Newbie With Questions (Holly) 10 y/o Sheltie/Chow mix

[IceAngel8381]

Hi Everyone!!

I came across this forum in doing research for Cushing's Disease for my 10 year old Sheltie/Chow mix, Holly. Holly is a rescue that my husband found at my in-laws house in December 2009, and they were going to keep her, but decided not to, then took her to the local shelter, and the shelter was going to put her down due to her age, approximately 8 at the time, my husband said that's not going to happen, so we adopted her, and have had her ever since. Well, last weekend, I took her to the vet thinking she would have to be put down due to arthritis (she has issues with our stairs), she can't see at night, she has numerous fatty lumps (they are not cancerous). So, after being examined by the vet, they vet says she has all the classic signs of Cushing's......excessive thirst, exesssive appetite (which we thought was due to her scavenger days), muscle atrophy in her hind legs, excessive panting, pot belly look, ect. So, the doctor says there is treatment, but it is expensive and due to her age, and what she is mixed with, she did not recommend the treatment (Deprenyl) because by the time it was expected to make a improvement, Holly would not be alive, and also the failure risk is higher is older dogs. So, she suggested Tramadol for treatment due to the medication not affecting her liver. It seems to be working because within 24 hours, Holly was breathing better at night (no longer loud and obnoxious, and just generally seemed to feel better). I just wanted to see what luck people have had with Tramadol, or with other treatments.

[addy]

Hi and Welcome,
I cannot give you any insight to Tramadol, I have never used it but I did want to take a moment and welcome you to our forum.

We have many knowledgeable and caring members. Some will be along soon. They tend to ask a lot of questions so please understand it is only to try to get a better feel for what is happening to your dog.

Many dogs are diagnosed with Cushings when they are older. Treatment options can depend on what other health conditions exist.
I have found that some vets are reluctant to try to diagnosis or treat the disease. Sometimes an Internal Medicine Specialist is a good option.

We have many good articles in our research section. It is always a good place to start.

Hang in there.

Hugs,
Addy

[Harley PoMMom]

Hi and welcome from me as well! I used tramadol for pain with my boy, Harley, and he responded to this medicine well. Some members have had their dogs become, lets say, loopy on the rx'd dosage and had to decrease the dosage.

Lysodren/Mitotane or Trilostane/Vetoryl are usually the top choices of medicines to treat Cushing Disease. And IMO, either medication is safe when monitored appropriately and with owner observation and each med can have similar adverse effects. So "owner observation" is always a crucial component of treatment.

Each has it's pros and cons, they work differently, they are both safe when monitored appropriately, yet they both can have the same and serious risks and adverse effects.

One or the other may work better for an individual dog.

Another important consideration is the degree of experience your vet has with whatever treatment he/she chooses. Cushing's requires a good partnership with one's vet.

One thing I want you to know is that 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!

Here are links which I hope you will find useful: Links to Cushings Websites (especially helpful for new members!). ( http://www.k9cushings.com/forum/showthread.php?t=180), Lysodren loading Instructions and related tips. (http://www.k9cushings.com/forum/showthread.php?t=181), Trilostane/Vetoryl Information and Resources. (http://www.k9cushings.com/forum/showthread.php?t=185)

Please know we will help you and Holly in any way we can so ask all the questions you want.

Love and hugs,
Lori

[IceAngel8381]

Thank you for the quick replies and the links.

I wanted to add that Holly is taking 50 mg/2 times a day of Tramadol. I have noticed that if she is given a lower dose of the med, she does not do as well, and if she is given a higher dose, she does stumble and acts like she is drunk. As of right now, the 50 mg/2 times a 2 seems to be the best dose for her.

I will be in additional discissions with my husband about additional treatment for Holly's Cushings, however, it seems that as of right now, she is doing well with the Tramadol. I know that does not address the high cortisol level in her bloodstream completely, but if she is not in as much pain, her stress level will be reduced, and the cortisol level will be reduced some. Our concern and the vets concern is how much longer she will live and how effetive the Cushing's treatment will be for the cost of it, for the length of time she would be on it. The vet's concern is that she will start treatment, and improvement will occur for say 2-4 weeks, and then Holly will pass away. The issue is, it is thought Holly is 10, we truly do not know and it is not known if her liver can handle the treatment. I guess the treatment are rough on older dogs??

