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Thread: Medication decision

  1. #1
    Join Date
    Oct 2019
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    3

    Default Medication decision

    I am very new to this disease. My 11 year old Cattle Dog/Shepard Mix has been diagnosed with Cushings. Her name is Dora. I am worried about starting treatment because except for panting and some leg weakness she seems ok. No accidents in the house, water and food consumption the same as always, no major hair loss either. When I do decide to start I was leaning towards the Lysodren(Mitotane) but I don't see that many go that route. Just wondering if anyone has had their dogs on this med ? Is the Vetorly the way to go ? Any info greatly appreciated.

  2. #2
    Join Date
    Apr 2009
    Location
    Georgia
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    14,426

    Default Re: Medication decision

    Hello and welcome! I have only a moment to post right now, but wanted to let you know that I’ve moved your thread to our main “Questions and Discussion” forum — this way, our members are more likely to see your question and have the chance to reply to you :-).

    I’ll be back myself later on today to write more, but at least wanted to have the chance now to welcome you here!

    Talk to you again later,
    Marianne

  3. #3
    Join Date
    Apr 2009
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    Georgia
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    Default Re: Medication decision

    Hello again! We’re so glad you and Dora have joined us :-). In order to give you our best feedback, I’m first going to pester you with a few questions. With so few classic symptoms, I’m wondering what prompted Dora’s Cushing’s diagnosis. Was it perhaps some abnormalities in her bloodwork as opposed to outward symptoms? We regularly hear from folks whose dogs have had bloodwork drawn in conjunction with something entirely different — in advance of a dental cleaning or surgery, for instance — and that’s how they have the first inkling that something’s wrong. So it will be helpful if you could tell us more about Dora’s diagnostic path, including actual numbers for any abnormal test results.

    Regardless of how the diagnosis was made, I, too, would not be rushing into treatment right now with so few outward symptoms. Even if the diagnosis is accurate, the main goal of treatment is to relieve symptoms and to halt the progression of internal damage. Right now, it sounds as though Dora has few observable symptoms against which to judge treatment success. And given her age, the slow development of systemic internal damage may not even become an issue within her natural lifespan. With older dogs, there can also be treatment trade-offs. For instance, lowering circulating cortisol levels can worsen certain arthritic issues.

    So all-in-all, it’ll help us a lot to find out some more specifics about Dora’s situation and overall health status. However, in the event that treatment does seem advisable, we’ve definitely had many members throughout the years who have successfully used Lysodren. We have a number of tips we can offer regarding the use of the medication, if that’s the route you choose to go. I can talk about that in another post, after we’ve learned a bit more about Dora herself.

    Marianne

  4. #4
    Join Date
    Mar 2009
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    rural central ARK
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    14,256

    Default Re: Medication decision

    Hi and welcome to you and Dora!

    Like Marianne, I would not be rushing into treatment with so few signs. The lessening or cessation of signs is one of the things we look to in order to see how the treatment is working so with no signs we have lost a guide in treatment. If she actually does have Cushing's the few signs she has will strengthen and others will show up. Cushing's is a very slowly progressing condition so there is seldom reason to rush into treatment, especially with little to no signs of of the disease. Cushing's is also one of, if not THE, most difficult canine condition to correctly diagnose and is easily misdiagnosed if any other health issue(s) is/are present. Other illnesses and diseases can cause false positives on the testing as well as cause signs that mimic Cushing's.

    As for the treatment choice, one of the major factors in deciding is which drug her vet is most familiar with and has had the best success using. Personally I like Lysodren and have used it with both my dogs who were diagnosed with Cushing's. But the vet's comfort and knowledge is paramount in this decision. So talk to them and see which they prefer. Either way, IF the time ever comes that Dora does start treatment we will be here to help you.

    I'm glad you found us and look forward to learning more about Dora!
    Hugs,
    Leslie
    "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.

  5. #5
    Join Date
    Oct 2019
    Posts
    3

    Default Re: Medication decision

    Hi, sorry this took so long. I actually thought I sent a reply the other day, but it looks like I did something wrong. I was waiting to get Dora's numbers from the vet. What I have is her ALP which is 1592, and gosh I hope that number can and does go down. Dex Supp Test: 1.8 pre / 3.3 @4hr, 3@8hr. That's all I have numbers wise. All in all she seems the same. Eating the same drinking the same. Panting seems to be the worst problem. Hair loss nothing unusual for this time of year. No huge bald spots. Her activity is less and hind end has significant weakness. I'm not sure when I should pursue treatment. I am pretty sure we will start with the Lysodren?? I hate to give her something that might make her feel worse that perhaps she already does. I think I'm kinda in a wait and see right now. Thank you for continued insight. Deb

  6. #6
    Join Date
    Apr 2009
    Location
    Georgia
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    14,426

    Default Re: Medication decision

    Hello again, and thanks for this new info. Yes, Cushpups typically have elevated levels of ALP, often even at higher levels than Dora’s is right now. The levels can and do lower with treatment, but sometimes they never return entirely to normal range. However, the reassuring thing is that this doesn’t necessarily mean that major harm is being caused to the liver’s actual ability to function properly.

