present and since Margot did have bladder crystals when that test was performed those LDDS test results could be wrong. In your situation I would wait to start treatment until her urine shows no signs of crystals or any other irregularities (UTI for example). What was the urine specific gravity (USG) of her urine?

Cushing's is a treatable disease and with treatment dogs with Cushing's can have a good quality of life and there is every reason to believe that they can live out their normal life span. However, for the treatment to work safely and successfully it requires an educated pet owner along with an experienced vet as adverse side effects are mostly seen when the proper protocols are not followed. The most important thing is that it be diagnosed correctly and since there is a question of the validity of her LDDS test results, at least in my mind, I wouldn't start treatment just yet and would wait until her urine shows clean.

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

Lori

[Margot]

Thank you for your quick response, Lori! I will definitely hold off on giving her the Vetoryl until the Urinary SO food has time to work it's magic and I can have her labs repeated. I don't believe her vet ordered a USG on her urinalysis. I'll make sure to ask for that next time. The only other information from her labs that I didn't share was her T4, which was 1.90 and her TSH, which was 0.18. Both normal.

I should also mention both times her ALP came back elevated/high she was under stress when her blood was drawn, not sure if this can alter results or not?

Thank you again for the information, you are a saint for taking the time to respond!

Katy

[labblab]

Hello Katy, and welcome to you and Margot from me, too! Lori has already given you a great introduction, and I only have a few thoughts to add right now. Given her elevated ALP and her few overt symptoms, Cushing’s may indeed end up being a consideration. However, even if so, you may not choose to rush into treatment right away. Rather than reinventing the wheel, I’m just going to recopy a message that I posted to another member who was debating treatment for her senior dog ;-). As Lori says, medication can definitely ease troublesome Cushing’s symptoms, and if you do ultimately decide to treat, we can help ease your mind about some of those horror stories. But given Margot’s age, you might choose to defer treatment until/unless her overt symptoms worsen.

Given her age, Gidget has now entered her senior years. That being the case, there may be pros-and-cons to Cushing's treatment that you'd want to think over. In my own mind, the decision whether or not to treat any dog depends on a number of factors: age of the dog, apparent discomfort, severity of symptoms (both external and internal), etc. Cushing's is typically a slowly developing syndrome, and the decision to actively treat may come sooner or later in the process. The primary goals of treament are to control the troublesome observable symptoms (things like excessive thirst, urination, hunger, panting, muscle wasting), and also to halt/delay silent internal damage. Untreated Cushing's can make dogs more vulnerable to things like high blood pressure, high cholesterol, protein-losing kidney disease, blindness (as a result of high blood pressure), pancreatitis, ligament damage and slow healing, chronic infections and skin issues, GI disturbance, etc. Not every dog will suffer from all or even many of these issues, but the disease can make them happen. For a younger dog, I would want to provide as many quality years of life that I could, and that would mean putting a stop to the development of the internal systemic damage as well as relieving the uncomfortable outward problems.

However, since the damage usually occurs over time, my own opinion is that I don't worry so much about the "silent" damage in a dog who is already elderly. Instead, my biggest concern for a senior dog is immediate quality of life. So if the overt symptoms are making the senior dog uncomfortable, I would treat. Otherwise, I might choose not to treat, especially if my senior dog suffers from inflammatory conditions like arthritis that may actually be soothed by the elevated cortisol level of Cushing's. Treatment also involves frequent vet visits and blood draws, especially at the beginning. So again, if vet visits are really stressful for a senior dog, I'd also factor that into my treatment decision.

Marianne

Definitely keep us updated regarding any additional test results. And no, stress ought not to have affected her ALP level. However, stress definitely increases cortisol production. Hopefully the UC:CR was performed on a urine sample that you obtained at home, while she was calm. UC:CR results from urine samples that are obtained under the stress of a vet visit can be falsely skewed upwards and therefore inaccurate.

Marianne

[Margot]

Thank you, Marianne! This is great information and not treating is definitely something I'm going to consider. Do you have an opinion on their lifespan untreated vs. treated? That's probably a tough question, and may vary case by case. I was just curious since Lori mentioned that treated Cushing's dogs can live out their normal lifespans.

Margot has always been such a healthy dog. Everyone always comments on how she still looks like a puppy.

I'll keep you updated on any additional tests.

Thanks again,
Katy

[labblab]

Hi again, Katy. I’m afraid you’re right — the effects of Cushing’s really do seem to progress on a case-by-case basis, and really can come down to a judgement call. My own Cushpup was so miserable with the excessive thirst/urination/hunger, muscle wasting and constant panting that I would have treated him at any age. I almost cried with gratitude when I could give him his first capsule, feeling as though I might finally bring him some relief. Which the medication did, for a time. Unfortunately for him, the pituitary tumor that caused his Cushing’s started enlarging and caused neurological problems that shortened his life. But most dogs with Cushing’s don’t have that particular issue.

Even in the absence of strong outward symptoms, I’d also likely opt to treat a dog of any age if he/she was exhibiting high blood pressure or protein loss in the urine. These issues can lead to problems such as blindness or worsening kidney damage.

So I certainly don’t want to wave you away from treatment, especially if you feel as though Margot is still quite youthful for her age, and has the potential for a relatively long life. But I just wanted to make you aware that, typically, Cushing’s is slowly developing so that you don’t have to make a snap judgement about jumping into treatment. However, on the flip side, I’m guessing the horror stories you’ve been reading may be giving you a distorted picture of the reality of treatment. To me, the biggest drawback is the need for the repeated monitoring blood testing, especially if you have a dog who hates going to the vet. And as I wrote earlier, for older dogs, arthritic issues may worsen once circulating steroid levels in the bloodstream are lowered. But there are other medications that can help ease arthritic pain. As long as you and your vet are well educated re: monitoring for signs of overdosing, treatment can go smoothly and offer significant symptom relief.

So we can keep talking more about Margot’s specific situation, and whether/when treatment seems to be the best route to go.

Marianne

[Margot]

This is so helpful, Marianne. Thank you so much for responding and easing my nerves. I want to be as informed as possible before I make any decisions.

Thanks again,
Katy