I just hate seeing her in pain but I am so thankful the Tramadol is helping her. :D

ETA: It's not the best pic, but I changed my avatar to the day we brought her home from the shelter. She os now shaved, due to the heat. She looks better with fur, but you do what you have to in the summer. :)

[Harley PoMMom]

Our concern and the vets concern is how much longer she will live and how effetive the Cushing's treatment will be for the cost of it, for the length of time she would be on it. The vet's concern is that she will start treatment, and improvement will occur for say 2-4 weeks, and then Holly will pass away. The issue is, it is thought Holly is 10, we truly do not know and it is not known if her liver can handle the treatment. I guess the treatment are rough on older dogs??


Elevated cortisol over a period of time wreaks havoc on a dog's internal organs. Many dogs with Cushing's do have a very high ALP (liver enzyme) and an enlarged liver. With treatment the liver enzymes do come down quite a bit.

Vetoryl and Lysodren can be compounded so the cost of a compounded medicine is a lot less expensive.

I was wondering if you could you post the test results that have been done on Holly, especially the ones that were performed to confirm her Cushing's diagnosis.

Love and hugs,
Lori

[lulusmom]

Hello and a belated welcome to you and Holly

I am sorry about the circumstances that brought you here but I'm glad you found us. We usually initiate new members with 20 questions and at some point, you'll probably figure out that I may be a bit more probing than most. That's because the more informaton you can give us about your sweet girl, the more meaningful our feedback will be. To make things a lot easier, please get copies of all testing done by your vet to confirm a cushing's diagnosis. We recommend that members maintain a folder with all of their dog's medical records in it. That folder will come in handy if you ever have to take Holly to an after hours clinic. ER vets appreciate having their patient's medical history at their finger tips. All those records will also come in handy when we nag you to post results. :D

So let me start the probing by inserting my comments in blue text below:


Hi Everyone!!

I came across this forum in doing research for Cushing's Disease for my 10 year old Sheltie/Chow mix, Holly. Holly is a rescue that my husband found at my in-laws house in December 2009, and they were going to keep her, but decided not to, then took her to the local shelter, and the shelter was going to put her down due to her age, approximately 8 at the time, my husband said that's not going to happen, so we adopted her, and have had her ever since.

Your husband is my kind of guy! God bless you both for rescuing Holly. I am a rescuer with a house full of vertically challenged dogs, two of which have cushing's. I wonder if Holly knows just how close she came to crossing the bridge two years ago.
Well, last weekend, I took her to the vet thinking she would have to be put down due to arthritis (she has issues with our stairs), she can't see at night, she has numerous fatty lumps (they are not cancerous). So, after being examined by the vet, they vet says she has all the classic signs of Cushing's......excessive thirst, exesssive appetite (which we thought was due to her scavenger days), muscle atrophy in her hind legs, excessive panting, pot belly look, ect.

By fatty lumps, I am assuming you mean lipomas, right? Lipomas always remind me of an interesting discussion I had with my dog's old IMS, who sadly left the state to open his own practice. He related a case to me that involved a dog with symptoms associated with cushing's who was ultimately diagnosed with atypical cushing's, meaning his cortisol was normal but he had elevations of intermediate hormones, most notably estradiol. Estradio is the only adrenal hormone that can be found outside of adrenal glands. Adipose (fatty) tissue is a likely host for estradiol which makes the rest of this story believable. To make a long story short, which I rarely succeed in doing, the vet removed the lipoma and all the dog's symptoms resolved. That enough about Lipomas for now but I'm sure we'll revisit them again before this is over. :D

So, the doctor says there is treatment, but it is expensive and due to her age, and what she is mixed with, she did not recommend the treatment (Deprenyl) because by the time it was expected to make a improvement, Holly would not be alive, and also the failure risk is higher is older dogs.

Deprenyl (Anipryl) is only effective in a very small percentage of dogs who have a tumor in the pars intermedia lobe of the pituitary gland. The Age and breed of a dog really has no bearing on it's efficacy. Your vet is right that it can take some time to figure out if the drug is going to work; however, because cushing's is a very, very graded disease, if Holly is otherwise healthy (aside from cushing's), I seriously doubt that she would have died before determining in three to four months that Anipryl was not going to work for her.

So, she suggested Tramadol for treatment due to the medication not affecting her liver. It seems to be working because within 24 hours, Holly was breathing better at night (no longer loud and obnoxious, and just generally seemed to feel better). I just wanted to see what luck people have had with Tramadol, or with other treatments.

Has your vet formally diagnosed Holly with cushing's based on appropriate testing? If so, please post the results of those tests here. Please post just the abnormal blood and urine values, including the normal reference ranges. To confirm a diagnosis, your vet should have done an acth stimulation test and/or a low dose dex suppression test (LDDS) and/or an abdominal ultrasound. You would definitely know the difference between the acth stim test and the LDDS as the acth stim test takes an hour or two and the LDDS is an all day, eight hour, affair. My dogs were tuckered out after that ordeal.

