Need Advice for my Orphan Annie

[ladyjayne]

My beautiful Annie, who was orphaned as a pup, is a 6-year old mixed Rottweiler/Lab mix. For the past year, the following symptoms appeared all at once and I went to the vet:
Obesity - Gaining 25 pounds
Excessive Thirst
Urinating all the Time (outside thankfully)
Great Appetite
Coat Looking Dull and Flaky
Lethargic

Took her to my regular vet year ago. Nothing said or done. Took her to a FL vet while I wintered down there and he took many blood tests and diagnosed her with Hyperthyroidism and put her on 1.1 of Soloxine. Very slight improvement of energy but that's all. He "mentioned" Cushings but didn't suggest treatment or diagnosis.
When I got back to Michigan to my regular vet, took her in again because I am concerned. They rechecked thyroid level and said it is much lower with the Soloxine, but since I had a "new" vet this time, she said "This really looks like Cushings."

I love this dog to death, but we have 3 other dogs and we are on a fixed income of social security and pension so want to use our money "in the most prudent way for Annie's comfort and health", and before I spend another $100 just to verify that she has Cushings, which she obviously does, should I try Supraglan which is a holistic treatment that seems to be getting rave reviews on the internet. If Cushings is usually caused by a benign tumor on the pituary, and to treat this at the University would probably cost thousands, I really need to get my facts and alternatives in hand. She is such a good dog and is obviously uncomfortable with that weight on her. People have started calling her "sausage dog". I don't want to overexercise her to get the weight off because she actually looks like she would die if I took her for a 2 mile walk with the way she pants. Please give me some advice starting with whether I need to take her in to my vets for this day-long diagnosis $100 visit.

[zoesmom]

Hi and welcome to you and Annie -

Her symptoms do suggest possible cushings but unfortunately, none of the holistic treatments are effective. Cushings, however, is very treatable, and yes, it can get expensive. Annie's hypothyroidism (hyperthyroidism is rare in dogs and since she was put on thyroxine, that indicates that she is hypothyroid.) That may, in fact, be a condition related to cushings, called sick euthyroid. If it is - and not primary hypothyroidism - that should improve on cushings tx and she may no longer need the thyroxine. Only time and her progress on cush treatent would tell for sure, on that.

If she's to stay all day at the vet for the test, your vet is most likely wanting to do an LDDS test (takes 8 hours and 3 blood draws). It is the gold standard for diagnosing cushings and really can't be avoided. If it is strongly positive, then you could probably proceed with tx, based on that aloone, altho' an abdominal ultrasound is always a worthwhile follow-up - and will futher confirm the dx and tell you lots of other things about the dog's overall health and any possible side effects of the untreated cushiings. If at all possible, I'd recommend it as well . . . provided the LDDS comes back positive.

The biggest cost with cushings is usually the ACTH tests, used to monitor them once they are on tx. And those may have to be done more often in the beginning. Over time, you may be able to get by with doing one every 3 - 6 months, and getting an abbreviated version of that test (to save $$), barring any problems. We can tell you more if the LDDS test results confirm cushings.

There are two meds which are in wide use for cushings - lysodren and trilostane. For a larger dog, they will cost more since dosing is based on the dog's weight. However, for both drugs, there are now some very reasonable prices available at online compounding pharmacies. The lysodren is given as a daily loading dose (usually anywhere from 3 - 10 days) and then is given on a weekly basis to maintain control of the dog's cortisol. Trilostane, the newer drug, requires no loading and the dose is given on a daily basis, from here on out. So for that reason, it tends to cost more over the long haul. Just lost our 13 yr old lab mix Zo in March, but she took trilostane for four years and did fine on it. When she started on it, we had to order the triilostane from the UK and it WAS big bucks, but it is now approved and available for purchase here in the states, much cheaper. I can tell you that for my 80 lb. Zoe, the cost (purchased at online compunding pharmacy) ran about $125/month (she took 180 mg bid). That may be discouraging to hear, however Zoe needed an unusually HIGH dose, even for a dog her size. I only know of one or two other, bigger dogs here who required a dose as high as Zoe. Most of the larger dogs end up on something like 60 - 120 mg (either once or twice a day) and so that cost would be considerably less. But it just depends on each individual dog. Some big dogs need less than the norm, some small ones end up needing an above average dose for their size. Also, vet schools are not necessarily more expensive. Oftentimes, they are actually cheaper.