    As for the diagnostic LDDS test results, they’re indeed consistent with Cushing’s. Sometimes the pattern of results can also point at a pituitary tumor vs. an adrenal tumor as the cause. However, in Dora’s case, the results could be produced by either type of tumor. That being the case, you may want to consider having an abdominal ultrasound performed. This imaging can show whether there are any tumors present on the adrenal glands. If not, we can assume that a pituitary tumor in the brain is responsible for producing the Cushing’s symptoms. Another “plus” to having an ultrasound performed is that it can give you a helpful status report on Dora’s other internal organs including the liver, kidneys, and spleen. That way, you have a better idea as to whether or not there may be other health issues that are complicating the picture.

    If you do decide to pursue treatment, knowing whether or not an adrenal tumor is present can affect your options. Surgery can actually provide a complete cure to adrenal Cushing’s. However, the surgery is very expensive and can be quite risky, so it is not a viable option for all dogs or their parents. In the absence of surgery, though, most specialists now prefer trilostane over Lysodren in the treatment of their patients with adrenal tumors. This is because higher doses of Lysodren may be needed to treat symptoms caused by adrenal tumors, with an associated higher likelihood of medication side effects than when the medication is used for pituitary tumors. Trilostane, on the other hand, seems to have the same effects regardless of tumor type.

    So if Dora was my own dog, I do believe an abdominal ultrasound would be my next step before deciding on a course of treatment. The adrenal glands can be difficult to see, and many general practice vets don’t have imaging equipment that’s of the high quality needed to get a truly useful view. For this reason, a referral to a specialty vet may be useful in this regard. But I’m sure your own vet can talk this all over with you in more detail. By the way, an ultrasound is not painful nor invasive, and many dogs don’t even require any sedation at all to have it done.

    Whatever you decide, please do keep us updated, OK?
    Marianne

  7. #7
    Join Date
    Oct 2019
    Posts
    3

    Default Re: Medication decision

    Hello again. With the holidays over, and Dora still pretty much the same we have made not decisions yet on treatment. Regarding the ultra sound, she did have one when this first began. I believe right after her first blood test. Showed a slightly enlarged liver and sludgey (?) gallbladder. I am so scared to start Dora on either of these medications. Like I have said her only real symptom is the panting, and back end weakness. The thought of making her feel worse is just my greatest fear, plus what if she gets worse when no one is home. My vet did seem pretty sure it is the pituitary cushings. I know going the holistic route might be futile, but any ideas or suggestions is so greatly appreciated. Also are cushing dogs in pain? Is a soft food diet the best way to go? Thank you so much

  8. #8
    Join Date
    Apr 2009
    Location
    Georgia
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    14,426

    Default Re: Medication decision

    Welcome back to you and Dora! I’m glad to hear that things have not really worsened for her. That being the case, I still support your decision to hold off on beginning treatment for the same reasons that we discussed earlier. If she was mine, I believe I’d remain in a wait-and-see mode for the time being, too.

    As far as holistic options, I’m afraid I’m not much help. Anecdotally, we’ve heard that some of the products can be helpful for a time. But I’m not aware of any solid research to support the claims, and I have never used them myself. My own Cushpup was so horribly symptomatic that I definitely felt compelled to treat him with one of the researched prescription meds, trilostane. In Dora’s case, though, I do realize why her lack of observable symptoms gives you pause in that regard.

    As far as food choices, I’ve not heard about any special recommendation for soft foods. Our experience here is that no one specific type of food seems to be universally better or worse for Cushpups. We do recommend foods with at least moderate protein content consisting of good-quality protein sources, and also lower fat. But whether the food is dry, wet, commercial or home cooked has not seemed to make a consistent difference in terms of treatment outcome among our members here.

    I’d say that if Dora is remaining stable, you’re already doing a good job with her care and feeding! So keep up the good work, and please do keep us updated.

    Marianne

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