Tramadol is a narcotic like pain reliever used to alleviate moderate pain and I don't believe it is an appropriate nor effective treatment for cushing's. You mentioned in your second post that Holly's symptoms improved with Tramadol which makes me wonder if Holly's symptoms are actually associated with cushing's. Unless a dog with cushing's has complicating issues, they are not actually in pain nor unhappy. Us pet owners are usually a lot more pained and worried than our dogs. Their bodies are usually awash in a sea of cortisol which is a feel good steroid that masks arthritic pain, discomfort of allergies and inflammation in general. Pains from these ailments are usually not felt until effective treatment has lowered cortisol to an acceptable level so a pain reliever is not necessary. I suppose the big question mark over my head will probably go away once you can provide us with more information on Holly's diagnosis. :D


Thank you for the quick replies and the links.

I wanted to add that Holly is taking 50 mg/2 times a day of Tramadol. I have noticed that if she is given a lower dose of the med, she does not do as well, and if she is given a higher dose, she does stumble and acts like she is drunk. As of right now, the 50 mg/2 times a 2 seems to be the best dose for her.

I will be in additional discissions with my husband about additional treatment for Holly's Cushings, however, it seems that as of right now, she is doing well with the Tramadol.

I know that does not address the high cortisol level in her bloodstream completely, but if she is not in as much pain, her stress level will be reduced, and the cortisol level will be reduced some.

As I mentioned before, it is highly unusual that Tramadol would be prescribed for cushing's and even more unusual that it would help resolve symptoms caused by cushing's. Tramadol acts like an opiate so if given to an uncontrolled cushdog, I don't believe improvements would be a result of alleviating pain but rather the tranquilizing effect of the drug.

Our concern and the vets concern is how much longer she will live and how effetive the Cushing's treatment will be for the cost of it, for the length of time she would be on it. The vet's concern is that she will start treatment, and improvement will occur for say 2-4 weeks, and then Holly will pass away. The issue is, it is thought Holly is 10, we truly do not know and it is not known if her liver can handle the treatment. I guess the treatment are rough on older dogs??

Unless Holly has primary liver disease or other condition that is impairing liver function, there is probably no reason that her liver couldn't handle effective treatment (Trilostane or Lysodren). Holly is a mix of two breeds whose life expectancy is 12 to 15 years and if she doesn't have any complicating diseases, with treatment, there is no reason to believe that she can't live out her normal life expectancy with a good quality of life. I have no idea why your vet thinks dogs see improvement on treatment and then die 2 to 4 weeks later. :confused::confused: If that were the case, very few of our dogs would be here. As for the expense of treatment, there are ways to save money.
I just hate seeing her in pain but I am so thankful the Tramadol is helping her. :D

If Holly is in pain, it is most likely not being caused by cushing's in which case, I would want to know what is causing it. Hopefully the additional information you can provide will answer a lot of questions. I'll be watching for your next post.

Glynda

[littleone1]

A belated welcome to you and Holly from Corky and me. You have gotten some very good information.

Corky was diagnosed with Cushings when he was 12 years old. He's soon going to be 14, and hasn't had any problems with Trilostane. I personally would rather treat cushings. If it is left untreated, it can definitely cause damage to many of the internal organs.

Terri

[IceAngel8381]

I'm sorry for taking so long to reply.

My vet did not run any tests on Holly (bloodwork was $200 and I was not expecting a tenative diagnosis of Cushing's). The vet is pretty convinced she has Cushing's. I assume the blookwork is a requirment for meds like Trilostane??

Yes, lulusmom, that is what the vet is referring to in reguard to the lumps. Surgery has not been discussed for those either. My vet immediately thought of Cushing's based on the symptoms she has. There is two on her chest that I may consider getting removed, if it is feasible (one is about the size of a softball and the other is about the size of a golf ball). The vet was not concerned about removing them, it will have to be a topic I bring up. The vet may not, due to her age.

As for the Tramadol helping with the Cushing's itself, I don't think it is, now that she has been on it for a bit. I think it is more so helping with her pain level (arthritis), which is allowing her to move more (I have noticed she has lost a small amout of weight, which is a good thing).

Over all, she seems to be feeling better and is more active, which to me, is well worth it.

I'm just stuck in a situation of not know how old she truely is, so I don't know that to do. I honestly think she is older than 10. I do want the remainder of her life to be a good one, but i can't afford to for out a lot of money for the treatment, if she may not live much long. I know that is selfish of me, and I don't mean it to be, but I feel like I'm stuck between a rock and a hard place. We honestly did not think she would survive this long, we thought *maybe* a year, and we are almost to two. :D