I can also tell you that if Annie's appetite is bonkers, she will slim down on cushings tx, her crazy drinking/peeing should go back to norm, the panting and exercise intolerance should improve dramatically, coat should also improve and she can go on to live out her normal lifespan. Do check out our resource section, and read all you can absorb about cushings diagnosis and treatment, including the info on financial resources for vet care. A case of untreated cushings is not pretty to watch, not to mention horrible for the dog, who will grow increasingly worse over time as it starts to affect all of their organs. There's lots of cumulative knowledge here among the members and we can guide you thru the process, so that you don't spend $$ unnecessarily and to help you know when and where it may be ok to cut corners, cost wise. And definitely, do NOT waste your money on the puruported holistic treatments/cures for cushings. If those worked, we'd all be using them. And please continue to ask questions. Sue

PS - What DOES Annie weigh, now . . . and what WAS her normal weight before?

[ladyjayne]

Thank you SO far for taking the time to describe in detail all that I need to know. So many people don't take the time and assume you know all about the disease. Annie is 108 now and previously was 87 pounds the last time I had her at the vet. The weight gain really came over I would say a 6-9 month period as I grew concerned and started asking questions. I definitely WILL take her for the 8 hour diagnosis test then and not bother with the holistic avenue. When the doc tells me what is wrong, I will go on and tell you what they said for more advice. Too bad I now trust your advice more than the vets who should have caught this earlier.

[StarDeb55]

Welcome to you & Annie! Sue has gotten you off to an excellent start, so I will try not to repeat what she has already passed on to you.

First of all when it comes to the thyroid treatment, Cushing's can affect the thyroid where the pup develops what is termed "sick euthyroid" syndrome. This is not really hypothyroidism. If "sick euthyroid" is suspected, the low result needs to be confirmed with a free T4 by equilibrium dialysis. With Cushing's treatment, the thyroid issues should correct themselves.

Did Annie have any type of general labwork done, such as a senior wellness panel or super chemistry panel? There are some very common abnormalities on this labwork, especially in the liver function tests, that may also point to Cushing's. If Annie had this type of labwork done, it would be extremely helpful if you could get a copy of the results from your vet, & post only the abnormal values, along with normal ranges & reporting units. Most members do get copies of all labwork from their vet to keep a file at home for their pups. You never know when that file might come in handy, especially if you end up at a strange vet or ER clinic. Was diabetes ruled out? I ask about this as both diabetes & thyroid have symptoms that may overlap with Cushing's.

If your vet has quoted you $100 for a LDDS test, which Sue has mentioned is the all day test, that is an excellent price. I will make another suggestion their is a screening test called a urine cortisol:creatinine ratio which is pretty reasonably priced. You could collect the urine at home, taking it to your vet for testing. You would need to collect the first morning pee for 3 consecutive days, combining the samples, to insure you get an accurate result. This UCCR test is what is called a "rule-out" test. If it's negative, you are done, you are not dealing with Cushing's. Positive simply means that Cushing's is a possibility, but further testing will be required for confirmation.

The last thing I will say is the best thing you can do for Annie is become a knowledgable, educated owner as you are her only voice & advocate. On that note, I hope you will take a look at our "helpful resources' section where you will find a huge number of links that will lead you to most any information you might need concerning Cushing's.

Again, welcome! We are here to help in any way we can. We know that the beginning of this journey can be very stressful to say the least, & we can help you understand what is going on.